Extending the reach and implementation of the successful REACH-HF programme with a digitally delivered training programme.

Background: Heart failure affects almost 1 million adults in the UK and has a major impact on patient quality of life and NHS resources.

The current proposal builds on a prior NIHR-funded research programme (RP-PG-1210-12004) which established the clinical effectiveness and cost-effectiveness of the REACH-HF home-based cardiac rehabilitation intervention for people with heart failure and their caregivers.

To build on this success we now wish to scale up implementation to the national level, by training a large proportion of the existing (over 250) NHS CR centres in the UK to deliver REACH-HF. To support this, it is necessary to adapt the health professional training course for online /digital delivery.

The face-to-face, three-day training used in our research programme is time-consuming and relatively expensive, so is not well suited for wide-scale implementation.

Aims and Objectives: To develop a digitally delivered version of the training course for the REACH-HF home-based cardiac rehabilitation programme.

We aim to test the feasibility and acceptability of the revised training and compare the resulting quality of delivery with benchmarks set in the REACH-HF trial.

This will ensure that quality of intervention delivery can be maintained when moving to a less intensive training format.

Development work plan: To develop the adapted training, we will apply the Person-Based Approach for digital intervention development in three stages: Firstly, working closely with groups of patients, caregivers and healthcare professionals, we will review the existing (face-to-face) REACH-HF training materials and examples of successful e-learning platforms.

We will identify a way to structure the training content for delivery as an interactive, online training course, using “wire-framing” to map out the navigational flow and broad content.

Secondly, we will use iterative cycles of qualitative research and stakeholder co-design workshops to try out and refine prototypes of the training materials. This will include think-aloud interviews, remote usability testing and a standardised usability questionnaire.

Thirdly, we will deliver the online REACH-HF training course to 15 CR staff at five CR centres, who will each treat at least two (total 30-40) patients with heart failure. We will check quality of delivery using a fidelity checklist developed for our REACH-HF trial. This will be applied to audio-recordings of all provider-patient interactions.

We will interview all CR staff about their experiences of being trained and delivering the intervention to identify any further training needs and will refine the training accordingly.

Timelines for delivery: The project will last 22 months, including a 10 month development-and-optimisation stage, followed by a 14-month (with slight overlap for recruitment) feasibility-testing phase.

Anticipated Impact and Dissemination: We envisage that the training course will be used to train 200 cardiac rehabilitation staff over the next five years, allowing REACH-HF to be delivered to approximately 20,000 people with heart failure per year.

This will help to deliver the benefits of cardiac rehabilitation at a national scale to both patients with heart failure and the NHS and enable the translation of the NIHR-funded REACH-HF research programme into real-world practice in a cost-efficient and sustainable way.