“Sick and tired of being sick and tired”: a qualitative study of a motivational approach to self-care behavior change in persons with heart failure

Abstract

Clinicians and scientists have pondered why some patients master self-care and others do not, even after extended educational interventions. The purpose of this qualitative study was to describe the characteristics of heart failure (HF) patients that make them receptive to self-care behavioral change. All patients received an enhanced educational intervention emphasizing motivation and skill building from an advanced practice nurse (APN) trained in motivational interviewing. Audiotaped intervention sessions were conducted during home visits following a HF hospitalization. Transcriptions were analyzed using Atlas software, examined for patient and situational characteristics explaining intervention effectiveness, and augmented with field notes and personal stories. Interviews from 2 to 4 sessions with 8 patients recruited from an urban medical center were analyzed for this study. The sample was 50% female, 62.5% African American with a mean age of 67.6 (±9.9) years. All were NYHA stage II-IV at enrollment; 50% were class II and 50% had systolic HF. Mean ejection fraction was 31.2±21.7%. General coding categories of “living with HF,” “self-care practices,” “supports,” and “knowledge” were derived from data and compared across time and cases to yield a rich description of the journey HF patients undergo as they commit to self-care behavioral change. Emerging themes included the interplay of identity, roles, supports, and values with realities of “living” with HF. The relationship between long standing values and roles surfaced as a critical theme in why some patients successfully adopted behavioral change and how they incorporated self-care practices into their lives. Among those who adopted self-care behavior change, identity shifted and patients began to see themselves as “someone with HF.” The likelihood of this change was influenced by values, goals, and supports. Credibility of coding categories and themes was addressed through persistent engagement with the data and discussions among research team members. An intervention approach that considers long-standing values and roles may be essential in the shift in identity from being “sick and tired of being sick and tired” to taking control of HF. This conclusion is consistent with findings from previous studies focused on other health-related behavioral change, such as smoking cessation and problem drinking.