Nursing interventions to enhance self-care in heart failure: a systematic review interpreted through the COM-B model

Abstract

Abstract Background Heart failure (HF) is a long-term illness, frequently requiring hospital stay and having a significant morbidity and mortality rate. In order to avoid decompensation, lower readmission rates, and promote quality of life, adequate self-care is vital. This review synthesised nursing interventions intended to improve self-care among adults and older adults with HF and retrospectively interpreted their components using the Capability, Opportunity, Motivation–Behaviour (COM-B) model. Method A systematic search was conducted on 11 November 2025 across seven electronic databases: PubMed, Scopus, Web of Science, CINAHL, Embase, MEDLINE, and PsycINFO. The review included randomised controlled studies evaluating behavioural, educational, psychological, or nursing interventions aimed at improving self-care among adults and older adults with HF. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Randomised Controlled Trials. Database-specific search strategies and publication-year filters are reported in Additional file 1. Results Nine studies met the inclusion criteria. The interventions included structured education, motivational interviewing, pre-discharge education, technology-based support, and multimodal programmes. Several studies reported improvements in self-care maintenance, management, or confidence; however, the direction and magnitude of effects varied across interventions and follow-up periods. Although none of the studies explicitly used the COM-B model, their intervention components could be retrospectively mapped to Capability, Opportunity, and Motivation. Conclusions Nursing interventions may improve selected dimensions of HF self-care, particularly when education is combined with follow-up, motivational support, or practical monitoring resources. However, the evidence was heterogeneous, and the magnitude and consistency of effects remain uncertain. COM-B may provide a useful framework for interpreting intervention components, but the retrospective mapping does not demonstrate that COM-B mechanisms were prospectively tested. Systematic review registration The procedure of this study was recently filed in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (No: CRD420251237974).