European Heart Failure Self-care Behaviour Scale

A cup of coffee with a heart in it, on a blue tinted table.
lev dolgachov

To use the scale, click here (link to page with the scale). No license is needed and it is free to use.

An estimated 15 million people in Europe are suffering from heart failure, a figure that is increasing due to an ageing population and improved treatment in acute cardiac conditions. Heart failure is associated with recurrent hospitalisations, emergency room visits and low quality of life, but good self-care has been shown to improve patients' prospects.

Self-care in heart failure patients refers to behaviours or actions that the patient himself performs with the aim of increasing longevity, health and well-being. This may include diet and exercise, the patient's ability to manage their situation and illness, and adherence to medication, but also daily weight control to prevent fluid retention, and contacting the healthcare system if symptoms occur.

In order to be able to evaluate interventions, it is important to assess patients' self-care and measure how they have changed their behaviour as a result of the intervention. The assessment can also help healthcare professionals to target education and support in their care.

We have developed a user-friendly and psychometricly tested instrument: the European Heart Failure Self-care Behaviour Scale, EHFScB scale.

The EHFScB scale was published in 2003 and consists of various statements (items) where the patient can mark their response on a five-point scale, from "totally agree" to "totally disagree". The EHFScB scale is today translated into a number of languages and is available (in some translations) in two versions with nine and twelve items respectively.

You are very welcome to use the EHFScB scale in the language you want. No license is needed and it is free to use. If there is no version in the language you wish, there is a manual of the translation procedure here.

Anyone who is interested in how the scale was developed can read more via the link below.


