Navigating life with heart failure: Patient and caregiver perspectives of the culturally adapted Educate, Nurture, Advise, Before Life Ends health coaching programme

Background: Heart failure (HF) imposes substantial physical, psychological, and social burdens on patients and caregivers. While the Educate, Nurture, Advise, Before Life Ends (ENABLE) programme has demonstrated potential benefits for HF populations, existing scholarship has yet to clarify how and to what extent health coaching interventions like ENABLE meet the expectations and needs of patients with HF and their caregivers. Objectives: To explore the experiences of patients with HF and caregivers who participated in a culturally adapted ENABLE programme in Singapore and to identify perceived benefits and persisting gaps to inform the design of future health coaching interventions. Design: A qualitative study involving in-depth individual or dyadic interviews with patients and caregivers who completed the ENABLE programme at the National Heart Centre Singapore (NHCS). Methods: Participants were drawn from a wait-list randomised controlled trial of ENABLE at NHCS. Purposive sampling ensured diversity in age, illness severity, and study arm. Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke's reflexive thematic analysis approach. Results: Fourteen participants were interviewed. They described initial disorientation arising from unmet informational needs and uncertainty about how to live meaningfully with HF. Health coaching mitigated this by providing personalised information and consistent access to professional support, fostering a sense of control and security. Nonetheless, participants expressed a need for more concrete lifestyle guidance and emotional support, noting that education alone was insufficient to address psychological and existential distress. Some struggled to reconcile hope for recovery with awareness of decline and mortality. Conclusion: The ENABLE programme reduced disorientation and enhanced reassurance through personalised and relational support. Future interventions should integrate actionable self-management guidance with psychosocial and existential support to address the intertwined informational, emotional, and meaning-related needs of people living with HF. Trial registration: ClinicalTrials.gov Identifier: NCT05211882.