The Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care: An Update.

Abstract

Heart failure (HF) self-care remains suboptimal in a large proportion of patients, and informal caregivers play a crucial role in supporting and helping patients to perform self-care behaviors. The Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, originally published in 2018, provided the first theoretical framework describing this process. Eight years after its initial formulation, substantial new empirical evidence, updated clinical guidelines, and advances in nursing knowledge call for a revision of the theory. To present an updated version of the Situation-Specific Theory of Caregiver Contributions to Heart Failure Self-Care, incorporating new evidence on contributors and mechanisms contributing to outcomes associated with caregiver contributions (CC) to HF self-care. The update followed the integrative approach proposed by Im and Meleis, drawing on 3 sources: the original theory, an integrative literature review of studies published between 2018 and 2026 (N = 17 studies), and the clinical insights and accumulated experience of the research team. The updated theory introduces a new definition of CC to HF self-care as a dynamic, relational, and context-sensitive dyadic process. New contributors at the caregiver (eg, health status), patient (eg, therapeutic complexity), and dyadic levels (eg, type of relationship) were identified. Caregiver self-efficacy was confirmed as the central mediator of the process. Three new potential moderators were added alongside culture: beliefs, cohabitation, and ability to use technology. Outcomes were expanded to include dyadic-level effects. The theoretical propositions were updated and refined, and a new conceptual framework graphic is presented. This updated theory offers a more comprehensive, multilevel, and context-sensitive framework to guide research, clinical practice, and interventions targeting the patient-caregiver dyad in HF.