The outputs from the first three stages of the intervention mapping process were used to generate detailed intervention materials and a training course for facilitators. The four main REACH-HF intervention elements were:

The Heart Failure Manual: A written self-help resource for use by patients and their caregivers. The resource includes a choice of two structured exercise programmes: A chair-based exercise DVD (developed by one member of the research team (PD) and colleagues specifically for people with heart failure) with seven levels of progressively increasing intensity which guides participants through exercises designed to build cardiovascular fitness and to strengthen muscles to facilitate activities of daily living; and a progressive walking-training programme based on increasing walk duration and intensity over time to build cardiovascular fitness (and leg muscle strength). The starting level (for the DVD) or walking time (for the walking programme) was set based on results from an incremental shuttle walk test (using a table which allows matching of the metabolic equivalent (MET) value of the patient’s individual test results against the MET values for different levels of the training activities). The manual also includes a CD for relaxation and breathing control exercises from the existing Heart Manual [38 ].

The Progress Tracker: An interactive booklet designed to facilitate learning from experience/over time and the building of understanding about how self-care activities impact on symptoms, emotional well-being and quality of life, through practice, self-monitoring of progress and (facilitated) problem solving.

The Family and Friends Resource: a manual for use by caregivers. This aims to increase caregiver understanding and skills both for helping the person with heart failure and for looking after their own physical and mental well-being. The resource is divided into three main sections: 1. Supporting the patient’s self-management of heart failure (“Providing Support”), 2. Caring for the caregiver (“Being a caregiver”) and 3. Practical advice including mobilising social support, accessing benefits and other formal and voluntary support (“Getting Help”).

A training course for facilitators. A training manual/syllabus for a 3-day training course for REACH-HF intervention facilitators was developed. Facilitators were defined as professionals with experience in cardiac rehabilitation or cardiac nursing. The facilitation role is crucial to the success of the REACH-HF programme. As well as being the main delivery process, it enables tailoring of the REACH-HF intervention resources to the individual needs of patients and their caregivers. The course includes the theory and process of facilitation (building rapport using patient-centred counselling techniques [46 ], empowerment and support of self-management, building understanding of the condition [29 (link)]); using behaviour change techniques; techniques for managing stress and anxiety; contents of the manual; supporting exercise and physical activity using the intervention materials; facilitation of the Family and Friends Resource and medical/nursing issues. The training was linked by three case studies of heart failure patients and opportunities to practice facilitation techniques and to problem-solve potentially difficult situations. Additional file 4 outlines the overall facilitation process.

The PPI group commented on the above materials in terms of both format and content. For instance, members of the group tried out the chair-based exercise DVD. They agreed that this would be a helpful component especially for patients with co-morbidities that limit mobility. The group also indicated that we should include the ability to mix and match exercise programmes if patients wished to do this. The PPI chair (KP) co-delivered content at all three training days. A set of quotes or “patient voices” from patients and caregivers in the PPI group and from qualitative interviews were also incorporated into the written resources to help illustrate key points.
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