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Sait MI, Christie RA, Cox C, Board M, Thomas S, O'Sullivan C, Davies C, Walker DM, Vassallo M, Sadler EA, Allen-Pick M, Moore P, Bradbury K, Murphy J. DIALOR (DIgitAL cOaching for fRailty): protocol for a single-arm mixed-methods feasibility study of a digital health coaching intervention for older people with frailty in primary care. BMJ Open 2024; 14:e080480. [PMID: 38760042 PMCID: PMC11103224 DOI: 10.1136/bmjopen-2023-080480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/15/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Multidomain interventions in older adults offer the best opportunity to prevent, delay or reverse existing symptoms in the earlier stages of frailty and improve independence but can be costly, and difficult to deliver at scale. However, digital health interventions enable personalised care and empowerment through self-management of long-term conditions, used at any time and when combined with health coaching offer the potential to enhance well-being and facilitate the achievement of health-related goals. We aim to evaluate the feasibility and acceptability of a digital health platform for long-term disease management combined with health coaching for people living with mild-moderate frailty, targeting self-identified goals-activity, nutrition, mood, enhancing social engagement and well-being. METHODS AND ANALYSIS This is a non-randomised feasibility, single-group, pretest/post-test study, using qualitative and quantitative methods. The digital health coaching intervention (DIALOR-DIgitAL cOaching for fRailty) has been developed for implementation to older adults, aged 65 years or older with mild to moderate frailty and diagnosis of one or more long-term health conditions in the community. Participants will receive 12 weeks of health coaching and have access to a mobile health platform for 6 months. The primary outcome measure is the acceptability and feasibility of DIALOR along with a range of secondary outcome measures (including frailty, functioning measures, quality of life, social engagement, diet quality and self-reported indicators) collected at baseline and at 6 months. The findings will inform whether a wider effectiveness trial is feasible and if so, how it should be designed. ETHICS AND DISSEMINATION Ethical approval has been granted by the Southeast Scotland Research Ethics Committee 02 (reference: 22/SS/0064). Research findings will be disseminated in a range of different ways to engage different audiences, including publishing in open-access peer-reviewed journals, conference presentations, social media, dissemination workshop with patients, carers, and healthcare professionals and on institution websites.
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Affiliation(s)
- Matthew I Sait
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Rachel A Christie
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Chantel Cox
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Michele Board
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Sarah Thomas
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | - Cheryl Davies
- Wessex Academic Health Science Network, Chilworth, UK
| | - Dawn-Marie Walker
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Michael Vassallo
- Older Person Medicine, University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - E A Sadler
- Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK
| | - Mark Allen-Pick
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | | | | | - Jane Murphy
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
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Smith J, Essery R, Yardley L, Richardson A, Slodkowska-Barabasz J, Chavlet C, Foster C, Watson E, Grimmett C, Geraghty AWA, Little P, Sharman G, Burford T, Bacon R, Turner L, Bradbury K. Experiences of using a supported digital intervention for cancer survivors in primary care: a qualitative process evaluation. J Cancer Surviv 2024; 18:144-156. [PMID: 37405560 PMCID: PMC10866764 DOI: 10.1007/s11764-023-01412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Increasing healthy behaviours (e.g. physical activity) can improve cancer survivors' quality of life. Renewed is a digital intervention developed to provide behaviour change advice with brief healthcare practitioner support. A three-arm randomised controlled trial (Renewed, Renewed with support or a control condition) suggested that prostate cancer survivors in the supported arm had slightly greater estimates of improvements in quality of life compared to other cancer survivors. This study explored participants' experiences using Renewed to understand how it might have worked and why it might have provided greater benefit for prostate cancer survivors and those in the supported arm. METHODS Thirty-three semi-structured telephone interviews with cancer survivors' (breast, colorectal, prostate) from the Renewed trial explored their experiences of using Renewed and their perceptions of the intervention. Data were analysed using inductive thematic analysis. RESULTS Some participants only used Renewed modestly but still made behaviour changes. Barriers to using Renewed included low perceived need, joining the study to advance scientific knowledge or 'to give back', or due to perceived availability of support in their existing social networks. Prostate cancer survivors reported less social support outside of Renewed compared to participants with other cancers. CONCLUSION Renewed may support healthy behaviour changes among cancer survivors even with limited use. Interventions targetting individuals who lack social support may be beneficial. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors' experiences may inform the development of digital interventions to better serve this population.
