REACH-HF is a comprehensive home-based cardiac rehabilitation (CR) programme for people with heart failure (HF). The 3-day facilitator training has trained over 500 NHS staff across the UK to date. However, to address the NHS Long Term Plan aim of increasing uptake of CR in HF to 85%, more scalable formats of training delivery are required.
Aim
To adapt REACH-HF facilitator training for scalable delivery in close collaboration with NHS staff involved in the delivery of CR.
Methods
In the first two phases we designed and developed the eLearning platform with active involvement from a patient advisory group and a service provider advisory group and tested usability of the platform with the training providers. The third and final phase consisted of the evaluation of the training course. Fifteen health professionals were trained. We conducted semi-structured interviews with 11 of these facilitators about the training and REACH-HF delivery. We also received audio recordings of programme delivery to seven patients and one caregiver to assess fidelity (quality of delivery).
Results
The resulting training consists of (a) an eLearning platform with core modules relating to REACH-HF programme elements and required patient-centred delivery, and (b) a group-based live session for consolidation. The platform was considered easy to use with good navigation through the modules. Trainees noted that there was a lot of content (time consuming), with perceived usefulness of specific modules being dependent on trainee background. Although sites were paid for 2.5 days per health professional for training time, some reported that this had not translated in allocation in their workload. The fidelity assessment is ongoing.
Conclusion
The project has developed a scalable format of delivering REACH-HF training to upskill the CR workforce in delivering HF specific rehabilitation. Some refinements (e.g. tailoring of content to trainee needs) are recommended prior to implementation.
IMAGE (Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention) was a European Union funded project (2003–2008) in the field of public health which focussed on diabetes prevention. The IMAGE study group comprised a Europe-wide consortium of healthcare professionals and behavioural and health scientists. This group has published guidelines, a toolkit and quality indicators for diabetes prevention and more recently a comprehensive curriculum for the training of diabetes prevention managers, the development of which is described herein.
Type 2 diabetes is a serious, expensive and growing public health challenge. NICE guidance recommends diabetes prevention in people at high risk via intensive lifestyle interventions promoting weight loss. There are few robustly evaluated ‘real-world' diabetes prevention programmes in the UK. Immediate evidence on the effectiveness, cost-effectiveness and deliverability of such programmes is needed to inform the proposed UK National Diabetes Prevention Programme.
Objective: Delivery is one of the most common ways of assessing fidelity in behavioral interventions.However, there is a lack of research reporting on how well an intervention protocol reflects its proposed theoretical principles (design fidelity).This study presents a systematic method for assessing design fidelity and applies it to the eMotion web-based intervention targeting physical activity and depression.Method: The eMotion intervention comprises of 13 web-based modules, designed according to an underlying intervention map.An independent rater with expertise in behavior change coded the presence or absence of behavior change techniques (BCTs) in the content of eMotion.Results of coding were compared to the intervention designers' a priori specification for interrater reliability.Results: After discussion, the independent rater and the intervention designer had a high agreement for the presence of BCTs relating to behavioral activation (AC1 ϭ 0.91) with "demonstration of behavior" and "monitoring of emotional consequences" having the lowest agreement (AC1 Ͻ 0.4).There was also high agreement for the presence of BCTs targeting physical activity (AC1 ϭ 0.88) with "demonstration of behavior" and "monitoring of emotional consequences" having the lowest agreement (AC1 Ͻ 0.4).The eMotion description was then amended to align the interrater agreement.Conclusions: This study presents a novel method for assessing design fidelity.Developers of behavioral (and other multicomponent) interventions are encouraged to develop and refine this method and assess design fidelity in future interventions to ensure BCTs are operationalized as intended.
Introduction Smoking reduction can lead to increased success in quitting. This study aims to determine if a client-focused motivational support package for smoking reduction (and quitting) and increasing (or otherwise using) physical activity (PA) can help smokers who do not wish to quit immediately to reduce the amount they smoke, and ultimately quit. This paper reports the study design and methods. Methods and analysis A pragmatic, multicentred, parallel, two group, randomised controlled superiority clinical trial, with embedded process evaluation and economics evaluation. Participants who wished to reduce smoking with no immediate plans to quit were randomised 1:1 to receive either (1) tailored individual health trainer face-to-face and/or telephone support to reduce smoking and increase PA as an aid to smoking reduction (intervention) or (2) brief written/electronic advice to reduce or quit smoking (control). Participants in both arms of the trial were also signposted to usual local support for smoking reduction and quitting. The primary outcome measure is 6-month carbon monoxide-confirmed floating prolonged abstinence following participant self-reported quitting on a mailed questionnaire at 3 and 9 months post-baseline. Participants confirmed as abstinent at 9 months will be followed up at 15 months. Ethics and dissemination Approved by SW Bristol National Health Service Research Committee (17/SW/0223). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will be disseminated to trial participants and healthcare providers. Trial registration number NCT47776579 .
Aims: To assess whether an existing community-based diabetes prevention programme delivered by voluntary sector providers is effective in modifying diabetes risk factors in adults with “pre-diabetes”.
Background: Type 2 diabetes is a growing public health challenge. NICE guidance recommends diabetes prevention in people at high risk via intensive lifestyle interventions promoting weight loss through diet and physical activity. However, there are few robustly evaluated ‘real-world’ diabetes prevention programmes in the UK.
Methods: ComPoD (www.isrctn.com/ISRCTN70221670) is a randomised, waiting list controlled trial of the LWTC programme conducted across two sites (Devon, West Midlands). Adults with pre-diabetes referred by GPs were randomised to receive LWTC immediately (intervention) or after 6 months (control). The trial supplements a wider parallel before-after service and process evaluation involving all LWTC programme participants. In line with guidance, LWTC comprises 4-6 weekly group sessions followed by regular support contacts and attendance at 5+ additional classes up to 12 months. Changes from baseline to 6 months in objective measures of weight, blood glucose and physical activity, and self-reported diet, health status and psychological well-being were assessed.
Results: Trial recruitment (n=314) was completed in June 2015, with 43% of participants male, a mean (SD) age of 61 (9.87) years, weight of 87.28 (15.14) kg and BMI of 31.83 (4.54) kg/m2. Amongst 191 overweight LWTC participants providing 6-month follow up data for the before-after evaluation by July 2015, there were significant positive changes in weight (1.77kg loss), blood glucose (1.85mmol reduction), healthy eating and depression (all p<0.01).
Conclusions: Initial findings on this innovative, replicable, real-world, voluntary-sector led programme are promising. However, 6-month comparative trial data due early 2016 will provide more robust evidence on programme effectiveness which will be timely in light of the proposed UK National Diabetes Prevention programme.
Funding: Big Lottery (LWTC); NIHR School for Public Health Research (ComPoD).
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