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      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

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          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.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s40814-016-0075-x) contains supplementary material, which is available to authorized users.

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          Most cited references39

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          Intrinsic Motivation and Self-Determination in Human Behavior

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            Epidemiology and risk profile of heart failure.

            Heart failure (HF) is a major public health issue, with a prevalence of over 5.8 million in the USA, and over 23 million worldwide, and rising. The lifetime risk of developing HF is one in five. Although promising evidence shows that the age-adjusted incidence of HF may have plateaued, HF still carries substantial morbidity and mortality, with 5-year mortality that rival those of many cancers. HF represents a considerable burden to the health-care system, responsible for costs of more than $39 billion annually in the USA alone, and high rates of hospitalizations, readmissions, and outpatient visits. HF is not a single entity, but a clinical syndrome that may have different characteristics depending on age, sex, race or ethnicity, left ventricular ejection fraction (LVEF) status, and HF etiology. Furthermore, pathophysiological differences are observed among patients diagnosed with HF and reduced LVEF compared with HF and preserved LVEF, which are beginning to be better appreciated in epidemiological studies. A number of risk factors, such as ischemic heart disease, hypertension, smoking, obesity, and diabetes, among others, have been identified that both predict the incidence of HF as well as its severity. In this Review, we discuss key features of the epidemiology and risk profile of HF.
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              Exercise training in patients with heart failure and preserved ejection fraction: meta-analysis of randomized control trials.

              Heart failure with preserved ejection fraction (HFPEF) is common and characterized by exercise intolerance and lack of proven effective therapies. Exercise training has been shown to be effective in improving cardiorespiratory fitness (CRF) in patients with systolic heart failure. In this meta-analysis, we aim to evaluate the effects of exercise training on CRF, quality of life, and diastolic function in patients with HFPEF.
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                Author and article information

                Contributors
                01392 722751 , c.j.greaves@exeter.ac.uk
                jennywingham@nhs.net
                Carolyn.Deighan@nhslothian.scot.nhs.uk
                patrick.doherty@york.ac.uk
                Jennifer.Elliott@nhslothian.scot.nhs.uk
                wendy.armitage@chss.org.uk
                Michelle.Clark@nes.scot.nhs.uk
                Jackie.Austin@wales.nhs.uk
                C.Abraham@exeter.ac.uk
                J.Frost@exeter.ac.uk
                sally.singh@uhl-tr.nhs.uk
                c.b.jolly@bham.ac.uk
                kevin.paul15@btinternet.com
                Louise.taylor@nhslothian.scot.nhs.uk
                sarah.buckingham4@nhs.net
                russelldavis@nhs.net
                h.dalal@nhs.net
                r.taylor@exeter.ac.uk
                Journal
                Pilot Feasibility Stud
                Pilot Feasibility Stud
                Pilot and Feasibility Studies
                BioMed Central (London )
                2055-5784
                2 August 2016
                2 August 2016
                2016
                : 2
                Affiliations
                [1 ]Institute for Health Research, University of Exeter Medical School, St Luke’s Campus, Magdalen Road, Exeter, EX1 2LU UK
                [2 ]Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK
                [3 ]Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK
                [4 ]Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York, YO10 5DD UK
                [5 ]Chest Heart & Stroke Scotland, 3rd floor, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ UK
                [6 ]Heart Failure and Cardiac Rehabilitation Services, Aneurin Bevan Health Board, Ty-Meddyg, Nevill Hall Hospital, Abergavenny, Gwent NP7 7EG UK
                [7 ]University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK
                [8 ]Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
                [9 ]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
                [10 ]Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK
                [11 ]University of Exeter Medical School (Primary Care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD UK
                Article
                75
                10.1186/s40814-016-0075-x
                5153822
                27965855
                23861800-5d4f-4479-bd3d-c9ebeac1267f
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health Research;
                Award ID: RP-PG-1210-12004
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                heart failure,self-care intervention,rehabilitation,physical activity,intervention mapping,behaviour change

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