Empowering Singaporeans to better manage chronic heart failure: Protocol for a mixed-methods study
- 1Duke-NUS Medical School
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.
Methods 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.
Ethics 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.
Registration detailsPROSPERO registration number: CRD420251249957; http://www.crd.york.ac.uk/PROSPERO
ARTICLE 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
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BibTeX
@misc{bairavee2026empowering,
title = {{Empowering Singaporeans to better manage chronic heart failure: Protocol for a mixed-methods study}},
author = {B. Bairavee and Y. Wang and D. Kanna Ravi and A. Lee Shan Yin and R. Ching Chiew Wong and S. Y. Loh and N. Graves and S. Sung and S. Yoon and D. J. Hausenloy and L. L. Low and K.-K. Yeo and K. L. D. Sim and Y. Zhang and S. Kularatna and S. Senanayake},
howpublished = {medRxiv},
year = {2026},
month = jul,
doi = {10.64898/2026.07.09.26357623},
url = {https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2},
note = {CC BY},
}
RIS
TY - UNPB
TI - Empowering Singaporeans to better manage chronic heart failure: Protocol for a mixed-methods study
AU - B. Bairavee
AU - Y. Wang
AU - D. Kanna Ravi
AU - A. Lee Shan Yin
AU - R. Ching Chiew Wong
AU - S. Y. Loh
AU - N. Graves
AU - S. Sung
AU - S. Yoon
AU - D. J. Hausenloy
AU - L. L. Low
AU - K.-K. Yeo
AU - K. L. D. Sim
AU - Y. Zhang
AU - S. Kularatna
AU - S. Senanayake
PY - 2026
DA - 2026/07/09
PB - medRxiv
DO - 10.64898/2026.07.09.26357623
UR - https://www.medrxiv.org/content/10.64898/2026.07.09.26357623v2
AB - 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. Methods 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. Ethics 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. Registration detailsPROSPERO registration number: CRD420251249957; http://www.crd.york.ac.uk/PROSPERO ARTICLE 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
ER -