Table 2.
Barriers to implementation of REACH-HF
| NPT construct | Barriers |
| Differentiation | |
| Communal specification | Confusion about patient criteria |
| Individual specification | Initial trial-and-error with operationalising the intervention |
| Internalisation | |
| Initiation | Lack of implementation plan |
| Lack of champions | |
| Enrolment | Routine of delivering group centre-based programmes |
| Practitioners being away from core cardiac rehabilitation duties/team being stretched | |
| Low team morale and lack of enthusiasm for REACH-HF | |
| Challenging personal circumstances | |
| Poor communication with heart failure team | |
| Legitimation | Initial hesitation about being part of project |
| Activation | Perception of REACH-HF in its current format as not implementable |
| Interactional workability | Additional time |
| Additional cost | |
| Additional admin | |
| Relational integration | Higher opinion of centre-based provision |
| Negative opinion of REACH-HF resources (DVDs are outdated, technical problems, written resources are too lengthy) | |
| Skill set workability (including REACH-HF practitioner’s training) | Disinclination for lone working |
| Disjointed working between cardiac rehabilitation and heart failure teams | |
| REACH-HF training not well-pitched to audience | |
| Contextual integration | Lack of time allocation |
| Lack of staff | |
| Staff redeployment due to COVID-19 | |
| Commissioning structure (lack of commissioning of cardiac rehabilitation for heart failure patients) | |
| Systematisation | Time required for evaluation |
| Task of evaluation lies with management | |
| Communal appraisal | |
| Individual appraisal | |
| Reconfiguration | |
| Non-NPT barriers | |
| Patient-level factors | Multimorbidity patients (frequent hospitalisations, not stable to exercise, additional time) |
| Engaging with technology (lack of DVD players or internet, not being technologically savvy) | |
| Apparent lack of improvement following REACH-HF | |
| Expectations and preferences (lack of motivation, preference for group centre-based programmes, dislike of home visits) | |
| Geographical factors | Size and type of patch (large catchment area, transport issues) |
NPT, Normalisation Process Theory; REACH-HF, The Rehabilitation EnAblement in CHronic Heart Failure programme.