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Yardley L, Morton K, Greenwell K, Stuart B, Rice C, Bradbury K, Ainsworth B, Band R, Murray E, Mair F, May C, Michie S, Richards-Hall S, Smith P, Bruton A, Raftery J, Zhu S, Thomas M, McManus RJ, Little P. Digital interventions for hypertension and asthma to support patient self-management in primary care: the DIPSS research programme including two RCTs. PROGRAMME GRANTS FOR APPLIED RESEARCH 2022. [DOI: 10.3310/bwfi7321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background
Digital interventions offer a potentially cost-effective means to support patient self-management in primary care, but evidence for the feasibility, acceptability and cost-effectiveness of digital interventions remains mixed. This programme focused on the potential for self-management digital interventions to improve outcomes in two common, contrasting conditions (i.e. hypertension and asthma) for which care is currently suboptimal, leading to excess deaths, illness, disability and costs for the NHS.
Objectives
The overall purpose was to address the question of how digital interventions can best provide cost-effective support for patient self-management in primary care. Our aims were to develop and trial digital interventions to support patient self-management of hypertension and asthma. Through the process of planning, developing and evaluating these interventions, we also aimed to generate a better understanding of what features and methods for implementing digital interventions could make digital interventions acceptable, feasible, effective and cost-effective to integrate into primary care.
Design
For the hypertension strand, we carried out systematic reviews of quantitative and qualitative evidence, intervention planning, development and optimisation, and an unmasked randomised controlled trial comparing digital intervention with usual care, with a health economic analysis and nested process evaluation. For the asthma strand, we carried out a systematic review of quantitative evidence, intervention planning, development and optimisation, and a feasibility randomised controlled trial comparing digital intervention with usual care, with nested process evaluation.
Setting
General practices (hypertension, n = 76; asthma, n = 7) across Wessex and Thames Valley regions in Southern England.
Participants
For the hypertension strand, people with uncontrolled hypertension taking one, two or three antihypertensive medications. For the asthma strand, adults with asthma and impaired asthma-related quality of life.
Interventions
Our hypertension intervention (i.e. HOME BP) was a digital intervention that included motivational training for patients to self-monitor blood pressure, as well as health-care professionals to support self-management; a digital interface to send monthly readings to the health-care professional and to prompt planned medication changes when patients’ readings exceeded recommended targets for 2 consecutive months; and support for optional patient healthy behaviour change (e.g. healthy diet/weight loss, increased physical activity and reduced alcohol and salt consumption). The control group were provided with a Blood Pressure UK (London, UK) leaflet for hypertension and received routine hypertension care. Our asthma intervention (i.e. My Breathing Matters) was a digital intervention to improve the functional quality of life of primary care patients with asthma by supporting illness self-management. Motivational content intended to facilitate use of pharmacological self-management strategies (e.g. medication adherence and appropriate health-care service use) and non-pharmacological self-management strategies (e.g. breathing retraining, stress reduction and healthy behaviour change). The control group were given an Asthma UK (London, UK) information booklet on asthma self-management and received routine asthma care.
Main outcome measures
The primary outcome for the hypertension randomised controlled trial was difference between intervention and usual-care groups in mean systolic blood pressure (mmHg) at 12 months, adjusted for baseline blood pressure, blood pressure target (i.e. standard, diabetic or aged > 80 years), age and general practice. The primary outcome for the asthma feasibility study was the feasibility of the trial design, including recruitment, adherence, intervention engagement and retention at follow-up. Health-care utilisation data were collected via notes review.
Review methods
The quantitative reviews included a meta-analysis. The qualitative review comprised a meta-ethnography.
Results
A total of 622 hypertensive patients were recruited to the randomised controlled trial, and 552 (89%) were followed up at 12 months. Systolic blood pressure was significantly lower in the intervention group at 12 months, with a difference of –3.4 mmHg (95% confidence interval –6.1 to –0.8 mmHg), and this gave an incremental cost per unit of systolic blood pressure reduction of £11 (95% confidence interval £5 to £29). Owing to a cost difference of £402 and a quality-adjusted life-year (QALY) difference of 0.044, long-term modelling puts the incremental cost per QALY at just over £9000. The probability of being cost-effective was 66% at willingness to pay £20,000 per quality-adjusted life-year, and this was higher at higher thresholds. A total of 88 patients were recruited to the asthma feasibility trial (target n = 80; n = 44 in each arm). At 3-month follow-up, two patients withdrew and six patients did not complete outcome measures. At 12 months, two patients withdrew and four patients did not complete outcome measures. A total of 36 out of 44 patients in the intervention group engaged with My Breathing Matters [with a median of four (range 0–25) logins].
Limitations
Although the interventions were designed to be as accessible as was feasible, most trial participants were white and participants of lower socioeconomic status were less likely to take part and complete follow-up measures. Challenges remain in terms of integrating digital interventions with clinical records.
Conclusions
A digital intervention using self-monitored blood pressure to inform medication titration led to significantly lower blood pressure in participants than usual care. The observed reduction in blood pressure would be expected to lead to a reduction of 10–15% in patients suffering a stroke. The feasibility trial of My Breathing Matters suggests that a fully powered randomised controlled trial of the intervention is warranted. The theory-, evidence- and person-based approaches to intervention development refined through this programme enabled us to identify and address important contextual barriers to and facilitators of engagement with the interventions.
Future work
This research justifies consideration of further implementation of the hypertension intervention, a fully powered randomised controlled trial of the asthma intervention and wide dissemination of our methods for intervention development. Our interventions can also be adapted for a range of other health conditions.
Trial and study registration
The trials are registered as ISRCTN13790648 (hypertension) and ISRCTN15698435 (asthma). The studies are registered as PROSPERO CRD42013004773 (hypertension review) and PROSPERO CRD42014013455 (asthma review).
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 11. See the NIHR Journals Library website for further information.
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Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Kate Morton
- School of Psychology, University of Southampton, Southampton, UK
| | - Kate Greenwell
- School of Psychology, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Cathy Rice
- Patient and public involvement contributor, UK
| | | | - Ben Ainsworth
- School of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Band
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Elizabeth Murray
- Primary Care and Population Health, University College London, London, UK
| | - Frances Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Susan Michie
- Centre for Behaviour Change, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Peter Smith
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Anne Bruton
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mike Thomas
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Williamson S, Dennison L, Greenwell K, Denison-Day J, Mowbray F, Richards-Hall S, Smith D, Bradbury K, Ainsworth B, Little P, Geraghty AWA, Yardley L. Using nasal sprays to prevent respiratory tract infections: a qualitative study of online consumer reviews and primary care patient interviews. BMJ Open 2022; 12:e059661. [PMID: 35772824 PMCID: PMC9247325 DOI: 10.1136/bmjopen-2021-059661] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Nasal sprays could be a promising approach to preventing respiratory tract infections (RTIs). This study explored lay people's perceptions and experiences of using nasal sprays to prevent RTIs to identify barriers and facilitators to their adoption and continued use. DESIGN Qualitative research. Study 1 thematically analysed online consumer reviews of an RTI prevention nasal spray. Study 2 interviewed patients about their reactions to and experiences of a digital intervention that promotes and supports nasal spray use for RTI prevention (reactively: at 'first signs' of infection and preventatively: following possible/probable exposure to infection). Interview transcripts were analysed using thematic analysis. SETTING Primary care, UK. PARTICIPANTS 407 online customer reviews. 13 purposively recruited primary care patients who had experienced recurrent infections and/or had risk factors for severe infections. RESULTS Both studies identified various factors that might influence nasal spray use including: high motivation to avoid RTIs, particularly during the COVID-19 pandemic; fatalistic views about RTIs; beliefs about alternative prevention methods; the importance of personal recommendation; perceived complexity and familiarity of nasal sprays; personal experiences of spray success or failure; tolerable and off-putting side effects; concerns about medicines; and the nose as unpleasant and unhygienic. CONCLUSIONS People who suffer disruptive, frequent or severe RTIs or who are vulnerable to RTIs are interested in using a nasal spray for prevention. They also have doubts and concerns and may encounter problems. Some of these may be reduced or eliminated by providing nasal spray users with information and advice that addresses these concerns or helps people overcome difficulties.