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Publications

Validation

  • Uchmanowicz I, Łoboz-Rudnicka M, Jaarsma T, Łoboz-Grudzień K. Cross-cultural adaptation and reliability testing of Polish adaptation of the European Heart Failure Self-care Behavior Scale (EHFScBS). Patient Preference and Adherence 2014:8 1521–26
  • Feijo MK, Avila CW, Nogueira de Souza, Jaarsma T, Rabelo ER. Cross-cultural adaptation and validation of the European Heart Failure Self-care Behavior Scale for Brazilian Portuguese. Rev. Latino-Am. Enfermagem. 2012 Sept.-Oct.;20(5):988-96
  • Jaarsma T, Arestedt KF, Mårtensson J, Dracup K, Strömberg A. The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument. Eur J Heart Fail 2009;11:99-105.
  • Gonzalez B, Lupon L, Parajon T, Urrutia A, Herreros J, Valle V. Use of the European Heart Failure Self-care Behaviour Scale (EHFScBS) in a heart failure unit in Spain. Rev Esp Cardiol 2006;59:166-70.
  • Shuldham C, Theaker C, Jaarsma T, Cowie M. Evaluation of the European heart failure self-care behaviour scale in a United Kingdom population. J Adv Nurs 2007;60:87-95.
  • Kato N, Kinugawa K, Ito N, Yao A, Watanabe M, Imai Y, Takeda N, Hatano M, Kazuma K. Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan. Heart Lung. 2009;38:398-409.
  • Pulignano G, Del Sindaco D, Minardi G, Tarantini L, Cioffi G, Bernardi L, Di Biagio D, Leonetti S, Giovannini E. Translation and validation of the Italian version of the European Heart Failure Self-care Behaviour Scale. J Cardiovasc Med (Hagerstown) 2010;11:493-8.
  • Yu DS, Lee DT, Thompson DR, Jaarsma T, Woo J, Leung EM. Psychometric properties of the Chinese version of the European Heart Failure Self-care Behaviour Scale. Int J Nurs Stud 2011;48:458-67.
  • Vellone E, Jaarsma T, Stromberg A, Fida R, Arestedt K, Rocco G, Cocchieri A, Alvaro R. The European Heart Failure Self-care Behaviour Scale: New insights into factorial structure, reliability, precision and scoring procedure. http://dx.doi.org/10.1016/j.pec.2013.09.01
  • Lee CS, Lyons KS, Gelow JM, Mudd JO, Hiatt SO, Nguyen T, Jaarsma T. Validity and reliability of the European Heart Failure Self-care Behavior Scale among adults from the United States with symptomatic heart failure. Eur J Cardiovasc Nurs. 2013 Apr;12(2):214-8. doi: 10.1177/1474515112469316. Epub 2012 Dec
  • Köberich S, Glattacker M, Jaarsma T, Lohrmann C, Dassen T Validity and reliability of the German version of the 9-item European Heart Failure Self-care Behaviour Scale. Eur J Cardiovasc Nurs. 2013 Apr;12(2):150-8. doi: 10.1177/1474515112438639. Epub 2012 Mar
  • Lin CY, Pakpour AH, Brostrom A, Fridlund B, Arestedt K, Stromberg A, et al. Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients. J Cardiovasc Nurs. 2018;33:281-8.
  • Ben Gal T, Kato NP, Yaari V, Avraham B, Klompstra L, Strömberg A, et al. Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale. Heart Lung Circ. 2020;29:e121-e30.
  • Baydemir C, Ozdamar K, Unalir A. Validity of the Turkish version of the European Heart Failure Self-Care Behavior Scale. Anadolu Kardiyol Derg. 2013;13:573-9.
  • Ozer S, Karaman E, Karaoz B, Fadiloglu C, Aykar FS. Validity and Reliability of the Turkish Version of the European Heart Failure Self-Care Behaviour Scale (Ehfscb-9). International Journal of Caring Sciences. 2019;12:1561-9.
  • Yildiz E, Erci B. The Turkish Version of Reliability and Validity of Nine Item-European Heart Failure Self-Care Behaviour Scale. Kafkas J Med Sci. 2018;8:55-60.
  • Kato N, Ito N, Kinugawa K, Kazuma K. Validity and reliability of the Japanese version of the European Heart Failure Self-Care Behavior Scale. Eur J Cardiovasc Nurs. 2008;7:284-9.
  • Uchmanowicz I, Wleklik M. Polish adaptation and reliability testing of the nine-item European Heart Failure Self-care Behaviour Scale (9-EHFScBS). Kardiol Pol. 2016;74:691-6.
  • Boisvert S, Francoeur J, Gallani MC. Cross-Cultural Adaptation and Reliability of the French-Canadian Version of the European Heart Failure Self-Care Behaviour Scale-9. J Nurs Meas. 2019;27:458-77.
  • Lambrinou E, Kalogirou F, Lamnisos D, Papathanassoglou E, Protopapas A, Sourtzi P, et al. The Greek version of the 9-item European Heart Failure Self-care Behaviour Scale: a multidimensional or a uni-dimensional scale? Heart Lung. 2014;43:494-9.
  • Ostergaard B, Mahrer-Imhof R, Lauridsen J, Wagner L. Validity and reliability of the Danish version of the 9-item European Heart Failure Self-care Behavior Scale. Scand J Caring Sci. 2017;31:405-12.
  • Son YJ, Won MH. Psychometric Validation of the Korean Version of the 9-Item European Heart Failure Self-Care Behaviour Scale. Eval Health Prof. 2020;43:33-40.
  • Sedlar N, Socan G, Farkas J, Mårtensson J, Strömberg A, Jaarsma T, et al. Measuring self-care in patients with heart failure: A review of the psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS). Patient Educ Couns. 2017;100:1304-13.
  • Jaarsma T, Stromberg A, Martensson J, Dracup K. Development and testing of the European Heart Failure Self-Care Behaviour Scale. Eur J Heart Fail. 2003;5:363-70.
  • Jaarsma T, Arestedt KF, Martensson J, Dracup K, Stromberg A. The European Heart Failure Self-care Behaviour scale revised into a nine-item scale (EHFScB-9): a reliable and valid international instrument. Eur J Heart Fail. 2009;11:99-105.
  • Wagenaar KP, Broekhuizen BD, Rutten FH, Strömberg A, van Stel HF, Hoes AW, Jaarsma T. Interpretability of the European Heart Failure Self-care Behaviour scale. Patient Prefer Adherence. 2017 Oct 26;11:1841-1849. doi: 10.2147/PPA.S144915. PMID: 29138538; PMCID: PMC5667783.