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Affiliation(s)
- Jazzine Smith
- School of Psychology, University of Southampton, Southampton, UK.
| | - Rosie Essery
- School of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
- University Hospital Southampton, Southampton, UK
| | | | | | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Community and Public Health Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK
| | | | | | - Roger Bacon
- Patient and Public Involvement Team, Southampton, UK
| | - Lesley Turner
- Patient and Public Involvement Team, Southampton, UK
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3
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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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4
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Smith J, Essery R, Yardley L, Richardson A, Slodkowska-Barabasz J, Foster C, Watson E, Grimmett C, Geraghty AWA, Little P, Bradbury K. Implementing a Health Care Professional-Supported Digital Intervention for Survivors of Cancer in Primary Care: Qualitative Process Evaluation of the Renewed Intervention. JMIR Cancer 2022; 8:e36364. [PMID: 35363143 PMCID: PMC9015743 DOI: 10.2196/36364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 01/12/2023] Open
Abstract
Background Primary care plays an important role in supporting survivors of cancer; however, support is limited because of practitioners’ perceived lack of expertise and time. A digital intervention for survivors of cancer could provide an efficient way for primary care staff to support survivors of cancer without the need to accumulate expertise and skills to help patients make behavior changes; providing very brief support alongside this could maximize adherence to digital interventions. Renewed is a digital intervention that combines web-based behavior change advice with brief health care practitioner support from a nurse or health care assistant. Knowledge about the views and experiences of primary care staff providing support alongside a digital intervention for survivors of cancer is sparse, limiting the understanding of the acceptability and feasibility of this type of intervention. Objective This study aims to explore supporters’ experiences of providing support to survivors of cancer using Renewed, understand potential barriers to and facilitators of the implementation of Renewed in practice, and investigate the strengths and weaknesses of the intervention from the perspective of health care professionals. Methods This was a qualitative process evaluation nested within a large trial evaluating Renewed. A total of 28 semistructured telephone interviews were conducted with nurses and health care assistants. Data were analyzed using inductive thematic analysis. Results Four themes were developed during the analysis, which reflected the factors that supporters identified as hindering or enabling them to provide support alongside Renewed Online: Renewed Online as an acceptable digital tool with some improvements, confidence in enacting the supporter role, practicalities of delivering support alongside a digital intervention, and managing a patient-led approach. The analysis suggests that supporters perceived that a digital intervention such as Renewed would be beneficial in supporting survivors of cancer in primary care and fit within current practices. However, barriers to providing support alongside the intervention were also identified, including concerns about how to facilitate rapport building and, in a minority, concerns about using a nondirective approach, in which most advice and support is provided through digital interventions, with brief additional support provided by primary care staff. Conclusions These findings add to the literature on how best to provide support alongside digital interventions, suggesting that although most practitioners cope well with a nondirective approach, a minority requires more training to feel confident in implementing this. This study suggests that the barriers to providing formal support to survivors of cancer in primary care could be successfully overcome with an approach such as Renewed, where a digital intervention provides most of the support and expertise, and health care practitioners provide additional brief human support to maximize engagement. Strategies to maximize the chances of successful implementation for this type of intervention are also discussed.
