The prescription of a low sodium diet is the cornerstone of nonpharmacologic therapy in heart failure (HF) patients; however, dietary sodium nonadherence is extremely common. Dietary sodium nonadherence contributes to an increase in symptoms such as edema and shortness of breath, rehospitalizations, and may contribute to a decrease in quality of life. The purpose of this dissertation was to investigate multiple aspects of dietary sodium adherence in patients with HF. A systematic review and three research studies were conducted as part of this dissertation. In the systematic review, three methods of measuring dietary sodium adherence were compared. The first research study was a qualitative descriptive study exploring the experience of 20 HF patients' in adhering to the low sodium diet regimen. The second was a psychometric evaluation of a new instrument, the Dietary Sodium Restriction Questionnaire (DSRQ), designed to measure patients' perceptions of their barriers to, and attitudes toward, following a low sodium diet. The third study was a randomized, controlled pilot study to test the feasibility and impact of a theory-based intervention designed to increase adherence to the low sodium diet, decrease the number of rehospitalizations, and improve quality of life. An additional purpose of the pilot study was to test the impact of the intervention on the constructs of the Theory of Planned Behavior. The 24-hour urine sodium is the most accurate measure of dietary sodium intake, but the 3-day food diary is a more reliable estimation of an individual's usual intake due to day-to-day variation. Patients identified three primary themes related to nonadherence to the low sodium diet: lack of knowledge, interference with socialization, and lack of food selections. Based on principal component analysis and Cronbach alpha coefficients, the DSRQ is a valid and reliable tool for measuring patients' attitudes, beliefs, and barriers related to following a low sodium diet. The theory-based intervention was feasible and patients in the intervention group developed a more positive attitude toward following a low sodium diet and increased dietary sodium adherence. The findings from this dissertation support further exploration of the theory-based intervention and its effect on adherence, rehospitalization rates, and quality of life in HF patients. Keywords . Dietary Sodium, Heart Failure, Adherence, Theory of Planned Behavior, Feasibility Study.
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