Abstract
Objectives: Clinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard, however uptake and adherence are sub-optimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact upon their effectiveness. The study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure.
Design: A qualitative focus group study was conducted. Data were analysed using thematic analysis.
Participants: A purposive sample of 16 patients, 82% males, aged 68 ± 7 years, with heart failure duration 10 ±9 years were recruited.
Intervention: A 12 week behavioural intervention targeting physical activity was delivered once per week by telephone.
Results: Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence.
Conclusions: Endorsement of interventions by clinicians to reduce patients’ fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support long-term maintenance
Design: A qualitative focus group study was conducted. Data were analysed using thematic analysis.
Participants: A purposive sample of 16 patients, 82% males, aged 68 ± 7 years, with heart failure duration 10 ±9 years were recruited.
Intervention: A 12 week behavioural intervention targeting physical activity was delivered once per week by telephone.
Results: Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence.
Conclusions: Endorsement of interventions by clinicians to reduce patients’ fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support long-term maintenance
| Original language | English |
|---|---|
| Journal | BMJ Open |
| Publication status | Accepted/In press - 7 Aug 2020 |