Clinical effectiveness and cost-effectiveness of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) facilitated self-care rehabilitation intervention in heart failure patients and caregivers: rationale and protocol for a multicentre randomised controlled trial Perceived barriers and enablers to participation in a community-tailored physical activity program with Indigenous Australians in a regional and rural setting: a qualitative study
Introduction The Rehabilitation EnAblement in CHronic Heart Failure ( REACH-HF ) trial is part of a research programme design ed to develop and evaluate a health professional facilitated , home-based , self-help rehabilitation intervention to improve self-care and health-related quality of life in people with heart failure and their caregivers . The trial will assess the clinical effectiveness and cost-effectiveness of the REACH-HF intervention in patients with systolic heart failure and impact on the outcomes of their caregivers . Methods and analysis A parallel two group r and omised controlled trial with 1:1 individual allocation to the REACH-HF intervention plus usual care ( intervention group ) or usual care alone ( control group ) in 216 patients with systolic heart failure ( ejection fraction < 45 % ) and their caregivers . The intervention comprises a self-help manual delivered by specially trained facilitators over a 12-week period . The primary outcome measure is patients ’ disease-specific health-related quality of life measured using the Minnesota Living with Heart Failure question naire at 12 months ’ follow-up . Secondary outcomes include survival and heart failure related hospitalisation , blood biomarkers , psychological well-being , exercise capacity , physical activity , other measures of quality of life , patient safety and the quality of life , psychological well-being and perceived burden of caregivers at 4 , 6 and 12 months ’ follow-up . A process evaluation will assess fidelity of intervention delivery and explore potential mediators and moderators of changes in health-related quality of life in intervention and control group patients . Qualitative studies will describe patient and caregiver experiences of the intervention . An economic evaluation will estimate the cost-effectiveness of the REACH-HF intervention plus usual care versus usual care alone in patients with systolic heart failure . Ethics and dissemination The study is approved by the North West — Lancaster Research Ethics Committee ( ref 14/NW/1351 ) . Findings will be disseminated via journals and presentations to publicise the research to clinicians , commissioners and service users . Trial registration number IS RCT N86234930 ; Pre- results Background Aboriginal and Torres Strait Isl and er people have higher rates of chronic disease and a lower life expectancy than non-Indigenous Australians . In non-urban areas these health disparities are even larger . The aim of this qualitative study was to explore perceived barriers and enablers to attending an eight-week physical activity program in a rural and regional setting which aim ed to improve health outcomes , but had a low attendance rate . Methods Thirty-four Indigenous Australians participated in the intervention from the rural ( n = 12 ) and the regional ( n = 22 ) community .  Qualitative semi-structured individual interviews were conducted at the follow-up health assessment s with 12 participants . A thematic network analysis was undertaken to examine the barriers and enablers to participation in the program . Results Overall , there were positive attitudes to , and high levels of motivation towards , the physical activity program . Enablers to participation were the inclusion of family members , no financial cost and a good relationship with the principal investigator , which was strengthened by the community-based participatory approach to the program design . Barriers to program attendance were mostly beyond the control of the individuals , such as ‘ sorry business ’ , needing to travel away from the community and lack of community infrastructure . Conclusions More consideration is needed prior to implementation of programs to underst and how community-specific barriers and enablers will affect attendance to the program . Trial registration ACTRN12616000497404 . Registered 18 April 2016
How individuals responded to their diagnosis and their altered physical status related to their activity levels , as did the degree of encouragement to exercise coming from family , friends , and professionals .
These findings can be connected to the theory of behavioral change developed by B and ura , known as social cognitive theory ( SCT ) .
SCT may be a useful framework for developing interventions to support patients with HF in undertaking and maintaining regular exercise patterns .
These were issues referred to in papers for the systematic review that appear to be particularly related to exercise adherence
OBJECTIVES Keeping physically active has been shown to bring positive outcomes for patients diagnosed with heart failure ( HF ) .
However , a number of individuals with this health problem do not undertake regular exercise .
A review of extant qualitative research was conducted to explore what it can tell us about barriers and enablers to physical activity among people with HF .