Outcomes

  • Peters-Klimm F, Campbell S, Hermann K, Kunz CU, Müller-Tasch T, Szecsenyi J; Competence Network Heart Failure Case management for patients with chronic systolic heart failure in primary care: the HICMan exploratory randomised controlled trial. Trials 2010 May 17;11:56.
  • Jaarsma T, Strömberg A, Ben Gal T, Cameron J, Driscoll A, Duengen HD, Inkrot S, Huang TY, Huyen NN, Kato N, Köberich S, Lupón J, Moser DK, Pulignano G, Rabelo ER, Suwanno J, Thompson DR, Vellone E, Alvaro R, Yu D, Riegel B. Comparison of self-care behaviors of heart failure patients in 15 countries worldwide. Patient Educ Couns. 2013 Jul;92(1):114-20. doi: 10.1016/j.pec.2013.02.017. Epub 2013 Apr 8.
  • Lee KS, Moser DK, Dracup K. Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs. 2018 Aug;17(6):496-504. doi: 10.1177/1474515117745056. Epub 2017 Dec 1. PMID: 29192794.
  • Stut W, Deighan C, Cleland JG, Jaarsma T. Adherence to self-care in patients with heart failure in the HeartCycle study. Patient Prefer Adherence. 2015 Aug 19;9:1195-206. doi: 10.2147/PPA.S88482. PMID: 26316725; PMCID: PMC4548736.
  • Linn AC, Azollin K, Souza EN. Association between self-care and hospital readmissions of patients with heart failure. Rev Bras Enferm. 2016 Jun;69(3):500-6. English, Portuguese. doi: 10.1590/0034-7167.2016690312i. Erratum in: Rev Bras Enferm. 2016 Sep-Oct;69(5):1003. PMID: 27355299.
  • Kato NP, Kinugawa K, Sano M, Kogure A, Sakuragi F, Kobukata K, Ohtsu H, Wakita S, Jaarsma T, Kazuma K. How effective is an in-hospital heart failure self-care program in a Japanese setting? Lessons from a randomized controlled pilot study. Patient Prefer Adherence. 2016 Feb 18;10:171-81. doi: 10.2147/PPA.S100203. PMID: 26937177; PMCID: PMC4762442.
  • Abe R, Sakata Y, Nochioka K, Miura M, Oikawa T, Kasahara S, Sato M, Aoyanagi H, Shiroto T, Sugimura K, Takahashi J, Miyata S, Shimokawa H; CHART-2 Investigators. Gender differences in prognostic relevance of self-care behaviors on mortality and hospitalization in patients with heart failure - A report from the CHART-2 Study. J Cardiol. 2019 May;73(5):370-378. doi: 10.1016/j.jjcc.2018.11.006. Epub 2018 Dec 31. PMID: 30606681.
  • Lee CS, Bidwell JT, Paturzo M, Alvaro R, Cocchieri A, Jaarsma T, Strömberg A, Riegel B, Vellone E. Patterns of self-care and clinical events in a cohort of adults with heart failure: 1 year follow-up. Heart Lung. 2018 Jan-Feb;47(1):40-46. doi: 10.1016/j.hrtlng.2017.09.004. Epub 2017 Oct 18. PMID: 29054487; PMCID: PMC6497061.
  • Vellone E, Fida R, Ghezzi V, D'Agostino F, Biagioli V, Paturzo M, Strömberg A, Alvaro R, Jaarsma T. Patterns of Self-care in Adults With Heart Failure and Their Associations With Sociodemographic and Clinical Characteristics, Quality of Life, and Hospitalizations: A Cluster Analysis. J Cardiovasc Nurs. 2017 Mar/Apr;32(2):180-189. doi: 10.1097/JCN.0000000000000325. PMID: 26938506.
  • Uchmanowicz I, Jankowska-Polańska B, Mazur G, Sivarajan Froelicher E. Cognitive deficits and self-care behaviors in elderly adults with heart failure. Clin Interv Aging. 2017 Oct 3;12:1565-1572. doi: 10.2147/CIA.S140309. PMID: 29042757; PMCID: PMC5633303.
  • Mlynarska A, Golba KS, Mlynarski R. Capability for self-care of patients with heart failure. Clin Interv Aging. 2018 Oct 8;13:1919-1927. doi: 10.2147/CIA.S178393. PMID: 30349210; PMCID: PMC6183697.
  • Prochota B, Szwamel K, Uchmanowicz I. Socio-clinical variables affecting the level of self-care in elderly patients with heart failure. Eur J Cardiovasc Nurs. 2019 Oct;18(7):628-636. doi: 10.1177/1474515119855600. Epub 2019 Jun 13. PMID: 31195805.
