The effect of guided reflection on heart failure self-care maintenance and management: A mixed methods study

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Evaluate the effect of structured, guided reflection on patient descriptions of self-care maintenance and management.


Inadequate HF self-care behaviors are linked to hospitalizations. Symptom monitoring and recognition are precursors to adequate HF self-care. Reflection on actions taken during HF exacerbations may lead to insights and future changes in HF self-care maintenance and management.


One-group mixed method pre-test/post-test design. Following cognitive screening, self-care maintenance and management was measured prior to the intervention at a home visit one-week after hospital discharge, and one-month post intervention. Qualitative data consisted of audiotaped individual interviews with participants, field notes and reflective diaries kept by patients.


The results (N = 10) demonstrate large effect sizes and increases in self-care maintenance (69.9 vs 79.6, d = 1.04) and management (47.2 vs 63.9, d = 2.53) scores after intervention. Eight themes emerged from the data that reflected the HF participant’s experience of self-care. Reflection evoked emotions around concerns for family and mortality. Participants linked symptoms experienced with contextual factors which facilitated discussion about changing future actions.


Purposeful reflection may be necessary for the development of self-care. Guided reflection on previous actions that includes contextual considerations may also play a role in enhancing self-care management by allowing the person to more fully understand the illness experience.

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