Review
Social support and self-care behaviors in individuals with heart failure: An integrative review

https://doi.org/10.1016/j.ijnurstu.2013.06.013Get rights and content

Abstract

Objectives

The purpose of this review is to examine and synthesize recent literature regarding the relationship between social support and self-care behaviors in individuals with heart failure (HF).

Background

Self-care is an important factor in maintaining health and well-being for individuals with heart failure. Self-care behaviors are an integral component of self-care, and may be impacted by the disease process of heart failure. However, social support may positively influence an individual's self-care behaviors by assisting with activities associated with symptom management and evaluation, as well as activities associated with maintaining heart failure-related treatment regimens. This review will synthesize the current knowledge related to the influence of social support on heart failure self-care behaviors.

Design and data sources

Using an integrative review method, a review of current empirical literature was conducted utilizing CINAHL, PsycARTICLES, and PubMed computerized databases for a period of January 2000 to December 2012. Thirteen studies were identified that met the inclusion criteria for review and investigated aspects of social support and heart failure self-care behaviors.

Results

Social support appears to have a positive relationship on heart failure self-care behaviors, with an individual's family playing an important role in assisting individuals to maintain positive self-care behaviors. Social support appears to influence both heart failure self-care maintenance and management related behaviors by assisting with maintaining treatment regimens and by participating in the decision-making process related to the management of symptoms, as well as seeking treatment for symptoms of heart failure.

Conclusions

All four types of social support (i.e., emotional support, instrumental/tangible support, informational support, and appraisal support) are involved in the interactive process between an individual's social network (i.e., family and peers) and the individual with heart failure to maintain self-care behaviors that enhance health and well-being. However, more research is needed, specifically longitudinal and experimental designs, to determine the effectiveness of social support on self-care behaviors in individuals with heart failure, since this review revealed mostly cross-sectional, correlational studies which limits the ability to infer causality.

Introduction

Heart failure (HF) is one of the most common reasons for hospitalization among individuals 65 years and older (AHA, 2010), especially if co-morbidities exist (Aranda et al., 2009). Currently, the prevalence of HF continues to increase, with approximately 660,000 new cases diagnosed each year. Morbidity and mortality rates remain high, with one out of five people dying within a year of diagnosis (AHA, 2010). Although hospital readmissions are common, the majority of individuals living with HF seek treatment as outpatients (Liu, 2010). The AHA (2010) reports that about 26.8 million individuals living in outpatient settings make approximately 16 million visits to ambulatory care centers for HF-related treatment; thus, increasing healthcare costs for both direct and indirect treatment of HF. In 2010, the cost of HF-related treatment was estimated to be 39.2 billion dollars (AHA, 2010). Therefore, it is vital that individuals with HF participate in self-care behaviors that may positively influence morbidity and decrease the number of visits to ambulatory care centers and hospitals for HF-related treatment.

Self-care is an important factor in maintaining optimal health for individuals with heart failure (Riegel et al., 2009). Self-care behaviors are an integral component of self-care, which is defined as a process by which individuals perform daily behaviors that promote or restore health and well-being and assist in illness prevention and management (Moser and Watkins, 2008). The progressive nature of HF and associated physical symptoms often impact an individual's ability to perform self-care behaviors (Carlson et al., 2001, Riegel and Carlson, 2002), predisposing one with HF to poor HF-related outcomes, including decreased quality of life and increased mortality, in addition to increased healthcare-related expenditures (Riegel et al., 2009).

However, social support may positively influence an individual's self-care behaviors. Support from one's family and social network has been found to influence optimal self-care by assisting with activities associated with symptom management and evaluation (Friedman and Quinn, 2008, Quinn et al., 2010, Riegel and Carlson, 2002, Riegel and Carlson, 2004), in addition to assisting with activities related to maintaining HF-related treatment regimens (i.e., dietary and mediation adherence) (Gallagher et al., 2011, Sayers et al., 2008). Although support can come from anyone within an individual's social network (Langford et al., 1997), an individual's family appears to be the most influential in assisting with maintenance of self-care activities (Dunbar et al., 2008).

Previous integrative reviews have focused solely on interventions that promote self-care (Barnason et al., 2012) and on the experiences and perceptions of those living with HF (Westland et al., 2009). Additionally, a state of the science examined the promotion of self-care (Riegel et al., 2009); however, no prior studies to date have synthesized the data related to the influence of social support on self-care behaviors. Thus, little is known regarding the influence of social support on self-care behaviors in individuals with HF or which type of social support may be more beneficial in enhancing specific self-care behaviors in this population. Therefore the purpose of this review was to: (1) examine recent literature regarding the relationship between social support and self-care behaviors in individuals with HF; (2) synthesize findings across those studies; (3) assess potential areas of future research regarding social support and self-care; and (4) identify implications for nursing practice.

