Published In

Patient Education and Counseling

Document Type


Publication Date



Veterans -- Medical care -- United States -- Statistics, Chronic Disease -- Self-care, Chronic disease -- Qualitative research, Chronic illness care, Health care redesign


Objective: Understand patients’ experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management.

Methods: We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis.

Results: Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on a daily basis. Participants also identified psychological symptoms as a major barrier to carrying out self-care.

Conclusion: Patients identify relationships with health care workers, help from family and friends, and mental health problems as major influences on the ability to manage their CHF.

Practice implications: Efforts to optimize CHF self-management should attend to health system and psychosocial barriers to care.


This manuscript was written in the course of employment by the United States Government and it is not subject to copyright in the United States.

Published 2014 by Elsevier Ireland Ltd.



Persistent Identifier