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Affiliation(s)
- Sian Williamson
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Laura Dennison
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Samantha Richards-Hall
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Deb Smith
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Ben Ainsworth
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Paul Little
- Primary Care and Population Science, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- Primary Care and Population Science, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Health Sciences, University of Bristol, Bristol, UK
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Alqahtani JS, Aldhahir AM, AlRabeeah SM, Alsenani LB, Alsharif HM, Alshehri AY, Alenazi MM, Alnasser M, Alqahtani AS, AlDraiwiesh IA, Alghamdi SM, Siraj RA, Alqahtani HS, Sreedharan JK, Alqahtani AS, Alzahrani EM. Future Acceptability of Respiratory Virus Infection Control Interventions in General Population to Prevent Respiratory Infections. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58070838. [PMID: 35888557 PMCID: PMC9318605 DOI: 10.3390/medicina58070838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 12/23/2022]
Abstract
Background and Objectives: In both pandemic and non-pandemic situations, nonpharmaceutical public health measures may offer easy, low-cost, and effective means of reducing the spread and impact of acute respiratory infections. It is unknown whether such measures would be acceptable to the Saudi community beyond the current pandemic. Materials and Methods: A validated survey was used to test community acceptance of the measures. Respondents were asked which infection control practices they planned to maintain and which they believed should be policies for the community as a whole after the COVID-19 pandemic has subsided. Results: The survey was completed by 2057 people (95% completion rate), 1486 (72%) of whom were female, 259 (12.5%) of whom were current smokers, and 72 (3.5%) of whom had chronic lung disease. The most prevalent age groups were 18−30 years (933; 45.4%) and 31−40 years (483; 23.5%), with 641 individuals over 40 years old. Of the responses, 93% indicated that they would continue washing their hands more often; 92% wanted both clinicians and patients to wear masks in hospitals; 86% would continue avoiding smoking in indoor and outdoor areas; 73% would continue wearing a face covering on public transportation; 70% indicated that they would continue wearing a face covering in indoor public places. Regarding the respiratory virus infection control measures, 85% (11/13) received significant support (≥70% acceptability level) for continuation as policies in the future. Wearing face coverings outdoors and social distancing outdoors received little support (45% and 66%, respectively). Of the respiratory virus infection control measures, 54% received less support from current smokers than non-smokers (acceptability level < 70%). People with chronic respiratory disease supported 77% of the measures being regarded as policies in the future. Conclusion: The Saudi community supports nonpharmacological respiratory infection control measures that reduce the likelihood of infection. Public health campaigns should target smokers to increase awareness of the importance of these measures in lowering infections. Based on the findings of this study, nonpharmacological treatments should be presented and included in future recommendations for both the public and patients diagnosed with chronic respiratory diseases.
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Affiliation(s)
- Jaber S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
- Correspondence: (J.S.A.); (S.M.A.)
| | - Abdulelah M. Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
| | - Saad M. AlRabeeah
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
- Correspondence: (J.S.A.); (S.M.A.)
| | - Lujain B. Alsenani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Haifa M. Alsharif
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Amani Y. Alshehri
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Mayadah M. Alenazi
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Musallam Alnasser
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Ahmed S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Ibrahim A. AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Saeed M. Alghamdi
- Clinical Technology Department, Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia;
- National Heart and Lung Institute, Imperial College London, London SW7 2BX, UK
| | - Rayan A. Siraj
- Respiratory Therapy Department, King Faisal University, Al-Ahsa 31982, Saudi Arabia;
| | - Hussain S. Alqahtani
- Department of Clinical Laboratory Sciences, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia;
| | - Jithin K. Sreedharan
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Abdullah S. Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia; (L.B.A.); (H.M.A.); (A.Y.A.); (M.M.A.); (M.A.); (A.S.A.); (I.A.A.); (J.K.S.); (A.S.A.)
| | - Eidan M. Alzahrani
- Physical Therapy Department, Prince Sultan Military College of Health Sciences, Dammam 34313, Saudi Arabia;
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Dennison L, Williamson S, Greenwell K, Handcock M, Bradbury K, Vennik J, Yardley L, Little P, Geraghty AWA. Patient perceptions of vulnerability to recurrent respiratory tract infections and prevention strategies: a qualitative study. BMJ Open 2022; 12:e055565. [PMID: 35443952 PMCID: PMC9021765 DOI: 10.1136/bmjopen-2021-055565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Respiratory tract infections (RTIs) are extremely common, usually self-limiting, but responsible for considerable work sickness absence, reduced quality of life, inappropriate antibiotic prescribing and healthcare costs. Patients who experience recurrent RTIs and those with certain comorbid conditions have higher personal impact and healthcare costs and may be more likely to suffer disease exacerbations, hospitalisation and death. We explored how these patients experience and perceive their RTIs to understand how best to engage them in prevention behaviours. DESIGN A qualitative interview study. SETTING Primary care, UK. METHODS 23 participants who reported recurrent RTIs and/or had relevant comorbid health conditions were interviewed about their experiences of RTIs. Interviews took place as the COVID-19 pandemic began. Data were analysed using inductive thematic analysis. RESULTS Three themes were developed: Understanding causes and vulnerability, Attempting to prevent RTIs, Uncertainty and ambivalence about prevention, along with an overarching theme; Changing experiences because of COVID-19. Participants' understandings of their susceptibility to RTIs were multifactorial and included both transmission via others and personal vulnerabilities. They engaged in various approaches to try to prevent infections or alter their progression yet perceived they had limited personal control. The COVID-19 pandemic had improved their understanding of transmission, heightened their concern and motivation to avoid RTIs and extended their repertoire of protective behaviours. CONCLUSIONS Patients who experience frequent or severe RTIs are likely to welcome and benefit from advice and support regarding RTI prevention. To engage people effectively, those developing interventions or delivering health services must consider their beliefs and concerns about susceptibility and prevention.
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Affiliation(s)
- Laura Dennison
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sian Williamson
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Molly Handcock
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- NIHR Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Jane Vennik
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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Morton K, Towler L, Groot J, Miller S, Ainsworth B, Denison-Day J, Rice C, Bostock J, Willcox M, Little P, Yardley L. Infection control in the home: a qualitative study exploring perceptions and experiences of adhering to protective behaviours in the home during the COVID-19 pandemic. BMJ Open 2021; 11:e056161. [PMID: 34853116 PMCID: PMC8637310 DOI: 10.1136/bmjopen-2021-056161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES We sought to explore people's experiences and perceptions of implementing infection control behaviours in the home during the COVID-19 pandemic, guided by an online behavioural intervention. DESIGN Inductive qualitative study. SETTING UK public during the COVID-19 pandemic. PARTICIPANTS Thirteen people took part in telephone interviews, and 124 completed a qualitative open-text survey. All were recruited from the public. Most survey participants were aged over 60 years, while interview participants were more distributed in age. Most reported being at increased risk from COVID-19, and were white British. INTERVENTION Online behavioural intervention to support infection control behaviours in the home during the COVID-19 pandemic. DATA COLLECTION Telephone think-aloud interviews and qualitative survey data. DATA ANALYSIS The think-aloud interview data and qualitative survey data were analysed independently using inductive thematic analysis. The findings were subsequently triangulated. RESULTS Thematic analysis of the telephone interviews generated seven themes: perceived risk; belief in the effectiveness of protective behaviours; acceptability of distancing and isolation; having capacity to perform the behaviours; habit forming reduces effort; having the confidence to perform the behaviours; and social norms affect motivation to engage in the behaviours. The themes identified from the survey data mapped well onto the interview analysis. Isolating and social distancing at home were less acceptable than cleaning and handwashing, influenced by the need for intimacy with household members. This was especially true in the absence of symptoms and when perceived risk was low. People felt more empowered when they understood that even small changes, such as spending some time apart, were worthwhile to reduce exposure and lessen viral load. CONCLUSIONS The current study provided valuable insight into the acceptability and feasibility of protective behaviours, and how public health guidance could be incorporated into a behaviour change intervention for the public during a pandemic.