Section snippets

Social support

Social support is a multi-faceted concept (Langford et al., 1997) that positively influences disease-related outcomes in multiple chronic illnesses (Elfstrom et al., 2005, Huang et al., 2010, Hunt et al., 2012), including HF (Gallagher et al., 2011, Park et al., 2006). Defined as the assistance and protection given to others (Langford et al., 1997), social support is thought to act as a buffer in stressful situations (House et al., 1988). Social support has also been described as the exchange

Methods

An integrative review of empirical literature was conducted using methodological processes described by Cooper (1982), in addition to that of others (Dixon-Woods et al., 2004, Lubbe et al., 2012, Whittemore and Knafl, 2005) for integrative reviews of quantitative and qualitative research. An integrative review includes both non-experimental and experimental designs, thus providing a synthesis of current knowledge that may potentially influence evidence-based nursing practice (Whittemore and

Study characteristics

Out of an initial 146 studies, 13 met inclusion criteria. In examining the literature, all of the included studies investigated the influence of social support on activities associated with self-care maintenance and self-care management. Self-confidence, which influences one's ability to perform self-care behaviors (Riegel and Dickson, 2008) was also investigated in four of the included studies (Chiaranai et al., 2009, Riegel et al., 2010, Salyer et al., 2012, Sayers et al., 2008). However,

Discussion

The purpose of this review was to examine recent literature regarding the relationship between social support and self-care behaviors in individuals with HF and to synthesize findings across those studies. Thirteen studies were identified that investigated aspects of social support and self-care behaviors (i.e., self-care maintenance and management), such as adhering to medication and dietary regimen, monitoring HF-related symptoms, managing symptoms, and making decisions related to seeking

Conclusion

Self-care behaviors are vital to maintaining health and well-being in individuals with HF (Moser and Watkins, 2008, Riegel et al., 2009). This review illustrates that family plays a pivotal role in assisting individuals with HF to maintain positive self-care behaviors (Riegel and Carlson, 2002, Riegel et al., 2010, Tierney et al., 2011). Additionally, this review suggests that all four types of support (i.e., emotional support, instrumental/tangible support, informational support, and appraisal

Conflict of interest

There are no conflicts of interest to report.

Funding

No funding was received for this work, either in part or whole.

Ethical approval

Not applicable.

References (54)

  • M.A. Woo et al.

    Brain injury in autonomic, emotional, and cognitive regulatory areas in patients with heart failure

    Journal of Cardiac Failure

    (2009)
  • J. Wu et al.

    Predictors of medication adherence using a multidimensional adherence model in patients with heart failure

    Journal of Cardiac Failure

    (2008)
  • American Heart Association (AHA)

    Heart Disease and Stroke Statistics

    (2010)
  • J.M. Aranda et al.

    Current trends in heart failure readmission rates: analysis of medicare data

    Clinical Cardiology

    (2009)
  • S. Barnason et al.

    An integrative review of interventions promoting self-care of patients with heart failure

    Journal of Clinical Nursing

    (2012)
  • S. Bennett et al.

    Cognitive deficits in patients with heart failure: a review of the literature

    Journal of Cardiovascular Nursing

    (2003)
  • J. Cameron et al.

    Self-care behaviours and heart failure: does experience with symtpoms really make a difference?

    European Journal of Cardiovascular Nursing

    (2010)
  • C. Chiaranai et al.

    Self-care and quality of life in patients with heart failure

    Thai Journal of Nursing Research

    (2009)
  • C.E. Connelly

    An empirical study of a model of self-care in chronic illness

    Clinical Nurse Specialist

    (1993)
  • H.M. Cooper

    Scientific guidelines for conducting integrative research reviews

    Review of Educational Research

    (1982)
  • R.L. Dekker et al.

    Living with depressive symptoms: patients with heart failure

    American Journal of Critical Care

    (2009)
  • M. Dixon-Woods et al.

    Integrative Approaches to Qualitative and Quantitative Evidence

    (2004)
  • S.B. Dunbar et al.

    Family influences on heart failure self-care and outcomes

    Journal of Cardiovascular Nursing

    (2008)
  • M.L. Elfstrom et al.

    Relations between coping strategies and health-related quality of life in patients with spinal cord lesion

    Journal of Rehabilitation Medicine

    (2005)
  • M.M. Friedman et al.

    Heart failure patients’ time, symptoms, and actions before a hospital admission

    Journal of Cardiovascular Nursing

    (2008)
  • R. Gallagher et al.

    Social support and self-care in heart failure

    Journal of Cardiovascular Nursing

    (2011)
  • J.S. Grant et al.

    Why people living with HIV/AIDS exclude individuals from their chosen families

    Nursing Research and Reviews

    (2013)
  • Cited by (0)

    View full text