Awareness as a path to inner strength: a qualitative study on women living with heart failure

Background Heart failure profoundly affects women's physical, emotional, and social well-being, often generating fear, uncertainty, and vulnerability that challenge adaptation and self-care. This study explored how women living with heart failure construct meaning and develop inner strength through illness awareness — defined as understanding the nature, severity, progression, and self-management implications of heart failure. Many women initially showed limited recognition of the seriousness and long-term trajectory of the condition, sometimes perceiving it as less threatening than other diagnoses (e.g., oncological conditions) and occasionally discontinuing treatment during periods of symptomatic improvement. The study also examined how awareness interacts with relationships and everyday adaptation. Methods A qualitative design was applied using reflexive thematic analysis based on in-depth, semi-structured interviews with eleven women recruited from a cardiology research hospital in Northern Italy. Data were analyzed through a six-phase analytical framework to identify patterns of meaning and transformation. Results Four interconnected themes described a developmental process of learning and adaptation: confronting vulnerability, reconnecting through others and faith, adapting daily life, and developing illness awareness and self-care. Participants revealed a gradual shift from emotional distress to reflective resilience, with awareness and self-reflection acting as catalysts for personal growth and empowerment. Limited illness awareness — particularly regarding disease severity, chronic progression, and the need for continuous treatment — conversely hindered adaptation and promoted passive coping. Conclusions Developing illness awareness emerged as both an educational and therapeutic that fosters resilience, self-reflection, and active engagement in self-care. Integrating structured educational and psychosocial interventions into heart failure management may strengthen women's inner resources and enhance their capacity to live meaningfully with chronic illness.