JMIR Publications

ABSTRACT

Aims: To explore participants’ perspectives on a nurse-led home-based heart failure self-management programme (HOM-HEMP) in a randomized controlled trial conducted in Singapore to gain insight into the effectiveness or failure of the study intervention. Design: A descriptive, qualitative approach was adopted. Method: English or Chinese-speaking participants from the intervention arms were recruited through a purposive sampling method from January 2019 to July 2019. Individual, face-to-face, semi-structured interviews were conducted with 11 participants. All the interviews were audio-recorded and transcribed verbatim, with the identifiers of the participants omitted to ensure confidentiality. The thematic analysis approach was used for identifying, analyzing and reporting the patterns (themes) within the data.

Results:

Six themes emerged from the process evaluation interviews and were categorized according to Donabedian’s structure-process-outcome framework as "intervention structure," "intervention process," and "intervention outcome". These six themes were manageability of intervention, areas for improvement, benefits of visiting, personal accountability in self-care, empowered with knowledge and skills in self-care after the intervention, and increased self-efficacy in cardiac care. Conclusion: The findings of the process evaluation provided additional information about participants' perceptions and experiences with the HOM-HEMP intervention. While home visit may be perceived as resource intensive, it remains the preferred way of engagement for most of the elderly patients. The nurse plays an important role in promoting heart failure self-care. The process of interaction with the patient can be an important empowering process for self-care behaviour changes. Impact: Process evaluation is an important step in the evaluation of a complex intervention. It allows researchers and practitioners to better understand the mechanism by which an intervention generates impact. Therefore, future intervention programmes can leverage on these mechanisms and adapt them to different contexts for better intervention effectiveness.