From novice to expert: Confidence and activity status determine heart failure self-care performance

Barbara Riegel, Christopher S. Lee, Nancy Albert, Terry Lennie, Misook Chung, Eun Kyeung Song, Brooke Bentley, Seongkum Heo, Linda Worrall-Carter, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

67 Scopus citations


Background: In a previous, small, mixed-methods study, heart failure patients were described as novice, expert, or inconsistent in self-care. In that study, self-care types differed in experience, confidence, attitudes, and skill. Objectives: The aims of this study were to validate the novice-to-expert self-care typology and to identify determinants of the heart failure self-care types. Methods: A cross-sectional descriptive study was performed using data from 689 adults with heart failure (61 ± 2.5 years; 36% female, 50% New York Heart Association class III). Two-step likelihood cluster analysis was used to classify patients into groups using all items in the maintenance and management scales of the Self-care of Heart Failure Index. Multinomial regression was used to identify the determinants of each self-care cluster, testing the influence of age, gender, left ventricular ejection fraction, body mass index, depression, anxiety, hostility, perceived control, social support, activity status (Duke Activity Status Index), and self-care confidence. Results: Self-care behaviors clustered best into three types: novice (n = 185, 26.9%), expert (n = 229, 33.2%), and inconsistent (n = 275, 39.9%). The model predicting self-care cluster membership was significant (χ = 88.67, p < .001); Duke Activity Status Index score and Self-care of Heart Failure Index confidence score were the only significant individual factors. Higher activity status increased the odds that patients would be inconsistent (odds ratio [OR] = 1.02-1.09) or novice (OR = 1.02-1.10) in self-care. Higher self-care confidence increased the odds of being an expert (OR = 1.05-1.09) or inconsistent (OR = 1.01-1.05) in self-care. Discussion: The three-level typology of heart failure self-care was confirmed. Patients who have fewer limitations to daily activities may not be driven adequately to engage in heart failure self-care and may need extra assistance in developing expertise.

Original languageEnglish
Pages (from-to)132-138
Number of pages7
JournalNursing Research
Issue number2
StatePublished - Mar 2011


  • activity status
  • confidence
  • heart failure
  • self-care

ASJC Scopus subject areas

  • Medicine (all)


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