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Andreae, C., Strömberg, A., Chung, M. L., Hjelm, C. & Årestedt, K. (2018). Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure. Journal of Cardiovascular Nursing, 33(2), E15-E20
Open this publication in new window or tab >>Depressive Symptoms Moderate the Association Between Appetite and Health Status in Patients With Heart Failure
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2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 2, p. E15-E20Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Decreased appetite and depressive symptoms are clinical problems in patients with heart failure. Both may result in impaired health status.

OBJECTIVE: The aims of this study were to investigate the association between appetite and health status in patients with heart failure and to explore whether depressive symptoms moderate this association.

METHODS: In this cross-sectional study, patients with heart failure (n = 186; mean age, 71 years), New York Heart Association class II to IV, participated. Data on appetite (Council of Nutrition Appetite Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and health status (EQ-5D 3-level scale [EQ-5D-3L] descriptive system, EQ-5D-3L index, and EQ Visual Analog Scale) were collected by self-rating questionnaires. Pearson correlation was used to investigate the association between appetite and health status. Multiple regression was performed to examine whether depressive symptoms moderate the association between appetite and health status.

RESULTS: There was a significant association between appetite and health status for EQ-5D-3L descriptive system, mobility (P < .001), pain/discomfort (P < .001), and anxiety/depression (P < .001). This association was also shown in EQ-5D-3L index (P < .001) and EQ Visual Analog Scale (P < .001). Simple slope analysis showed that the association between appetite and health status was only significant for patients without depressive symptoms (B = 0.32, t = 4.66, P < .001).

CONCLUSIONS: Higher level of appetite was associated with better health status. In moderation analysis, the association was presented for patients without depressive symptoms. Decreased appetite is an important sign of poor health status. To improve health status, health professionals should have greater attention on appetite, as well on signs of depressive symptoms.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
appetite, association, depression, health status, heart failure, nutritional status
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-139105 (URN)10.1097/JCN.0000000000000428 (DOI)000440241700003 ()28574973 (PubMedID)2-s2.0-85020167287 (Scopus ID)
Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2018-09-27Bibliographically approved
Thrysoee, L., Strömberg, A., Brandes, A. & Hendriks, J. (2018). Management of newly diagnosed atrial fibrillation in an outpatient clinic settingpatients perspectives and experiences. Journal of Clinical Nursing, 27(3-4), 601-611
Open this publication in new window or tab >>Management of newly diagnosed atrial fibrillation in an outpatient clinic settingpatients perspectives and experiences
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 3-4, p. 601-611Article in journal (Refereed) Published
Abstract [en]

Aims and objectivesTo gain in-depth knowledge of patients experiences of the consultation processes at a multidisciplinary atrial fibrillation outpatient clinic in a university hospital in Denmark. BackgroundAtrial fibrillation is the most common cardiac arrhythmia associated with morbidity and mortality if not diagnosed and treated as recommended. Patients with newly diagnosed atrial fibrillation preferably should be managed in an outpatient setting which includes medical examination, patient education and decision-making on medical therapy. DesignThis is a qualitative study of 14 patients newly diagnosed with atrial fibrillation, ranging from asymptomatic patients, to those with mild to severe symptoms; they were all referred from general practitioners. MethodsData were generated in 2013-2015 using participant observation during each consultation, followed by individual interviews postconsultation. ResultsPatients were referred with limited information on AF and knowledge about the management consultation procedures. The consultations were performed in a professional way by the cardiologist as well as by the nurses with an emphasis on the medical aspects of atrial fibrillation. The understanding that atrial fibrillation is not a fatal disease in itself was very important for patients. At the same time, visiting the clinic was overwhelming, information was difficult to understand, and patients found it difficult to be involved in decision-making. ConclusionsThis study indicates that patients were uncertain on what AF was before as well as after their consultation. The communication was concentrated on the medical aspects of atrial fibrillation and visiting the clinic was an overwhelming experience for the patients. They had difficulty understanding what atrial fibrillation was, why they were treated with anticoagulation, and that anticoagulating was a lifelong treatment. Relevance for clinical practiceThis study demonstrates some lack of patient-centred care and an absence of tailored patient AF-related education. Furthermore, the study highlights the need for and importance of active patient involvement.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
atrial fibrillation; clinical management; multidisciplinary care; outpatient clinic; patient experiences
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-145787 (URN)10.1111/jocn.13951 (DOI)000425733600031 ()28677250 (PubMedID)
Note

