Psychological, social, and structural barriers to self-care in heart failure: A scoping review

Introduction Self-care is central to long-term heart failure (HF) management, yet patients encounter multiple barriers to sustaining recommended behaviors. Existing evidence remains fragmented across individual, social, and healthcare contexts. This scoping review aimed to synthesize barriers to HF self-care and interpret them using the Capability–Opportunity–Motivation–Behavior (COM-B) model. Methods This scoping review followed the Population–Concept–Context framework and PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Five electronic databases (PubMed, Scopus, ScienceDirect, CINAHL, and ProQuest) were searched for studies published from 2016 to 2026. Eligible primary qualitative, quantitative, and mixed-methods studies were screened against predefined criteria, and identified barriers were synthesized thematically and mapped onto the COM-B model. Results Nineteen studies were included. Barriers were synthesized into individual, sociocultural, and healthcare system domains. Knowledge- and information-related barriers were reported in 13 studies, healthcare access, continuity, and system-related barriers in 12, and practical adherence or lifestyle difficulties in nine. Emotional and physical or symptom-related barriers were each identified in eight studies, while barriers related to family and social support were identified in nine studies. Communication, cultural, motivational, and financial barriers were also identified across the evidence. The expression of barriers varied across country income contexts. COM-B mapping demonstrated limitations across capability, opportunity, and motivation. Conclusion HF self-care barriers are multidimensional and extend beyond knowledge deficits. Understanding how behavioral and contextual barriers interact may help identify relevant targets for context-sensitive self-care support.