Barriers and facilitators to self-care in chronic heart failure: A meta-synthesis of qualitative studies

Chronic heart failure (CHF) is a costly condition that places large demands on self-care. Failure to adhere with self-care recommendations is common and associated with frequent hospitalization. Understanding the factors that enable or inhibit self-care is essential in developing effective health care interventions. This qualitative review was conducted to address the research question, "What are the barriers and facilitators to self-care among patients with CHF?" Electronic databases including Medline, EMBASE, CINAHL, Web of Science, Scopus and Google scholar were searched. Articles were included if they were peer reviewed (1995 to 2012), in English language and investigated at least one contextual or individual factor impacting on self-care in CHF patients > 18years. The criteria defined by Kuper et al. including clarity and appropriateness of sampling, data collection and data analysis were used to appraise the quality of articles. Twenty-three articles met the inclusion criteria. Factors impacting on self-care included: factors related to symptoms of CHF and the self-care process; factors related to personal characteristics; environmental and health care system factors. Important factors such as socioeconomic situation and education level have not been explored extensively and there is minimal data on the influence of age, gender, selfconfidence and duration of disease. Although there is an emerging literature, further research is required to address the barriers and facilitators of self-care in patients with CHF in order to provide an appropriate guide for intervention strategies to improve self-care in CHF.