Funding Agencies|Novo Nordisk Foundation

Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-05-09
Allemann, H., Strömberg, A. & Thylén, I. (2018). Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study. Journal of Cardiovascular Nursing, 33(6), E1-E8
Open this publication in new window or tab >>Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study
2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 6, p. E1-E8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The links between chronic illness, psychological well-being, and social support have previously been established. Social isolation and loneliness have shown an increased mortality risk for those with heart failure (HF). Increasingly more people with HF are living with an implantable cardioverter defibrillator (ICD), but only a few small-scale studies have focused on social support in this population.

OBJECTIVE: The aim of this study was to explore factors related to perceived social support in a large cohort of individuals with HF living with an ICD.

METHODS: All eligible adult ICD recipients in the Swedish ICD registry were invited to participate in this cross-sectional study. For this analysis, those with HF and complete data on perceived social support were included (N = 1550; age, 67.3 (SD, 9.8) years; 19.5% female).

RESULTS: Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity were not related to the outcome.

CONCLUSION: One in five participants reported low/medium social support. Our study underlines the complex relationships between perceived social support, psychological well-being and perceived control over the heart condition. Multiple aspects need to be taken into account when developing interventions to provide psychosocial support and optimize outcomes in this patient group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-154035 (URN)10.1097/JCN.0000000000000523 (DOI)000457866800001 ()30063538 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-18
Andreae, C., Franzén Årestedt, K., Evangelista, L. & Strömberg, A. (2018). The associations between physical activity and appetite in patients with heart failure – a prospective observational study. In: : . Paper presented at American Heart Association. 10-12 November. Chicago, Illinois.. American Heart Association, Inc., 138, Article ID A14932.
Open this publication in new window or tab >>The associations between physical activity and appetite in patients with heart failure – a prospective observational study
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction: Physical activity and appetite both play a crucial role for health outcomes and quality of life in patients with heart failure. Nevertheless, both of these key functions are frequently decreased in patients with heart failure. Whilst most attention focuses independently on the physical activity levels, the associations with appetite has been insufficiently investigated. The aim was therefore to explore the associations between physical activity and appetite in community dwelling heart failure patients.

Methods: This prospective observational study consisted of 186 patients with symptomatic heart failure of whom 56 (30%) were women and 130 (70%) were men. Mean age was 70.7 (SD=11 years), the majority had NYHA-class II, 114 (63%). Objective and subjective methods were used to measure physical activity include a wearable actigraph (SenceWear) for 4 days and six minutes’ walk test. The actigraph calculate total energy expenditure, active energy expenditure, number of steps and METs daily average index. Patients also stated their physical activity level on a numeric rating scale. A self-reported questionnaire, the Council on Nutrition Appetite Questionnaire was used to assess appetite. Simple linear regression was conducted to explore the associations between physical activity and appetite at baseline and at 18-month follow-up.

Results: In general, the levels of physical activity in this sample was low and appetite was poor. There was a significant association between objective physical activity measures and appetite at baseline ranging between (p=<0.001-0.041). The number of steps and walking distance had the strongest association, each explaining 6% and 7% of the total variance in appetite. At the 18-month follow-up, all objective and subjective physical activity measures were associated with appetite (p=0.001-0.035) with the number of steps being most strongly associated (p=<0.001) explaining 14% of the total variation in appetite.

Conclusions: Patients with heart failure who are more physically active experiences better appetite. These findings underscore the importance of placing greater attention on both physical activity and appetite in clinical practice as these factors has implications for patient’s health outcomes. Further longitudinally oriented studies are needed to determine whether there is a causal relationship between physical activity and appetite in heart failure populations.

