Heart Failure Self-Care Behaviour through the COM-B Model: A Systematic Review of Behavioural Determinants and Mechanisms

Background: Self-care behavior is essential in managing heart failure (HF), but its implementation varies greatly. The COM-B (Capability, Opportunity, Motivation, Behavior) model has been widely used as a framework for behavioral change. Still, there has been no systematic mapping of its use in self-care for heart failure patients. Objective: This study aims to identify, map, and synthesize scientific evidence on how the COM-B model explains and/or influences self-care behaviors in HF adult patients. Method: This systematic review follows PRISMA 2020. Searches were conducted in PubMed, Scopus, Web of Science, CINAHL, EMBASE, MedLine, and PsycInfo for publications in 2020 and 2025. Screening and deduplication were managed using EndNote. Inclusion criteria comprised empirical studies on HF adults (≥18 years), self-care explorations mappable to COM-B, and reporting of self-care behavior outcomes. Joanna Briggs Institute (JBI) critical appraisal was use to assess the methodological quality of studies, and data were synthesized narratively and thematically. A total of 25 articles met the criteria for analysis. Results: Most studies show that Capability is facilitated through education and training. Opportunity is supported by technology, caregivers, and service systems, while Motivation is strengthened through psychosocial approaches such as motivational interviewing and self-efficacy training. Interventions involving all three elements simultaneously tend to be more effective in improving self-care behaviors. Conclusion: The COM-B model helps understand and guide self-care behaviors in heart failure patients. This model is essential when designing interventions and evaluating behaviors to make chronic disease management programs more effective and sustainable.