Motivation, Challenges and Self-Regulation in Heart Failure Self-Care: a Theory-Driven Qualitative Study

Self-care behaviours are crucial in reducing chronic heart failure (HF) morbidity and mortality but performance remains poor worldwide. This study draws on Temporal Self-regulation Theory (TST) to explore participants' motivations, challenges and personalised self-regulation strategies to enhance self-care.

Seventeen HF patients were purposively sampled and recruited from outpatient and inpatient settings at a Singaporean tertiary hospital from December 2017 to March 2018. Unstructured face-to-face interviews were conducted. Data were analysed using thematic analysis with constant comparison.

Five themes emerged. Self-care motivations were (1) consideration of family's future and (2) consideration of own past, while demotivation was (3) fatalistic consideration of own future. Barriers of behaviour change were (4) difficulty adopting physical activity and (5) difficulty deviating from personal dietary habits and sociocultural dietary norms. Personalised strategies to overcome these challenges were described in the 12 subthemes that emerged. Themes were well-fitted into the TST-(1-3) corresponded to time perspective, (4-5) corresponds to behaviour prepotency and the subthemes corresponded to self-regulatory capacity. Motivation could be enhanced by stimulating considerations of one's past regrets, family's future well-being and real-life success stories to instil hope. Clinicians and case managers could enhance self-regulation by empowering patients with tactical and situational skills to develop personalised plans to improve lifestyle habits and strategies to resist temptations.

Future person-centred self-care interventions could be tailored according to the study findings. Better self-care could improve patient outcomes, reduce rehospitalisation and alleviate global healthcare burden. Findings could be generalised to healthy populations as primary prevention.