Developing a conceptual model to guide a self-care management intervention in patients with heart failure

Patients with heart failure (HF) often have bothersome symptoms that affect their daily life and require ongoing self-care. Yet, many patients struggle to monitor symptoms routinely and to manage the symptoms after they detect them, thus leading to a delay in timely actions and worse outcomes. The SympTom mAnagement and self-caRe (STAR) study aims to improve symptom recognition and response in patients with HF. In the STAR study we use the Multiphase Optimization Strategy (MOST) to prepare, optimize, and evaluate the digital STAR intervention. In the MOST framework, developing a conceptual model is an important step in intervention optimization.

To develop a conceptual model that describes how the STAR intervention is expected to influence self-care management and improve patient outcomes.

We developed a conceptual model based on the Middle-Range Theory of Self-Care of Chronic Illness, as well as findings from previous studies. The model specifies candidate components for the intervention and their hypothesized mechanism of action. For each component, we defined proximal and distal outcomes. We refined the model through discussions within a multidisciplinary self-care research group, other researchers, and patients.

The conceptual model consists of four connected intervention components. The basic module aims to increase HF knowledge, illness perceptions, and prepare patients for the following components. Its proximal outcomes are increased HF knowledge and illness perceptions. The second module (symptom awareness training) focuses on noticing signs and symptoms and recognizing changes in symptom patterns; its proximal outcome is earlier recognition of symptom changes. The third module (symptom management counseling) supports patients in choosing appropriate and feasible management actions; its proximal outcome is timely and thoughtful responses to symptoms. Finally, the symptom management experiments module encourages patients to try the actions and evaluate the results; its proximal outcome is enactment of behavioral experimentation and active decision making. We predict that these proximal outcomes will lead to beneficial distal outcomes, including reduced interference of bothersome symptoms, improved self-care, fewer hospital admissions, and improved HF-related quality of life.

This conceptual model will guide the preparation, optimization, and evaluation phases of MOST in the STAR study.