Illness perceptions of heart failure patients as a predictor of self-care behaviours and medication adherence

Abstract

Background: Self-care and medication adherence are two important principles in the management of Heart Failure. Along the path of living with Heart Failure the individual establishes a set of illness perceptions, believed to be important determinants of selfcare and medication adherence. The Common-Sense Model of self-regulation of illness provides a theoretical framework to assess the relationship between the perceived illness perceptions and coping procedures, expressed by the actions taken to manage the illness. Objectives: To determine whether the illness perceptions of individuals living with Heart Failure act as a predictor of self-care, including medication adherence, and to identify possible significant differences in illness perceptions, self-care, and medication adherence between subgroups of socio-demographic characteristics and clinical data. Study Design: Descriptive correlational design. Setting: Nurse-led Heart Failure clinic and specialised Heart Failure clinic at the national hospital in Malta, Europe. Sample: A convenience sample of 280 individuals living with Heart Failure, aged 18 years or older, were recruited in this research study. Methods: A survey including the Brief Illness Perception Questionnaire, the European Heart Failure Self-care Behaviour Scale, and the Medication Adherence Reporting Scale was constructed to measure the illness perceptions, self-care, and medication adherence, respectively. Research instruments were translated from their original language to the Maltese language. Data collected was analysed using SPSS version 26. Statistical tests used include the Shapiro-Wilk, Spearman correlation coefficient, Mann Whitney U, Kruskal Wallis with Dunn’s Bonferroni post-hoc tests, and Generalised Linear Models assuming a gamma distribution and a reciprocal canonical link function. Results: Overall, Heart Failure was perceived to be of moderate threat, with a chronic timeline, and can be controlled by treatment. Perceptions about Heart Failure on the consequences, timeline, personal control, identity, and emotions were correlated with self-care, while the perception of identity was correlated with medication adherence. Generalised Linear Models revealed that the illness perception of consequences, timeline, personal control, and illness comprehensibility as predictors of self-care, while perceptions on the consequences, timeline, illness comprehensibility, and emotions as predictors of medication adherence. Further analysis revealed that in addition to the mentioned predictors, NYHA Class and age were predictors of self-care, while occupation and living arrangement were predictors of medication adherence. Conclusions: Illness perceptions are significant predictors of self-care and medication adherence, thereby suggesting that these perceptions should be the target of interventions aimed to improve self-care and medication adherence. Health-care professionals should practice a person-centred approach, to assist their clients in perceiving a set of helpful illness perceptions while assisting them to identify any barriers and solutions which may influence self-care and medication adherence.