Keywords: Appetite, Heart Failure, Physical activity

Place, publisher, year, edition, pages
American Heart Association, Inc., 2018
Series
Circulation, ISSN 0569-6704 ; 138
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-153900 (URN)
Conference
American Heart Association. 10-12 November. Chicago, Illinois.
Available from: 2019-01-18 Created: 2019-01-18 Last updated: 2019-01-22Bibliographically approved
Mourad, G., Jaarsma, T., Strömberg, A., Svensson, E. & Johansson, P. (2018). The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?. BMC Psychiatry, 18(1), Article ID 172.
Open this publication in new window or tab >>The associations between psychological distress and healthcare use in patients with non-cardiac chest pain: does a history of cardiac disease matter?
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2018 (English)In: BMC Psychiatry, ISSN ISSN 1471-244X, Vol. 18, no 1, article id 172Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychological distress such as somatization, fear of body sensations, cardiac anxiety and depressive symptoms is common among patients with non-cardiac chest pain, and this may lead to increased healthcare use. However, the relationships between the psychological distress variables and healthcare use, and the differences in relation to history of cardiac disease in these patients has not been studied earlier. Therefore, our aim was to explore and model the associations between different variables of psychological distress (i.e. somatization, fear of body sensations, cardiac anxiety, and depressive symptoms) and healthcare use in patients with non-cardiac chest pain in relation to history of cardiac disease.

METHODS: In total, 552 patients with non-cardiac chest pain (mean age 64 years, 51% women) responded to the Patient Health Questionnaire-15, Body Sensations Questionnaire, Cardiac Anxiety Questionnaire, Patient Health Questionnaire-9 and one question regarding number of healthcare visits. The relationships between the psychological distress variables and healthcare visits were analysed using Structural Equation Modeling in two models representing patients with or without history of cardiac disease.

RESULTS: A total of 34% of the patients had previous cardiac disease. These patients were older, more males, and reported more comorbidities, psychological distress and healthcare visits. In both models, no direct association between depressive symptoms and healthcare use was found. However, depressive symptoms had an indirect effect on healthcare use, which was mediated by somatization, fear of body sensations, and cardiac anxiety, and this effect was significantly stronger in patients with history of cardiac disease. Additionally, all the direct and indirect effects between depressive symptoms, somatization, fear of body sensations, cardiac anxiety, and healthcare use were significantly stronger in patients with history of cardiac disease.

CONCLUSIONS: In patients with non-cardiac chest pain, in particular those with history of cardiac disease, psychological mechanisms play an important role for seeking healthcare. Development of interventions targeting psychological distress in these patients is warranted. Furthermore, there is also a need of more research to clarify as to whether such interventions should be tailored with regard to history of cardiac disease or not.

Keywords
Cardiac anxiety, Cardiac disease, Depressive symptoms, Fear of body sensations, Healthcare visits, Non-cardiac chest pain, Somatization
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-148445 (URN)10.1186/s12888-018-1689-8 (DOI)000434313300001 ()29866125 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden [LIO-439131]; Medical Research of Southeast Sweden [FORSS-475291]

