克服心力衰竭患者参与和坚持家庭体育活动干预的障碍：一项定性焦点小组研究。
Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study.
作者信息
Okwose Nduka C, O'Brien Nicola, Charman Sarah, Cassidy Sophie, Brodie David, Bailey Kristian, MacGowan Guy A, Jakovljevic Djordje G, Avery Leah
机构信息
Translational and Clinical Research Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom.
Department of Psychology, Northumbria University - City Campus, Newcastle upon Tyne, Tyne and Wear, United Kingdom.
出版信息
BMJ Open. 2020 Sep 21;10(9):e036382. doi: 10.1136/bmjopen-2019-036382.
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.
TRIAL REGISTRATION NUMBER
NCT03677271.
目的
临床指南建议心力衰竭患者定期进行体育活动，以改善功能能力和症状，并减少住院次数。心脏康复计划在这方面已取得成效；然而，其接受度和依从性并不理想。基于家庭的体育活动计划因解决这些问题而受到欢迎，尽管人们认识到其提供个性化支持的能力会影响其效果。本研究旨在确定参与和坚持基于家庭的体育活动计划的障碍和促进因素，并确定将该计划纳入心力衰竭患者护理路径的方法。
设计
进行了一项定性焦点小组研究。使用主题分析法对数据进行分析。
参与者
招募了16名患者的目的样本，其中82%为男性，年龄68±7岁，心力衰竭病程10±9年。
干预措施
针对体育活动的为期12周的行为干预，每周通过电话进行一次。
结果
产生了十个主要主题，全面概述了干预措施在参与和依从方面的有效成分。据报告，害怕进行体育活动是参与的一个重大障碍。家庭成员的影响既是参与和依从的障碍，也是促进因素。促进因素包括在心力衰竭背景下了解体育活动的临床医生对干预措施的认可；团队成员持续的支持和个性化反馈，包括根据个人需求量身定制、克服障碍并增强信心。
结论
临床医生对干预措施的认可，以减少患者对进行体育活动的恐惧，以及为克服障碍而进行的个性化调整，对于长期依从性是必要的。为了提高依从性并提供长期维持的同伴支持，应考虑鼓励家庭成员参加咨询，以消除对心力衰竭背景下体育活动禁忌症的误解和恐惧。
试验注册号
NCT03677271。
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