Medication Adherence, Self-care Behavior and Knowledge on Treatment among Heart Failure Patients on Follow up at Cardiac Clinic, Jimma University Specialized Hospital, South West Ethiopia

Abstract

Adherence to self-care behavior is important for patients with heart failure (HF). Adherence with multiple self-care instructions among HF patients is not well described in Ethiopia. This study assessed adherence to medication, self-care behaviors and knowledge among adult patients with chronic heart failure on follow-up at the cardiac follow-up clinic of Jimma University Specialized Hospital (JUSH). Materials and Methods: Hospital based cross-sectional study was employed and patientreported adherence to HF self-care behaviors and knowledge was assessed among 328 sampled adult patients attending the cardiac follow up clinic at JUSH from February 30 to May 30 in 2013. Patients were interviewed using systematic sampling technique. Data were collected using structured questionnaire. Data were analyzed using SPSS version 19.0 of the computer software. Bivariate and multivariable analyses were conducted to identify factors associated with poor adherence to self-care behaviors. Results: Four of the top eight most frequently performed self-care behaviors were related to taking prescribed medications, and the seven least frequently performed self-care behaviors were concerned with symptom monitoring or management. There were significant relationships between the total self-care behavior score and age (p=0.02), marital status (p=0.09), readmission (p=0.003) and New York heart association functional class (p=0.023) and knowledge (p=0.000) in bivariate analysis. In addition, a number of significant relationships between patient factors and individual self-care behaviors were observed, (e.g. occupation was predictor of poor medication adherence in multivariable analysis (p<0.05)). Multivariable analysis showed that being old age (p<0.05), co-morbid, New York heart association functional class I and II and low HF knowledge were independent predictors of poor overall adherence to self-care behavior (P<0.01), while marital status were not associated significantly. There was a significant correlation between the mean total knowledge score and the total mean self-care score (r = 0.61, P =0.01). Conclusion and recommendation: In this study, we found that patient-reported overall adherence with HF self-care behaviors is low and selective. Many patients in the study reported a knowledge deficit related to HF and the HF self-care behaviors, particularly salt restriction, and daily weighing. There is, therefore, a need to develop strategies aimed at improving adherence. Such strategies may include carrying out effectively self-care practices/measures directed toward prevention of exacerbations or complication of HF (early IV symptom recognition and contacting doctors, being aware of the effects and results of HF (noted hard activities, daily rest times), modifying the self-concept in accepting oneself as having HF, improved communication between patients and health care providers (physicians) and repetitive, objective evaluation of adherence. Providing comprehensive HF education and counseling that target knowledge, skill and behavior ameliorates level of adherence.