Table 1 SYMPERHEART intervention

1. Brief name

SYMPERHEART supports SYMptom PERception in persons with HEART failure including their informal caregivers

2. Why, intervention rationale, theory, or goal

SYMPERHEART is a complex evidence-based intervention targeting both body observation and body analysis to support and educate persons with HF and their informal caregivers to monitor, recognize and interpret their HF symptoms, in order to guide symptom response

Based on the situation-specific theory of HF self-care [8], symptom perception is a needed step to attain self-care management in the process of HF self-care. Based on evidence synthesis on symptom perception in HF [9, 10] and on care needs [31], the SYMPERHEART intervention was detailed [16] to be tested in the local setting

3. What, materials

Materials used to prepare the intervention delivery:

 • Patient-reported outcomes to identify HF self-care [32] and symptom burden [33] in persons with HF

 • Informal caregivers-reported outcomes to identify contribution to HF self-care [34] and caregiver burden [35] in informal caregivers of persons with HF

Materials used to deliver the intervention to participants:

 • HF booklet of the Swiss Heart Foundation [36]

 • Paper graphs for daily symptom monitoring [13]

 • Digital weighing scale

 • Guided reflection questions [16]

 • Heartfailurematters.org web site

Materials used to train the nurses delivering the intervention:

 • An intervention manual detailing how the intervention components are operationalized

 • A training manual detailing the learning objectives and the resources used during the teaching

4. What, procedures, and support activities

The SYMPERHEART intervention is composed of three intervention components to be delivered to persons with HF and their informal caregivers [16]:

 1. Intervention prerequisite: the nurse identifies symptom perception barriers and facilitators [10], identifies HF self-care behaviors and individual symptom clusters based on patient-reported outcomes, discusses with the person with HF’s their main concerns related to HF, and supports self-care maintenance in discussion with the person using the HF booklet [36]. The nurse asks the informal caregiver their role related to the person’s HF and their wished role related to symptom perception, informs the informal caregiver about how symptom perception can be supported and about the heartfailurematters’ web site

 2. Body observation: the nurse discusses individual symptom clusters with the person with HF in identifying the three most severe symptoms for daily self-monitoring. Persons with HF and informal caregivers are instructed on symptom monitoring with paper graphs and on weight and edema monitoring [13]. The nurse discusses symptom monitoring behaviors to facilitate symptom monitoring embedded in daily routine. A digital weighing scale is provided if needed. Weight gain or loss are discussed. Symptom response is guided with information on how to respond to symptoms in case of alarm signs [36]

 3. Body analysis: the nurse uses person recall to support situation awareness about HF symptoms. Then, guided reflection questions are used both in persons with HF and their informal caregivers to support symptom recognition and interpretation [16]. The nurse informs the participants on self-care management activities [3]

5. Who provided

Home-care nurses who were previously trained by GCS with a one-day course on SYMPERHEART intervention components. All were registered nurses. The median years of professional experience was 10 (IQR 10) and the median years of professional experience in home-based care was 3 (IQR 5)

Seven home-care nurses were trained to deliver the intervention, and five of them delivered the intervention. One nurse on maternity leave did not deliver the intervention and was replaced by GCS who delivered the intervention to one participant

6. How, modes of delivery

Face to face contacts with the person with HF with or without any informal caregiver

7. Where, location

Home visits at person’s with HF home

8. When and how much

The intervention was composed by three one-hour meetings delivered during a one-month period

9. Intervention tailoring

The intervention was tailored to the person’s self-care behaviors and individual symptom clusters, to the person with HF’s main concerns related to HF. The intervention was tailored to the informal caregiver's contribution in HF self-care, to the informal caregiver’s wished role in symptom perception and considering also caregiver burden

10. Modifications

None

11. How well intervention fidelity was planned, strategies used

Nurses filled an intervention fidelity checklist after each meeting. Monitoring intervention fidelity was done with one or several observations by GCS with each nurse at person’s with HF home filling the same intervention fidelity checklist

Several strategies were used to support intervention fidelity and included the detailed description of the intervention components in an intervention manual available on French for the nurses, training the nurses to deliver the intervention, monthly team meetings with the nurses to maintain intervention fidelity, monitoring intervention fidelity during intervention delivery with each nurse, providing feedback about intervention fidelity to the nurses, and fidelity optimization by GCS enhancing fidelity during the monitoring of intervention fidelity

12. How well intervention fidelity was actual

17/18 persons with HF exposed to the intervention. 5/7 informal caregivers exposed to the intervention

 1. Intervention prerequisite: 15/18 persons with HF exposed to the total of activities, 2/18 exposed to several activities;

3/7 informal caregivers exposed to the total of activities, 2/7 exposed to several activities

 2. Body observation: 16/18 persons with HF exposed to the total of activities, 1/18 exposed to several activities;

5/7 informal caregivers exposed to the total of activities

 3. Body analysis: 14/18 persons with HF exposed to the total of activities, 2/18 exposed to several activities;

5/7 informal caregivers exposed to the total of activities