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Affiliation(s)
- Katherine Morton
- School of Psychology, University of Southampton, Southampton, Hants, UK
| | - Lauren Towler
- School of Psychology, University of Southampton, Southampton, Hants, UK
| | - Julia Groot
- Department of Psychology, University of Bath, Bath, UK
| | - Sascha Miller
- School of Psychology, University of Southampton, Southampton, Hants, UK
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, UK
- NIHR Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - James Denison-Day
- School of Psychology, University of Southampton, Southampton, Hants, UK
| | - Cathy Rice
- The Quality Safety and Outcomes Policy Research Unit, University of Kent, Canterbury, UK
| | - Jennifer Bostock
- The Quality Safety and Outcomes Policy Research Unit, University of Kent, Canterbury, UK
| | - Merlin Willcox
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, Hants, UK
- School of Psychological Science, University of Bristol, Bristol, UK
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Peterson LM, Helweg-Larsen M, DiMuccio S. Descriptive Norms and Prototypes Predict COVID-19 Prevention Cognitions and Behaviors in the United States: Applying the Prototype Willingness Model to Pandemic Mitigation. Ann Behav Med 2021; 55:1089-1103. [PMID: 34487142 PMCID: PMC8499892 DOI: 10.1093/abm/kaab075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, prevention behavior adoption occurred in a rapidly changing context. In contrast to expectancy-value theories, the Prototype Willingness Model (PWM) is well-suited for investigating novel and socially informed behaviors. PURPOSE We explored whether PWM social cognitions predicted coronavirus prevention behaviors. METHOD A representative sample of United States adults (N = 738; Mage = 46.8; 51.8% women; 78% white; April 2020) who had not had COVID-19 reported PWM predictor variables (perceived vulnerability, prevention descriptive norms, prototypes engaging in prevention behavior, and prevention behavioral intentions). Two weeks later, participants reported their prevention behaviors (handwashing, mask-wearing, social distancing, etc.) and future public health behavioral willingness (contact tracing, temperature checks, etc.). RESULTS Controlling for putative demographic, past behavior, and coronavirus-contextual (e.g., local infection rates) covariates, mediation models indicated that higher norms and favorable prototypes were associated with greater prevention behavioral intentions, which in turn predicted increased prevention behavior, F(18, 705) = 92.20, p < .001, R2 = .70. Higher norms and favorable prototypes associated both directly and indirectly (through greater prevention behavioral intention) with greater willingness to engage in emerging public health behaviors, F(15, 715) = 21.49, p < .001, R2 = .31. CONCLUSIONS Greater descriptive norms and favorable prototypes for prevention behavior predicted: (a) future prevention behaviors through increases in behavioral intentions and (b) willingness to participate in emerging public health behaviors. These results held across demographic groups, political affiliation, and severity of regional outbreaks. Public health efforts to curb pandemics should highlight normative prevention participation and enhance positive prototypes.
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Miller S, Ainsworth B, Weal M, Smith P, Little P, Yardley L, Morrison L. A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination. J Med Internet Res 2021; 23:e26104. [PMID: 34519661 PMCID: PMC8494071 DOI: 10.2196/26104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background Washing hands helps prevent transmission of seasonal and pandemic respiratory viruses. In a randomized controlled trial (RCT) during the swine flu outbreak, participants with access to a fully automated, digital intervention promoting handwashing reported washing their hands more often and experienced fewer respiratory tract infections than those without access to the intervention. Based on these findings, the intervention was adapted, renamed as “Germ Defence,” and a study was designed to assess the preliminary dissemination of the intervention to the general public to help prevent the spread of seasonal colds and flu. Objective This study compares the process evaluations of the RCT and Germ Defence dissemination to examine (1) how web-based research enrollment procedures affected those who used the intervention, (2) intervention usage in the 2 contexts, and (3) whether increased intentions to wash hands are replicated once disseminated. Methods The RCT ran between 2010 and 2012 recruiting participants offline from general practices, with restricted access to the intervention (N=9155). Germ Defence was disseminated as an open access website for use by the general public from 2016 to 2019 (N=624). The process evaluation plan was developed using Medical Research Council guidance and the framework for Analyzing and Measuring Usage and Engagement Data. Both interventions contained a goal-setting section where users self-reported current and intended handwashing behavior across 7 situations. Results During web-based enrolment, 54.3% (17,511/32,250) of the RCT participants dropped out of the study compared to 36.5% (358/982) of Germ Defence users. Having reached the start of the intervention, 93.8% (8586/9155) of RCT users completed the core section, whereas 65.1% (406/624) of Germ Defence users reached the same point. Users across both studies selected to increase their handwashing in 5 out of 7 situations, including before eating snacks (RCT mean difference 1.040, 95% CI 1.016-1.063; Germ Defence mean difference 0.949, 95% CI 0.766-1.132) and after blowing their nose, sneezing, or coughing (RCT mean difference 0.995, 95% CI 0.972-1.019; Germ Defence mean difference 0.842, 95% CI 0.675-1.008). Conclusions By comparing the preliminary dissemination of Germ Defence to the RCT, we were able to examine the potential effects of the research procedures on uptake and attrition such as the sizeable dropout during the RCT enrolment procedure that may have led to a more motivated sample. The Germ Defence study highlighted the points of attrition within the intervention. Despite sample bias in the trial context, the intervention replicated increases in intentions to handwash when used “in the wild.” This preliminary dissemination study informed the adaptation of the intervention for the COVID-19 health emergency, and it has now been disseminated globally. Trial Registration ISRCTN Registry ISRCTN75058295; https://www.isrctn.com/ISRCTN75058295
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Affiliation(s)
- Sascha Miller
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ben Ainsworth
- Bath Centre for Mindfulness and Compassion, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Mark Weal
- Web and Internet Science Group, Electronics and Computer Science, University of Southampton, Southampton, United Kingdom
| | - Peter Smith
- Department of Social Statistics and Demography, School of Economic, Social and Political Scientces, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care and Population Sciences, School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.,Centre for Academic Primary Care, School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Leanne Morrison
- Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Southampton, United Kingdom.,Primary Care and Population Sciences, School of Medicine, University of Southampton, Southampton, United Kingdom
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Jadil Y, Ouzir M. Exploring the predictors of health-protective behavior during the COVID-19 pandemic: A multi-country comparison. ENVIRONMENTAL RESEARCH 2021; 199:111376. [PMID: 34043969 PMCID: PMC9750228 DOI: 10.1016/j.envres.2021.111376] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/19/2021] [Accepted: 05/19/2021] [Indexed: 05/24/2023]
Abstract
In recent years, examining the determinants of health behaviors on a multi-country level remains limited. Therefore, the purpose of this study is to explore the key factors that may enhance the adoption of health-protective behaviors during the COVID-19 pandemic in Morocco and India. A theoretical framework derived from the health belief model (HBM) was used for this research. Data was collected from a sample of 444 adult individuals split across Morocco (n = 215) and India (n = 229). Data analysis was carried out using two-stage multiple-analytic techniques. First, structural equation modeling (SEM) was employed to test the hypothesized relationships. Second, an artificial neural network (ANN) model was employed to rank the significant independent variables obtained from SEM analysis. The results of SEM showed that perceived benefit is the key predictor of the protective behavior in Morocco, followed by self-efficacy, and then perceived severity. By contrast, ANN analysis showed that perceived severity was the most vital factor for predicting the protective behavior in Morocco, followed by perceived benefits, and then self-efficacy. For the Indian sample, both SEM analysis and the ANN model revealed that the impact of perceived susceptibility on the adoption of the protective measure is stronger than that of cues to action. Theoretical contributions and managerial implications are also discussed toward the end.
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Affiliation(s)
| | - Mounir Ouzir
- Faculty of Science, University Mohammed V, Rabat, Morocco.
