Understanding Contextual Stimuli of Adherence to Treatment in Heart Failure Patients: Study based on Roy Adaptation Model

Abstract

Background: Non-adherence to medications and lifestyle recommendations in heart failure is associated with
poor clinical outcomes including recurrent hospitalization, deterioration of the disease condition, and increased
health care costs.
Objectives: This study aimed to identify the contextual stimuli related with adherence to treatment among the
patients with heart failure based on Roy Adaptation Model in the cultural and socio-economical context of Iran.
Methods: This qualitative study was performed in 6 cardiovascular referral centers using the conventional
content analysis. Data were collected through semi‑structured interviews in 2017–2018. Each interview was
started using general questions about self-care behaviors and barriers/ facilitator to adherence to treatment.
Also, the Three‑step content analysis approach proposed by Elo was used for data analysis.
Results: The concepts considered in the experiences of participants as contextual stimuli of treatment adherence
were categorized into 16 subcategories and also 4 categories as follows: cultural factors, socioeconomic factors,
physical / psychological stress, coping abilities and strategies.
Conclusion: Given that HF patients experience numerous self-management challenges to adherence to
treatment, Nurses can play an important role in promoting the adaptation and improving the patient adherence
through managing the contextual stimuli mentioned in this study by applying Roy Adaptation Model. The
relationships among numerous contextual stimuli mentioned in this study should be tested through quantitative
studies, and nursing interventions should be developed and tested to improve the adherence to treatment.