Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
A Journal of Nursing Values.
Innovation.
Collaboration, and Global Impact Volume 12.
Issue 2.
April 2026 Published by STIKep PPNI Jawa Barat ISSN 2354-8428, e-ISSN 2598-8727 Original Article Self-Efficacy as a Behavioral Enabler of Self-Care in Chronic Heart Failure Tobi Pitora1.
Helza Risdianti1.
Dzikra Fitria Amita1.
Aurellia Firstania1.
Dinda Nur Fajri Hidayati Bunga1.
Annisa Pratiwi Gunawan1.
Yusuf Hanafiah1 1Department of Nursing.
Faculty of Health.
Politeknik Negeri Subang.
Subang.
Indonesia Abstract Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
Volume 12 .
, 189-195 https://doi.
org/10.
33755/jkk.
Article info Received Revised Accepted Published February 12, 2026 April 18, 2026 April 23, 2026 April 24, 2026 Corresponding author Tobi Pitora* Department of Nursing.
Faculty of Health.
Politeknik Negeri Subang Jl.
Brigjen Katamso No.
Subang Phone : 0852-1004-8343 Email: tobi.
pitora@polsub.
Citation Pitora.
Risdianti.
Amita.
Firstania.
Bunga.
Gunawan.
, & Hanafiah.
Self-efficacy as a behavioral enabler of self-care in chronic heart failure.
Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journa.
, 12.
, 189Ae195.
https://doi.
org/10.
33755/jkk.
Website https://journal.
stikep-ppnijabar.
id/jkk This is an Open Access article distributed under the terms of the Creative Commons Attribu tion-NonCommercial 4.
0 International License p-ISSN : 2354 8428 e-ISSN: 2598 8727 Background: Chronic heart failure (CHF) is a major health problem associated with morbidity, repeated hospitalization, and long-term self-management demands.
Although self-care is essential for symptom control and prevention of deterioration, many patients have difficulty maintaining effective daily Self-efficacy is considered an important psychological factor that may support self-care behavior.
Objective: This study aimed to examine the relationship between self-efficacy and self-care among patients with chronic heart failure and to contextualize the role of self-efficacy in supporting self-management behavior.
Methods: A cross-sectional study was conducted involving 74 patients with CHF.
Data were collected using the Self-Care of Heart Failure Index (SCHFI) v.
2 and the General Self-Efficacy (GSE) Scale.
Data were analyzed using descriptive statistics.
PearsonAos correlation, independent t-test, and multiple linear Results: Most participants were male .
3%), with a mean age 01 A 13.
46 years.
The mean self-efficacy score was 35.
A 3.
75, and the mean self-care score was 69.
66 A 3.
Selfefficacy was positively correlated with self-care .
= 0.
343, p = .
and remained a significant predictor in multivariate analysis ( = 0.
31, p = 0.
Conclusion: Self-efficacy was positively associated with selfcare among patients with chronic heart failure, but the modest strength of the relationship suggests that self-care is shaped by multiple interacting factors.
These findings support the view that self-efficacy functions as a behavioral enabler rather than a standalone determinant of self-care.
Interventions aimed at improving CHF self-management should therefore combine confidence-building strategies with broader educational, clinical, and contextual support.
Keywords: chronic heart failure.
self-efficacy.
self-care.
cardiovascular nursing.
self-management INTRODUCTION characterized by structural and functional impairment in ventricular filling or blood With a global prevalence of 2% and an annual incidence of approximately 0.
CHF
now affects more than 64.
3 million people, placing significant pressure on primary and Chronic heart failure (CHF) remains a critical global health burden, with projections of increasing prevalence as the world's population ages .
Chronic heart failure (CHF) is Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Self-efficacy in chronic heart failure care secondary healthcare systems in many countries .
Despite significant advances in evidencebased therapy, readmission rates remain a systemic challenge, often rooted in patients' failure to integrate self-care management in the home environment .
may differ across healthcare systems, age profiles, and sociocultural contexts.
Second, much of the existing evidence comes from older heart failure populations in high-income settings, whereas younger and economically diverse populations may experience self-care in substantially different ways.
Third, self-efficacy is often discussed as if it directly drives self-care, even though daily self-management in chronic heart failure is likely shaped by a broader interaction between confidence, health literacy, symptom burden, and contextual support.
