POSTER - #PI1055

A Qualitative Study Exploring the Perceptions and Motivations of Patients with Heart Failure who Transitioned from Non-Adherence to Adherence

Sharon L. Myers MA, RN, Elena O. Siegel PhD ,RN, Dianne A. Hyson PhD, RDN, Julie T. Bidwell PhD, RN
UC DAVIS HEALTH -  RESEARCH

Background & Purpose
• Successful management of heart failure (HF) involves complex self-care recommendations including medical therapy, dietary sodium and fluid restriction, self-assessment of symptoms, & physical activity.1-4
• Adherence to these self-care recommendations can reduce readmissions and mortality.5
• The majority of patients have difficulty adhering to these recommendations with up to a 60-80 % non-adherence rate.6,7
• The mechanisms that support the transition from non-adherence to adherence are poorly understood.8

Purpose
The objective of this study was to explore the perceptions and motivations of individuals with HF who had transitioned from self-care non-adherence to adherence, with emphasis on characterizing the main components that motivated behavior change.

Design & Methods
• This was a qualitative descriptive study.
• Purposive sampling was used to recruit adults with HF from cardiology clinics at UC Davis Health who had been identified by their provider as having transitioned from non-adherence to adherence.
• Participants completed a one-time, face-to-face, audio recorded interview, consisting, open-ended questions regarding patient’s experiences managing HF.
• Data were analyzed using thematic analysis.

Results
• The sample included 8 participants
• The majority identifying as male (n=7) and white (n=5).
• All were NYHA Class III
• Most had HF with reduced ejection fraction (n=7)

Five major themes were identified across the sample:
(See poster)

There was no consistent chronological ordering of these themes across narratives.
The presence and influence of the healthcare clinician was a cross-cutting theme and intersected with each of the main components.

Results- Making Connections
(See poster)

Conclusions & Further Study
• We uncovered 5 common themes across participant narratives: 1) experiencing mortality, 2) experiencing hope 3) making connections, 4) having self-efficacy and 5) influence of the healthcare clinician.
• The input of the healthcare clinician was mentioned by each participant and was a cross-cutting theme, thus showing the potential value of the provider’s presence as important to promote a shift from non-adherence to adherence.
• Our findings add a new dimension to our current understanding of HF self-care literature and theories.

Implications for Research
• This study provides foundational data identifying potential motivational components for adherence to HF self-care behaviors.
• This work may support a larger, prospective longitudinal study to examine the value of integrating these components into an educational intervention.
• Such a study should not only further expand upon our understanding of identified components associated with eventual adherence, but also examine the element of proximity for these components.

References
1. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239
2. . O'Connor CM, Whellan DJ, Lee KL, et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA. 2009;301(14):1439-1450.
3. Ruppar TM, Delgado JM, Temple J. Medication adherence interventions for heart failure patients: A meta-analysis. Eur J Cardiovasc Nurs. 2015;14(5):395-404.
4. Song EK, Moser DK, Kang SM, Lennie TA. Self-reported Adherence to a Low-Sodium Diet and Health Outcomes in Patients With Heart Failure. J Cardiovasc Nurs. 2016;31(6):529-534
5. Ditewig JB, Blok H, Havers J, van Veenendaal H. Effectiveness of self-management interventions on mortality, hospital readmissions, chronic heart failure hospitalization rate and quality of life in patients with chronic heart failure: a systematic review. Patient Educ Couns. 2010;78(3):297-315.
6. Oosterom-Calo R, van Ballegooijen AJ, Terwee CB, et al. Determinants of adherence to heart failure medication: a systematic literature review. Heart Fail Rev. 2013;18(4):409-427.
7. van der Wal MH, Jaarsma T. Adherence in heart failure in the elderly: problem and possible solutions. Int J Cardiol. 2008;125(2):203-208
8. Riegel B, Moser DK. Self-care: An Update on the State of the Science One Decade Later. J Cardiovasc Nurs. 2018;33(5):404-407.