From awareness to action: a mixed-methods evaluation of a digital training tool for heart failure management in care homes

Background:<br/><br/>Heart failure (HF) is a common condition among care home residents, affecting approximately 20% of this population and contributing to high rates of morbidity and mortality. Despite the prevalence of HF in long-term care settings, most care home nursing staff lack specialist training in HF management. There is limited evidence on the effectiveness of educational interventions tailored for this workforce. This mixed-methods study aimed to co-design and evaluate a digital intervention to enhance care home staff’s knowledge, self-efficacy, and ability to recognize and respond to HF deterioration.<br/><br/>Objectives:<br/><br/>To develop and assess the feasibility and impact of a co-designed digital HF education intervention for care home nursing staff, focusing on generalist knowledge and real-world applicability.<br/><br/>Methods:<br/><br/>The study was conducted in three phases. During Phase 1 (Theory Generation), a scoping review following PRISMA-ScR guidelines identified seven international studies on HF education in care homes, revealing limited effectiveness on resident outcomes and implementation challenges. Seventeen qualitative interviews with care home staff and a Delphi study involving 54 care home nurses were conducted to define educational needs. Findings emphasized the importance of generalist HF knowledge and person-centered care, and highlighted a key theme, “It’s fine until it’s not,” reflecting staff struggles to detect early signs of HF deterioration. In Phase 2 (Co-Design), four structured workshops were held with 15 stakeholders, including people living with HF, HF clinicians, and care home staff. These sessions informed the design and development of a digital education resource focused on early symptom recognition, communication strategies, and team-based care. Phase 3 (Feasibility Testing) involved pre- and post-intervention assessments of knowledge and self-efficacy using validated measures, completed by 106 care home staff. In addition, 14 post-intervention qualitative interviews were conducted to explore participants’ experiences with the tool. Quantitative data were analyzed using paired t-tests, and qualitative data were thematically analyzed.<br/><br/>Results:<br/><br/>Quantitative results demonstrated statistically significant improvements (p &lt; 0.01) in staff knowledge, self-efficacy, and confidence in managing HF following completion of the intervention. Nurses reported feeling more competent in recognizing symptom changes and communicating concerns. Thematic analysis of interviews revealed three core themes. First, “Learning” described participants’ increased understanding of HF and enhanced ability to identify deterioration. Second, “Doing” captured the application of this knowledge in everyday practice, particularly in monitoring, documentation, and interprofessional communication. Third, “Sharing” reflected a growing culture of knowledge exchange, where staff took the initiative to share the digital resource with peers, creating informal learning networks within the care home.<br/><br/>Conclusion:<br/><br/>This mixed-methods study provides evidence that a co-designed digital intervention can effectively improve care home staff’s HF knowledge, self-efficacy, and confidence. The integration of lived experience, clinical expertise, and staff perspectives ensured that the tool was relevant and usable in practice. Participants applied their learning directly to resident care and supported peer learning. These findings suggest the intervention has potential to enhance HF care quality in care home settings. Future studies should explore its long-term impact on resident outcomes and system-level implementation.<br/><br/>Keywords:<br/><br/>Care homes; Digital education; Heart failure; Mixed methods; Nursing staff