gms | German Medical Science

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.