Digital training to support delivery of an evidence-based cardiac rehabilitation programme for heart failure: a mixed-methods evaluation of healthcare professionals' training experiences and intervention fidelity.

OBJECTIVES

The Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) programme is an evidence-based, healthcare professional-facilitated, home-based cardiac rehabilitation intervention for people living with heart failure. Digital training may provide a scalable approach to preparing healthcare professionals to deliver REACH-HF. This study aimed to describe observed patterns of fidelity across REACH-HF intervention components following digital training, and to explore healthcare professional views of the training’s feasibility, acceptability and usability and its perceived influence on intervention delivery.

DESIGN

Mixed-methods implementation evaluation combining descriptive assessment of fidelity with semi-structured interviews analysed using reflexive thematic analysis.

SETTING

Five National Health Service cardiac rehabilitation services in England.

PARTICIPANTS

15 healthcare professionals were recruited, 14 completed the digital training and 7 subsequently delivered REACH-HF. Fidelity data comprised 17 audio-recorded intervention sessions delivered by six facilitators. 11 healthcare professionals participated in the semi-structured interviews.

INTERVENTION: Co-designed training programme to train healthcare professionals as facilitators of the REACH-HF programme. Delivered in a hybrid format with self-paced learning modules accessible via a bespoke eLearning platform (asynchronous) with subsequent 3-hour virtual group session (synchronous) to complete the training.

OUTCOME MEASURES: Competence of REACH-HF delivery, assessed using an established intervention fidelity checklist, alongside qualitative inquiry concerning healthcare professional experiences of the training, including its feasibility, acceptability and usability, and its perceived influence on intervention delivery.

RESULTS

Adequate fidelity was observed across most REACH-HF components. Delivery was strongest for patient involvement, the physical activity programme and programme closure; competent delivery was observed for needs assessment, tailored planning, understanding of heart failure and progress monitoring. Lower scores were seen for emotional support, medication-related discussions and active exploration of caregiver involvement. Caregiver emotion and well-being could not meaningfully be assessed due to limited caregiver presence. Facilitators generally perceived the training as usable and valuable, but engagement and preparedness were shaped by prior experience, perceived relevance and service pressures affecting protected training time. Confidence was consolidated primarily through real-world delivery rather than training completion alone. Non-delivery reflected constrained operational opportunities rather than a consistent difference in confidence or preparedness.

CONCLUSION

Co-designed digital training may support healthcare professional preparation for REACH-HF delivery. Further research with larger and more complete fidelity datasets is required before firm conclusions can be drawn about overall delivery fidelity or equivalence with face-to-face training. Translating digital training into practice requires protected time for training and intervention delivery, timely opportunities for delivery and ongoing practical and organisational support.