Validity and reliability of the Danish version of the 9‐item European Heart Failure Self‐care Behavior Scale

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It is estimated that approximately 1–2% of the adult population in developed countries has heart failure (HF), with the prevalence rising to ≥10% among persons of age 70 or older 1. In Denmark, about 11 000 hospitalisations per year are due to HF, and the incidence is 162 per 100 000 among women and 284 per 100 000 among men 2. In spite of improved treatment regimens mortality is about 20% 1 year after the diagnosis is made, rising to approximately 50% after 5 years 2. Besides optimising pharmacological treatment, nonpharmacological strategies have been extended into patient care. The recent guidelines of the European Society of Cardiology for acute and chronic HF suggest a holistic and multidisciplinary approach that includes education as well as promotion of self‐care behaviour comprising such things as aetiology, progression of the disease, symptom management, medication, adherence, physical activity, smoking, alcohol intake, sexual activity, sleep and breathing disorders and emotional status 1. The interventions often provided by nurses entail comprehensive education to increase decision‐making skills in patients regarding when to seek consultations with health care professionals 3. Furthermore, the patients’ ability to manage their own disease is one of the cornerstones for a successful outcome of nursing care for patients with HF 1.
To monitor the educational efforts of HF nurses, not only survival rates, readmission, cost and quality of life have to be investigated 6, but it is also important for nurses who deliver HF self‐care education to understand adherence to patients’ self‐care behaviours. Once self‐care behaviours are known, nurses can adapt patient education programmes to support patients’ behavioural changes 7. HF‐related self‐care behaviour reflects the actions that a patient with HF undertakes to promote healthy functioning, well‐being as well as maintaining life 6. The topics included are daily weighing in order to detect fluid retention and seeking appropriate assistance when symptoms occur, as well as adherence to medication, diet, and exercise 9.
An effective scale to assess self‐care in patients with HF is a cornerstone to detecting patients’ needs to improve self‐care in order to evaluate the effects of such programmes 11. For clinical use, the instruments need to be simple administer, accurate, and able to detect changes 9. In recent decades, several scales have been developed 10. Among scales, the European Heart Failure Self‐care Behavior Scale (EHFScBS) is easy to understand and the briefest to complete (in 5‐10 minutes) 9 and is based on the international guidelines for HF management. Conceptually, the questionnaire covers the patient's ability to participate in effective self‐care and the results can be used by nurses to evaluate the effectiveness of patient education related to self‐care behaviours 1.
The original 12‐item Dutch version has been tested in a variety of European countries 10 as well as in China 17, Japan 18 and Brazil 19. The EHFScBS was reliable in each population group and in the entire sample 10. During its development, the scale was reduced from 12 items to nine items (EHFScBS‐9) consist of two factors: consulting behaviours and adherence to regimen 9. However, these suggested factorial structures of the EHFScBS‐9 have not been consistent in the following various psychometric studies but fluctuating across a one 20, two 9 or three 21 factorial structures across populations. Only the factor consulting behaviour has been fairly stable in all studies 24. The factorial structures of the EHFScBS‐9 can be used to compute a total and specific score for each identified factor 23.
Among the studies, internal consistency of the instrument varied with a Cronbach's alpha of 0.66 to 0.87 for the total score 9.

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