Date of Award

Summer 8-7-2022

Degree Type


Degree Name

PhD Health Sciences


Health and Medical Sciences


Deborah DeLuca, J.D., MS

Committee Member

Paul Franco, Ph.D., MBS

Committee Member

Terrence Cahill, Ed.D., FACHE


self-care, heart failure, healthcare providers, intelligent non-adherence


Background and Purpose of the Study: Research shows that six in ten U.S. adults have a chronic disease and four in ten have two or more (CDC, 2018). Of all chronic diseases, heart failure is the leading cause of hospitalization and mortality in the U.S. (Kilgore, Patel, Kielhorn, Maya, & Sharma, 2017). Luckily, this condition can be managed through various self-care practices. Although healthcare providers are educating their patients on these self-care practices, patients are making a conscious decision to non-adhere. This phenomenon is known as intelligent non-adherence and is mostly affected by an individual’s level of knowledge, attitudes, beliefs, and behaviors. The purpose of this study is to understand intelligent non-adherence by measuring the differences in knowledge, attitudes, beliefs, and behaviors of self-care in heart failure patients in hopes of acquiring crucial information for future use in the tailoring of heart failure self-care educational programs. Doing so by creating, validating, and utilizing a Principal Investigator survey instrument (SC-KABBINA).

Methods: This study utilized a quantitative methodology with a descriptive, exploratory, cross-sectional, and correlational research design to measure heart failure patients’ (ages 18-44 and 45-95) level of knowledge, attitudes, beliefs, and behaviors. A sample of 343 of heart failure patients was attained for this study.

Results: As a whole, SC-KABBINA’s reliability was acceptable (Cronbach’s alpha α = .75). Individually, each of the four variables of SC-KABBINA, had a reliability ranging from unacceptable to excellent: Behaviors (α = .44), Attitudes (α = .55), Knowledge (α = .69), and Beliefs (α = .80).

Based on the descriptive statistics, heart failure patients’ (regardless of age) showed a high level of knowledge toward self-care, more favorable level of attitudes and beliefs, and were more prone to perform self-care behaviors; however, based on the inferential statistics (one-way ANOVA and linear regression), there was no significance found for any of the four dependent variables.

Conclusion: Although knowledge, attitudes, beliefs, and behaviors have an impact on an individual’s level of intelligent non-adherence and self-care, there may have been other factors that influenced this study and its results.

Keywords: heart failure, self-care, intelligent non-adherence, chronic disease, healthcare providers