Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study

Nduka C Okwose; Nicola O'Brien; Sarah Charman; Sophie Cassidy; David Brodie; Kristian Bailey; Guy A MacGowan; Djordje G Jakovljevic; Leah Avery

doi:10.1136/bmjopen-2019-036382

Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study

Nduka C Okwose, Nicola O'Brien, Sarah Charman, Sophie Cassidy, David Brodie, Kristian Bailey, Guy A MacGowan, Djordje G Jakovljevic, Leah Avery

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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 suboptimal. 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 on their effectiveness. This 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% male, aged 68±7 years, with heart failure duration of 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 for long-term maintenance.

Original language	English
Article number	e036382
Number of pages	10
Journal	BMJ Open
Volume	10
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2019-036382
Publication status	Published - 21 Sept 2020

Bibliographical note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

This is an open access article distributed in accordance with the
Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work for any
purpose, provided the original work is properly cited, a link to the licence is given,
and indication of whether changes were made. See: https://creativecommons.org/
licenses/by/4.0/.

Funder

National Institute for Health Research Biomedical Research Centre (grant number: BH142109

Keywords

adult cardiology
heart failure
qualitative research

ASJC Scopus subject areas

Medicine(all)

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10.1136/bmjopen-2019-036382Licence: CC BY

PublishedFinal published version, 289 KBLicence: CC BY

Cite this

Okwose, N. C., O'Brien, N., Charman, S., Cassidy, S., Brodie, D., Bailey, K., MacGowan, G. A., Jakovljevic, D. G., & Avery, L. (2020). Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study. BMJ Open, 10(9), Article e036382. https://doi.org/10.1136/bmjopen-2019-036382

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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 suboptimal. 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 on their effectiveness. This 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% male, aged 68±7 years, with heart failure duration of 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 for long-term maintenance.",

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AU - Charman, Sarah

AU - Cassidy, Sophie

AU - Brodie, David

AU - Bailey, Kristian

AU - MacGowan, Guy A

AU - Jakovljevic, Djordje G

AU - Avery, Leah

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N2 - 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 suboptimal. 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 on their effectiveness. This 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% male, aged 68±7 years, with heart failure duration of 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 for long-term maintenance.

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Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study

Abstract

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