These gaps indicate the need for context-sensitive evidence that not only tests association, but also clarifies how self-efficacy may operate within real-world self-care behavior.
The high rate of rehospitalisation among CHF patients, reaching 60.
9% within one year of treatment, and a mortality rate of 4.
3% .
These high figures are closely linked to patientsAo inability to manage their own care at home, which is a key factor in the worsening of symptoms .
Self-care is a crucial aspect for heart failure patients in managing, monitoring, and maintaining their condition .
Self-care assists patients in managing symptoms such as shortness of breath, palpitations, and chest pain, as well as monitoring fluid intake, checking for oedema in the limbs, daily weight monitoring, and physical activity .
Therefore, this study aimed to examine the relationship between self-efficacy and self-care among patients with chronic heart failure in a middle-income Beyond measuring statistical association, this study sought to contribute a contextual interpretation of self-efficacy as a behavioral enabler that may help translate patient knowledge and intention into practical self-care action.
The success of clinical management of CHF is highly dependent on self-care behaviors, a form of naturalistic decision-making process involving health maintenance and symptom perception .
However, the implementation of self-care still faces a number of obstacles.
This may be due to several factors, such as a lack of knowledge, understanding and applying the information provided, and low self-efficacy .
Ae.
The significance of self-care for CHF patients cannot be underestimated.
adequate self-care practices, such as medication adherence, sodium restriction, and daily monitoring of body mass, have been shown to significantly reduce the risk of acute exacerbations, improve quality of life, and prolong life expectancy .
Without effective self-management, even the most advanced pharmacological interventions often fail to prevent clinical deterioration in patients.
METHODS
Study Design and Setting A cross-sectional correlational study was conducted to examine the relationship between self-efficacy and self-care among patients with chronic heart failure.
Data collection was carried out in three tertiary referral hospitals to capture a broader clinical profile and enhance contextual relevance across institutional settings.
Participants and Recruitment Participants were recruited using purposive Eligible participants were adults aged 18 years or older with a confirmed diagnosis of chronic heart failure for at least six months and classified as New York Heart Association (NYHA) functional class IAeIV.
Patients with severe cognitive impairment, as screened using the Mini-Mental State Examination, and those with unstable hemodynamic status were excluded.
total of 74 participants met the eligibility criteria and provided written informed consent.
The main psychological determinant that drives self-care behavior is self-efficacy.
Based on social cognitive theory, self-efficacy is defined as an individual's belief in their ability to manage and carry out the necessary actions in specific situations .
In the context of CHF, self-efficacy is crucial because it acts as a mediator between health knowledge and actual actions .
Although the association between self-efficacy and self-care has been reported in previous studies, the literature still shows several important limitations.
First, many studies treat self-efficacy as a single and stable psychological construct, with limited attention to how its role Instrumentation To ensure high internal consistency and construct validity, the following validated instruments were employed:
Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Pitora et al.
Self-Care of Heart Failure Index (SCHFI) v.
This updated tool measures three primary Scores are standardized to a 0Ae100 scale, with 70 indicating adequate self-care (Jaarsma et al.
, 2.
The SCHFI instrument used in this study utilised the Indonesian version, which is accessible via the website https://selfcare-measures.
com/project/patient-versionschfi-indonesian/ From the results of statistical tests involving 154 respondents, it was found that the alpha coefficient for the 10 items on selfcare maintenance was 0.
% CI = 0.
439Ae standard value 0.
, the alpha coefficient for the 6 items on self-care management was 0.
% CI = 0.
434Ae0.
standard value 0.
, the alpha coefficient for the 6 items on self-care confidence was 0.
% CI = 0.
781Ae0.
standard value 0.
Ethical Considerations The protocol was formally endorsed by the relevant authorities (Hasan Sadikin General Hospital.
Ref No: No.
LB.
01/X.
5/112/2.
Before the commencement of data collection, all participants provided written informed consent ensuring anonymity and the right to withdraw without affecting their clinical treatment.
RESULTS
A total of 74 patients with chronic heart failure were included in the analysis.
The sample was predominantly male .
3%), while 29.
7% were In terms of educational attainment, most participants had completed high school .
6%),
followed by academy or university education .
3%), elementary school .
