title: The importance of interactions between patients and healthcare professionals for heart failure self-care: A systematic review of qualitative research into patient perspectives.
abstract: BACKGROUND
  Effective heart failure (HF) self-care can improve clinical outcomes but is dependent on patients' undertaking a number of complex self-care behaviors. Research into the effectiveness of HF management programs demonstrates mixed results. There is a need to improve understanding of patient perspectives' of self-care need in order to enhance supportive interventions.
  
  
  OBJECTIVE
  This paper reports selected findings from a systematic review of qualitative research related to HF self-care need from the patients' perspective. The focus here is on those facets of patient-healthcare professional relationships perceived by patients to influence HF self-care.
  
  
  METHODS
  We searched multiple healthcare databases to identify studies reporting qualitative findings with extractable data related to HF self-care need. Joanna Briggs Institute systematic review methods were employed and recognized meta-synthesis techniques were applied. Critical realist theory provided analytical direction to highlight how individual and contextual factors came together in complex ways to influence behavior and outcomes.
  
  
  RESULTS
  Altogether 24 studies (1999-2012) containing data on patient-healthcare professional relationships and HF self-care were included. Interaction with healthcare professionals influenced self-care strongly but was notably mixed in terms of reported quality. Effective HF self-care was more evident when patients perceived that their healthcare professional was responsive, interested in their individual needs, and shared information. Poor communication and lack of continuity presented common barriers to HF self-care.
  
  
  CONCLUSIONS
  Interactions and relationships with clinicians play a substantial role in patients' capacity for HF self-care. The way healthcare professionals interact with patients strongly influences patients' understanding about their condition and self-care behaviors.
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Scotland.
authors.forename: Kay
authors.initials: K
authors.lastname: Currie
authors.affiliation: School of Nursing, McMaster University, Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.affiliation: Faculty of Nursing, University of Alberta, Canada.
authors.forename: Melisa
authors.initials: M
authors.lastname: Spaling
authors.affiliation: School of Nursing, McMaster University, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.affiliation: School of Health and Life Sciences, Glasgow Caledonian University, Scotland.
authors.forename: David
authors.initials: D
authors.lastname: Barber
authors.affiliation: University of Alberta, Canada alex.clark@ualberta.ca.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clark
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003142:Communication; D005260:Female; D006282:Health Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011379:Prognosis; D036301:Qualitative Research; D018570:Risk Assessment; D012648:Self Care / Q000379:methods* / Q000523:psychology; D012944:Social Support; D016896:Treatment Outcome
keywords: Communication; heart failure; professional-patient relationship; qualitative research; self-care; systematic review