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9
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Morton K, Ainsworth B, Miller S, Rice C, Bostock J, Denison-Day J, Towler L, Groot J, Moore M, Willcox M, Chadborn T, Amlot R, Gold N, Little P, Yardley L. Adapting Behavioral Interventions for a Changing Public Health Context: A Worked Example of Implementing a Digital Intervention During a Global Pandemic Using Rapid Optimisation Methods. Front Public Health 2021; 9:668197. [PMID: 33981669 PMCID: PMC8109268 DOI: 10.3389/fpubh.2021.668197] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background: A rigorous approach is needed to inform rapid adaptation and optimisation of behavioral interventions in evolving public health contexts, such as the Covid-19 pandemic. This helps ensure that interventions are relevant, persuasive, and feasible while remaining evidence-based. This paper provides a set of iterative methods to rapidly adapt and optimize an intervention during implementation. These methods are demonstrated through the example of optimizing an effective online handwashing intervention called Germ Defense. Methods: Three revised versions of the intervention were rapidly optimized and launched within short timeframes of 1-2 months. Optimisations were informed by: regular stakeholder engagement; emerging scientific evidence, and changing government guidance; rapid qualitative research (telephone think-aloud interviews and open-text surveys), and analyses of usage data. All feedback was rapidly collated, using the Table of Changes method from the Person-Based Approach to prioritize potential optimisations in terms of their likely impact on behavior change. Written feedback from stakeholders on each new iteration of the intervention also informed specific optimisations of the content. Results: Working closely with clinical stakeholders ensured that the intervention was clinically accurate, for example, confirming that information about transmission and exposure was consistent with evidence. Patient and Public Involvement (PPI) contributors identified important clarifications to intervention content, such as whether Covid-19 can be transmitted via air as well as surfaces, and ensured that information about difficult behaviors (such as self-isolation) was supportive and feasible. Iterative updates were made in line with emerging evidence, including changes to the information about face-coverings and opening windows. Qualitative research provided insights into barriers to engaging with the intervention and target behaviors, with open-text surveys providing a useful supplement to detailed think-aloud interviews. Usage data helped identify common points of disengagement, which guided decisions about optimisations. The Table of Changes was modified to facilitate rapid collation and prioritization of multiple sources of feedback to inform optimisations. Engagement with PPI informed the optimisation process. Conclusions: Rapid optimisation methods of this kind may in future be used to help improve the speed and efficiency of adaptation, optimization, and implementation of interventions, in line with calls for more rapid, pragmatic health research methods.
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Affiliation(s)
- Katherine Morton
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Ben Ainsworth
- Department of Psychology, University of Bath, Bath, United Kingdom
- NIHR Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sascha Miller
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Cathy Rice
- Public Contributor, Bristol, United Kingdom
| | - Jennifer Bostock
- Public Contributor, London, United Kingdom
- Quality Safety & Outcomes Policy Research Unit, University of Kent & Oxford, Kent, United Kingdom
| | - James Denison-Day
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Lauren Towler
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Julia Groot
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Michael Moore
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Merlin Willcox
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Tim Chadborn
- Public Health England Behavioural Insights, Public Health England, London, United Kingdom
| | - Richard Amlot
- Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, London, United Kingdom
| | - Natalie Gold
- Public Health England Behavioural Insights, Public Health England, London, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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10
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Ainsworth B, Miller S, Denison-Day J, Stuart B, Groot J, Rice C, Bostock J, Hu XY, Morton K, Towler L, Moore M, Willcox M, Chadborn T, Gold N, Amlôt R, Little P, Yardley L. Infection Control Behavior at Home During the COVID-19 Pandemic: Observational Study of a Web-Based Behavioral Intervention (Germ Defence). J Med Internet Res 2021; 23:e22197. [PMID: 33566791 PMCID: PMC7909304 DOI: 10.2196/22197] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 12/15/2020] [Accepted: 01/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To control the COVID-19 pandemic, people should adopt protective behaviors at home (self-isolation, social distancing, putting shopping and packages aside, wearing face coverings, cleaning and disinfecting, and handwashing). There is currently limited support to help individuals conduct these behaviors. OBJECTIVE This study aims to report current household infection control behaviors in the United Kingdom and examine how they might be improved. METHODS This was a pragmatic cross-sectional observational study of anonymous participant data from Germ Defence between May 6-24, 2020. Germ Defence is an open-access fully automated website providing behavioral advice for infection control within households. A total of 28,285 users sought advice from four website pathways based on household status (advice to protect themselves generally, to protect others if the user was showing symptoms, to protect themselves if household members were showing symptoms, and to protect a household member who is at high risk). Users reported current infection control behaviors within the home and intentions to change these behaviors. RESULTS Current behaviors varied across all infection control measures but were between sometimes (face covering: mean 1.61, SD 1.19; social distancing: mean 2.40, SD 1.22; isolating: mean 2.78, SD 1.29; putting packages and shopping aside: mean 2.75, SD 1.55) and quite often (cleaning and disinfecting: mean 3.17, SD 1.18), except for handwashing (very often: mean 4.00, SD 1.03). Behaviors were similar regardless of the website pathway used. After using Germ Defence, users recorded intentions to improve infection control behavior across all website pathways and for all behaviors (overall average infection control score mean difference 0.30, 95% CI 0.29-0.31). CONCLUSIONS Self-reported infection control behaviors other than handwashing are lower than is optimal for infection prevention, although handwashing is much higher. Advice using behavior change techniques in Germ Defence led to intentions to improve these behaviors. Promoting Germ Defence within national and local public health and primary care guidance could reduce COVID-19 transmission.
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Affiliation(s)
- Ben Ainsworth
- Department of Psychology, University of Bath, Bath, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Sascha Miller
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - James Denison-Day
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Julia Groot
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Cathy Rice
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Jennifer Bostock
- Policy Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Xiao-Yang Hu
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Katherine Morton
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Lauren Towler
- School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Michael Moore
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Merlin Willcox
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Tim Chadborn
- Public Health England Behavioural Insights, Public Health England, London, United Kingdom
| | - Natalie Gold
- Public Health England Behavioural Insights, Public Health England, London, United Kingdom
- Centre for the Philosophy of Natural and Social Sciences, London School of Economics, London, United Kingdom
| | - Richard Amlôt
- Behavioural Science Team, Emergency Response Department Science and Technology, Public Health England, London, United Kingdom
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, United Kingdom
- School of Psychological Science, University of Bristol, Bristol, United Kingdom
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11
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Hashem F, Stephensen D, Drechsler WI, Bladen M, Carroll L, Tracy P, Saloniki E. Muscle strengthening intervention for boys with haemophilia: Developing and evaluating a best-practice exercise programme with boys, families and health-care professionals. Health Expect 2020; 23:1350-1361. [PMID: 33405345 PMCID: PMC7696141 DOI: 10.1111/hex.13119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/13/2020] [Accepted: 07/21/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Muscle strengthening exercises have the potential to improve outcomes for boys with haemophilia, but it is unclear what types of exercise might be of benefit. We elicited the views of health-care professionals, boys and their families to create and assess a home-based muscle strengthening programme. OBJECTIVE To design and develop a muscle strengthening programme with health-care professionals aimed at improving musculoskeletal health, and refine the intervention by engaging boys with haemophilia and their families (Study 1). Following delivery, qualitatively evaluate the feasibility and acceptability of the exercise programme with the boys and the study's physiotherapists (Study 2). DESIGN A person-based approach was used for planning and designing the exercise programme, and evaluating it post-delivery. The following methods were utilized: modified nominal group technique (NGT) with health-care professionals; focus group with families; exit interviews with boys; and interviews with the study's physiotherapists. RESULTS Themes identified to design and develop the intervention included exercises to lower limb and foot, dosage, age accommodating, location, supervision and monitoring and incentivization. Programme refinements were carried out following engagement with the boys and families who commented on: dosage, location, supervision and incentivization. Following delivery, the boys and physiotherapists commented on progression and adaptation, physiotherapist contact, goal-setting, creating routines and identifying suitable timeframes, and a repeated theme of incentivization. CONCLUSIONS An exercise intervention was designed and refined through engagement with boys and their families. Boys and physiotherapists involved in the intervention's delivery were consulted who found the exercises to be generally acceptable with some minor refinements necessary.