1%), and junior high school .
1%).
The mean age of participants 01 A 13.
46 years, indicating that CHF in this sample affected a relatively younger adult population compared to typical heart failure The mean duration of illness was 3.
71 years (Table .
General Self-Efficacy (GSE) Scale: A 10-item Likert scale used to assess the participants' confidence in managing .
The three main aspects measured in this instrument are:
motivation, behaviour, and one's social Validity tests show Cronbach's alpha values ranging from 0.
76 to 0.
90, with the majority at 0.
The average self-efficacy score was 35.
00 A 3.
moderate-to-high confidence in managing health-related demands.
The mean self-care score was 69.
66 A 3.
80, which approached the commonly referenced adequacy threshold of 70 for SCHFI-based self-care (Table Clinical and Demographic Questionnaire: Used to collect data on age, education, gender, duration of illness, and socioeconomic status.
Data Analysis PearsonAos correlation analysis showed a statistically significant positive association between self-efficacy and self-care .
= 0.
343, p = This indicates that higher levels of selfefficacy were associated with better self-care, although the magnitude of the relationship was modest (Table .
Data were analyzed using SPSS version 31.
Descriptive statistics were used to summarize demographic and clinical characteristics.
Prior to inferential testing, assumptions for PearsonAos correlation were assessed, including normality of the main study variables.
PearsonAos correlation coefficient was then used to examine the association between self-efficacy and self-care.
addition, a multiple linear regression analysis was performed to control for potential confounding variables.
Self-efficacy remained significantly associated with self-care after adjustment, suggesting that its role is A multiple linear regression analysis was conducted to examine whether self-efficacy remained associated with self-care after adjusting for demographic and clinical variables, including age, gender, education level, and duration of illness.
The model demonstrated that self-efficacy remained a significant independent predictor of self-care ( OO 0.
31, p < 0.
, while age, gender, and duration of illness were not statistically significant predictors.
The regression model explained a modest proportion of variance in self-care (RA = 0.
, suggesting that although self-efficacy contributes to self-care behavior, a substantial proportion of variability remains unexplained by the variables included in this model (Table .
Furthermore, when categorized based on selfcare adequacy, patients with adequate self-care demonstrated higher self-efficacy scores compared to those with inadequate self-care, reinforcing the clinical relevance of the observed The significance level was set at p < 05 with a 95% confidence interval (CI).
Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Self-efficacy in chronic heart failure care Table 1.
Distribution of respondents based on education and gender Variable Gender Male Female Education Elementary school Junior high school High school Academy/university Frequency Percentage (%) Table 2.
Average respondents based on age, duration of illness.
Self-efficacy and Self-care Variable Age
Duration of illness Self-efficacy Self-care Mean
1,710
Table 3.
Pearson correlation test between self-efficacy and self-care in patients with Chronic Heart Failure Self-care Variable p-value Self-efficacy Table 4.
Multiple Linear Regression Predicting Self-Care Variable Constant 45 Ai Self-Efficacy Age Gender (Male=.
Education Duration of Illness Note: RA = 0.
Adjusted RA = 0.
F = 2.
49, p = 0.
,6,.
DISCUSSION
This study examined the relationship between self-efficacy and self-care among patients with chronic heart failure and found a modest but statistically significant positive association.
Importantly, significant after controlling for demographic and clinical variables, suggesting that self-efficacy contributes independently to self-care behavior.
However, the relatively small effect size indicates that self-efficacy alone does not fully explain patientsAo ability to perform effective selfmanagement.
This finding is consistent with previous studies indicating that self-care in CHF is multifactorial and influenced by both p-value <0.
One of the key contributions of this study lies in moving beyond a purely correlational interpretation toward a more nuanced understanding of self-efficacy as a behavioral enabler rather than a dominant determinant.
While patients with higher self-efficacy demonstrated better self-care, the modest correlation coefficient .
= 0.
and limited explained variance (RA OO 0.
suggest that selfcare in chronic heart failure is shaped by a broader constellation of factors.
These likely include symptom burden, cognitive capacity, emotional status, health literacy, family support.
Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Pitora et al.
and healthcare accessibility, as highlighted in prior research .
Ae11,.
ongoing motivational and practical support, as supported by previous intervention studies .
