title: 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.
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.
authors.affiliation: Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
authors.affiliation: Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK ; Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wingham
authors.affiliation: Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Deighan
authors.affiliation: Department of Health Sciences, University of York, Area 4, Seebohm Rowntree Building, York, YO10 5DD UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
authors.affiliation: Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elliott
authors.affiliation: Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK ; Chest Heart & Stroke Scotland, 3rd floor, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Armitage
authors.affiliation: Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Clark
authors.affiliation: Heart Failure and Cardiac Rehabilitation Services, Aneurin Bevan Health Board, Ty-Meddyg, Nevill Hall Hospital, Abergavenny, Gwent NP7 7EG UK.
authors.forename: Jackie
authors.initials: J
authors.lastname: Austin
authors.affiliation: Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Abraham
authors.affiliation: Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Frost
authors.affiliation: University Hospitals of Leicester NHS Trust, Glenfield Hospital, Groby Road, Leicester, LE3 9QP UK.
authors.forename: Sally
authors.initials: S
authors.lastname: Singh
authors.affiliation: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Jolly
authors.affiliation: 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.
authors.forename: Kevin
authors.initials: K
authors.lastname: Paul
authors.affiliation: Heart Manual Department, NHS Lothian Heart Manual Department, Astley Ainslie Hospital, 133 Grange Loan, Edinburgh, EH9 2HL UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Taylor
authors.affiliation: Research, Development & Innovation, Royal Cornwall Hospitals NHS Trust, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Buckingham
authors.affiliation: Sandwell & West Birmingham Hospitals NHS Trust, Sandwell General Hospital, Lyndon, West Bromwich, West Midlands B71 4HJ UK.
authors.forename: Russell
authors.initials: R
authors.lastname: Davis
authors.affiliation: University of Exeter Medical School (Primary Care), Truro Campus, Knowledge Spa, Royal Cornwall Hospital, Truro, TR1 3HD UK.
authors.forename: Hasnain
authors.initials: H
authors.lastname: Dalal
authors.affiliation: Institute for Health Research, University of Exeter Medical School, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU UK.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
keywords: Behaviour change; Heart failure; Intervention mapping; Physical activity; Rehabilitation; Self-care intervention