NPPB and hydrops fetalis: This study contributes to the field of SM in rural HF population by adding the following evidence: 1) understanding the effect of patient activation on SM behaviors, 2) development of a conceptual framework to guide the design and implementation of activation-enhancing interventions to promote life-long SM adherence; 3) using clinical biomarkers (BNP and urine Na/Cr) to assess SM adherence; and 4) feasibility and patients’ acceptance of home- based interventions to improve SM behaviors.