Factors influencing sodium restriction behavior among patients with chronic heart failure: a cross-sectional study based on the value co-creation theory

BACKGROUND: Digital health–supported value co-creation involves patients actively seeking information, communicating with healthcare professionals, and participating in shared decision-making throughout care. Sodium restriction is a cornerstone of chronic heart failure self-management, but adherence in real-world settings is often inadequate. Digital health technologies could strengthen patient–professional value co-creation; however, how value co-creation behaviours relate to sodium-restriction adherence remains unclear, particularly among Chinese patients with chronic heart failure. OBJECTIVE: To investigate the current status of value co-creation behaviors among chronic heart failure patients and analyze factors influencing sodium restriction adherence, thereby providing new perspectives and theoretical directions for sodium restriction management in this population. METHODS: Chronic heart failure patients who visited a large hospital in Guangxi, China from January to July 2025 were selected as study subjects. Data collection employed a general information questionnaire, Value Co-creation Behavior Measurement Scale, Sodium-Restricted Diet Questionnaire, Social Support Rating Scale, and Self-Rating Anxiety and Depression Scales. Univariate, correlation, and multivariate regression analyses were conducted to assess current value co-creation behaviors and identify factors influencing sodium-restricted dietary adherence. RESULTS: A total of 229 patients with chronic heart failure were included. Overall sodium restriction adherence was moderate, with 31.44% demonstrating good compliance. The mean value co-creation score was (46.183 ± 5.423). Univariate analysis revealed statistically significant differences between good and poor sodium restriction adherence in age, taste preferences, body mass index, sodium restriction-related cognition and attitudes, social support, and all dimensions of value co-creation behavior (P < 0.05). Multivariate linear regression analysis indicated that older age, preference for salty flavors, and higher body mass index were independently associated with poorer self-reported sodium-restricted dietary adherence. Higher levels of social support and value co-creation behaviors (information seeking, interactive collaboration, and shared decision-making) were independently associated with better self-reported adherence (P < 0.05). CONCLUSION: Patients with chronic heart failure showed moderate levels of value co-creation on all dimensions. Higher levels of value co-creation may be associated with better sodium-restricted dietary behaviors. Future research should develop and evaluate digital health technologies with a sustained focus on patients’ ability to access reliable information and health literacy, thereby promoting patient engagement and shared decision making and reducing the burden of dietary self-management. Follow-up studies should incorporate objective measures such as sodium intake and 24-hour urine sodium testing into the assessment framework.