Table 3.
Facilitators to implementation of REACH-HF
| NPT construct | Facilitators |
| Differentiation | Good grasp of difference between REACH-HF and usual service delivery |
| Communal specification | Good grasp of purpose of REACH-HF |
| Agreement that REACH-HF adds value to service | |
| Initial dissemination of purpose and structure of REACH-HF | |
| Awareness of service gap | |
| Clear vision for REACH-HF | |
| Individual specification | Clear procedures and increased efficiency |
| Internalisation | Good grasp of value of intervention to heart failure population |
| Initiation | Availability of champions (whole team, organisation, three REACH-HF practitioners, single REACH-HF practitioner) |
| Identification of potential referrers/referral streams | |
| Enrolment | Strong endorsement for REACH-HF |
| Interest in heart failure | |
| Effective communication (within cardiac rehabilitation team, between cardiac rehabilitation and heart failure teams) | |
| Legitimation | Feeling positive about involvement |
| Feeling positive about challenge of introducing REACH-HF | |
| Being part of innovative team | |
| Activation | REACH-HF part of service going forward |
| Watchful waiting | |
| Implementing REACH-HF post-COVID-19 | |
| Interactional workability | Gaining balanced perspective of time involved in delivery of REACH-HF |
| COVID-19 led to changes in service provision | |
| Good fit with service and with patient | |
| Relational integration | More objective opinion of centre-based programmes |
| Positive opinion of REACH-HF resources (written resources are just right, being able to use friends and family resource) | |
| Trust in intervention and each other | |
| REACH-HF practitioner’s peer support | |
| Skill set workability (including REACH-HF practitioner’s training) | Preference for home-visits |
| Close working with heart failure team | |
| Choice of REACH-HF practitioners (self-selection, personal attributes, training more than one individual, experiences of working with multimorbidity patients) | |
| Skills combination (cardiac rehabilitation, physiotherapy/exercise physiology and heart failure) | |
| Improvements to REACH-HF training (making it more practical, more emphasis on exercise component, input from previous implementers, shorter modular online training, having more in-depth pretraining reading around self-management approach, recommending pretraining course—the BACPR heart failure exercise or activity training course | |
| Contextual integration | Protected time |
| Management team is proactive (securing additional funding, redesigning service, offering flexible rehabilitation) | |
| Commissioning structure (being block contractor) | |
| Support from management | |
| Systematisation | Planned, formal evaluation (by management) |
| Reflective, informal evaluation (by REACH-HF practitioners) | |
| Communal appraisal | Developing more balanced view of intervention and implementation process |
| Individual appraisal | Job satisfaction |
| Continuous professional development | |
| Positive feedback from patients | |
| Reconfiguration | Fully home-based programme |
| Fully remote delivery during COVID-19 pandemic | |
| Smoother enrolment onto programme | |
| Reduced home visits | |
| Home/centre hybrid | |
| Group centre-based programme | |
| Inspiration for better service delivery in general | |
| Amendments to REACH-HF resources (careful wording, simplified version of exercises, online resources) | |
| Non-NPT facilitators | |
| Patient-level factors | Simplified version of exercises |
| Overcoming technological issues | |
| Expectations and preferences (preference for, and motivation to, take part in home-based programme, being housebound) | |
| Geographical factors | Size and type of patch (small catchment area, availability of transport) |
BACPR, British Association for Cardiovascular Prevention and Rehabilitation; NPT, Normalisation Process Theory; REACH-HF, The Rehabilitation EnAblement in CHronic Heart Failure programme.