Co-designing a digital intervention to support care home staff managing heart failure in people living with dementia

Background:<br/>Heart failure frequently co-exists with dementia, affecting around one in five care home residents. This combination creates diagnostic and communication challenges, as symptoms of heart failure such as fatigue and confusion can be masked by dementia. Care home staff often have limited training or confidence to identify deterioration or respond appropriately. This study aimed to co-design and test a digital intervention to improve staff knowledge, confidence and person-centered practice when supporting people living with dementia who also have heart failure.<br/><br/>Methods:<br/>A mixed-methods study used an Accelerated Experience -Based Co-Design approach underpinned by implementation science principles drawn from the Theoretical Domains Framework and Normalization Process Theory. Phase one included a scoping review, seventeen qualitative interviews and a Delphi study with fifty-four care home nurses to identify key learning needs such as recognising atypical symptoms, improving communication and timely escalation. Phase two involved four co-design workshops with fifteen stakeholders including people living with dementia, carers, heart failure specialists and care home staff to create a digital learning resource tailored for dementia care. Phase three piloted the intervention in twelve care homes with 108 staff, using pre- and post-intervention measures of heart failure knowledge and self-efficacy alongside qualitative interviews to explore experiences of implementation.<br/><br/>Results:<br/><br/>Statistically significant improvements were observed in heart failure knowledge (p&lt;.001) and self-efficacy (p&lt;.001). Staff showed greater ability to recognise early and atypical symptoms in people with dementia, acted more confidently in escalating concerns, and reported positive changes to teamwork, communication, and reflective practice. Acceptability was high, with strong evidence of behavioural change and sustained learning.<br/><br/>Conclusion:<br/>This co-designed digital intervention improved knowledge, confidence and practice among care home staff supporting people living with dementia who have heart failure. Grounded in implementation science, the intervention shows promise for scalable, sustainable improvement in complex dementia care.