  • Hu X, Hu X, Su Y, Qu M, Dolansky MA. The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure. Patient Prefer Adherence. 2015 Nov 9;9:1593-601. doi: 10.2147/PPA.S88431. PMID: 26635468; PMCID: PMC4646583.
  • Uchmanowicz I, Wleklik M, Gobbens RJ. Frailty syndrome and self-care ability in elderly patients with heart failure. Clin Interv Aging. 2015 May 18;10:871-7. doi: 10.2147/CIA.S83414. PMID: 26028966; PMCID: PMC4441356.
  • Müller-Tasch T, Löwe B, Lossnitzer N, Frankenstein L, Täger T, Haass M, Katus H, Schultz JH, Herzog W. Anxiety and self-care behaviour in patients with chronic systolic heart failure: A multivariate model. Eur J Cardiovasc Nurs. 2018 Feb;17(2):170-177. doi: 10.1177/1474515117722255. Epub 2017 Jul 18. PMID: 28718661.
  • Peters-Klimm F, Freund T, Kunz CU, Laux G, Frankenstein L, Müller-Tasch T, Szecsenyi J. Determinants of heart failure self-care behaviour in community-based patients: a cross-sectional study. Eur J Cardiovasc Nurs. 2013 Apr;12(2):167-76. doi: 10.1177/1474515112439964. Epub 2012 Apr 18. PMID: 22514139.
  • Santesmases-Masana R, González-de Paz L, Real J, Borràs-Santos A, Sisó-Almirall A, Navarro-Rubio MD. Alfabetización en salud en pacientes con insuficiencia cardiaca atendidos en atención primaria [Health literacy in patients with heart failure treated in primary care]. Aten Primaria. 2017 Jan;49(1):28-34. Spanish. doi: 10.1016/j.aprim.2016.03.003. Epub 2016 May 25. PMID: 27236716; PMCID: PMC6875916.
  • León-González R, García-Esquinas E, Paredes-Galán E, Ferrero-Martínez AI, González-Guerrero JL, Hornillos-Calvo M, Menéndez-Colino R, Torres-Torres I, Galán MC, Torrente-Carballido M, Olcoz-Chiva M, Rodríguez-Pascual C, Rodríguez-Artalejo F. Health Literacy and Health Outcomes in Very Old Patients With Heart Failure. Rev Esp Cardiol (Engl Ed). 2018 Mar;71(3):178-184. English, Spanish. doi: 10.1016/j.rec.2017.06.010. Epub 2017 Jul 8. PMID: 28697926.
  • Salvadó-Hernández C, Cosculluela-Torres P, Blanes-Monllor C, Parellada-Esquius N, Méndez-Galeano C, Maroto-Villanova N, García-Cerdán RM, Núñez-Manrique MP, Barrio-Ruiz C, Salvador-González B; en representación del grupo de investigación del proyecto COIB 5367-11. Insuficiencia cardiaca en atención primaria: actitudes, conocimientos y autocuidado [Heart failure in primary care: Attitudes, knowledge and self-care]. Aten Primaria. 2018 Apr;50(4):213-221. Spanish. doi: 10.1016/j.aprim.2017.03.008. Epub 2017 Jun 23. PMID: 28652033; PMCID: PMC6837070.
  • Lupón J, González B, Mas D, et al. Patients’ Self-Care Improvement with Nurse Education Intervention in Spain Assessed by the European Heart Failure Self-Care Behaviour Scale. European Journal of Cardiovascular Nursing. 2008;7(1):16-20. doi:10.1016/j.ejcnurse.2007.05.004
  • Lupón J, González B, Mas D, et al. Patients’ Self-Care Improvement with Nurse Education Intervention in Spain Assessed by the European Heart Failure Self-Care Behaviour Scale. European Journal of Cardiovascular Nursing. 2008;7(1):16-20. doi:10.1016/j.ejcnurse.2007.05.004
  • Kessing D, Denollet J, Widdershoven J, Kupper N. Self-Care and All-Cause Mortality in Patients With Chronic Heart Failure. JACC Heart Fail. 2016 Mar;4(3):176-83. doi: 10.1016/j.jchf.2015.12.006. Epub 2016 Feb 10. PMID: 26874385.
  • Wagenaar KP, Broekhuizen BDL, Jaarsma T, Kok I, Mosterd A, Willems FF, Linssen GCM, Agema WRP, Anneveldt S, Lucas CMHB, Mannaerts HFJ, Wajon EMCJ, Dickstein K, Cramer MJ, Landman MAJ, Hoes AW, Rutten FH. Effectiveness of the European Society of Cardiology/Heart Failure Association website 'heartfailurematters.org' and an e-health adjusted care pathway in patients with stable heart failure: results of the 'e-Vita HF' randomized controlled trial. Eur J Heart Fail. 2019 Feb;21(2):238-246. doi: 10.1002/ejhf.1354. Epub 2018 Nov 28. PMID: 30485612; PMCID: PMC6607483.
