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

Abstract

Background Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence. The aim of this study is to identify relevant factors to successfully implement a complex, theory-based HF self-care intervention into routine practice. Methods We conducted semi-structured interviews to obtain key stakeholders’ opinions on previously developed behaviour change techniques for enhancing HF patients’ self-care behaviours, in order to optimise implementation of these techniques in an intervention. The interview topic guide was developed based on the Normalisation Process Theory (NPT), a tool that takes into account the feasibility of implementation and the acceptability to stakeholders. Interviews were analysed using thematic analysis and supported by MAXQDA 2020, a software for qualitative research. Results Interview participants included 18 key stakeholders consisting of three crucial groups: clinical experts (n = 7), patients (n = 3) and high calibre policy makers/potential funders (n = 8). The interviews revealed numerous factors to consider for successful implementation of an intervention into routine practice. The findings are presented according to two major categories: (1) themes within the NPT framework and (2) themes beyond the NPT framework. Themes within the NPT component ‘Coherence’ include three sub-themes: ‘understandability’, ‘value beyond existing interventions’ and ‘perceived benefits’. The NPT component ‘Cognitive participation’ revealed two sub-themes: ‘time resources’ and ‘financial sustainability’. Finally, the NPT component ‘Collective action’ uncovered three sub-themes: ‘need for training’, ‘compatibility with existing practice’ and ‘influence on roles’. A further two themes were identified beyond the NPT framework, namely: ‘structural challenges’ and (2) ‘role of carers’. Conclusions Factors identified previously by NPT were validated, but stakeholders further identified relevant aspects beyond NPT. Based on these findings, we suggest the existing NPT framework could be expanded to include a fifth component: questions considering specific environmental factors (contextual considerations). Sensitising researchers to these issues at an early stage when designing an intervention can facilitate its later success.

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

“…Eighteen key stakeholders who had previously participated in semistructured expert interviews about intervention implementation were invited to take part in the Delphi study ( Herber et al, 2021 ). Key stakeholders were selected according to the following criteria: (1) expertise in HF, (2) diverse perspectives, (3) responsibility and authority to facilitate the implementation, (4) influence, and (5) commitment ( Eldredge et al, 2016 ).…”

“…A questionnaire was developed in which stakeholders could select response items for Factor 1 and rank response options for Factors 2 to 8. The first-round Delphi questionnaire ( Supplemental Appendix 1 ) comprised responses from stakeholders obtained during the interviews regarding the eight factors ( Herber et al, 2021 ). For Factor 1 (content of the intervention), ambivalent behavior change techniques (BCTs) on which stakeholders expressed different opinions during the interviews were included to achieve a clearer vote.…”

“…Expert interviews with three major stakeholder groups were conducted previously: (1) clinicians, (2) patients, and (3) policymakers and potential funders (Herber et al, 2021). Among other things, stakeholders were asked to elucidate their preferred choices for each of the eight factors needed for developing a full intervention by sharing their views on the most important contextual factors to facilitate the implementation of a theory-based HF intervention in Germany (Herber et al, 2021). In this study, the Delphi approach was used to reach consensus among these key stakeholders regarding the eight factors to adequately define the intervention for the German context.…”

“…With the help of key stakeholders, this study aims to define the eight factors described by Davidson et al (2003) to successfully implement a theory-based HF self-care intervention in the German health care system (Herber et al, 2018). Expert interviews with three major stakeholder groups were conducted previously: (1) clinicians, (2) patients, and (3) policymakers and potential funders (Herber et al, 2021). Among other things, stakeholders were asked to elucidate their preferred choices for each of the eight factors needed for developing a full intervention by sharing their views on the most important contextual factors to facilitate the implementation of a theory-based HF intervention in Germany (Herber et al, 2021).…”

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.…”