Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE)

There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.

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Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study)

BMC Health Services Research ◽

10.1186/s12913-021-06596-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Oliver Rudolf Herber ◽

Isabell Ehringfeld ◽

Paula Steinhoff ◽

Amanda Whittal

Keyword(s):

Heart Failure ◽

Early Stage ◽

Self Care ◽

Normalisation Process Theory ◽

Routine Practice ◽

Behaviour Change Techniques ◽

Successful Implementation ◽

Care Intervention ◽

Key Stakeholders ◽

Relevant Factors

Abstract Background Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence. The aim of this study is to identify relevant factors to successfully implement a complex, theory-based HF self-care intervention into routine practice. Methods We conducted semi-structured interviews to obtain key stakeholders’ opinions on previously developed behaviour change techniques for enhancing HF patients’ self-care behaviours, in order to optimise implementation of these techniques in an intervention. The interview topic guide was developed based on the Normalisation Process Theory (NPT), a tool that takes into account the feasibility of implementation and the acceptability to stakeholders. Interviews were analysed using thematic analysis and supported by MAXQDA 2020, a software for qualitative research. Results Interview participants included 18 key stakeholders consisting of three crucial groups: clinical experts (n = 7), patients (n = 3) and high calibre policy makers/potential funders (n = 8). The interviews revealed numerous factors to consider for successful implementation of an intervention into routine practice. The findings are presented according to two major categories: (1) themes within the NPT framework and (2) themes beyond the NPT framework. Themes within the NPT component ‘Coherence’ include three sub-themes: ‘understandability’, ‘value beyond existing interventions’ and ‘perceived benefits’. The NPT component ‘Cognitive participation’ revealed two sub-themes: ‘time resources’ and ‘financial sustainability’. Finally, the NPT component ‘Collective action’ uncovered three sub-themes: ‘need for training’, ‘compatibility with existing practice’ and ‘influence on roles’. A further two themes were identified beyond the NPT framework, namely: ‘structural challenges’ and (2) ‘role of carers’. Conclusions Factors identified previously by NPT were validated, but stakeholders further identified relevant aspects beyond NPT. Based on these findings, we suggest the existing NPT framework could be expanded to include a fifth component: questions considering specific environmental factors (contextual considerations). Sensitising researchers to these issues at an early stage when designing an intervention can facilitate its later success.

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Randomized Clinical Trial of an Integrated Self-Care Intervention for Persons With Heart Failure and Diabetes: Quality of Life and Physical Functioning Outcomes

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2015.05.012 ◽

2015 ◽

Vol 21 (9) ◽

pp. 719-729 ◽

Cited By ~ 28

Author(s):

Sandra B. Dunbar ◽

Carolyn M. Reilly ◽

Rebecca Gary ◽

Melinda K. Higgins ◽

Steven Culler ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Clinical Trial ◽

Randomized Clinical Trial ◽

Physical Functioning ◽

Self Care ◽

Care Intervention

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A pilot test of an integrated self-care intervention for persons with heart failure and concomitant diabetes

Nursing Outlook ◽

10.1016/j.outlook.2013.09.003 ◽

2014 ◽

Vol 62 (2) ◽

pp. 97-111 ◽

Cited By ~ 28

Author(s):

Sandra B. Dunbar ◽

Brittany Butts ◽

Carolyn M. Reilly ◽

Rebecca A. Gary ◽

Melinda K. Higgins ◽

...

Keyword(s):

Heart Failure ◽

Self Care ◽

Pilot Test ◽

Care Intervention

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Developing a Culturally-Relevant Self-Care Intervention for Hispanic Adults with Heart Failure

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2012.06.401 ◽

2012 ◽

Vol 18 (8) ◽

pp. S104-S105

Author(s):

Victoria Vaughan Dickson ◽

Joan L. Combellick ◽

Marnie Malley ◽

Luis Sanchez ◽

Allison Squires ◽

...

Keyword(s):

Heart Failure ◽

Culturally Relevant ◽

Self Care ◽

Care Intervention ◽

Hispanic Adults

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A digital self-care intervention for Ugandan patients with heart failure and their clinicians: User-centred design and usability study

10.1101/2022.01.13.22268796 ◽

2022 ◽

Author(s):

Jason Hearn ◽

Sahr Wali ◽

Patience Birungi ◽

Joseph A. Cafazzo ◽

Isaac Ssinabulya ◽

...

