Enhancing self-care adherence in heart failure patients by developing a manual containing well-defined and theory-based behaviour change interventions through the application of the COM-B behaviour model
Final Report Abstract
The ACHIEVE study aimed to develop a theory-based heart failure (HF) behaviour change manual and understand local factors affecting the feasibility of implementing strategies that target improved and sustained HF self-care. Adherence to HF self-care is effective for maintaining the condition, improving quality of life and reducing hospital admissions. Many patients, however, struggle to implement regular self-care into their daily life. Previous interventions to enhance HF self-care were not theory-based and reported inconsistent results. To better ensure success, barriers and facilitators to implementation of a theoretical intervention in a specific local setting must be known and appropriately considered. Theory-based behaviour change techniques (BCTs) to improve HF self-care were identified using the Capability-Opportunity-Motivation-Behaviour (COM-B) model. Semi-structured interviews were conducted with 18 key stakeholders, including patients and carers, clinicians and policy makers/potential funders. These stakeholders were then invited to participate in a Delphi study to gain consensus on acceptance and implementation feasibility of the intervention in Germany. Stakeholders provided opinions on the eight intervention descriptors to facilitate effective and sustainable implementation: (1) content, (2) characteristics of interventionists, (3) target population, (4) delivery location, (5) delivery mode, (6) format, (7) intensity, and (8) duration. The intervention was generally viewed as understandable, valuable and comprehensive. Inclusion of carers and healthcare system characteristics were identified as important factors to consider for improving implementation success. In terms of the eight descriptors, stakeholders concluded that the intervention should be delivered by HF nurses, intervention recipients should include patients and carers, and an outpatient HF clinic was perceived as the best location. 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. In summary, the key scientific deliverables from this work were: 1) a theoretically derived list of BCTs, validated by 31 HF patients, 2) identification of aspects determining acceptability and feasibility of implementing the BCTs, 3) identification of the eight most relevant descriptors for implementing the proposed intervention in Germany. The developed BCTs were internationally derived and nationally tested for their relevance. Therefore, they can be tailored to national, regional and local contexts with stakeholder involvement to enhance self-care of HF patients. To ease implementation and comparability, dedicated materials were developed in the study, namely, an interview guide and a Delphi questionnaire. The ACHIEVE study thus successfully combined the development of a theory-based behaviour change intervention with implementation science to enhance intervention success for the improvement of HF self-care. 'Action planning’ was a BCT that originally had been selected during the mapping phase of the project. ‘Action planning’ is well researched in health psychology and regarded an effective means to change behaviour. Surprisingly, in our project, we had to eliminate ‘action planning’ from the list of BCTs, as it was extremely unpopular amongst the 31 patients who validated the BCTs.
Publications
- (2018). Enhancing self-care adherence in patients with heart failure: a study protocol for developing a theory-based behaviour change intervention using the COM-B behaviour model (ACHIEVE study). BMJ open, 8(9), e025907
Herber, O. R., Atkins, L., Störk, S., & Wilm, S.
(See online at https://dx.doi.org/10.1136/bmjopen-2018-025907) - October 9-11, 2019: 18th Deutscher Kongress für Versorgungsforschung. Berlin, Germany. Developing a manual containing well-defined and theory-based behaviour change interventions for enhancing self-care of patients with heart failure
Amanda Whittal, Oliver Rudolf Herber
(See online at https://dx.doi.org/10.3205/19dkvf041) - September 12-14, 2019: 53rd Kongress für Allgemeinmedizin und Familienmedizin. Erlangen, Germany. Developing a manual of behaviour change interventions for patients with heart failure
Amanda Whittal, Oliver Herber
(See online at https://dx.doi.org/10.3205/19degam040) - September 3-5, 2019: Royal College of Nursing Conference. Sheffield, UK. Oral presentation. Developing a theory-based intervention manual to enhance self-care of patients with heart failure; session no 1.7.3; abstract no: 0275. Book of abstracts p. 17
Oliver Herber, Amanda Whittal
- (2020). Applying the COM-B behaviour model to overcome barriers to heart failure self-care: a practical application of a conceptual framework for the development of complex interventions (ACHIEVE study). European Journal of Cardiovascular Nursing
Whittal, A., Störk, S., Riegel, B., & Herber, O. R.
(See online at https://doi.org/10.1177/1474515120957292) - (2020). Ethical aspects of self-care: Comment on Riegel et al (2019) Self-care research: Where are we now? Where are we going? International journal of nursing studies, 111, 103758
Herber, O. R., Krischel, M., & Whittal, A.
(See online at https://doi.org/10.1016/j.ijnurstu.2020.103758) - (2020). What the guide does not tell you: reflections on and lessons learned from applying the COM-B behavior model for designing real life interventions. Translational Behavioral Medicine
Whittal, A., Atkins, L., & Herber, O. R.
(See online at https://doi.org/10.1093/tbm/ibaa116) - September 30-October 1, 2020: 19th Deutscher Kongress für Versorgungsforschung. Berlin, Germany; virtual conference. Developing theory-based interventions to improve heart failure self-care adherence based on the COM-B behaviour model: the ACHIEVE study
Amanda Whittal, Lou Atkins, Paula Steinhoff, Isabell Ehringfeld, Stefan Störk, Oliver Herber
(See online at https://dx.doi.org/10.3205/20dkvf149) - (2021). Determining contextual factors for a heart failure self-care intervention: A consensus Delphi study (ACHIEVE). Health Education & Behavior (in press)
Whittal, A., Ehringfeld, I., Steinhoff, P., & Herber, O.R.
(See online at https://doi.org/10.1177%2F10901981211043116) - (2021). Identifying relevant factors for successful implementation into routine practice: Expert interviews to inform a heart failure self-care intervention (ACHIEVE study). BMC Health Services Research, 21(1), 1- 11
Herber, O.R., Ehringfeld, I., Steinhoff, P., & Whittal, A.
(See online at https://doi.org/10.1186/s12913-021-06596-w)