  • Lycholip E, Thon Aamodt I, Lie I, Šimbelytė T, Puronaitė R, Hillege H, de Vries A, Kraai I, Stromberg A, Jaarsma T, Čelutkienė J. The dynamics of self-care in the course of heart failure management: data from the IN TOUCH study. Patient Prefer Adherence. 2018 Jun 26;12:1113-1122. doi: 10.2147/PPA.S162219. PMID: 29983549; PMCID: PMC6027682.
  • Liljeroos M, Kato NP, van der Wal MH, Brons M, Luttik ML, van Veldhuisen DJ, Strömberg A, Jaarsma T. Trajectory of self-care behaviour in patients with heart failure: the impact on clinical outcomes and influencing factors. Eur J Cardiovasc Nurs. 2020 Jun;19(5):421-432. doi: 10.1177/1474515120902317. Epub 2020 Jan 29. PMID: 31992064; PMCID: PMC7272123.
  • Ingadottir B, Thylén I, Jaarsma T. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation. Patient Prefer Adherence. 2015 Jul 2;9:913-21. doi: 10.2147/PPA.S83069. PMID: 26170641; PMCID: PMC4494625.
  • Ketilsdottir A, Ingadottir B, Jaarsma T. Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study. ESC Heart Fail. 2019 Feb;6(1):111-121. doi: 10.1002/ehf2.12369. Epub 2018 Oct 18. PMID: 30338668; PMCID: PMC6351898.
  • Kartamysheva ED, Lopatin YM. [Comparative analysis of self-care assessment scales in patients with chronic heart failure, advantages and disadvantages]. Kardiologiia. 2020 Sep 17;60(8):84-89. Russian. doi: 10.18087/cardio.2020.8.n1114. PMID: 33155963.
  • Grebennikova AA, Stoliarov AY, Lopatin YM. [The use of platform for remote monitoring on the base of mobile app for improving self-care in patients with chronic heart failure]. Kardiologiia. 2017 Apr;57(S4):11-18. Russian. doi: 10.18087/cardio.2413. PMID: 29466178.
  • Ingadottir B, Thylén I, Jaarsma T. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation. Patient Prefer Adherence. 2015 Jul 2;9:913-21. doi: 10.2147/PPA.S83069. PMID: 26170641; PMCID: PMC4494625.
  • Johansson P, Jaarsma T, Andersson G, Lundgren J. The impact of internet-based cognitive behavioral therapy and depressive symptoms on self-care behavior in patients with heart failure. A secondary analysis of a randomised controlled trial. Int J Nurs Stud. 2019 Oct 31:103454. doi: 10.1016/j.ijnurstu.2019.103454. Epub ahead of print. PMID: 31727306.
  • Hjelm CM, Broström A, Riegel B, Årestedt K, Strömberg A. The association between cognitive function and self-care in patients with chronic heart failure. Heart Lung. 2015 Mar-Apr;44(2):113-9. doi: 10.1016/j.hrtlng.2014.12.003. Epub 2015 Feb 11. PMID: 25682390.
  • Holst M, Willenheimer R, Mårtensson J, Lindholm M, Strömberg A. Telephone follow-up of self-care behaviour after a single session education of patients with heart failure in primary health care. Eur J Cardiovasc Nurs. 2007 Jun;6(2):153-9. doi: 10.1016/j.ejcnurse.2006.06.006. Epub 2006 Aug 22. PMID: 16928469.
  • Melin M, Hägglund E, Ullman B, Persson H, Hagerman I. Effects of a Tablet Computer on Self-care, Quality of Life, and Knowledge: A Randomized Clinical Trial. J Cardiovasc Nurs. 2018 Jul/Aug;33(4):336-343. doi: 10.1097/JCN.0000000000000462. PMID: 29369123.
  • Hedemalm A, Schaufelberger M, Ekman I. Reported adherence and social support among immigrants compared to native Swedes. J Immigr Minor Health. 2010 Feb;12(1):124-31. doi: 10.1007/s10903-009-9235-x. Epub 2009 Mar 3. PMID: 19255854.
  • Róin T, Á Lakjuni K, Kyhl K, Thomsen J, Veyhe AS, Róin Á, Jan R, Marin S. Knowledge about heart failure and self-care persists following outpatient programme- a prospective cohort study from the Faroe Islands. Int J Circumpolar Health. 2019 Dec;78(1):1653139. doi: 10.1080/22423982.2019.1653139. PMID: 31429677; PMCID: PMC6713150.

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