The Situation-Specific Theory of Heart Failure Self-care: An Update on the Problem, Person, and Environmental Factors Influencing Heart Failure Self-care

Barbara Riegel, Victoria Vaughan Dickson, Ercole Vellone, Barbara Riegel, Victoria Vaughan Dickson, Ercole Vellone

Abstract

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.

Objective: The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF.

Methods: This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized.

Results: Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy.

Conclusions: A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.

Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.

Figures

FIGURE 1
FIGURE 1
Decisions in the natural world often have ill-defined, shifting, and competing goals, which produce high-stress, ambiguous situations. Naturalistic decision making is both an automatic, fast process bringing promising solutions to mind rapidly and a deliberate, slow activity in which mental simulation is used to choose the best option.
FIGURE 2
FIGURE 2
The clinical syndrome of heart failure progresses through stages of prevention to severe symptoms at rest. Limitations due to symptoms are captured in the New York Heart Association (NYHA) classes I to IV.
FIGURE 3
FIGURE 3
Numerous person factors or individual characteristics influence heart failure self-care.
FIGURE 4
FIGURE 4
A variety of physical, chemical, biological, and cultural or social hazards exist in the environment and influence the outcomes of heart failure through effects on the person and/or the problem. Public policy can mitigate or exacerbate these hazards.
FIGURE 5
FIGURE 5
The interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. NYHA, New York Heart Association.

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