Self- care behaviors and its determinents among heart failure patients in Karachi

Objective: To determine the level of self-care behaviors (SCB) and its associated factors among heart failure (HF) patients in Karachi, Pakistan. Background: HF is a progressively worsening clinical syndrome which not only deteriorates the quality of life of the patients but also stretches the utilization of health care resources and increases the cost of the health care. Therefore self-care in HF is now considered equally important to its pharmacological management. The level of self-care among HF patients of developed countries is well documented, however, little is known about the SCB and its predictors among HF patients in the developing countries. Methods: The study was conducted using a sequential mixed method approach. The SCB of 230 heart failure patients (recruited from four tertiary care hospitals of Karachi) were assessed using European Heart Failure Self-care Behavior Scale (EHFScBS) via a cross sectional survey. Moreover, purposively, eight patients from the quantitative survey were also interviewed to explore the factors affecting their SCB. Results: The study sample comprised of two third males and one third females with mean age of 58+/-12 years. The average score of the EHFScBS was (29.30+/-6.81) indicating a moderate level of self-care. Adherence to self-maintenance behaviors was higher (15.4+/-3.9) as compared to the self-management behaviors (13.2+/-3.6). In multivariate analysis, education, high income and chronicity of the HF diagnosis were found significantly positive predictors of the SCB (P\u3c0.005, R2=23.4). Also financial status, family support, health literacy and support of the health care system were found as important factors affecting the SCB of the patients, through analysis of patients’ narratives. Hence, from the convergence of the quantitative and qualitative findings, it can be predicted that patients ‘financial status, education and experience of the illness are the key determinants of SCB among HF patients in Pakistan. Keywords: Heart Failure, self-care behaviors, self-maintenance, self managemen