Digital training gave NHS facilitators a workable route into REACH-HF delivery
Digital training can prepare healthcare professionals to deliver a home-based cardiac rehabilitation programme for people with heart failure, but the strongest gains still came when clinicians had the chance to use the programme in practice. In a mixed-methods evaluation across five National Health Service cardiac rehabilitation services in England, investigators examined whether a co-designed hybrid training package could equip facilitators for delivery of the Rehabilitation Enablement in Chronic Heart Failure, or REACH-HF, programme and how closely real-world sessions matched the intended intervention.
The training combined self-paced modules on a bespoke eLearning platform with a 3-hour virtual group session. Fourteen of 15 recruited healthcare professionals completed the training, and seven later delivered REACH-HF. Fidelity analysis drew on 17 audio-recorded intervention sessions from six facilitators, while 11 professionals took part in semi-structured interviews.
Fidelity was strongest where the programme was most concrete
Across most REACH-HF components, delivery reached an adequate level of fidelity. The clearest strengths appeared in patient involvement, the physical activity programme and programme closure. Competent delivery was also seen in needs assessment, tailored planning, understanding of heart failure and progress monitoring. Those elements map closely to the practical spine of cardiac rehabilitation: helping patients understand their condition, setting realistic activity goals, tracking progress and bringing sessions to a structured close.
Some elements were less consistently delivered. Emotional support, medication-related discussions and active exploration of caregiver involvement scored lower. Caregiver emotion and well-being could not be meaningfully assessed because caregivers were present in too few sessions. In a programme built around home-based self-management, the absence of caregivers from many encounters matters because family support often shapes adherence, confidence and the day-to-day burden of living with chronic cardiac symptoms.
A single training package cannot fully substitute for the lived complexity of rehabilitation conversations.
Experience, not just course completion, shaped confidence
Facilitators generally described the digital training as usable and valuable. Its design allowed clinicians to work through content asynchronously, then consolidate learning during the virtual group session. Even so, engagement and preparedness were not uniform. Prior experience with rehabilitation, how relevant the material felt to a given service, and pressure on clinical time all influenced whether trainees could fully engage with the package.
One of the most important findings was the way confidence developed. Completion of the training did not automatically translate into delivery-ready competence. Confidence was consolidated mainly through real-world use of the programme, when clinicians had to apply the training to actual patient conversations, adapt to patient needs and manage the flow of a session. In other words, the training established the framework, but practice supplied the clinical muscle memory.
Non-delivery did not appear to arise from a consistent lack of confidence or preparedness. Instead, it reflected limited operational opportunity. Services needed protected time not only for training, but also for intervention delivery itself. Without that time, a capable facilitator may still remain on the sidelines.
Hybrid training may widen access, but implementation support remains the bottleneck
The appeal of digital training is obvious in a stretched service. A hybrid format can reduce the need for repeated face-to-face teaching sessions, making standardised training more scalable across geographically dispersed teams. For a programme such as REACH-HF, which depends on skilled facilitation rather than a simple protocol handout, that scalability is clinically important. If services can train more clinicians without waiting for in-person education slots, patient access to rehabilitation could improve.
Still, scalability does not guarantee consistency. The fidelity findings suggest that digital training can support delivery of the core REACH-HF structure, yet some of the more relational or nuanced elements of care were less secure. Emotional support, medication conversations and caregiver engagement require not only content knowledge, but also confidence, timing and the ability to respond to what unfolds in the room or on the call. Those features are harder to standardise through online modules alone.
The study also makes clear that implementation support has to extend beyond education. Timely opportunities to deliver the programme, organisational backing and protected time were all necessary to turn training into clinical activity. Without those supports, even a well-designed digital package may sit unused or only partially translated into routine practice.
What the evaluation can and cannot prove
This evaluation supports the feasibility and acceptability of co-designed digital training for REACH-HF facilitators and suggests that delivery fidelity was adequate across most programme components. It does not establish equivalence with face-to-face training. The fidelity dataset was also modest, with 17 recorded sessions from six facilitators, and caregiver-related components were difficult to assess because caregivers rarely attended.
Those limits matter when considering implementation at scale. The evidence base here is encouraging, but not yet complete enough to settle whether digital training performs as well as traditional methods across different service settings, different levels of clinician experience or a fuller range of patient and caregiver interactions. Larger studies with more complete fidelity data will need to test whether the pattern holds when the programme is delivered more widely and under less constrained conditions.
For now, the practical message is straightforward: digital training can prepare clinicians to deliver REACH-HF, but the training only becomes clinically meaningful when services make room for delivery, supervision and repeated use in routine care.