Subjects were purposively recruited from among patients
treated for over 3 months by a physician at one outpatient
department. Investigators read the questionnaire instructions
and questions to participants who were unable to read the
research instruments. Inclusion criteria for participation were
as follows: (a) a physician diagnosis of heart failure (International
Classification of Diseases’ codes 4280 and 4289); (b)
left ventricular hypertrophy indicated by electrocardiogram;
(c) a previous myocardial infarction or ventricular hypertrophy,
abnormal left ventricular end-diastolic diameter, partial
abnormality on chamber function, abnormal systolic and
diastolic pressures, or abnormal valve structure as revealed
by cardiac echo; (d) left ventricular ejection fraction (LVEF)
of G40%; (e) being conscious, orientated, and able to communicate
verbally; (f) Q65 years old; and (g) no diagnosis of
psychiatric disorders (excluding depression with appropriate
medications or counseling support). Patients in all NYHA
classes were invited to enroll. Exclusion criteria were as
follows: (a) being bed-ridden for Q3 months and inability to
walk unaided, (b) severe vision or hearing impairment, and
(c) prognosis of G6 months. On the basis of a review of the
literature on heart failure (Mendez, Betancourt, & Galicia-
Mora, 2007), a sample of 103 participants was required to
reach an actual power of " = .80 with an ! error probability
of G.05 in accordance with the equation of N = A2 (Z! / 2 +
Z")2 / (21 j 20).