Identifying critical success factors in Heart Failure Self-Care using fuzzy DEMATEL method

Abstract

Heart failure (HF) has become a global public health issue due to its high prevalence and the significant cost of treatment. Today, one of the major challenges faced by clinicians is understanding the complex HF self-care process to develop suitable interventions. The self-care process of maintaining physiologic stability and manage the disease symptoms of HF patients is influenced by several factors, complicating the process for patients, caregivers and managers. In this research, the objective was to reduce the complexity of HF self-care process and to optimize it as a critical success factor (CSFs). Therefore, fuzzy decision-making trial and evaluation laboratory (DEMATEL) method were used to identify CSFs in HF self-care in an uncertain environment. Based on the literature review on HF self-care, 10 factors were identified as affecting HF self-care. A questionnaire, specifically designed for double-sided comparison DEMATEL Technique, covered these factors. Four experts were selected t evaluation using snowball sampling method. These experts assessed the direct associations between influential factors in HF self-care. The initial assessments were then turned into triangular fuzzy numbers (TFNs), and group opinions were fused; thus, the total relation matrix with TFNs elements was obtained. Defuzzification of the fuzzy total relation matrix was performed by converting fuzzy data into crisp scores (CFCS). After extracting the results of the model, influential factors were categorized as cause or effect, with cause factors identified as CSFs in HF self-care. Five influential factors were identified as CSFs by the proposed method, including F4 (cultural beliefs and values) > F9 (improving patient’s self-efficacy and ensuring HF self-care by patients (expecting proper self-care and long-term effort to maintain HF self-care)) > F7 (family and friends support and social relation network to support patients with HF) > F8 (easy access to care (regular outpatient clinic visits with a professional HF nurse and easy access to care in order to support HF self-care, guidance and training)) > F6 (confidence of patients and caregivers regarding HF self-care). Based on the results of this study, the optimization of HF self-care can be efficiently simplified into optimizing five CSFs. Therefore, to improve HF self-care process, it is suggested that decision makers and managers in the design of interventions focus on these five factors as CSFs, particularly under conditions with limited resources.