Patients’ Perspectives on Barriers and Facilitators of Self-Management in Chronic Heart Failure: A Systematic Review of Qualitative Studies Using COM-B Model

Background: Self-management is critical to improving outcomes and is a central component of international heart failure management guidelines. However, self-management for patients with chronic heart failure can be challenging. Objective: In this study, we aimed to identify and synthesize qualitative studies on barriers and facilitators to engage in self-management of patients with chronic heart failure. Methods: This was a systematic review of qualitative studies. Qualitative articles were extracted from 8 databases: PubMed, CINAHL, Web of Science, Cochrane Library, LISA, VIP, CNKI, and Wanfang. The search spanned from database inception to April 2025. Instruments from the Joanna Briggs Institute were used to evaluate the articles. The Capability, Opportunity, Motivation, Behavior model was used to thematically analyze along with qualitative data, to identify common themes and concepts. Results: Twenty-one articles (16 qualitative and 5 mixed-methods) on barriers and facilitators to patients’ self-management of chronic heart failure were included. We identified barriers and facilitators relating to capability (eg, physical functional disorders and concurrent disease constraints; lack of knowledge and skills related to self-management), opportunity (eg, limited tools, resources, and education; support from family, caregivers, and employers; traditional habits prioritize to self-management), and motivation (positive vigilance and confidence; fear; personal fatalism and spiritual beliefs). Conclusions: In this review, we identified barriers and facilitators of self-management in patients with chronic heart failure, grounded in a theoretical framework. Further research should focus on enhancing patients’ capabilities, opportunities, and motivation in conducting self-management while managing the barriers effectively.