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Affiliation(s)
- Ferhana Hashem
- University of KentCentre for Health Service StudiesCanterburyUK
| | - David Stephensen
- East Kent Hospitals University NHS TrustHaemophilia and Thrombosis CentreCanterburyUK
- Royal London HospitalHaemophilia CentreLondonUK
| | - Wendy I. Drechsler
- Kings College LondonSchool of Population Health & Environmental SciencesLondonUK
| | - Melanie Bladen
- Great Ormond Street Hospital For Children NHS Foundation TrustHaemophilia CentreLondonUK
- Institute of Child HealthUniversity College LondonLondonUK
| | | | | | - Eirini‐Christina Saloniki
- University of KentCentre for Health Service StudiesCanterburyUK
- University of KentPersonal Social Services Research UnitCanterburyUK
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12
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Howarth A, Quesada J, Donnelly T, Mills PR. The development of 'Make One Small Change': an e-health intervention for the workplace developed using the Person-Based Approach. Digit Health 2019; 5:2055207619852856. [PMID: 31210960 PMCID: PMC6546946 DOI: 10.1177/2055207619852856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/04/2019] [Indexed: 11/16/2022] Open
Abstract
Background The application of digital health interventions is widespread and many
employers are implementing employee e-health programs. Intended to enhance
productivity by increasing wellbeing, workplace interventions often lack
evidence of effectiveness and have low rates of retention. Use of the
person-based approach (PBA) is one solution, which offers a systematic
framework for developing effective digital health interventions. This paper
describes the application of the PBA to the development of ‘Make one small
change’ (Cigna MSC™), an online behaviour change system for lifestyle habits
focused on resilience, movement, eating and sleep. Method and results The development of Cigna MSC™ took place over four stages with colleagues
(n = 79) across Cigna globally. Application of the PBA
entailed using high amounts of qualitative data to inform development and a
cyclical process of ‘listening, applying and delivering’ was adhered to
throughout. Early stages involved review of current literature and the
collection of feedback in relation to existing interventions. Combined,
results revealed key intervention development issues that were then used to
form guiding principles. Guiding principles ensured intervention objectives
translated into relevant design features. The final stages of evaluation
included testing images, text and content approaches. Feedback dictated that
the intervention should be fun, easy to use and include milestones for
self-monitoring. The resulting version was finalised and made ready to pilot
so future analysis can be made in relation to real-world engagement and the
embedded evaluative content can be used to provide evidence of intervention
effectiveness. Conclusions Using the PBA, which was evolved specifically to improve development of
digital interventions, resulted in a workplace intervention embedded with
in-depth user input combined with evidenced-based theory. This paper
illustrates how using a rigorous methodology can drive the creation of an
effective digital health intervention that uniquely allows for refinement at
each stage.
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Affiliation(s)
- Ana Howarth
- Cigna, Global Wellbeing Solutions Ltd, London, UK.,Population Health Research Institute, St George's, University of London, UK
| | - Jose Quesada
- Cigna Health and Life Insurance Company, Bloomfield, USA
| | | | - Peter R Mills
- Cigna, Global Wellbeing Solutions Ltd, London, UK.,Department of Respiratory Medicine, The Whittington Hospital NHS Trust, London, UK
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13
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Pasterfield M, Clarke SA, Thompson AR. The development of a self-help intervention to build social confidence in people living with visible skin conditions or scars: a think-aloud study. Scars Burn Heal 2019; 5:2059513118822954. [PMID: 30675396 PMCID: PMC6330721 DOI: 10.1177/2059513118822954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION People with a visible difference, such as scarring or a skin condition, can experience anxiety and intrusive reactions from others when in social situations. The use of products to conceal marks on the skin is provided in a number of different hospital services and by charities. However, there are relatively few psychosocial interventions available for these individuals. OBJECTIVES To examine the views of skin camouflage users and practitioners on the acceptability, usability and need for a specifically developed cognitive behavioural therapy (CBT) self-help booklet. METHODS A think-aloud protocol and descriptive form of thematic analysis were used to ascertain participants' views of this novel psychosocial intervention. Nine participants took part in think-aloud interviews that were analysed using thematic analysis. Six skin camouflage users and three skin camouflage practitioners participated in the study. RESULTS Support for the relevance, acceptability and usability of the booklet was found from both participants who used camouflage and those who provided it. However, some participants reported that they would envisage that some people would need additional support so as to be able to use the techniques described within the booklet. CONCLUSIONS This study represents an important step towards developing a brief self-help intervention for people with living with visible skin conditions or scars and demonstrates the importance of seeking feedback from experts by experience on theoretically informed psychological interventions for this patient group.
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Affiliation(s)
- Madeline Pasterfield
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Andrew R Thompson
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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14
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Lucas PJ, Ingram J, Redmond NM, Cabral C, Turnbull SL, Hay AD. Development of an intervention to reduce antibiotic use for childhood coughs in UK primary care using critical synthesis of multi-method research. BMC Med Res Methodol 2017; 17:175. [PMID: 29281974 PMCID: PMC5745782 DOI: 10.1186/s12874-017-0455-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/06/2017] [Indexed: 01/20/2023] Open
Abstract
Background Overuse of antibiotics contributes to the global threat of antimicrobial resistance. Antibiotic stewardship interventions address this threat by reducing the use of antibiotics in occasions or doses unlikely to be effective. We aimed to develop an evidence-based, theory-informed, intervention to reduce antibiotic prescriptions in primary care for childhood respiratory tract infections (RTI). This paper describes our methods for doing so. Methods Green and Krueter’s Precede/Proceed logic model was used as a framework to integrate findings from a programme of research including 5 systematic reviews, 3 qualitative studies, and 1 cohort study. The model was populated using a strength of evidence approach, and developed with input from stakeholders including clinicians and parents. Results The synthesis produced a series of evidence-based statements summarizing the quantitative and qualitative evidence for intervention elements most likely to result in changes in clinician behaviour. Current evidence suggests that interventions which reduce clinical uncertainty, reduce clinician/parent miscommunication, elicit parent concerns, make clear delayed or no-antibiotic recommendations, and provide clinicians with alternate treatment actions have the best chance of success. We designed a web-based within-consultation intervention to reduce clinician uncertainty and pressure to prescribe, designed to be used when children with RTI present to a prescribing clinician in primary care. Conclusions We provide a worked example of methods for the development of future complex interventions in primary care, where multiple factors act on multiple actors within a complex system. Our synthesis provided intervention guidance, recommendations for practice, and highlighted evidence gaps, but questions remain about how best to implement these recommendations. The funding structure which enabled a single team of researchers to work on a multi-method programme of related studies (NIHR Programme Grant scheme) was key in our success. Trial registration The feasibility study accompanying this intervention was prospectively registered with the ISRCTN registry (ISRCTN23547970), on 27 June 2014. Electronic supplementary material The online version of this article (10.1186/s12874-017-0455-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patricia J Lucas
- School for Policy Studies, University of Bristol, 8 Priory Rd, Bristol, UK.
| | - Jenny Ingram
- Centre for Child and Adolescent Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Niamh M Redmond
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Christie Cabral
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sophie L Turnbull
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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15
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Davies EL, Law C, Hennelly SE, Winstock AR. Acceptability of targeting social embarrassment in a digital intervention to reduce student alcohol consumption: A qualitative think aloud study. Digit Health 2017; 3:2055207617733405. [PMID: 29942615 PMCID: PMC6001214 DOI: 10.1177/2055207617733405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/30/2017] [Indexed: 11/23/2022] Open
Abstract
Objective Increasing knowledge about alcohol-related harms, changing social norms, or encouraging drinking within safe unit levels often fails to change behaviour in young people. A novel intervention called ‘OneTooMany’ was developed, which targets the short-term social, and potentially, embarrassing consequences of drinking alcohol. The aim of this paper was to explore its acceptability, and to determine any features that might influence its effectiveness as a means of reducing alcohol consumption. Methods Participants were 23 young adults (aged 18–30) currently studying at university (n = 18) or in the first six months following graduation (n = 5). A think aloud interview approach was employed. Three main themes were identified in a deductive thematic analysis. Results Embarrassing experiences were a normalised part of drinking occasions, while some were actively avoided, others were celebrated. Humour served as a device to engage and interest participants, but could also diminish intervention messages. OneTooMany prompted reflections on many regrettable drinking experiences, but the participants did not see themselves as the target audience for this intervention. Conclusions Interventions may benefit from focusing on some of the short term, embarrassing consequences of excessive alcohol consumption. Further research is needed to ensure that reflections on past behaviour are helpful in addressing future behaviour.
