ACHIEVE study

Although international guidelines recommend continuous self-care as part of routine heart failure treatment and although studies show the positive effects of self-care, patients are often unable to take good care of themselves.

Behaviour change interventions (BCIs) can modify and improve self-care in heart failure. However, previous self-management interventions have shown limited success as they were neither theory-based nor well-described. As a result, underlying correlations could hardly be recognised; the proposed measures were not very transparent and the interventions were not reproducible.

The ACHIEVE study therefore developed an intervention manual with theory-based and standardised descriptions of BCIs. The manual serves as a blueprint and was used in a subsequent exploratory study to find out whether it helps patients to actually implement self-care measures.

• Based on the 37 statements from the qualitative meta-summary results, the researchers developed theory-based behaviour change interventions to help heart failure patients implement self-care interventions prescribed to them during treatment.
• The project team identified underlying factors that present barriers to self-care. They linked these to a behavioural model to provide strategies and techniques to help patients change unwanted behaviours.
• The researchers also identified factors that favour self-care. They also linked these to a behavioural model to provide strategies and techniques that reinforce desired behaviours.
• Over the course of four project phases, the team designed feasible interventions (BCIs) and summarised them in a manual. The proposed BCIs now support patients with heart failure in actually implementing self-care measures.

In order to systematically develop BCIs, the research group worked in four phases:

• Stage 1: The proposed behaviour change interventions are based on selected statements and findings from two papers: firstly, from a qualitative meta-summary project (HE 7352/1-1) by the research team itself; secondly, from the quantitative meta-analysis by Kessing et al. (2016). From these two recent reviews, the project team extracted factors (target behaviours) that indicate whether or not patients adhere to the prescribed self-care measures.
• Stage 2: In the second phase, the aim was to strengthen patients' health behaviours with regard to their own self-care. Behaviours that have a negative impact on self-care should be replaced with new, desirable behaviours. The behaviours associated with following or not following the self-care measures were then applied to the COM-B model (Capability, Opportunity, Motivation and Behaviour) and the underlying mechanisms were recorded.
• Stage 3: The "taxonomy of behaviour change techniques" was used to develop approaches for change. It enables target behaviours to be applied to established behaviour change techniques in order to reinforce facilitating factors and eliminate hindering factors.
• Stage 4: Finally, the proposed BCIs were translated into locally relevant interventions using normalisation process theory (NPT), which could be tested in practice. This showed whether the theoretically derived interventions can survive in everyday life. The application of NPT helps to identify factors that promote/hinder the effective and sustainable implementation of interventions in routine clinical work. The consensus development method (Delphi technique) was also used to review the content and acceptance of the intervention manual in order to increase the likelihood of successful piloting and implementation of BCIs in the German healthcare system.