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Affiliation(s)
- Jazzine Smith
- Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, United Kingdom
| | - Rosie Essery
- Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Lucy Yardley
- Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, United Kingdom.,School of Psychological Science, University of Bristol, Bristol, United Kingdom
| | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, United Kingdom.,Cancer Care Group, University Hospital Southampton, Southampton, United Kingdom
| | - Joanna Slodkowska-Barabasz
- Community and Public Health Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Claire Foster
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Eila Watson
- Community and Public Health Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Chloe Grimmett
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Adam W A Geraghty
- Primary Care Research, University of Southampton, Southampton, United Kingdom
| | - Paul Little
- Primary Care Research, University of Southampton, Southampton, United Kingdom
| | - Katherine Bradbury
- Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, United Kingdom
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5
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Cruz-Martínez RR, Wentzel J, Bente BE, Sanderman R, van Gemert-Pijnen JE. Toward the Value Sensitive Design of eHealth Technologies to Support Self-management of Cardiovascular Diseases: Content Analysis. JMIR Cardio 2021; 5:e31985. [PMID: 34855608 PMCID: PMC8686487 DOI: 10.2196/31985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 10/03/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth can revolutionize the way self-management support is offered to chronically ill individuals such as those with a cardiovascular disease (CVD). However, patients' fluctuating motivation to actually perform self-management is an important factor for which to account. Tailoring and personalizing eHealth to fit with the values of individuals promises to be an effective motivational strategy. Nevertheless, how specific eHealth technologies and design features could potentially contribute to values of individuals with a CVD has not been explicitly studied before. OBJECTIVE This study sought to connect a set of empirically validated, health-related values of individuals with a CVD with existing eHealth technologies and their design features. The study searched for potential connections between design features and values with the goal to advance knowledge about how eHealth technologies can actually be more meaningful and motivating for end users. METHODS Undertaking a technical investigation that fits with the value sensitive design framework, a content analysis of existing eHealth technologies was conducted. We matched 11 empirically validated values of CVD patients with 70 design features from 10 eHealth technologies that were previously identified in a systematic review. The analysis consisted mainly of a deductive coding stage performed independently by 3 members of the study team. In addition, researchers and developers of 6 of the 10 reviewed technologies provided input about potential feature-value connections. RESULTS In total, 98 connections were made between eHealth design features and patient values. This meant that some design features could contribute to multiple values. Importantly, some values were more often addressed than others. CVD patients' values most often addressed were related to (1) having or maintaining a healthy lifestyle, (2) having an overview of personal health data, (3) having reliable information and advice, (4) having extrinsic motivators to accomplish goals or health-related activities, and (5) receiving personalized care. In contrast, values less often addressed concerned (6) perceiving low thresholds to access health care, (7) receiving social support, (8) preserving a sense of autonomy over life, and (9) not feeling fear, anxiety, or insecurity about health. Last, 2 largely unaddressed values were related to (10) having confidence and self-efficacy in the treatment or ability to achieve goals and (11) desiring to be seen as a person rather than a patient. CONCLUSIONS Positively, existing eHealth technologies could be connected with CVD patients' values, largely through design features that relate to educational support, self-monitoring support, behavior change support, feedback, and motivational incentives. Other design features such as reminders, prompts or cues, peer-based or expert-based human support, and general system personalization were also connected with values but in narrower ways. In future studies, the inferred feature-value connections must be validated with empirical data from individuals with a CVD or similar chronic conditions.
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Department of Health and Social Studies, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - Britt Elise Bente
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,General Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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6
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Essery R, Pollet S, Smith KA, Mowbray F, Slodkowska-Barabasz J, Denison-Day J, Hayter V, Bradbury K, Grey E, Western MJ, Milton A, Hunter C, Ferrey AE, Müller AM, Stuart B, Mutrie N, Griffin S, Kendrick T, Brooker H, Gudgin B, Phillips R, Stokes T, Niven J, Little P, Yardley L. Planning and optimising a digital intervention to protect older adults' cognitive health. Pilot Feasibility Stud 2021; 7:158. [PMID: 34407886 PMCID: PMC8371874 DOI: 10.1186/s40814-021-00884-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.
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Affiliation(s)
- Rosie Essery
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
| | - Sebastien Pollet
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Kirsten A Smith
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Fiona Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Joanna Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - James Denison-Day
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Victoria Hayter
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | | | | | - Alexander Milton
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Cheryl Hunter
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Centre for Sport & Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Nanette Mutrie
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Kendrick
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Bernard Gudgin
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Rosemary Phillips
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Tom Stokes
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - John Niven
- Public and Patient Involvement (PPI) representative, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK. .,School of Psychological Science, University of Bristol, Bristol, UK.
