gms | German Medical Science

19. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

30.09. - 01.10.2020, digital

Developing theory-based interventions to improve heart failure self-care adherence based on the COM-B behaviour model: the ACHIEVE study

Meeting Abstract

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  • Oliver Herber - Heinrich Heine University Düsseldorf, Institute of General Practice (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland
  • Amanda Whittal - Heinrich Heine University Düsseldorf, Institute of General Practice (ifam), Centre for Health and Society (chs), Düsseldorf, Deutschland

19. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 30.09.-01.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dkvf149

doi: 10.3205/20dkvf149, urn:nbn:de:0183-20dkvf1497

Published: September 25, 2020

© 2020 Herber et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background and current state of (inter)national research: Adhering to heart failure (HF) self-care recommendations can reduce hospital (re-)admissions. However, patients are often unable to adhere to on-going self-care. Previous interventions to improve HF self-care adherence have shown inconsistent results, partly because they were not theory-based. The COM-B behaviour model has been used successfully in other health-related contexts for the development of behaviour change interventions (BCIs). It was thus used for the first time as the theoretical basis to develop BCIs for improving HF self-care adherence.

Research questions and objectives: What are appropriate behaviour change techniques (BCTs) to overcome barriers associated with HF self-care non-adherence?

Methods or hypothesis: Barriers to HF-self care were identified via qualitative and quantitative meta-review articles. Preliminary BCIs were developed by mapping barriers onto the COM-B model and identifying appropriate BCTs. Subsequently, expert interviews with key stakeholders (patients, clinicians, policy makers) were conducted and analysed using thematic analysis to receive and integrate critical feedback on the BCTs developed thus far.

Results: Twenty-eight barriers to self-care were derived from the meta-review articles. When mapped onto the COM-B model, this led to identification of 229 potential BCTs for HF self-care. With the help of expert interviews, this number was reduced to 48 BCTs. Stakeholders largely agreed with the existing BCTs; however, there were some BCTs such as ‘anticipated regret’ or ‘salience of consequences’ that HF patients disliked. As a result, these were removed from the list. Overall, stakeholders saw the value and feasibility in implementing such interventions into daily practice, but expressed different opinions in relation to the mode of delivery. Depending on the context, in some cases it might be more appropriate to use an individual approach for HF patients, while in others small group sessions may be more feasible and/or beneficial.

Discussion: The COM-B model provided a comprehensive guide for designing BCIs. Some BCTs listed in the BCT taxonomy, however, such as ‘anticipated regret’ or ‘salience of consequences’ could be intimidating to patients and even alienate the relationship between patient and healthcare provider. The effectiveness of the developed theory-based BCIs will be tested in a subsequent feasibility study, and if warranted, a full-scale randomised controlled trial will be conducted.

Practical implications: The final BCI manual has a high potential for becoming an effective tool to improve adherence to HF self-care recommendations and as a result, reduce the number of hospital (re-)admissions.


References

1.
Barnason S, Zimmerman L, Young L. An integrative review of interventions promoting self-care of patients with heart failure. J Clin Nurs. 2012 Feb;21(3-4):448-75. DOI: 10.1111/j.1365-2702.2011.03907.x External link
2.
Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. UK: Silverback Publishing; 2014.