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The Influence of Heart Failure Patients’ Values on Self-Care Decision-Making Open Access


Other title
Patients' Values, Self-care, Heart Failure, Concept Analysis, Mixed Methods Systematic Review, Focused Study
Type of item
Degree grantor
University of Alberta
Author or creator
Karimi-Dehkordi, Mehri
Supervisor and department
Clark, Alexander M. (Faculty of Nursing)
Examining committee member and department
Whitfield, Kyle (Faculty of Extension)
Spiers, Jude (Faculty of Nursing)
Faculty of Nursing

Date accepted
Graduation date
2017-11:Fall 2017
Doctor of Philosophy
Degree level
Heart failure (HF) is a common, costly, disabling and deadly syndrome. It places a considerable burden on Canadian society and on patients, their families, and the health care system. Self-care behaviors are essential to effective HF management. Adherence to some self-care recommendations, however, is selective – that is, patients may choose certain recommendations but not others. They may be influenced by many factors, such as patients’ belief systems. A core component of these systems, which may influence behaviors, are patients’ values. Values have not been clearly defined or explored in relation to HF self-care behaviors. As a consequence, practical approaches to and models of the self-care decision-making process lack adequate incorporation of individuals’ values. As such, this project seeks to understand the nature and influence of HF patients’ values in relation to self-care decisions. As human behavior is best studied in natural situations, critical realism (CR) was selected the ontological foundation for this project. The lens of CR reveals that individuals live in open complex (“real world”) systems with behavior being influenced by the interplay between different factors in these systems. Using CR helped me to design and choose appropriate approaches for this project in order to generate fundamental knowledge concerning HF patients’ values, and to develop models. To provide the full context and description of my dissertation project, this dissertation offers insights into the background and rationale for the study of patients’ values and self-care behavior in HF patients. This thesis also aims to present manuscripts of three interrelated studies, which are: a concept analysis of HF patients’ values, a systematic review to synthesize evidence, and a qualitative study to examine how HF patients’ values influence their self-care decision-making. iii For the first study, a concept analysis of “patients’ values”, I reviewed 121 papers and books. Based on this work, I defined the concept of patients’ values as meaning core beliefs, which are abstract and subjective in nature, and perceived as very significant to individuals. Values function within a system and the priority of values can be changed under certain circumstances. The second paper reports a mixed-methods systematic review. From this work, two models are proposed: the first conveys how patients’ values are involved in self-care decision-making, while the second addresses what types of patients’ values are involved in self-care decision-making. In the third paper, I identify two types of values, functional and emotional, which influence self-care decisions in HF patients with NYHA class II and III. Each type of values relates to self, others, and health professionals. In addition, this study sheds light on five ways that values are involved in patients’ prioritization of their values in order to make self-care decisions. These three studies may enable nurses and other health professionals to understand HF patients’ values, and how those values affect self-care decision-making. Furthermore, the studies may inform future research to develop self-care models and approaches that enable healthcare professionals to help HF patients in their self-care decision-making based on their values.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
Karimi, M., & Clark, A. M. (2016). How do patients’ values influence heart failure self-care decision-making?: A mixed-methods systematic review. International Journal of Nursing Studies, 59, 89-104. doi:10.1016/j.ijnurstu.2016.03.010.

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