Gender differences in heart failure self-care: A multinational cross-sectional study

Christopher S. Lee, Barbara Riegel, Andrea Driscoll, Jom Suwanno, Debra K. Moser, Terry A. Lennie, Victoria V. Dickson, Jan Cameron, Linda Worrall-Carter

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


Background: Despite a common view that women are better at self-care, there is very little evidence to support or challenge this perspective in the heart failure (HF) population. Objective: The purpose of this study was to determine if there are cross-cultural gender differences in self-reported HF self-care and to describe gender differences in the determinants of HF self-care. Design, setting, and participants: A secondary analysis was completed of cross-sectional study data collected on 2082 adults with chronic HF from the United States, Australia and Thailand. Methods: Comparisons were made between men and women regarding self-care maintenance, management and confidence as assessed by the Self-Care of Heart Failure Index, as well as the proportion of subjects engaged in adequate self-care. Multivariate comparisons were made to determine if gender explained sufficient variance in HF self-care and the likelihood of reporting adequate self-care, controlling for nine model covariates. Results: The sample was comprised of 1306 men and 776 women. Most (73.5%) had systolic or mixed systolic and diastolic HF and 45% had New York Heart Association class III or IV HF. Although small and clinically insignificant gender differences were found in self-care maintenance, gender was not a determinant of any aspect of HF self-care in multivariate models. Married women were 37% less likely to report adequate self-care maintenance than unmarried women. Comorbidities only influenced the HF self-care of men. Being newly diagnosed with HF also primarily affected men. Patients with diastolic HF (predominantly women) had poorer self-care maintenance and less confidence in self-care. Conclusion: Differences in HF self-care are attributable to factors other than gender; however, there are several gender-specific determinants of HF self-care that help identify patients at risk for practicing poor self-care.

Original languageEnglish
Pages (from-to)1485-1495
Number of pages11
JournalInternational Journal of Nursing Studies
Issue number11
StatePublished - Nov 2009

Bibliographical note

Funding Information:
This research was supported partially by funding from the U.S. National Institute of Nursing Research (F31NR010299, Lee). The parent studies had numerous sources of funding including the American Association of Critical Care Nurses-Philips Medical Award, the U.S. National Institute of Nursing Research (R01 NR009280, Lennie), the U.S. National Institute of Nursing Research (R01 NR008567, Moser) and a U.S. National Institutes of Health Center grant to the University of Kentucky College of Nursing (NINR, 1P20NR010679, Moser). Other funders include the National Heart Foundation of Australia (Australia) (Driscoll; Worrall-Carter), National Health and Medical Research Council (Australia) (Driscoll), the National Health and Medical Research Council & National Heart Foundation (Australia) (Cameron), U.S. National Institute for Occupational Safety and Health (Dickson), the University of Pennsylvania School of Nursing Investing in the Future Initiative, and the U.S. National Heart, Lung & Blood Institute (R01 HL084394-01A1, Riegel).


  • Adherence
  • Gender
  • Heart failure
  • Self-care

ASJC Scopus subject areas

  • Nursing (all)


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