Available from: 2018-06-11 Created: 2018-06-11 Last updated: 2018-08-30
Lycholip, E., Aamodt, I. T., Lie, I., Simbelyte, T., Puronaite, R., Hillege, H., . . . Celutkiene, J. (2018). The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study. Patient Preference and Adherence, 12, 1113-1122
Open this publication in new window or tab >>The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study
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2018 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 12, p. 1113-1122Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-care is an important patient-reported outcome (PRO) for heart failure (HF) patients, which might be affected by disease management and/or telemonitoring (TM). The number of studies reporting the influence of TM on self-care is limited. Aims: This study aimed: to assess whether TM, in addition to information-and-communication-technology (ICT)-guided disease management system (ICT-guided DMS), affects self-care behavior; to evaluate the dynamics of self-care during the study; to investigate factors contributing to self-care changes; and to identify a patient profile that predisposes the patient to improvement in self-care. Methods: In the INnovative ICT-guided-DMS combined with Telemonitoring in OUtpatient clinics for Chronic HF patients (IN TOUCH) study, 177 patients were randomized to either ICT-guided DMS or TM+ICT-guided DMS, with a follow-up of 9 months. The current analysis included 118 participants (mean age: 69 +/- 11.5 years; 70% male) who filled the following PRO instruments: the nine-item European Heart Failure Self-care Behaviour scale (EHFScBs), Hospital Anxiety and Depression scale (HADs), and Minnesota Living with HF Questionnaire (MLHFQ). Results: The baseline level of self-care was better in the TM+ICT-guided-DMS group (n=58) compared to ICT-guided-DMS group (n=60, p=0.023). Self-care behavior improved in the ICT-guided-DMS group (p amp;lt; 0.01) but not in the TM+ICT-guided-DMS group. Factors associated with self-care worsening were as follows: higher physical subscale of MLHFQ (per 10 points, p amp;lt; 0.05), lower left ventricular ejection fraction (LVEF) (per 5%, p amp;lt; 0.05), lower New York Heart Association (NYHA) class (class III vs class II, p amp;lt; 0.05). The subgroups of patients who had an initial EHFScBs total score amp;gt; 28, or from 17 to 28 with concomitant HADs depression subscale (HADs_D) score amp;lt;= 8, demonstrated the greatest potential to improve self-care during the study. Conclusion: TM did not have an advantage on self-care improvement. Poor physical aspect of quality of life. lower LVEF, and lower NYHA class were associated with self-care worsening. The greatest self-care improvement may be achieved in those patients who have low or medium initial self-care level in the absence of depression.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2018
Keywords
heart failure; self-care; telemonitoring; disease management; patient-reported outcomes
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-149751 (URN)10.2147/PPA.S162219 (DOI)000437184500001 ()29983549 (PubMedID)
Note

Funding Agencies|Dutch Ministry of Health, Department of Pharmaceutical Affairs and Medical Technology (GMT); NordForsks "Nordic Programme on Health and Welfare" [76015]

Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2018-08-14Bibliographically approved
Lawson, C., Pati, S., Green, J., Messin, G., Strömberg, A., Nante, N., . . . Kadam, U. T. (2017). Development of an international comorbidity education framework. Nurse Education Today, 55, 82-89
Open this publication in new window or tab >>Development of an international comorbidity education framework
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2017 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 55, p. 82-89Article in journal (Refereed) Published
Abstract [en]

Context The increasing number of people living with multiple chronic conditions in addition to an index condition has become an international healthcare priority. Health education curricula have been developed alongside single condition frameworks in health service policy and practice and need redesigning to incorporate optimal management of multiple conditions. Aim: Our aims were to evaluate current teaching and learning about comorbidity care amongst the global population of healthcare students from different disciplines and to develop an International Comorbidity Education Framework (ICEF) for incorporating comorbidity concepts into health education. Methods: We surveyed nursing, medical and pharmacy students from England, India, Italy and Sweden to evaluate their understanding of comorbidity care. A list of core comorbidity content was constructed by an international group of higher education academics and clinicians from the same disciplines, by searching current curricula and analysing clinical frameworks and the student survey data. This list was used to develop the International Comorbidity Education Framework. Results: The survey sample consisted of 917 students from England (42%), India (48%), Italy (8%) and Sweden (2%). The majority of students across all disciplines said that they lacked knowledge, training and confidence in comorbidity care and were unable to identify specific teaching on comorbidities. All student groups wanted further comorbidity training. The health education institution representatives found no specific references to comorbidity in current health education curricula. Current clinical frameworks were used to develop an agreed list of core comorbidity content and hence an International Comorbidity Education Framework. Conclusions: Based on consultation with academics and clinicians and on student feedback we developed an International Comorbidity Education Framework to promote the integration of comorbidity concepts into current healthcare curricula.