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Affiliation(s)
- Emma L Davies
- 1Department of Psychology, Oxford Brookes University, UK
| | - Cara Law
- 1Department of Psychology, Oxford Brookes University, UK
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16
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Crane D, Garnett C, Brown J, West R, Michie S. Factors Influencing Usability of a Smartphone App to Reduce Excessive Alcohol Consumption: Think Aloud and Interview Studies. Front Public Health 2017; 5:39. [PMID: 28421175 PMCID: PMC5376568 DOI: 10.3389/fpubh.2017.00039] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/20/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Interventions delivered by smartphone apps have the potential to help drinkers reduce their consumption of alcohol. To optimize engagement and reduce the high rates of attrition associated with the use of digital interventions, it is necessary to ensure that an app's design and functionality is appropriate for its intended purposes and target population. AIMS To understand the usability of an app to help people reduce their alcohol consumption. METHOD The app, Drink Less, contains a core module focusing on goal setting, supplemented by five additional modules: self-monitoring and feedback, identity change, cognitive bias re-training, action planning, and social comparison. Two studies were conducted, a "think aloud" study performed with people using the app for the first time and a semistructured interview study performed after users had had access to the app for at least 2 weeks. A thematic analysis of the "think aloud" and interview transcripts was conducted by one coder and verified by a second. RESULTS Twenty-four participants, half of whom were women and half from disadvantaged groups, took part in the two studies. Three main themes identified in the data were "Feeling lost and unsure of what to do next," "Make the app easy to use," and "Make the app beneficial and rewarding to use." These themes reflected participants' need for (i) guidance, particularly when first using the app or when entering data; (ii) the data entry process to be simple and the navigation intuitive; (iii) neither the amount of text nor range of options to be overwhelming; (iv) the app to reward them for effort and progress; and (v) it to be clear how the app could help alcohol reduction goals be reached. CONCLUSION First-time and experienced users want an alcohol reduction app to be easy, rewarding, and beneficial to use. An easy-to-use app would reduce user burden, offer ongoing help, and be esthetically pleasing. A rewarding and beneficial app would provide positive reinforcement, give feedback about progress, and demonstrate credibility. Users need help when first using the app, and they need a compelling reason to continue using it.
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Affiliation(s)
- David Crane
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Claire Garnett
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jamie Brown
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Robert West
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Davies EL. Feasibility of the Prototype Willingness Model as the basis for school-delivered alcohol misuse prevention: A qualitative think-aloud study to explore acceptability of 'The Alcohol Smart Quiz' with adolescents and teachers. J Health Psychol 2016; 23:1196-1210. [PMID: 27247092 DOI: 10.1177/1359105316648481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study sought feedback from teachers and adolescents on a novel intervention to reduce alcohol misuse based on the Prototype Willingness Model. A qualitative, think-aloud interview study was conducted with 17 adolescents aged 11-14 years and nine teachers. Transcripts were analysed using thematic analysis. Adolescents found the content of the intervention appealing and credible. Teachers welcomed the content and format as a means of generating discussion. 'Moderate' drinking appeared to be an acceptable message, although difficult to define. Enacting 'if-then' plans in real social situations might be challenging and representations of drinking on social media should be considered.
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Greenwell K, Sereda M, Coulson N, Hoare DJ. Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Process Evaluation Protocol. JMIR Res Protoc 2016; 5:e49. [PMID: 27009548 PMCID: PMC4823589 DOI: 10.2196/resprot.5008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 11/10/2015] [Accepted: 11/22/2015] [Indexed: 12/03/2022] Open
Abstract
Background Tinnitus is a common medical symptom that can affect an individual’s emotional and functional quality of life. Psychological therapies are acknowledged as beneficial to people with tinnitus; however, such therapies are not always readily accessible. With their global reach, automated Internet-based interventions have the potential to reduce the disparity in access to psychological support that people with tinnitus currently experience. However, the evidence on the acceptability and efficacy of these interventions is lacking. Process evaluations that develop an in-depth understanding of how users experience these interventions provide an essential first step when evaluating complex psychological interventions. Objective To describe the protocol for a study that will explore past, current, and new users’ reactions to and interactions with the Tinnitus E-Programme, an Internet-based intervention for the self-management of tinnitus. Methods Two parallel mixed-methods studies will be carried out with 2 different populations. Study 1 will use an online survey to gather past and current users’ views of the program. Study 2 will recruit new program users to take part in an interview and complete a relaxation log to explore how well they were able to implement the skills they learned during the program in their everyday lives. The findings from both studies will be triangulated to develop an in-depth understanding of the program’s mechanisms of impact and identify any implementation or contextual factors that strengthen or impede its delivery and functioning. Results Study 1 is open for recruitment with a projected completion in June 2016 and Study 2 was completed November 2015. At the time of submission, 36 participants have been recruited to Study 1 and 12 participants have taken part in Study 2. Conclusions Findings will inform the optimization of the Tinnitus E-Programme and guide future evaluation work to assess the program’s effectiveness as a therapy for people with tinnitus.
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Affiliation(s)
- Kate Greenwell
- National Institute for Health Research (NIHR) Nottingham Hearing Biomedical Research Unit, Nottingham, United Kingdom.
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Webster R, Thompson AR, Norman P, Goodacre S. The acceptability and feasibility of an anxiety reduction intervention for emergency department patients with non-cardiac chest pain. PSYCHOL HEALTH MED 2016; 22:1-11. [PMID: 26924523 PMCID: PMC5105082 DOI: 10.1080/13548506.2016.1144891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite good physical prognosis, patients who receive a diagnosis of non-cardiac chest pain (NCCP) may experience persistent pain and distress. While cognitive-behavioural interventions have been found to be effective for this group, they are difficult to deliver in busy emergency department (ED) settings. Addressing the acceptability and relevance of self-help interventions is an important initial step in addressing this need. This study sought to examine the acceptability and relevance of an evidence-based self-help intervention for ED patients with persistent NCCP and anxiety. Patient (interviews: N = 11) and specialist chest pain nurse (focus group: N = 4) views on acceptability and feasibility were examined. Data were analysed using thematic analysis. Patients and nurses reported that there was a need for the intervention, as stress and anxiety are common among patients with NCCP, and provision of psychosocial support is currently lacking. Both patients and nurses reported that the intervention was relevant, acceptable, and potentially useful. Some changes to the intervention were suggested. Nurses reported that the intervention could be used within the existing staff resources available in an ED setting. This study represents an important first step towards developing a brief self-help intervention for ED patients with NCCP and anxiety. Further research should seek to determine the efficacy of the intervention in a pilot trial.
