¶ … managing of heart failure is complex as it encompasses a treatment regimen that has to follow a lot of norms. One of the key elements in heart failure care is self-care behaviors that are essentially required to be learnt for patients through self-participation. According to Britz and Dunn, (2010), there are certain self-efficacy norms that need to be followed by heart failure patient rat include regimens like weighing themselves or a regular basis, adhering to the a diet with low sodium, monitoring symptoms for worsening of the hearth conditions, adhering to a regimen that entails restricted fluid consumption and participating in physical activity either alone or in groups (Britz & Dunn, 2010). Moreover the patients with heart failure need to follow a strict regimen of medicines. This complicated pharmacologic regimen is often very critical in continued care for heart patients. Medicines need to be taken at regular intervals and within the time that is specified by doctors and physicians. Any irregularity in the intake of medicine can result in deterioration of the health conditions of the patients. Additionally patients with heart failure also has to make symptom management decisions according to their assessment of the symptoms and the medical prescriptions like the decreasing or increasing of the sodium intake or deciding when it would be an appropriate time for calling of the health care staff. The need for assessment of one's medical condition and the adjustments of the treatment regimen also is a cause for the increasing complexity of the heart failure care management. This is often due to the fact that patients needing changes in treatment according to the changing health conditions may often find it hard to assess the need for change. Heart failure patients may find it difficult to detect gradual and small changes in their health status and therefore be unable to correctly assess the time for alerting the health care providers. According to Friedman and Quinn, (2008), argued on the above mentioned points and claimed that this increases the need and makes it very critical for the heart failure patients to engage in educative measures of self-efficacy (Friedman & Quinn, 2008). Improvement of the self-care behavior is the primary aim of and the focus of education of patients with heart failures. Such education of patients in heart failure management and self-efficacy include topics like medications, exercise, symptoms, exercise, diet, fluid restriction and importance of activities like the daily weighing of the patient. But experts like J. Mattera, (2011) often claim that adherence to self-care behaviors related to heart failure patients is not always successful through education (Mattera, 2011). Thus experts often describe self-efficacy as the belief in one's ability to achieve a desired result and changes only happen when the education of self-efficacy is able to influence the health choices and behaviors of the patients with heart failure (Bandura, 1977).

Outcome and efficacy expectations are differentiated in Bandura's theory. The expectations from outcomes related to the belief of an individual that a particular activity would lead to a particular outcome. On the other hand while talking about the expectations of efficacy or the perception of self-efficacy is the belief of an individual on the self-ability to be able to conduct or perform a particular behavior (Bandura, 1977).

Self-ability to have control of the health practices and the belief on the level of self-efficacy and its related impact on the goals and faithfulness for an individual is the perceived self-efficacy in health care (Bandura, 2004). The responses to the challenges and set-backs in health care and the individual's expectation about the result of embarking on a behavior change are influenced by self-efficacy (Bandura, 2004).

One of the key areas in the management of heart failures is the monitoring of the weight of the individual. Some type of adjustments need to be done for patients of heart failure when there is any gain or increase in weight and this adjustment needs to be initiated by the individual patient. In cases of patients with heart failure, the adjustments that needs to be undertaken in case of weight gain needs to flow from the knowledge or the belief that the an increase in the diuretic would help the patient in reducing weight. The heart failure oatie3nt also needs to have the confidence that the corrective action that the individual would undertake to reduce weight is the correct way to address the problem. While the knowledge and belief is called efficacy expectation, the confidence of the patient about the corrective measure is referred to as efficacy expectation. Therefore education in self-efficacy according to Bandura's theory does not only involve the gaining of knowledge but the belief...

Research has suggested that self-care ability improves when there is an increase in self-efficacy among individuals. Glasgow et al., (1997) in their work claim that studies have indicated that the individualization of the patients' experience with the intervention based on self-efficacy was the focus of a dietary behavioral intervention in patients with diabetes apart from the need for educating the patients (Glasgow et al., 1997)). Improvements in abilities to take care of oneself was improved after educational intervention among the diabetic patients about their eating habits such as consumption of fewer calories and fat. The intervention yielded desirable primary results for the patients which was lower serum cholesterol.
Certain references in literature suggest that often assessment of the primary outcomes that were relevant to the chronic illness were not studied when researchers and investigators made assessment of self-efficacy. Adherence to specific health behaviors that have the potential to influence primary positive health outcomes for patients leads to improvement of self-efficacy and hence self-efficacy is also often considered to be an intermediate measure.

Therefore patients with heart failure would probably not be properly prepared and thus would not be able to perform all recommended self-care behaviors in case there is a failure to increase self-efficacy in health care education intervention programs. Poor or non-adherence to self-care practices as prescribed to patients with heart failure have been seen, in certain studies, as the primary result of low levels of self-efficacy (Ni et al., 1999). Hence it has been suggested by many researchers that educational intervention programs that are intended to increase self-efficacy needs to address the aspect of how interventions affect self-efficacy and this understanding should be used to decide the approach that needs to be taken by health care practitioners for the designing of health care interventions (Young, Barnason & Do, 2015).

Period of Educational Interventions

It is therefore also critical to understand the components that make up a structured educational intervention that aim to improve the self-efficacy in order to enhance and positively enhance the self-care behaviors in heart failure patients (STAMP, 2012). In this context what is most important as the elements of educational intervention that aims to influence and enhance self-efficacy in heart failure patients is the number of educational intervention sessions organized for an individual, the length of the individual sessions for patients and the type of contact that is made for the intervention program which include options like face-to-face interventions, interventions through telephonic conversation and instructions and the internet.

There are several studies that point out at varying lengths of time that should be used to measure the amount education by numbers of minutes per educational session. For example according to Flynn et al. (2005) provided, a good health education program efficacy needs to be conducted for ninety minutes of educational sessions for over twelve months (Flynn et al., 2005). On the other hand experts like Gary, (2006) suggested that the best timing for the length and duration of such intervention programs would be at least weekly education over twelve weeks (Gary, 2006). Others like Riegel and Carlson's educational interventions were organized on a weekly basis for the first thirty days and then once a month for the next 90 days (Riegel & Carlson, 2004). There were a number of other experts who recommended various other timings for the health educational interventions. Dunagan et al. (2005) suggests that heart failure patients should be educated at least weekly over two weeks (Dunagan et al., 2005) and Yehle et al. (2009) claimed that two education interventions sessions over a period of sixteen weeks at eight-week's interval was enough (Yehle et al., 2009). Other experts like Schreurs et al. (2003) was of the view that administering health educational intervention programs for heart failure patients should be conducted on a bi-weekly for four times which should be followed by a one-time session after a period of one month (Schreurs et al., 2003. The educational intervention sessions of Kline, Scott, and Britton's occurred weekly for a total period of eight weeks (KLINE, SCOTT & BRITTON, 2007) and Maddison, Prapavessis and Armstrong believed that a onetime ten-minute education intervention sessions was enough (Maddison et al., 2008).

Researchers however while agreeing to the varied needs about periods and number of sessions of educational…