Keyword(s):

Heart Failure ◽

Design Process ◽

Digital Health ◽

Self Care ◽

Usability Testing ◽

Health Intervention ◽

Limited Information ◽

User Centred Design ◽

Care Intervention ◽

Evaluation Phase

Background: The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness, disease management, or empowerment to engage in self-care behaviors. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and to reduce hospitalizations in high-income countries. However, such interventions remain underutilized in resource-limited settings like Uganda. Objective: To develop a digital health intervention that enables improved self-care amongst HF patients in Uganda. Methods: We implemented a user-centred design process to develop a self-care intervention entitled Medly Uganda. The ideation phase comprised a systematic scoping review and preliminary data collection amongst HF patients and clinicians in Uganda. An iterative design process was then used to advance an initial prototype into a fully-functional digital health intervention. The evaluation phase involved usability testing of the developed intervention amongst Ugandan patients with HF and their clinicians. Results: Medly Uganda is a digital health intervention that is fully integrated within a government-operated mobile health platform. The system allows patients to report daily HF symptoms, receive tailored treatment advice, and connect with a clinician when showing signs of decompensation. Medly Uganda harnesses Unstructured Supplementary Service Data technology that is already widely used in Uganda for mobile phone-based financial transactions. Usability testing showed the system to be accepted by patients, caregivers, and clinicians. Conclusions: Medly Uganda is a fully-functional and well-accepted digital health intervention that enables Ugandan HF patients to better care for themselves. Moving forward, we expect the system to help decongest cardiac clinics and improve self-care efficacy amongst HF patients in Uganda.

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Rationale and Design of Different Self-care Models for Adults With Heart Failure: a Systematic Review and Network Meta-analysis

10.21203/rs.3.rs-961643/v1 ◽

2021 ◽

Author(s):

Mingzhi Hu ◽

Hengheng Dai ◽

Kehua Zhou ◽

Jingjing Zhang ◽

Ying Chen ◽

...

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Meta Analysis ◽

Self Care ◽

Risk Of Bias ◽

Cochrane Library ◽

Intervention Model ◽

Care Intervention ◽

Credible Intervals

Abstract Background: Active self-care improves quality of life, lowers hospital readmission risks, and decreases mortality from heart failure. Different self-care intervention models for these patients involve a variety of care contributions from healthcare professionals and caregivers, and little is known about which self-care intervention model is the most effective.Methods: We will search the MEDLINE/PubMed, the Cochrane Library, CINAHL, ClinicalTrials.gov, Embase and PsycINFO databases from January, 2000 to April, 2021. The gray literature will also be searched to ensure randomized controlled trials are included as comprehensively as possible. Summary standardized mean differences and 95% credible intervals will be calculated via Bayesian random-effects network meta-analysis. Heterogeneity will be evaluated, and risk of bias will be assessed using the Cochrane Risk of Bias tool.Discussion: This network meta-analysis will analyze outcomes including quality of life, healthcare use, readmission rate, and mortality to identify the most effective intervention model.Impact: We will analyze self-care interventions and determine which is most effective through this meta‐analysis.Registration number: PROSPERO CRD42021253179

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Abstract 2720: “Stop telling us what to do and tell us how to do it”: A Qualitative Meta-Analysis of Skill Development in Heart Failure Self-Care

Circulation ◽

10.1161/circ.118.suppl_18.s_768-c ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Victoria V Dickson ◽

Barbara Riegel

Keyword(s):

Heart Failure ◽

Meta Analysis ◽

Nyha Class ◽

Healthcare Providers ◽

Self Care ◽

Role Playing ◽

Class Iii ◽

Daily Lives ◽

Qualitative Descriptive ◽

Over Time

Background : Heart failure (HF) self-care requires both knowledge and skill, but little attention has been given to identifying how to improve skill in HF self-care. Methods: We assessed what self-care skills are needed and how patients develop these skills using qualitative descriptive meta-analysis techniques. Transcripts from three mixed methods studies (n=85) were re-examined and translated to yield themes about the process of developing skill in HF self-care, defined as behaviors that maintain physiologic stability (maintenance) and the response to symptoms when they occur (management). Results: The sample was 63.5% Caucasian and 58.8% male, mean age of 55.69 years (± 13.42). Most (52.9%) were NYHA class III. Narrative accounts of HF self-care revealed that the most challenging self-care maintenance skills were diet, and exercise. The management skill that was most challenging was how to titrate diuretics in response to a weight gain. Skills developed over time through coaching by trusted resources (mostly friends or family with HF). Tactical skills (“how to” prepare low salt meals; “how to” start an exercise plan) were helped by role-playing. Situational skills (“what to do when”) most essential for self-care management were evident in descriptions of how they planned for special occasions. For example, significant others helped patients think through how to manage symptoms of fluid retention while traveling. Few patients saw traditional healthcare providers as resources they could call upon to aid them in developing tactical and situational skills. Patient education was not identified as a factor associated with the development of HF self-care skill. Rather, they struggled to operationalize the self-care knowledge they attained. Conclusion: Skill in HF self-care evolves over time, with experience and practice, as patients learned how to make self-care practices fit into their daily lives, but coaching by nurses may help patients develop the skill needed to master self-care skills. Research testing coaching interventions that target skill building tactics such as role-playing in specific situations is needed.

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