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Affiliation(s)
- Rosie Webster
- a Research Department of Primary Care and Population Health , University College London , Royal Free Campus, Rowland Hill Street, London , NW3 2PF , UK.,b Department of Psychology , University of Sheffield , UK
| | - Andrew Robert Thompson
- c Department of Psychology , University of Sheffield , Western Bank, Sheffield , S10 2TN , UK
| | - Paul Norman
- d Department of Psychology , University of Sheffield , UK
| | - Steve Goodacre
- e School of Health and Related Research , University of Sheffield , UK
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Yardley L, Ainsworth B, Arden-Close E, Muller I. The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot Feasibility Stud 2015; 1:37. [PMID: 27965815 PMCID: PMC5153673 DOI: 10.1186/s40814-015-0033-z] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/12/2015] [Indexed: 12/26/2022] Open
Abstract
Background This paper provides three illustrations of how the “person-based approach” can be used to assess and enhance the acceptability and feasibility of an intervention during the early stages of development and evaluation. The person-based approach involves using mixed methods research to systematically investigate the beliefs, attitudes, needs and situation of the people who will be using the intervention. The in-depth understanding of users’ perspectives derived from this research then enables intervention developers to design or modify the intervention to make it more relevant, persuasive, accessible and engaging. Methods The first illustration describes how relevant beliefs and attitudes of people with asthma were identified from the existing qualitative and quantitative literature and then used to create guiding principles to inform the design of a web-based intervention to improve quality of life. The second illustration describes how qualitative “think-aloud” interviews and patient and public involvement (PPI) input are used to improve the acceptability of a booklet for people with asthma. In the third illustration, iterative think-aloud methods are used to create a more accurate and accessible activity planner for people with diabetes. Results In the first illustration of the person-based approach, we present the guiding principles we developed to summarise key design issues/objectives and key intervention features to address them. The second illustration provides evidence from interviews that positive, non-medical messages and images were preferred in booklet materials for people with asthma. The third illustration demonstrates that people with diabetes found it difficult to complete an online activity planner accurately, resulting in incorrect personalised advice being given prior to appropriate modification of the planner. Conclusions The person-based approach to intervention development can complement theory- and evidence-based development and participant input into intervention design, offering a systematic process for systematically investigating and incorporating the views of a wide range of users. Electronic supplementary material The online version of this article (doi:10.1186/s40814-015-0033-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucy Yardley
- School of Psychology, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Ben Ainsworth
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Emily Arden-Close
- Centre for Behaviour Change, Department of Psychology, Bournemouth University, Bournemouth, UK
| | - Ingrid Muller
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK ; Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Little P, Stuart B, Hobbs FDR, Moore M, Barnett J, Popoola D, Middleton K, Kelly J, Mullee M, Raftery J, Yao G, Carman W, Fleming D, Stokes-Lampard H, Williamson I, Joseph J, Miller S, Yardley L. An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. Lancet 2015; 386:1631-9. [PMID: 26256072 DOI: 10.1016/s0140-6736(15)60127-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members. METHODS We recruited individuals sharing a household by mailed invitation through general practices in England. After consent, participants were randomised online by an automated computer-generated random number programme to receive either no access or access to a bespoke automated web-based intervention that maximised handwashing intention, monitored handwashing behaviour, provided tailored feedback, reinforced helpful attitudes and norms, and addressed negative beliefs. We enrolled participants into an additional cohort (randomised to receive intervention or no intervention) to assess whether the baseline questionnaire on handwashing would affect handwashing behaviour. Participants were not masked to intervention allocation, but statistical analysis commands were constructed masked to group. The primary outcome was number of episodes of RTIs in index participants in a modified intention-to-treat population of randomly assigned participants who completed follow-up at 16 weeks. This trial is registered with the ISRCTN registry, number ISRCTN75058295. FINDINGS Across three winters between Jan 17, 2011, and March 31, 2013, we enrolled 20,066 participants and randomly assigned them to receive intervention (n=10,040) or no intervention (n=10,026). 16,908 (84%) participants were followed up with the 16 week questionnaire (8241 index participants in intervention group and 8667 in control group). After 16 weeks, 4242 individuals (51%) in the intervention group reported one or more episodes of RTI compared with 5135 (59%) in the control group (multivariate risk ratio 0·86, 95% CI 0·83-0·89; p<0·0001). The intervention reduced transmission of RTIs (reported within 1 week of another household member) both to and from the index person. We noted a slight increase in minor self-reported skin irritation (231 [4%] of 5429 in intervention group vs 79 [1%] of 6087 in control group) and no reported serious adverse events. INTERPRETATION In non-pandemic years, an effective internet intervention designed to increase handwashing could have an important effect in reduction of infection transmission. In view of the heightened concern during a pandemic and the likely role of the internet in access to advice, the intervention also has potential for effective implementation during a pandemic. FUNDING Medical Research Council.
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Affiliation(s)
- Paul Little
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK.
| | - Beth Stuart
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - F D R Hobbs
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike Moore
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | | | - Karen Middleton
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Joanne Kelly
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Mark Mullee
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK; NIHR Research Design Service South Central, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Guiqing Yao
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - William Carman
- West of Scotland Specialist Virology Centre, University of Glasgow, Glasgow, UK
| | | | | | - Ian Williamson
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Judith Joseph
- Centre for Applications of Health Psychology University of Southampton, Southampton, UK
| | - Sascha Miller
- Centre for Applications of Health Psychology University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Applications of Health Psychology University of Southampton, Southampton, UK
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Davies EL, Martin J, Foxcroft DR. Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study. JMIR Hum Factors 2015; 2:e13. [PMID: 27025403 PMCID: PMC4797700 DOI: 10.2196/humanfactors.4452] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 05/31/2015] [Accepted: 06/19/2015] [Indexed: 11/17/2022] Open
Abstract
Background The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis. Results The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people.
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Affiliation(s)
- Emma Louise Davies
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Oxford, United Kingdom.
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Morrison LG. Theory-based strategies for enhancing the impact and usage of digital health behaviour change interventions: A review. Digit Health 2015; 1:2055207615595335. [PMID: 29942544 PMCID: PMC5999061 DOI: 10.1177/2055207615595335] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is growing evidence that digital interventions can successfully effect
meaningful changes in health-related behaviour. However, optimisation of digital
intervention delivery is challenged by low usage, high attrition and small
effect sizes. Whilst a number of conceptual frameworks and models exist to guide
intervention planning and development, insufficient attention has been paid to
how existing psychological theory could inform the optimal implementation and
delivery of the design features commonly used in digital health behaviour change
interventions. This paper provides a critical review of psychological theories
and models in order to consider their implications for the design of digital
interventions. The theories reviewed include theories of: persuasion and
attitude change; motivation; volition and self-regulation; patient preferences
for participation in medical decision making; and social support. A set of
theory-based guidelines is provided to inform the development of future
interventions.
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Yardley L, Morrison L, Bradbury K, Muller I. The person-based approach to intervention development: application to digital health-related behavior change interventions. J Med Internet Res 2015; 17:e30. [PMID: 25639757 PMCID: PMC4327440 DOI: 10.2196/jmir.4055] [Citation(s) in RCA: 676] [Impact Index Per Article: 75.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/05/2015] [Accepted: 01/09/2015] [Indexed: 12/15/2022] Open
Abstract
This paper describes an approach that we have evolved for developing successful digital interventions to help people manage their health or illness. We refer to this as the “person-based” approach to highlight the focus on understanding and accommodating the perspectives of the people who will use the intervention. While all intervention designers seek to elicit and incorporate the views of target users in a variety of ways, the person-based approach offers a distinctive and systematic means of addressing the user experience of intended behavior change techniques in particular and can enhance the use of theory-based and evidence-based approaches to intervention development. There are two key elements to the person-based approach. The first is a developmental process involving qualitative research with a wide range of people from the target user populations, carried out at every stage of intervention development, from planning to feasibility testing and implementation. This process goes beyond assessing acceptability, usability, and satisfaction, allowing the intervention designers to build a deep understanding of the psychosocial context of users and their views of the behavioral elements of the intervention. Insights from this process can be used to anticipate and interpret intervention usage and outcomes, and most importantly to modify the intervention to make it more persuasive, feasible, and relevant to users. The second element of the person-based approach is to identify “guiding principles” that can inspire and inform the intervention development by highlighting the distinctive ways that the intervention will address key context-specific behavioral issues. This paper describes how to implement the person-based approach, illustrating the process with examples of the insights gained from our experience of carrying out over a thousand interviews with users, while developing public health and illness management interventions that have proven effective in trials involving tens of thousands of users.
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Affiliation(s)
- Lucy Yardley
- Department of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom.
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Flowers P, Davis M, Lohm D, Waller E, Stephenson N. Understanding pandemic influenza behaviour: An exploratory biopsychosocial study. J Health Psychol 2014; 21:759-69. [DOI: 10.1177/1359105314537542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pandemic influenza represents an ongoing public health threat. Understanding the associated behavioural domain is vital for future intervention development. Cross-sectional qualitative research employing purposive sampling employed a combination of one-to-one semi-structured interviews ( n = 57) and focus groups ( n = 59). Data were analysed using (1) inductive thematic analysis and (2) theoretical thematic analysis focusing upon resonance with psychosocial and sociocultural constructs. Two broad themes highlighted an important duality regarding the determinants of pandemic behaviour: (1) psychosocial determinants (e.g. agency, cognitions and identity) and (2) sociocultural determinants (e.g. social context and capacity). These findings suggest this duality should shape future intervention development.
