title: Improving support for heart failure patients: a systematic review to understand patients' perspectives on self-care.
abstract: OBJECTIVE
  This systematic review aimed to generate patient-focussed recommendations to enhance support of heart failure self-care by examining patients' experiences, perspectives and self-care behaviours.
  
  
  BACKGROUND
  Despite increased recognition of the importance of heart failure self-care, patients' knowledge and practices around this self-care and interventions to improve it are inconsistent. Consequently, current guidelines focus on what the domains of heart failure self-care are, more so than the ways to improve this care.
  
  
  METHODS
  Systematic review and qualitative interpretive synthesis.
  
  
  METHODS
  A systematic, comprehensive and detailed search of 11 databases was conducted until March, 2012 for papers published 1995-2012: 37 studies were included (1343 patients, 75 caregivers, 63 health care professionals) that contained a qualitative research component and data on adult patients' heart failure self-care.
  
  
  METHODS
  This interpretive synthesis used a recognized approach consisting of a multi-stage analytic process; in addition, the included studies underwent quality appraisal.
  
  
  RESULTS
  Findings indicate that while patients could often recall health professionals' self-care advice, they were unable to integrate this knowledge into daily life. Attempts to manage HF were based on how patients 'felt' rather than clinical indicators of worsening symptoms. Self-efficacy and learning from past management experiences facilitated favourable outcomes - these enabled patients and caregivers to adeptly apply self-care strategies into daily activities.
  
  
  CONCLUSIONS
  Addressing common but basic knowledge misconceptions regarding the domains of HF self-care is insufficient to increase effective HF self-care; this should be supplemented with strategies with patients and family members to promote self-efficacy, learning and adaptation/application of recommendations to daily life.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Melisa A
authors.initials: MA
authors.lastname: Spaling
authors.affiliation: Glasgow Caledonian University, Scotland, UK.
authors.forename: Kay
authors.initials: K
authors.lastname: Currie
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Strachan
authors.affiliation: McMaster University, Hamilton, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Harkness
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Clark
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004032:Diet; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000451:nursing*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012648:Self Care / Q000379:methods / Q000592:standards*; D020377:Self Efficacy
keywords: chronic disease management; complex interventions; literature review; meta-synthesis; nursing; qualitative; self-management