ReviewSocial support and self-care behaviors in individuals with heart failure: An integrative review
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.
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