Identifying the active ingredients of training interventions for healthcare professionals to promote and support increased levels of physical activity in adults with heart failure: A systematic review.

ABSTRACT Heart failure (HF) is characterised by breathlessness and fatigue that impacts negatively on patients' intentions to prioritise physical activity (PA). As such, healthcare professionals (HCPs) experience challenges when motivating patients to increase and maintain PA. It is therefore important to enhance our understanding on how to better equip HCPs with the skills required to deliver interventions to increase physical activity levels of patients with HF. We conducted a systematic review to identify active ingredients of training interventions for HCPs to enable them to deliver corresponding PA interventions to adults with HF. Nine databases were searched. Two reviewers assessed study eligibility. Data were extracted on study characteristics, active ingredients, outcomes, and fidelity measures. The Cochrane Collaboration Risk of Bias tool for RCTs was used to assess methodological quality. Data were synthesised narratively, and a promise analysis conducted on key intervention features. Ten RCTs, which reported on a training intervention for HCPs to deliver a concomitant patient intervention, fulfilled the review criteria (N = 22 HCPs: N = 1,414 HF patients). Two studies reported use of theory to develop training interventions for HCPs. Seven behaviour change techniques (BCTs) were identified across the 10 HCP training interventions. The most 'promising' BCTs were 'instruction on how to perform the behaviour' (PA) and 'problem solving' (Quality of Life). Two studies reported that HCP training interventions had been formally evaluated. Fidelity domains relating to study design, monitoring, and improving delivery of treatment, intervention delivery and provider training were infrequently reported. Future research should prioritise theory-informed development and robust evaluation of training interventions for HCPs to enable faithful and quality delivery of patient interventions.