The Effect of Self Care Education on Adherence to Treatment in Elderly Patients with Heart Failure: A Randomized Clinical Trial

Saeed Eimer, Gholam Reza Mahmoodi Shan, Ali Akbar Abdollahi


Background: Noncompliance with treatment in the elderly with Heart Failure (HF) may result in a lack of recovery, a decrease in longevity, rehospitalization, and additional costs. Therefore, this study was conducted to determine the effect of self‑care education on adherence to treatment among elderly patients with HF.

Materials and Methods: This study was a parallel clinical trial on 90 elderly people over 60 years of age who were hospitalized in cardiac wards. Data were collected using a demographic characteristics form and the adherence to treatment questionnaire. Individuals who met the study inclusion criteria were randomly allocated to the intervention and control groups. The intervention group training was performed before and after discharge. The adherence to treatment questionnaire was completed again by both groups 2 months after discharge. Data were analyzed using Chi‑squared test; ex. (?2 = 3.95, df = 1, p = 0.046), paired and independent t‑tests, and analysis of covariance.

Results: The mean (standard deviation) total score of adherence to treatment in the intervention group was 39.71 (4.51) and 78.72 (10.47) before and after the self‑care education, respectively. Paired t‑test showed a significant difference in both groups after the intervention compared to before the intervention, and independent t‑test showed a significant difference between the groups after the intervention (p = 0.001). Conclusions: Self‑care education before discharge and home‑based education were effective in promoting adherence to treatment among patients with HF. Therefore, self‑care education before discharge may improve adherence to treatment among elderly patients with HF.


Aging, education, heart failure, nursing, self care, treatment adherence and compliance

Full Text:



Saaima P, Bochra Z, Anojhaan A, Caroline K, Jens F, Lars K, et al. Association between early detected heart failure stages and future cardiovascular and non cardiovascular events in the elderly (Copenhagen Heart Failure Risk Study). BMC Geriatr 2022;22:1 10. doi: 10.1186/s12877 022 02875 1.

Mesquita ET, Jorge AJL, Rabelo LM, Souza CV Jr. Understanding hospitalization in patients with heart failure. Int J Cardiovasc Sci 2017;30:81 90.

Chen Scarabelli C, Saravolatz L, Hirsh B, Agrawa P, Scarabelli TM. Dilemmas in end stage heart failure. J Geriatr Cardiol 2015;12:57 65.

Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev 2017;3:7 11.

Ziaeiana B, Fonarowc GC. The prevention of hospital readmissions in heart failure. Prog Cardiovasc Dis 2017;58:379 85.

Nieuwenhuis MMW, Jaarsma T, van Veldhuisen DJ, van der Wal MHL. Self reported versus ‘true’ adherence in heart failure patients: A study using the medication event monitoring system. Neth Heart J 2012;20:313 9.

Seid E, Engidawork E, Alebachew M, Mekonnen D, Berha AB. Evaluation of drug therapy problems, medication adherence and treatment satisfaction among heart failure patients on follow up at a tertiary care hospital in Ethiopia. PLoS One 2020;15 e0237781. doi: 10.1371/journal.pone. 0237781.

Danielson E, Melin Johansson C, Modanloo M. Adherence to treatment in patients with chronic diseases: From alertness to persistence. Int J Community Based Nurs Midwifery 2019;7:248 57.

Gholamaliei B, Karimi Shahanjarini A, Roshanaei G, Rezapour Shahkolaei F. Medication adherence and its related factors in patients with type II diabetes. J Educ Community Health 2016;2:3 12.

Karami Salaheddin Kola M, Jafari H, Charati JY, Shafipour V. Comparing the effects of teach back method, multimedia and blended training on self care and social support in patients with heart failure: A randomized clinical trial. J Edu Health Promot 2021;10:248. doi: 10.4103/jehp.jehp_1481_20.

Pobrotyn P, Mazur G, Kałużna Oleksy M, Uchmanowicz B, Lomper K. The level of self care among patients with chronic heart failure. Healthcare 2021;9:1179. doi: 10.3390/ healthcare9091179.

