Illness representations, treatment beliefs and the relationship to self-care in heart failure

Purpose The purpose of this study was to explore the beliefs people with heart failure hold about their illness and its treatment and to determine any relationships between these beliefs and self-care using the Common Sense Model (CSM) of illness cognitions and behaviour as the theoretical framework (Leventhal et al, 1980). Methods Using a mixed methodology (Creswell and Plano Clark, 2007), findings from patient interviews were used to adapt the Revised Illness Perception Questionnaire (IPQ-R) (Moss-Morris et al, 2002) and the Beliefs about Medicines Questionnaire (BMQ) (Horne et al, 1999) in order to make them illness-specific. A questionnaire assessing self-care was developed based on the European Heart Failure Self-care Behaviour Scale (EHFScBS) (Jaarsma et al, 2003), the interview findings and a nominal group technique with specialist heart failure nurses. These questionnaires were used to determine beliefs and the relationship to behaviour in a cross-sectional survey of 169 patients with heart failure. Results A number of statistically significant correlations were found between beliefs and self-care. Most notably, perceived medication knowledge (r = 0.51, p ≤ 0.01), beliefs about the necessity of medication (r = 0.45, p ≤ 0.01) and illness coherence (r = 0.39, p ≤ 0.01). Multiple regression analysis revealed that 46% of the variance in self-care could be explained by illness representations and treatment beliefs (Adj. R2 = 0.46, F = 9.93, p = 0.00). Three factors were significant predictors of self-care - medication knowledge (β = 0.319, p = 0.003), a belief in the illness having serious consequences (β = 0.258, p = 0.008) and the impact of medication use on lifestyle (β = -0.231, p = 0.03). Discussion The exploration of illness representations revealed a realistic picture of heart failure with a cluster of beliefs around a chronic illness with serious consequences and a high number of symptoms. There was a strong belief in the necessity of medication but for some, medication use had a negative impact on daily life. Patients were confident in their knowledge of medication but this was reduced when family members took control of medication management. A number of beliefs were predictive of self-care, suggesting that interventions designed to maximise these beliefs and correct any misconceptions may enhance self-care and potentially improve clinical outcomes in this population