Negotiating illness, culture, and care: A qualitative study of heart failure self-management in Jordan

BACKGROUND Heart failure (HF) requires ongoing patient engagement in self-care to manage symptoms and improve outcomes. However, limited research explores how self-care behaviors are shaped by cultural, personal, and contextual factors in Middle Eastern settings, particularly in Jordan. OBJECTIVE To explore the self-care behaviors of Jordanian patients living with HF and examine the factors that influence their self-management practices. METHODS A qualitative explorative design was employed. Semi-structured interviews were conducted with 25 patients recruited from four hospitals across Jordan using purposive sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically using NVivo 15. Trustworthiness was ensured through reflexivity, peer debriefing, and audit trail documentation. RESULTS Three interrelated themes were identified: (1) Negotiating daily life under constraint, reflecting the ongoing tension between self-care demands and cultural, physical, and occupational limitations; (2) Reconstructing control and identity through self-management, highlighting patients' personalized strategies, resilience, and evolving self-care; and (3) Family as the backbone of self-care, emphasizing the essential role of familial support in enabling or impeding self-care practices. These findings were interpreted through the Situation-Specific Theory of HF Self-Care. CONCLUSION Self-care among Jordanian HF patients is a dynamic, culturally embedded process influenced by personal capacity, family involvement, and contextual barriers. Nursing interventions should adopt family-centered, culturally tailored approaches that support patients' lived realities and enhance sustained self-care engagement.