Artikel
Developing a manual containing well-defined and theory-based behaviour change interventions for enhancing self-care of patients with heart failure
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Veröffentlicht: | 2. Oktober 2019 |
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Background: Heart failure (HF) is a clinical and public health issue associated with morbidity, mortality and increased healthcare expenditure. Although international guidelines recommend on-going self-care as part of routine HF management, and despite evidence supporting positive outcomes related to self-care, patients are frequently unable to adhere to self-care behaviour recommendations. Current interventions aiming to improve self-care have shown inconsistent results, because of a lack of underlying theoretical models. This precludes identification of underlying causal mechanisms, and lacks a detailed description of the active ingredient(s) driving the intervention. Thus, a detailed intervention manual to designing evidence-based behaviour change interventions (BCIs) could serve to improve the effectiveness of interventions, and contribute to enhancing self-care in HF patients.
Research question: Can a detailed intervention manual for designing theory-based BCIs based on the COM-B behaviour model and behaviour change techniques (BCTs) improve self-care in HF patients?
Methods: The overall study design involves application of the COM-B behaviour model, 15-17 qualitative semi-structured interviews, and a consensus development method (Delphi technique). A participatory planning group of key stakeholders (patients, healthcare professionals) is involved throughout the development process to provide real world input. The study consists of four stages:
- Stage 1 (complete): One qualitative and one quantitative meta-review were selected to identify determinants associated with adherence/non-adherence to HF self-care. Behaviour extraction was conducted by two researchers independently; notes were compared to create a final list of behavioural determinants.
- Stage 2 (complete): The list of behaviours was mapped onto the COM-B model to determine relevant target behaviours.
- Stage 3 (complete): Target behaviours were then mapped onto BCTs according to the Taxonomy of Behaviour Change Techniques, including advice from the participatory planning group.
- Stage 4 (to be conducted): Semi-structured interviews will be conducted with patients and healthcare professionals using Normalization Process Theory, in combination with the Delphi technique, to fine-tune BCI content and help ensure the BCIs are applicable for the German health system.
Results: The selected BCTs provide the basis for an intervention manual containing well-defined, theory-based BCIs that are relevant for enhancing adherence to HF related self-care recommendations. All BCIs will be described according to the following eight descriptors to ensure future reproducibility of the intervention:
- 1.
- content of elements of the intervention,
- 2.
- characteristics of self-care tutors (e.g. health professionals, lay tutors),
- 3.
- characteristics of target population (e.g. adults, children),
- 4.
- delivery location (e.g. hospital, GP practice, home environment),
- 5.
- mode of delivery (e.g. group based, individual approaches),
- 6.
- format (e.g. lectures, manual),
- 7.
- intensity (e.g. contact time) and
- 8.
- duration (e.g. number of sessions over a given period).
Discussion: In a subsequent study, the final intervention manual will be piloted to test its feasibility and acceptance, followed by the execution of a full randomised controlled trial. In addition, an economic evaluation (cost-effectiveness analysis) will be conducted as part of evaluating the BCIs compared to an appropriate alternative.
Practical implications: Successful implementation of self-care interventions requires enabling patients to overcome their barriers and make use of available techniques to enhance self-care adherence. The manual that will be produced from this study can provide guidance in practice regarding which interventions are most applicable to overcome certain self-care barriers. For patients, learning how to effectively engage in self-care can dramatically increase illness outcomes and quality of life. For practitioners, the ability to facilitate self-care in patients can help improve patient outcomes.