Title : Barriers and enablers in evidence-based nutritional management for heart failure patients: A qualitative study
Abstract:
Aims: To analyze the barriers and enablers in facilitating stakeholder participation in the evidence-based nutritional management of patients with heart failure (HF), and to explore the perspectives of medical professionals on nutritional interventions. Design: Descriptive qualitative research was conducted during March–April 2023 within two cardiovascular departments in a Chinese hospital.
Methods: We used objective sampling, enlisting sixteen nurses/physicians. Semi-structured interviews and data analysis were conducted using the Consolidated Framework for Implementation Research (CFIR), with encoding performed via NVivo 14 software.
Results: Nineteen implementation determinants were identified. The CFIR framework encompasses seven key elements across three domains. Key intervention plan features include the implementer’s trust in the quality/validity of evidence and tailored ongoing quality-enhancement strategies. Key internal elements include effective intraorganizational teamwork and communication channels, cohesive team environments, promptness in implementing changes, and early planning by leaders. Individual traits involve proactive coping mechanisms. Twelve components in four CFIR domains are obstacles, such as the intervention program’s intricacy, increased patient costs, and increased learning expenses and workloads. External elements include suboptimal disease conditions, a lack of awareness of nutritional intervention, and insufficient social/family support in patients; uncooperativeness and rivalry with other medical entities; and a lack of intrahospital external recognition and incentive schemes. Internal elements include vague implementation goals and a lack of knowledge/informational resources for staff; personal traits include patients’ insufficient understanding of HF-related nutritional management and an absence of a robust interdisciplinary collaboration system for colleagues.
Conclusions: Utilizing CFIR methods and analysis, we identified barriers and enablers in evidence-based nutritional management practice implementation, laying the groundwork for additional modifications and the fine-tuning of intervention strategies.
Impact: We described methods for modifying the conduct of clinical staff, organizations, and systems to enhance the results for HF patients, which serve as foundational data for contrasting pre- and post implementation barriers and enablers in evidence-based practical research. Reporting method: We adhered to relevant EQUATOR guidelines with the COREQ reporting method.
