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)

Abstract

Background: Effective interventions to enhance adherence to self-care recommendations in patients with heart failure have immense potential to improve health and wellbeing. However, there is substantial inconsistency in the effectiveness of existing self-management interventions, partly because they lack theoretical models underpinning intervention development. Aim: To outline how the capability, opportunity and motivation behaviour model has been applied to guide the development of a theory-based intervention aiming to improve adherence to heart failure self-care recommendations. Methods: The application of the capability, opportunity and motivation behaviour model involved three steps: (a) identification of barriers and facilitators to heart failure self-care from two comprehensive meta-studies; (b) identification of appropriate behaviour change techniques to improve heart failure self-care; and (c) involvement of experts to reduce and refine potential behaviour change techniques further. Results: A total of 119 barriers and facilitators were identified. Fifty-six behaviour change techniques remained after applying three steps of the behaviour model for designing interventions. Expert involvement ( n=39, of which 31 were patients (67% men; 45% New York Heart Association II)) further reduced and refined potential behaviour change techniques. Experts disliked some behaviour change techniques such as ‘anticipated regret’ and ‘salience of consequences’. This process resulted in a final comprehensive list consisting of 28 barriers and 49 appropriate behaviour change techniques potentially enhancing self-care that was put forward for further use. Conclusion: The application of the capability, opportunity and motivation behaviour model facilitated identifying important factors influencing adherence to heart failure self-care recommendations. The model served as a comprehensive guide for the selection and design of interventions for improving heart failure self-care adherence. The capability, opportunity and motivation behaviour model enabled the connection of heart failure self-care barriers to particular behaviour change techniques to be used in practice.

Do patient-reported outcome measures measure up? A qualitative study to examine perceptions and experiences with heart failure proms among diverse, low-income patients

“…Using the COM-B framework [ 16 ], we identified several key issues for the self-management of heart failure congruent with prior research [ 28 , 29 ]. The KCCQ-12 most heavily captures capability, particularly physical issues, and patients’ feedback in this domain primarily focused on its psychological components.…”

Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study)

“…First, we were only able to recruit three patients as compared to seven clinicians and eight policy makers/potential funders for involvement as key stakeholders. However, at an earlier stage of the study 31 patients with HF were interviewed to specifically obtain their views on the intervention [ 19 ]. Additionally, it was important to focus on clinicians and policy makers/potential funders, since they have more knowledge about the implementation of interventions within health care system infrastructure.…”

“…Stakeholders were selected by the participatory planning group according to the following criteria: expertise in their field, diverse perspectives, responsibility and authority to facilitate the implementation, influence and commitment [ 24 ]. The patient voice had been well-represented in a previous stage of the study, in which we interviewed 31 HF patients about their views on the intervention [ 19 ]. Nonetheless, we felt it was important to include patients in this phase of the study as well, to ensure adequate patient involvement as the end users of the intervention.…”

“…The result was a long list of potential BCTs that could be used to develop a full intervention. This list and the process leading to its development has been published previously [ 19 ]. It is intended to provide a basis of BCT options that can be used by health professionals with patients to address numerous HF self-care barriers depending on individual patient’s needs.…”

“…The aim of this study is to identify relevant factors to successfully implement a complex, theory-based intervention into routine practice [ 22 ]. Key stakeholders’ opinions on previously developed BCTs that seek to enhance the adherence of HF patients’ self-care behaviours [ 19 ] will be obtained in the light of NPT parameters to optimise implementation. Stakeholders provide specific insight into intervention implementation in the German context, however, these perspectives are extracted to a more conceptual level to examine factors that may be relevant in other contexts beyond Germany.…”