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Affiliation(s)
- Paul Flowers
- School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
| | - Mark Davis
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Davina Lohm
- School of Social Sciences, Monash University, Melbourne, Australia
| | - Emily Waller
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Niamh Stephenson
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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26
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Teasdale E, Santer M, Geraghty AWA, Little P, Yardley L. Public perceptions of non-pharmaceutical interventions for reducing transmission of respiratory infection: systematic review and synthesis of qualitative studies. BMC Public Health 2014; 14:589. [PMID: 24920395 PMCID: PMC4063987 DOI: 10.1186/1471-2458-14-589] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/02/2014] [Indexed: 12/31/2022] Open
Abstract
Background Non-pharmaceutical public health interventions may provide simple, low-cost, effective ways of minimising the transmission and impact of acute respiratory infections in pandemic and non-pandemic contexts. Understanding what influences the uptake of non-pharmaceutical interventions such as hand and respiratory hygiene, mask wearing and social distancing could help to inform the development of effective public health advice messages. The aim of this synthesis was to explore public perceptions of non-pharmaceutical interventions that aim to reduce the transmission of acute respiratory infections. Methods Five online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and Web of Science) were systematically searched. Reference lists of articles were also examined. We selected papers that used a qualitative research design to explore perceptions and beliefs about non-pharmaceutical interventions to reduce transmission of acute respiratory infections. We excluded papers that only explored how health professionals or children viewed non-pharmaceutical respiratory infection control. Three authors performed data extraction and assessment of study quality. Thematic analysis and components of meta-ethnography were adopted to synthesise findings. Results Seventeen articles from 16 studies in 9 countries were identified and reviewed. Seven key themes were identified: perceived benefits of non-pharmaceutical interventions, perceived disadvantages of non-pharmaceutical interventions, personal and cultural beliefs about infection transmission, diagnostic uncertainty in emerging respiratory infections, perceived vulnerability to infection, anxiety about emerging respiratory infections and communications about emerging respiratory infections. The synthesis showed that some aspects of non-pharmaceutical respiratory infection control (particularly hand and respiratory hygiene) were viewed as familiar and socially responsible actions to take. There was ambivalence about adopting isolation and personal distancing behaviours in some contexts due to their perceived adverse impact and potential to attract social stigma. Common perceived barriers included beliefs about infection transmission, personal vulnerability to respiratory infection and concerns about self-diagnosis in emerging respiratory infections. Conclusions People actively evaluate non-pharmaceutical interventions in terms of their perceived necessity, efficacy, acceptability, and feasibility. To enhance uptake, it will be necessary to address key barriers, such as beliefs about infection transmission, rejection of personal risk of infection and concern about the potential costs and stigma associated with some interventions.
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Affiliation(s)
- Emma Teasdale
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
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Developing digital interventions: a methodological guide. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:561320. [PMID: 24648848 PMCID: PMC3932254 DOI: 10.1155/2014/561320] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022]
Abstract
Digital interventions are becoming an increasingly popular method of delivering healthcare as they enable and promote patient self-management. This paper provides a methodological guide to the processes involved in developing effective digital interventions, detailing how to plan and develop such interventions to avoid common pitfalls. It demonstrates the need for mixed qualitative and quantitative methods in order to develop digital interventions which are effective, feasible, and acceptable to users and stakeholders.
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Michie S, Brown J, Geraghty AWA, Miller S, Yardley L, Gardner B, Shahab L, McEwen A, Stapleton JA, West R. Development of StopAdvisor: A theory-based interactive internet-based smoking cessation intervention. Transl Behav Med 2012; 2:263-75. [PMID: 24073123 PMCID: PMC3717907 DOI: 10.1007/s13142-012-0135-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Reviews of internet-based behaviour-change interventions have shown that they can be effective but there is considerable heterogeneity and effect sizes are generally small. In order to advance science and technology in this area, it is essential to be able to build on principles and evidence of behaviour change in an incremental manner. We report the development of an interactive smoking cessation website, StopAdvisor, designed to be attractive and effective across the social spectrum. It was informed by a broad motivational theory (PRIME), empirical evidence, web-design expertise, and user-testing. The intervention was developed using an open-source web-development platform, 'LifeGuide', designed to facilitate optimisation and collaboration. We identified 19 theoretical propositions, 33 evidence- or theory-based behaviour change techniques, 26 web-design principles and nine principles from user-testing. These were synthesised to create the website, 'StopAdvisor' (see http://www.lifeguideonline.org/player/play/stopadvisordemonstration). The systematic and transparent application of theory, evidence, web-design expertise and user-testing within an open-source development platform can provide a basis for multi-phase optimisation contributing to an 'incremental technology' of behaviour change.
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Affiliation(s)
- Susan Michie
- />UCL Medical School and Division of Psychology and Language Sciences, University College London, London, UK
- />NHS Centre for Smoking Cessation and Training, London, UK
| | - Jamie Brown
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | | | - Sascha Miller
- />School of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- />School of Psychology, University of Southampton, Southampton, UK
| | - Benjamin Gardner
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Lion Shahab
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Andy McEwen
- />NHS Centre for Smoking Cessation and Training, London, UK
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - John A Stapleton
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
| | - Robert West
- />NHS Centre for Smoking Cessation and Training, London, UK
- />Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT UK
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Miller S, Yardley L, Little P. Development of an intervention to reduce transmission of respiratory infections and pandemic flu: Measuring and predicting hand-washing intentions. PSYCHOL HEALTH MED 2012; 17:59-81. [DOI: 10.1080/13548506.2011.564188] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yardley L, Miller S, Schlotz W, Little P. Evaluation of a Web-based intervention to promote hand hygiene: exploratory randomized controlled trial. J Med Internet Res 2011; 13:e107. [PMID: 22155673 PMCID: PMC3278093 DOI: 10.2196/jmir.1963] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/09/2011] [Accepted: 11/17/2011] [Indexed: 12/17/2022] Open
Abstract
Background Hand-washing is regarded as a potentially important behavior for preventing transmission of respiratory infection, particularly during a pandemic. Objective The objective of our study was to evaluate whether a Web-based intervention can encourage more frequent hand-washing in the home, and to examine potential mediators and moderators of outcomes, as a necessary first step before testing effects of the intervention on infection rates in the PRIMIT trial (PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory infection Transmission). Methods In a parallel-group pragmatic exploratory trial design, 517 nonblinded adults recruited through primary care were automatically randomly assigned to a fully automated intervention comprising 4 sessions of tailored motivational messages and self-regulation support (n = 324) or to a no-intervention control group (n = 179; ratio 2:1). Hand-washing frequency and theory of planned behavior cognitions relating to hand-washing were assessed by online questionnaires at baseline (in only half of the control participants, to permit evaluation of effects of baseline assessment on effect sizes), at 4 weeks (postintervention; all participants), and at 12 weeks. Results Hand-washing rates in the intervention group were higher at 4 weeks than in the control group (mean 4.40, n = 285 and mean 4.04, n = 157, respectively; P < .001, Cohen d = 0.42) and remained higher at 12 weeks (mean 4.45, n = 282 and mean 4.12, n = 154, respectively; P < .001, Cohen d = 0.34). Hand-washing intentions and positive attitudes toward hand-washing increased more from baseline to 4 weeks in the intervention group than in the control group. Mediation analyses revealed positive indirect effects of the intervention on change in hand-washing via intentions (coefficient = .15, 95% confidence interval [CI], .08–.26) and attitudes (coefficient = 0.16, 95% CI, .09–.26). Moderator analyses confirmed that the intervention was similarly effective for men and women, those of higher and lower socioeconomic status, and those with higher and lower levels of perceived risk. Conclusions This study provides promising evidence that Web-based interventions could potentially provide an effective method of promoting hand hygiene in the home. Data were collected during the 2010 influenza pandemic, when participants in both groups had already been exposed to extensive publicity about the need for hand hygiene, suggesting that our intervention could add to existing public health campaigns. However, further research is required to determine the effects of the intervention on actual infection rates. Trial International Standard Randomized Controlled Trial Number (ISRCTN): 75058295; http://www.controlled-trials.com/ISRCTN75058295 (Archived by WebCite at http://www.webcitation.org/62KSbkNmm)
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Affiliation(s)
- Lucy Yardley
- Academic Unit of Psychology, Faculty of Human and Social Sciences, University of Southampton, Southampton, UK.
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