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7
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Morton K, Dennison L, Band R, Stuart B, Wilde L, Cheetham-Blake T, Heber E, Slodkowska-Barabasz J, Little P, McManus RJ, May CR, Yardley L, Bradbury K. Implementing a digital intervention for managing uncontrolled hypertension in Primary Care: a mixed methods process evaluation. Implement Sci 2021; 16:57. [PMID: 34039390 PMCID: PMC8152066 DOI: 10.1186/s13012-021-01123-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/29/2021] [Indexed: 01/28/2023] Open
Abstract
Background A high proportion of hypertensive patients remain above the target threshold for blood pressure, increasing the risk of adverse health outcomes. A digital intervention to facilitate healthcare practitioners (hereafter practitioners) to initiate planned medication escalations when patients’ home readings were raised was found to be effective in lowering blood pressure over 12 months. This mixed-methods process evaluation aimed to develop a detailed understanding of how the intervention was implemented in Primary Care, possible mechanisms of action and contextual factors influencing implementation. Methods One hundred twenty-five practitioners took part in a randomised controlled trial, including GPs, practice nurses, nurse-prescribers, and healthcare assistants. Usage data were collected automatically by the digital intervention and antihypertensive medication changes were recorded from the patients’ medical notes. A sub-sample of 27 practitioners took part in semi-structured qualitative process interviews. The qualitative data were analysed using thematic analysis and the quantitative data using descriptive statistics and correlations to explore factors related to adherence. The two sets of findings were integrated using a triangulation protocol. Results Mean practitioner adherence to escalating medication was moderate (53%), and the qualitative analysis suggested that low trust in home readings and the decision to wait for more evidence influenced implementation for some practitioners. The logic model was partially supported in that self-efficacy was related to adherence to medication escalation, but qualitative findings provided further insight into additional potential mechanisms, including perceived necessity and concerns. Contextual factors influencing implementation included proximity of average readings to the target threshold. Meanwhile, adherence to delivering remote support was mixed, and practitioners described some uncertainty when they received no response from patients. Conclusions This mixed-methods process evaluation provided novel insights into practitioners’ decision-making around escalating medication using a digital algorithm. Implementation strategies were proposed which could benefit digital interventions in addressing clinical inertia, including facilitating tracking of patients’ readings over time to provide stronger evidence for medication escalation, and allowing more flexibility in decision-making whilst discouraging clinical inertia due to borderline readings. Implementation of one-way notification systems could be facilitated by enabling patients to send a brief acknowledgement response. Trial registration (ISRCTN13790648). Registered 14 May 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01123-1.
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Affiliation(s)
- Kate Morton
- Academic Unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Research, University of Southampton, Southampton, UK
| | - Laura Wilde
- Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Tara Cheetham-Blake
- NIHR Evaluation, Trials and Studies Coordinating Centre, University of Southampton, Southampton, UK
| | - Elena Heber
- GET.ON Institut, Hamburg, Germany, & University of Southampton, Southampton, UK
| | | | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
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8
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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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9
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McManus RJ, Little P, Stuart B, Morton K, Raftery J, Kelly J, Bradbury K, Zhang J, Zhu S, Murray E, May CR, Mair FS, Michie S, Smith P, Band R, Ogburn E, Allen J, Rice C, Nuttall J, Williams B, Yardley L. Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial. BMJ 2021; 372:m4858. [PMID: 33468518 PMCID: PMC7814507 DOI: 10.1136/bmj.m4858] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. DESIGN Unmasked randomised controlled trial with automated ascertainment of primary endpoint. SETTING 76 general practices in the United Kingdom. PARTICIPANTS 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. INTERVENTIONS Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. MAIN OUTCOME MEASURES The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. RESULTS After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of -3.4 mm Hg (95% confidence interval -6.1 to -0.8 mm Hg) and a mean difference in diastolic blood pressure of -0.5 mm Hg (-1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. CONCLUSIONS The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. TRIAL REGISTRATION ISRCTN13790648.
