Heart failure affects more than 5 million Americans, with more than 500,000 new cases diagnosed each year. Although, most persons with heart failure are elderly, 7% of Americans or 1.4 million adults with heart failure are of pre-retirement age. Self-care, the cornerstone of heart failure management, is often challenging for individuals with heart failure and few master it. For the purposes of this study, self-care was defined as an active, cognitive process in which persons engage for the purpose of maintaining their health or managing their disease and illness. In recent years, heart failure researchers have investigated the complex interplay of biobehavioral variables on heart failure self-care maintenance, e.g., treatment adherence and symptom monitoring. However, the variables influencing self-care management (symptom recognition, symptom evaluation, treatment implementation and evaluation) have not been investigated. Research on selfcare in employed persons with heart failure is nonexistent.;A concurrent nested mixed methods design (QUAL + quan) was used to characterize the contribution of attitudes, self-efficacy, and cognition to heart failure self-care and to explore how employment interacts with these variables in heart failure self-care management. The sample (n=41) was recruited from outpatient settings associated with a large urban medical center in Philadelphia, Pennsylvania. Inclusion was based on age (18 to 65 years), history of chronic heart failure for at least three months and confirmed based on echocardiographic and clinical evidence, NYHA classification (II or III), and employment within the past two years. The data were gathered using in-depth interviews, a demographic survey and a set of structured instruments on heart failure self-care, cognition, self-efficacy and knowledge.;The major findings of this study were that: (1) there is a typology of self-care management: Experts, Novices and those Inconsistent in self-care management; (2) persons are Inconsistent in self-care for various reasons including impaired cognition; (3) self-care management is strongly influenced by attitudes and self-efficacy; (4) self-care management can not be evaluated without considering self-care maintenance-maintenance and management are interconnected; and (5) although self-care management and maintenance were poorer overall in employed persons, the intrinsic and extrinsic rewards of employment conferred great benefit.;The results of this mixed methods study show that the biobehavioral variables of attitudes, self-efficacy and cognition play a critical role in heart failure self-care. How individuals develop expertise in self-care management and sustain self-care has important implications for clinical practice and future research. Further research is needed to design, implement and test interventions that assess these variables, facilitate positive attitudes and self-efficacy, and support self-care practices among those who are employed and patients with cognitive decline.
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