**4. Self-care in advanced stage heart failure**

Heart failure self-care is defined as the process of health care and disease management, which maintains stability in decisions and behaviours, defined by changes in the patient status and provided by correct applications.

To be able to maintain healthy self-care in patients with advanced stage heart failure, it is necessary to first know the barriers to self-care. These barriers can be examined under 3 headings as personal factors, disease burden, and an unproductive support system [18].

#### **4.1 Factors affecting self-Care in Heart Failure**

### *4.1.1 Personal factors*

### *4.1.1.1 Lack of self-care information*

The first step in preventing barriers to poor health outcomes that can be experienced by heart failure patients is for patients and carers to have knowledge at a level that will enable them to adopt and maintain a complex series of behavioural changes.

The reasons for a lack of knowledge of advanced stage heart failure patients and their carers include low education levels, limited health literacy, and education programmes that are presented by healthcare institutions but that do not establish behavioural changes. It has been reported to be important that sources of information are accessible and are prepared taking into consideration the age, sight and hearing impairments, forgetfulness, and low health literacy levels of patients with heart failure, and that regular medical visits are made by healthcare professionals [19].