Place, publisher, year, edition, pages
CHURCHILL LIVINGSTONE, 2017
Keywords
Comorbidity; Multimorbidity; Health; Curriculum; Education
National Category
Pedagogy
Identifiers
urn:nbn:se:liu:diva-139549 (URN)10.1016/j.nedt.2017.05.011 (DOI)000404700900015 ()28535380 (PubMedID)
Available from: 2017-08-08 Created: 2017-08-08 Last updated: 2018-05-03
Näsström, L., Luttik, M. L., Idvall, E. & Strömberg, A. (2017). Exploring partners’ perspectives on participation in heart failure home-care: A mixed method design. Journal of Advanced Nursing, 73(5), 1208-1219
Open this publication in new window or tab >>Exploring partners’ perspectives on participation in heart failure home-care: A mixed method design
2017 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 73, no 5, p. 1208-1219Article in journal (Refereed) Published
Abstract [en]

Previous research has shown that partners are involved in the care of patients with heart failure. The aim of this study was to gain a better understanding of the partners ‘perspectives on participation in the care for patients with heart failure receiving structured home-care. A parallel convergent mixed method design with data from interviews analyzed with content analysis and questionnaires statistically analyzed (n=15). Results were analyzed with regard to whether they were comparable and convergent, expanded the understanding, or were inconsistent. Partners scored that they were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation; adapting to the caring needs and illness trajectory, mastering caregiving demands, interacting with health care providers, and gaining knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Caregivers, family, heart failure, home- care, mixed method, participation
National Category
Nursing Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-117094 (URN)10.1111/jan.13216 (DOI)000403110000019 ()27878851 (PubMedID)
Note

Funding agencies: European Commission [222954]; Linkoping University; Swedish Heart and Lung Association; Medical Research Council of Southeast Sweden; County Council Ostergotland, Sweden

The previous status of this publication was manuscript

Available from: 2015-04-15 Created: 2015-04-15 Last updated: 2018-04-19Bibliographically approved
Sedlar, N., Lainscak, M., Mårtensson, J., Strömberg, A., Jaarsma, T. & Farkas, J. (2017). Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies. European Journal of Cardiovascular Nursing, 16(4), 272-282
Open this publication in new window or tab >>Factors related to self-care behaviours in heart failure: A systematic review of European Heart Failure Self-Care Behaviour Scale studies
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2017 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 4, p. 272-282Article, review/survey (Refereed) Published
Abstract [en]

Background: Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing. Aims: The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS. Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored. Results: We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies. Conclusion: A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2017
Keywords
Self-care behaviours; European Heart Failure Self-Care Behaviour Scale; systematic review; heart failure
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-136359 (URN)10.1177/1474515117691644 (DOI)000396200300002 ()28168895 (PubMedID)
Note

Funding Agencies|Slovenian Research Agency [J3-7405]

Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-05-03
Jaarsma, T., Cameron, J., Riegel, B. & Strömberg, A. (2017). Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update. Current Heart Failure Reports, 14(2), 71-77
Open this publication in new window or tab >>Factors Related to Self-Care in Heart Failure Patients According to the Middle-Range Theory of Self-Care of Chronic Illness: a Literature Update
2017 (English)In: Current Heart Failure Reports, ISSN 1546-9530, E-ISSN 1546-9549, Vol. 14, no 2, p. 71-77Article, review/survey (Refereed) Published
Abstract [en]

As described in the theory of self-care in chronic illness, there is a wide range of factors that can influence self-care behavior. The purpose of this paper is to summarize the recent heart failure literature on these related factors in order to provide an overview on which factors might be suitable to be considered to make self-care interventions more successful.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Heart failure; Self-care; Self-care maintenance; Self-care management; Self-care monitoring
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-146068 (URN)10.1007/s11897-017-0324-1 (DOI)28213768 (PubMedID)
Available from: 2018-03-27 Created: 2018-03-27 Last updated: 2018-04-25
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4259-3671

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