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Affiliation(s)
- Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - 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
| | - Katherine Morton
- School of Psychology, University of Southampton, Southampton, UK
| | - James Raftery
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | | | - Jin Zhang
- School of Psychology, University of Southampton, Southampton, UK
| | - Shihua Zhu
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health Sciences, University College London, London, UK
| | - Carl R May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, University College London, London, UK
| | - Peter Smith
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, UK
| | - Rebecca Band
- School of Psychology, University of Southampton, Southampton, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Julie Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Cathy Rice
- Patient and Public Contributor, Bristol, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Bryan Williams
- Institute of Cardiovascular Sciences, NIHR UCL Hospitals Biomedical Research Centre, University College London, London, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, UK
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10
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Geraghty AWA, Roberts L, Hill J, Foster NE, Yardley L, Hay E, Stuart B, Turner D, Griffiths G, Webley F, Durcan L, Morgan A, Hughes S, Bathers S, Butler-Walley S, Wathall S, Mansell G, Leigh L, Little P. Supporting self-management of low back pain with an internet intervention in primary care: a protocol for a randomised controlled trial of clinical and cost-effectiveness (SupportBack 2). BMJ Open 2020; 10:e040543. [PMID: 32819960 PMCID: PMC7440707 DOI: 10.1136/bmjopen-2020-040543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Self-management and remaining physically active are first-line recommendations for the care of patients with low back pain (LBP). With a lifetime prevalence of up to 85%, novel approaches to support behavioural self-management are needed. Internet interventions may provide accessible support for self-management of LBP in primary care. The aim of this randomised controlled trial is to determine the clinical and cost-effectiveness of the 'SupportBack' internet intervention, with or without physiotherapist telephone support in reducing LBP-related disability in primary care patients. METHODS AND ANALYSIS A three-parallel arm, multicentre randomised controlled trial will compare three arms: (1) usual primary care for LBP; (2) usual primary care for LBP and an internet intervention; (3) usual primary care for LBP and an internet intervention with additional physiotherapist telephone support. Patients with current LBP and no indicators of serious spinal pathology are identified and invited via general practice list searches and mailouts or opportunistic recruitment following LBP consultations. Participants undergo a secondary screen for possible serious spinal pathology and are then asked to complete baseline measures online after which they are randomised to an intervention arm. Follow-ups occur at 6 weeks, 3, 6 and 12 months. The primary outcome is physical function (using the Roland and Morris Disability Questionnaire) over 12 months (repeated measures design). Secondary outcomes include pain intensity, troublesome days in pain over the last month, pain self-efficacy, catastrophising, kinesophobia, health-related quality of life and cost-related measures for a full health economic analysis. A full mixed-methods process evaluation will be conducted. ETHICS AND DISSEMINATION This trial has been approved by a National Health Service Research Ethics Committee (REC Ref: 18/SC/0388). Results will be disseminated through peer-reviewed journals, conferences, communication with practices and patient groups. Patient representatives will support the implementation of our full dissemination strategy. TRIAL REGISTRATION NUMBER ISRCTN14736486.
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Affiliation(s)
- Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Lisa Roberts
- School of Health Sciences, University of Southampton & University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Jonathan Hill
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, Hampshire, UK
- School of Psychological Science, University of Bristol, Bristol, Bristol, UK
| | - Elaine Hay
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, UK
| | - Beth Stuart
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - David Turner
- Keele Clinical Trials Unit, School of Primary, Community and Social Care, Keele University, Keele, Newcastle, UK
| | - Gareth Griffiths
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Frances Webley
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Lorraine Durcan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Alannah Morgan
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Stephanie Hughes
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
| | - Sarah Bathers
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | | | - Simon Wathall
- Keele Clinical Trials Unit, Keele University, Keele, Staffordshire, UK
| | - Gemma Mansell
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Linda Leigh
- Patient and Public Involvement Representative, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, Hampshire, UK
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11
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Cruz-Martínez RR, Wentzel J, Asbjørnsen RA, Noort PD, van Niekerk JM, Sanderman R, van Gemert-Pijnen JE. Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development. J Med Internet Res 2020; 22:e16157. [PMID: 32436852 PMCID: PMC7273239 DOI: 10.2196/16157] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/19/2019] [Accepted: 02/07/2020] [Indexed: 02/07/2023] Open
Abstract
Background Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the use of different terms and concepts to explain the same phenomena and lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A review of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to achieve an understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods The metaethnography approach was used to review and synthesize researchers’ reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, Association for Computing Machinery Digital Library, and Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results Of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) applied by the projects were identified. Key ingredients (n=293) of the included articles were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) it targets behavior change; (7) it targets technology adoption; and (8) it targets health-related outcomes. Conclusions The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modeling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches. Trial Registration PROSPERO CRD42018104397; https://tinyurl.com/y8ajyajt International Registered Report Identifier (IRRID) RR2-10.2196/13334
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Affiliation(s)
- Roberto Rafael Cruz-Martínez
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Jobke Wentzel
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Saxion University of Applied Sciences, Deventer, Netherlands
| | - Rikke Aune Asbjørnsen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway
| | - Peter Daniel Noort
- Embedded Information Services, Library, ICT Services & Archive, University of Twente, Enschede, Netherlands
| | - Johan Magnus van Niekerk
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Robbert Sanderman
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands.,GZW-Health Psychology-GZW-General, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
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12
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Murry LT, Kennelty K. Opportunity for Pharmacists in Telehealth, Team-Based Care: Clinical Inertia. Telemed J E Health 2020; 26:1199-1201. [PMID: 31971882 DOI: 10.1089/tmj.2019.0242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: A variety of team-based telehealth interventions have recently been developed and piloted in a number of practice settings. Despite the variety of intervention designs, clinical inertia (CI) continues to be problematic for therapeutic intensification and subsequent disease control. Commentary: Based on recent literature, pharmacists have the ability to mitigate a number of factors contributing to CI. Considering CI continues to limit overall effectiveness of team-based telehealth interventions, involving pharmacists more intentionally in these interventions would provide benefit to therapeutic intensification and therapeutic outcomes.
