Nursing interventions to enhance self-care in heart failure: a systematic review interpreted through the COM-B model

Heart failure (HF) is a long-term illness, frequently requiring hospital stay and having a significant morbidity and mortality rate. In order to avoid decompensation, lower readmission rates, and promote quality of life, adequate self-care is vital. This review synthesised nursing interventions intended to improve self-care among adults and older adults with HF and retrospectively interpreted their components using the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

A systematic search was conducted on 11 November 2025 across seven electronic databases: PubMed, Scopus, Web of Science, CINAHL, Embase, MEDLINE, and PsycINFO. The review included randomised controlled studies evaluating behavioural, educational, psychological, or nursing interventions aimed at improving self-care among adults and older adults with HF. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Randomised Controlled Trials. Database-specific search strategies and publication-year filters are reported in Additional file 1.

Nine studies met the inclusion criteria. The interventions included structured education, motivational interviewing, pre-discharge education, technology-based support, and multimodal programmes. Several studies reported improvements in self-care maintenance, management, or confidence; however, the direction and magnitude of effects varied across interventions and follow-up periods. Although none of the studies explicitly used the COM-B model, their intervention components could be retrospectively mapped to Capability, Opportunity, and Motivation.

Nursing interventions may improve selected dimensions of HF self-care, particularly when education is combined with follow-up, motivational support, or practical monitoring resources. However, the evidence was heterogeneous, and the magnitude and consistency of effects remain uncertain. COM-B may provide a useful framework for interpreting intervention components, but the retrospective mapping does not demonstrate that COM-B mechanisms were prospectively tested.

The procedure of this study was recently filed in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (No: CRD420251237974).