{
  "abstract": "IntroductionThe prevalence of chronic heart failure is increasing in Singapore and is associated with frequent hospitalisations, high costs, and impaired quality of life. Patient empowerment interventions for chronic diseases, which are structured approaches that enable patients to actively engage in and influence their care, have demonstrated promising effects on health-related outcomes. In chronic heart failure, however, many interventions focus on selected aspects of empowerment, and there remains limited synthesis of which approaches are most acceptable, preferred, and effective as comprehensive intervention packages. This protocol describes the methods for a study to identify an empowerment-based intervention for adults with chronic heart failure that is both contextually suitable and cost-effective in Singapore.\n\nMethods and analysisWe will use a staged, sequential design comprising three objectives. Objective one is to conduct a systematic review and meta-analysis to synthesise international evidence of the effectiveness of empowerment-based interventions for adults with chronic heart failure. Objective two is to complete a mixed-methods study. Semi-structured interviews with patients and their caregivers, analysed using codebook thematic analysis, will identify empowerment-related needs, barriers and facilitators in local chronic heart failure care. Findings from the review and interviews will then inform a discrete choice experiment to elicit patients preferences for features of an empowerment-based intervention, analysed using multinomial logit and latent class models. Objective three is to conduct a cost-effectiveness analysis of the selected intervention compared with usual care, using a decision tree and Markov model from the perspective of the Singapore health system.\n\nEthics and disseminationEthics approval for the qualitative study has been obtained from the SingHealth Centralised Institutional Review Board (ECOS Ref: 2025-1152); ethics approval for the discrete choice experiment will be sought prior to recruitment. Findings will be disseminated through peer-reviewed publications and conference presentations.\n\nRegistration detailsPROSPERO registration number: CRD420251249957; http://www.crd.york.ac.uk/PROSPERO\n\nARTICLE SUMMARYO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThe staged, sequential design integrates a systematic review, qualitative interviews, a discrete choice experiment and a cost-effectiveness analysis, with each component informing the next, combining international evidence with local stakeholder perspectives and patient preferences to inform a feasible, patient-centred intervention. C_LIO_LIInterviews with patients and caregivers across three institutions, offered in four languages and using purposive sampling by age, sex, language and socioeconomic status, aim to capture diverse local experiences of empowerment. C_LIO_LIOlder adults and those with limited digital literacy may be under-represented or find the online discrete choice experiment difficult to complete, introducing potential selection bias and measurement error. C_LIO_LIIntervention uptake and adherence in the cost-effectiveness model will be based on stated rather than observed preferences, and effectiveness will be informed by existing evidence rather than a locally conducted trial. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Duke-NUS Medical School"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "name": "B. Bairavee"
    },
    {
      "name": "Y. Wang"
    },
    {
      "name": "D. Kanna Ravi"
    },
    {
      "name": "A. Lee Shan Yin"
    },
    {
      "name": "R. Ching Chiew Wong"
    },
    {
      "name": "S. Y. Loh"
    },
    {
      "name": "N. Graves"
    },
    {
      "name": "S. Sung"
    },
    {
      "name": "S. Yoon"
    },
    {
      "name": "D. J. Hausenloy"
    },
    {
      "name": "L. L. Low"
    },
    {
      "name": "K.-K. Yeo"
    },
    {
      "name": "K. L. D. Sim"
    },
    {
      "name": "Y. Zhang"
    },
    {
      "name": "S. Kularatna"
    },
    {
      "affs": [
        0
      ],
      "name": "S. Senanayake"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1ckb5xdy23rdc.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.09.26357623",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2.full",
  "id": "1ckb5xdy23rdc",
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  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "health systems and quality improvement"
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    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7168126844",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-09",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1ckb5xdy23rdc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:49Z",
      "native_id": "10.64898/2026.07.09.26357623",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:health systems and quality improvement",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Empowering Singaporeans to better manage chronic heart failure: Protocol for a mixed-methods study",
  "title_text": "Empowering Singaporeans to better manage chronic heart failure: Protocol for a mixed-methods study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:49Z",
  "url": "https://research.draconitic.com/paper/1ckb5xdy23rdc",
  "venue": "medRxiv",
  "versions": []
}