Dissertations & Theses (Open Access)

Date of Award

Summer 8-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)


Diane Wind Wardell, PhD, RN, WHNP-BC - Chair

Second Advisor

Joan Engebretson, DrPH, AHN-BC, RN, FAAN

Third Advisor

Anne Hamilton Dougherty, M.D., F.A.C.C., F.H.R.S., F.A.H.A.


Background: Heart Failure self-care becomes exceedingly difficult to perform as the disease progresses; therefore social support becomes important in facilitating heart failure self-care. Woman with heart failure represent a significant and growing vulnerable population. Women tend to have lower self-confidence in providing self-care, experience greater negative emotions, decreased social support, experience more adverse psychosocial factors affecting self-care and experience greater psychosocial adversity than do men. Self-care is vital in managing heart failure and social support greatly facilitates self-care behaviors.

Purpose: The purpose of this pilot study was to gain a deeper understanding about the sources of perceived social support and how those sources influenced heart failure self-care behavior in women in two generational cohorts. Understanding sources of social support and how they influenced heart failure self-care is necessary in order to develop future interventions that might enhance social support and subsequently create more positive self-care behaviors in women with heart failure.

Methods: This study used a cross-sectional, mixed method variant, explanatory concurrent design. A total of 16 female study participants were recruited from two different cohorts, those born from 1925 to 1942 and those born from 1943 to 1960. The Multidimensional Scale of Perceived Social Support, the European Heart Failure Self-Care Behavioral Scale – 9, the Duke Activity Status Index, the Standardized Mini Mental State Exam, the Geriatric Depression Scale - Short Form, the Self-Assessed New York Heart Association Functional Class questionnaire and a demographic form were used along with a semi-structured interview, which sought to elaborate instrument findings. Dominant themes were highlighted in order to help explain quantitative instrument results.

Findings: Significant differences were found between cohorts for the Multidimensional Scale of Perceived Social Support and between the Multidimensional Scale of Perceived Social Support and the Geriatric Depression Scale - Short Form and the Standardized Mini Mental State Exam. Interview data indicated that: (1) “special persons” were friends, family or other person that helped the most, (2) distance to support network was a factor in receiving support, (3) religion/spirituality was used as coping mechanism and source of support, (4) participants viewed self-care as those things that they can only do themselves without help from others, (5) participants felt that they didn’t need help with self-care even though they did and (6) participants received mostly instrumental support from support source.

Conclusion: Research that explores females with heart failure, their social support networks, and self-care practices with a particular emphasis on their place in history through cohort grouping is suggested to gain a better understanding of heart failure self-care. Understanding cohort differences in terms of socio demographic and other factors could uncover unique differences among cohorts which could lead to more targeted interventions.


Self-care, Women, Heart failure, Pilot study, Compliance



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