Optimising self-care support for people with heart failure and their caregivers: development of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention using intervention mapping

Research output: Contribution to journalArticle

Authors

  • Colin Greaves
  • Jennifer Wingham
  • Carolyn Deighan
  • Patrick Doherty
  • Jennifer Elliott
  • Wendy Armitage
  • Michelle Clark
  • Jackie Austin
  • Charles Abraham
  • Julia Frost
  • Sally Singh
  • Kate Jolly
  • Kevin Paul
  • Louise Taylor
  • Sarah Buckingham
  • Russell Davis
  • Hasnain Dalal
  • Rod S Taylor
  • REACH-HF investigators

External organisations

  • University of Exeter
  • Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK ; Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK.
  • Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK.
  • Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York, YO10 5DD UK.
  • Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK ; Chest Heart & Stroke Scotland, 3rd floor, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ UK.
  • Heart Failure and Cardiac Rehabilitation Services, Aneurin Bevan Health Board, Ty-Meddyg, Nevill Hall Hospital, Abergavenny, Gwent NP7 7EG UK.
  • University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK.
  • Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
  • REACH-HF Patient and Public Involvement Group, c/o Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, BIU, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK.
  • Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK.
  • Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK.

Abstract

BACKGROUND: We aimed to establish the support needs of people with heart failure and their caregivers and develop an intervention to improve their health-related quality of life.

METHODS: We used intervention mapping to guide the development of our intervention. We identified "targets for change" by synthesising research evidence and international guidelines and consulting with patients, caregivers and health service providers. We then used behaviour change theory, expert opinion and a taxonomy of behaviour change techniques, to identify barriers to and facilitators of change and to match intervention strategies to each target. A patient and public involvement group helped to identify patient and caregiver needs, refine the intervention objectives and strategies and deliver training to the intervention facilitators. A feasibility study (ISRCTN25032672) involving 23 patients, 12 caregivers and seven trained facilitators at four sites assessed the feasibility and acceptability of the intervention and quality of delivery and generated ideas to help refine the intervention.

RESULTS: The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention is a comprehensive self-care support programme comprising the "Heart Failure Manual", a choice of two exercise programmes for patients, a "Family and Friends Resource" for caregivers, a "Progress Tracker" tool and a facilitator training course. The main targets for change are engaging in exercise training, monitoring for symptom deterioration, managing stress and anxiety, managing medications and understanding heart failure. Secondary targets include managing low mood and smoking cessation. The intervention is facilitated by trained healthcare professionals with specialist cardiac experience over 12 weeks, via home and telephone contacts. The feasibility study found high levels of satisfaction and engagement with the intervention from facilitators, patients and caregivers. Intervention fidelity analysis and stakeholder feedback suggested that there was room for improvement in several areas, especially in terms of addressing caregivers' needs. The REACH-HF materials were revised accordingly.

CONCLUSIONS: We have developed a comprehensive, evidence-informed, theoretically driven self-care and rehabilitation intervention that is grounded in the needs of patients and caregivers. A randomised controlled trial is underway to assess the effectiveness and cost-effectiveness of the REACH-HF intervention in people with heart failure and their caregivers.

Details

Original languageEnglish
Article number37
Number of pages17
JournalPilot and Feasibility Studies
Volume2
Publication statusPublished - 2 Aug 2016