Predictors of Adherence to Self-Care in Rural Patients With Heart Failure

Martha J. Biddle, Debra K. Moser, Michele M. Pelter, Susan Robinson, Kathleen Dracup

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: The common reality of not following a recommended course of treatment is a major cause of poor health outcomes in patients with heart failure (HF). The purpose of this study was to identify predictors of adherence to HF self-care recommendations in rural HF patients who received an intervention to promote symptom management and self-care. Methods: Data from 349 rural HF patients (42% female, 90% Caucasian) randomized to the intervention arms of the study were used. Adherence was measured using the European Heart Failure Self-Care Scale questionnaire, a brief measure that asks patients to report their adherence to a variety of recommended HF symptom management behaviors (ie, daily weight monitoring, when to call the physician, medications, diet, and exercise). The following predictors were tested: age, gender, marital status, education level, depression score (measured using PHQ-9), anxiety score (measured with the Brief Symptom Inventory), and level of perceived control (measured using Control Attitudes Scale-R). Multivariate linear regression was used to test the model. Results: The model to predict adherence was significant (P <.0001). Of the covariates tested in the regression model, being a male (P =.009), having less anxiety (P =.018), not being depressed (P =.017), and having higher perceived control (P =.003) were predictors of improved self-care score at 3 months. Conclusion: Adherence is a multifaceted and a challenging behavior based on the assumption that the patient agrees with self-care recommendations. These data suggest interventions designed to promote adherence behaviors should include an assessment of gender, anxiety, depression, and perceived control for optimal outcomes.

Original languageEnglish
Pages (from-to)120-129
Number of pages10
JournalJournal of Rural Health
Issue number1
StatePublished - Jan 1 2020

Bibliographical note

Publisher Copyright:
© 2019 National Rural Health Association


  • adherence
  • heart failure
  • rural
  • self-care

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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