This interpretation challenges the common assumption that improving self-efficacy alone will lead to optimal self-care outcomes.
In clinical reality, many patients possess adequate knowledge and even confidence, yet still struggle to consistently implement self-care behaviors.
The findings of this study support the view that self-efficacy may function as a mechanism that facilitates the translation of intention into action, rather than acting as a standalone driver of This perspective aligns with BanduraAos social cognitive theory, which emphasizes the role of self-efficacy as a mediator between knowledge and behavior .
The regression findings further reinforce this Although self-efficacy remained a significant predictor, other variables included in the model did not reach statistical significance, and overall explanatory power remained limited.
This suggests that key determinants of self-care may not have been captured in this study, including psychosocial and environmental Future research should therefore incorporate broader including variables such as depression, resilience, social support, and health literacy, which have been shown to influence chronic disease self-management .
,11,.
The subgroup analysis further strengthens this Patients categorized as having adequate self-care demonstrated significantly higher self-efficacy, suggesting that confidence plays a meaningful role in achieving clinically relevant thresholds of self-management.
However, the presence of patients with relatively high self-efficacy but suboptimal self-care highlights a potential disconnect between belief and behavior.
This gap suggests that external and contextual barriers may limit the extent to which self-efficacy can be translated into effective action, as also reported in previous CHF studies .
Limitation Several limitations should be acknowledged.
The cross-sectional inference, and the relationship between selfefficacy and self-care may be bidirectional.
It is possible that successful self-care experiences reinforce self-efficacy over time, rather than selfefficacy solely driving behavior .
In addition, the relatively small sample size and singlecountry setting may limit generalizability.
The use of a general self-efficacy instrument, rather than a disease-specific measure, may also reduce conceptual specificity in capturing CHF-related Despite these limitations, this study provides important context-specific evidence by self-efficacy relevance in a younger CHF population within a middle-income setting.
More importantly, it advances the conceptual understanding of selfefficacy as part of a broader behavioral system, rather than an isolated predictor.
This perspective is essential for designing more effective and realistic self-care interventions in chronic heart failure management.
Another important contextual finding is the relatively younger age profile of the study With a mean age of approximately 52 years, this cohort differs from many heart failure populations typically reported in high-income settings, which often involve older adults .
Younger patients may face different challenges, work-related responsibilities, and long-term adaptation to chronic illness.
These factors may influence both self-efficacy and self-care behaviors, potentially explaining why self-efficacy alone accounts for only a modest proportion of variance in self-care.
Implications The findings indicate that improving self-care in chronic heart failure should not rely solely on enhancing self-efficacy.
Although self-efficacy was significantly associated with self-care, its interventions must also address broader factors such as health literacy, symptom management skills, and ongoing clinical support.
Nurse-led, integrated approaches that combine education, behavioral guidance, and follow-up may be particularly effective in translating patient From a clinical perspective, these findings have important implications.
Interventions aimed at improving self-care in CHF should not rely solely on enhancing patient confidence.
Instead, a more comprehensive approach is needed, integrating education, behavioral support, symptom monitoring guidance, and structured follow-up.
Nurse-led interventions, in particular, are wellpositioned to address this multidimensional need by combining knowledge reinforcement with Jurnal Keperawatan Komprehensif.
Volume 12 Issue 2.
April 2026 Self-efficacy in chronic heart failure care confidence into consistent self-care practices.
Future research should incorporate additional psychosocial and contextual variables and use longitudinal designs to better understand the dynamics of self-management.
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jehp_1797_23 CONCLUSION This study found a modest but significant positive association between self-efficacy and self-care in patients with chronic heart failure.
Self-efficacy appears to function as a behavioral enabler rather than a standalone determinant of self-care.
These findings highlight the need for comprehensive, patient-centered strategies that address both psychological and contextual factors to improve self-management in CHF.
Acknowledgement The author would like to thank Dr.
Hasan Sadikin General Hospital for facilitating this research.
Funding None Author Contributions conceptualized and designed the study.
and D.
contributed to data collection and project administration.
and D.
performed data analysis and interpretation.
contributed to literature review and manuscript drafting.
supervised the study and critically revised the manuscript.
All authors reviewed and approved the final version of the Conflict of Interest The authors hereby declare that they have no competing interests.
REFERENCES