Khademian Z, Ara FK, Gholamzadeh S. The effect of self care education based on Orem’s nursing theory on quality of life and self efficacy in patients with hypertension: A quasi experimental study. Int J Community Based Nurs Midwifery 2020;8:140 9.

Wagenaar KP, Broekhuizen BD, Rutten FH, Strömberg A, Stel HFv, Hoes AW, et al. Interpretability of the European heart failure self care behaviour scale. Patient Prefer Adherence 2017;11:1841 9.

Jaarsma T, Hill L, Bayes Genis A, Rocca H PBL, Castiello T, Čelutkienė J, et al. Self care of heart failure patients: Practical management recommendations from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021;23:157 74.

Eimer S, Mahmoodi Shan GR. Self care behaviour of the elderly with heart failure and its associated factors in hospitals of Gonbad Kavus in 2018. J Res Dev Nurs Midw 2020;17:12 23.

Mohamadi SZ, Alhani F, Shakoor M, Farmani P, Mohseni B, Taherpazir EF. Self care behaviors in patients with systolic heart failure. J Nurs Midwifery Sci 2015;2:46 54.

Kamrani F, Nikkhah S, Borhani F, Jalali M, Shahsavari S, Nirumand Zandi K. The effect of patient education and nurse led telephone follow up (telenursing) on adherence to treatment in patients with acute coronary syndrome. Cardiovasc Nurs J 2015;4:16 24.

Niakan MA, Ezat A, Shekholeslam F, Kazemnezhad LE, Rad MA, Bonakdar HR, et al. Self care behaviors in patients after myocardial infarction. Holistic Nurs Midwifery 2013;23:63 70.

Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in patients with chronic disease: A mix method study. Koomesh 2018;20:179 91.

Ogungbe O, Byiringiro S, Adedokun Afolayan A, Seal SM, Dennison Himmelfarb CR, Davidson PM, et al. Medication adherence interventions for cardiovascular disease in low and middle income countries: A systematic review. Patient Prefer Adherence 2021;15:885 97.

Zorina O, Fatkulina N, Saduyeva F, Omarkulov B, Serikova S. Patient adherence to therapy after myocardial infarction: A scoping review. Patient Prefer Adherence 2022;16:1613 22.

Zakerimoghadam M, Ebrahimi S, shahsavari H, Haghani H. The effect of self management program after discharging on therapeutic adherence in patient with ischemic heart disease. Iran J Nurs Res 2016;11:17 24.

Fabbri M, Murad H, Wennberg AM, Turcano P, Erwin PJ, Alahdab F, et al. Health literacy and outcomes among patients with heart failure: A systematic review and meta analysis. JACC Heart Fail 2020;:451 60.

Sedri N, Asadi Noughabi A, Zolfaghari M, Haghani H, Tavan A. Comparison of the effect of two types of short message service (interactive and non interactive) on anticoagulant adherence of patients with prosthetic heart valves. J Nurs Educ 2014;2:1 11.

RafieeVardanjani L, Parvin N, Mahmoodi Shan G. The effects of an individual, multistep intervention on adherence to treatment in hemodialysis patients. Disabil Rehabil 2016;38:768 72.

Poshtchaman Z, Jadid Milani M, Atashzadeh S, Akbarzadeh Bagheban A. Assesing patient adherence to treatment after coronary artery bypass graft. JSUMS 2015;22:668 75.

Poshtchaman Z, Jadid Milani M, Atashzadeh Shoorideh F, Akbarzadeh Bagheban A. The effect of two ways of using the phone and SMS follow up care on treatment adherence in Coronary Artery Bypass Graft patients. Cardiovasc Nurs J 2014;3:6 14.

Navidian A, Moradgholi M, Kykhaee A, Saeedinegad F. Relationship between attachment styles and self care behaviors in patients with heart failure. Hayat 2015;21:6 17.

Oscalices MIL, Okuno MFP, Lopes MCBT, Batista REA, Campanharo CRV. Health literacy and adherence to treatment of patients with heart failure. Rev Esc Enferm USP 2019;15:e03447. doi: 10.1590/S1980 220X2017039803447


  • There are currently no refbacks.