Determining Contextual Factors for a Heart Failure Self-Care Intervention: A Consensus Delphi Study (ACHIEVE)

Abstract

There is a rising recognition of the crucial role self-care plays in managing heart failure (HF). Yet patients often have difficulties implementing ongoing self-care recommendations into their daily lives. There is also recognition of the importance of theory for successful intervention design, and understanding of key factors for implementation so interventions fit a given context. Local key stakeholders can provide valuable insights to help understand relevant context-specific factors for intervention implementation. This study sought to engage stakeholders to explore and determine relevant contextual factors needed to design and facilitate successful implementation of an HF self-care intervention in the German health care system. A ranking-type Delphi approach was used to establish consensus from stakeholders (i.e., clinicians, patients, policymakers/potential funders) regarding eight factors (content, interventionist, target group, location, mode of delivery, intensity, duration, and format) to adequately define the components and implementation strategy of the intervention. Seventeen participants were invited to participate in the first Delphi round. A response rate of 94% (16/17) was achieved and maintained for all three Delphi rounds. Stakeholder consensus determined that nurses specializing in HF are the most appropriate interventionists, target groups should include patients and carers, and the intervention should occur in an outpatient HF clinic, be a mixture of group and individual training sessions, and last for 30 minutes. Sessions should take place more frequently in the beginning and less often over time. Local stakeholders can help determine contextual factors that must be taken into account for successful delivery of an intervention. This enables the intervention to be developed and applied based on these factors, to make it suitable for the target context and to enhance participation to achieve the desired outcomes.

Suggestions to Improve Research on Motivational Interviewing for Heart Failure Self-care

“…Six or seven sessions occurred for a period of 6 months. This is consistent with published recommendations that HF interventions should last 30 minutes and be more intensive for the first month's follow-ups 7 …”

“…Evidence suggests that training sessions should last a minimum of 30 minutes and be scheduled more often in the short term and less frequently in the long term. 7 Finally, in light of our results, we recommend a dyadic approach to delivering MI sessions; dyad-level interventions have the intrinsic advantage of targeting processes such as coping efforts, communication, and reciprocal support behaviors between patients and caregivers.…”

“…This is consistent with published recommendations that HF interventions should last 30 minutes and be more intensive for the first month's follow-ups. 7 A few years ago, our group conducted a randomized controlled trial (the MOTIVATE-HF study). 8 The aim of the study was to evaluate the effectiveness of MI in improving self-care (primary end point), as well as a few secondary outcomes measured in patients with HF (generic and disease-specific quality of life, physical symptoms, anxiety and depression, sleep quality, mortality, and use of healthcare services) and in their informal caregivers (contribution to self-care, preparedness, selfefficacy).…”

Remote motivational interviewing to improve patient self‐care and caregiver contribution to self‐care in heart failure (REMOTIVATE‐HF): Rationale, design, and methodology for a multicentre randomized controlled trial

“…The intervention, which will be delived to patient and caregiver together, consists of two parts: a first and more intensive part in which four MI‐based educational sessions will be performed within 2 months; and a second and less intensive part in which the sessions will be performed at 5, 8, and 11 months from enrollment. We decided on these two parts of the intervention because in our prior experience with face‐to‐face MI (Vellone et al, 2020), four sessions in 2 months were successful in improving patient self‐care maintenance at 3 months from enrollment and because a recent Delphi survey involving several stakeholders (patients, clinicians, and policymakers) suggested that the best approach for an HF self‐care intervention would be one with more intense sessions for the first 2−3 months, followed by less intense sessions over time (Whittal et al, 2021). Conducting a study over 1 year might affect the retention of participants.…”

The Voting Scheme Determines the Winner. Considering Possible Options for Designing a Delphi Study

“…Within the context of our study, we applied the Delphi technique following qualitative interviews with key stakeholders for a heart failure (HF) behaviour change intervention (Herber et al, 2021; Whittal et al, 2021). So far, self-care interventions for improving health outcomes for patients with HF have shown mixed results (Jonkman et al, 2016), which might be due to the fact that these interventions were not theory-based or not well described for certain contexts.…”