gms | German Medical Science

Background and status of (inter)national research: Adherence to heart failure (HF) self-care has been found to be effective for maintaining the condition and reducing hospital admissions. Many patients, however, struggle to implement regular self-care into daily routines. Previous interventions to enhance HF self-care have not been theory-based, and have shown mixed results. Moreover, to better ensure success, relevant barriers and facilitators to implementation of a theoretical intervention must be considered. It is therefore essential to develop effective theory-based interventions to increase HF self-care and understand local contextual factors to optimise implementation.

Objective: To design a theory-based HF behaviour change manual and understand local factors affecting implementation feasibility.

Method: Theory-based behaviour change techniques (BCTs) to be used in an intervention for improving HF self-care were identified using the Capability-Opportunity-Motivation-Behaviour (COM-B) model. From February 2020–February 2021, qualitative interviews were conducted with 18 key stakeholders, including patients and carers, clinicians and policy makers/potential funders. In a subsequent step, the same stakeholders were invited to participate in a ranking-type Delphi study to gain consensus on acceptance and implementation feasibility of the intervention in the German healthcare system. Stakeholders’ opinion was sought on the following eight intervention descriptors to facilitate effective implementation and reproducibility:

1.

content,

2.

characteristics of interventionists,

3.

target population,

4.

delivery location,

5.

delivery mode,

6.

format,

7.

intensity, and

8.

duration.

Results: The proposed intervention was generally viewed as understandable, valuable and comprehensive. Factors to consider for improving implementation success were identified, such as time resources, inclusion of carers and healthcare system characteristics. In terms of the eight descriptors, stakeholders concluded that the intervention should be delivered by HF nurses, the intervention recipients should include patients and carers and an outpatient HF clinic was perceived as the best location for intervention delivery. The intervention should include a combination of group and individual training sessions and last for 30 minutes. There should be more frequent sessions initially, gradually decreasing over time.

Discussion: The HF self-care intervention is both theoretically-based and its parameters have been co-created with high calibre local key stakeholders with invaluable experiential insight into the local implementation context. The possibility of successful implementation and intervention effectiveness should therefore be high, and will be tested in a subsequent feasibility study.

Practical implications: The developed BCTs can be tailored to local contexts with stakeholder involvement, and used in practice to enhance self-care of HF patients.

Appeal for practice (science and/or care) in one sentence: A well-designed intervention based on both theory and practical perspectives can facilitate intervention success and thus improve illness outcomes and quality of life of HF patients.