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Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
| | - Korey Kennelty
- The University of Iowa College of Pharmacy, Iowa City, Iowa, USA
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13
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McCrorie C, Benn J, Johnson OA, Scantlebury A. Staff expectations for the implementation of an electronic health record system: a qualitative study using normalisation process theory. BMC Med Inform Decis Mak 2019; 19:222. [PMID: 31727063 PMCID: PMC6854727 DOI: 10.1186/s12911-019-0952-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Global evidence suggests a range of benefits for introducing electronic health record (EHR) systems to improve patient care. However, implementing EHR within healthcare organisations is complex and, in the United Kingdom (UK), uptake has been slow. More research is needed to explore factors influencing successful implementation. This study explored staff expectations for change and outcome following procurement of a commercial EHR system by a large academic acute NHS hospital in the UK. METHODS Qualitative interviews were conducted with 14 members of hospital staff who represented a variety of user groups across different specialities within the hospital. The four components of Normalisation Process Theory (Coherence, Cognitive participation, Collective action and Reflexive monitoring) provided a theoretical framework to interpret and report study findings. RESULTS Health professionals had a common understanding for the rationale for EHR implementation (Coherence). There was variation in willingness to engage with and invest time into EHR (Cognitive participation) at an individual, professional and organisational level. Collective action (whether staff feel able to use the EHR) was influenced by context and perceived user-involvement in EHR design and planning of the implementation strategy. When appraising EHR (Reflexive monitoring), staff anticipated short and long-term benefits. Staff perceived that quality and safety of patient care would be improved with EHR implementation, but that these benefits may not be immediate. Some staff perceived that use of the system may negatively impact patient care. The findings indicate that preparedness for EHR use could mitigate perceived threats to the quality and safety of care. CONCLUSIONS Health professionals looked forward to reaping the benefits from EHR use. Variations in level of engagement suggest early components of the implementation strategy were effective, and that more work was needed to involve users in preparing them for use. A clearer understanding as to how staff groups and services differentially interact with the EHR as they go about their daily work was required. The findings may inform other hospitals and healthcare systems on actions that can be taken prior to EHR implementation to reduce concerns for quality and safety of patient care and improve the chance of successful implementation.
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Affiliation(s)
- Carolyn McCrorie
- Patient Safety Translational Research Centre, Bradford Institute of Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK.
| | - Jonathan Benn
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Arabella Scantlebury
- York Trials Unit, Department of Health Sciences, ARRC Building, University of York, York, YO10 5DD, UK
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14
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Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach. NPJ Digit Med 2019; 2:85. [PMID: 31508496 PMCID: PMC6718425 DOI: 10.1038/s41746-019-0163-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022] Open
Abstract
This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review that identified cancer survivors' needs, including barriers and facilitators to intervention success. Review evidence (N = 49 papers) informed the intervention's Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N = 96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N = 31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions.
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15
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Krusche A, Bradbury K, Corbett T, Barnett J, Stuart B, Yao GL, Bacon R, Böhning D, Cheetham-Blake T, Eccles D, Foster C, Geraghty AWA, Leydon G, Müller A, Neal RD, Osborne R, Rathod S, Richardson A, Sharman G, Summers K, Watson E, Wilde L, Wilkinson C, Yardley L, Little P. Renewed: Protocol for a randomised controlled trial of a digital intervention to support quality of life in cancer survivors. BMJ Open 2019; 9:e024862. [PMID: 30826763 PMCID: PMC6429898 DOI: 10.1136/bmjopen-2018-024862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/09/2018] [Accepted: 12/21/2018] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Low quality of life is common in cancer survivors. Increasing physical activity, improving diet, supporting psychological well-being and weight loss can improve quality of life in several cancers and may limit relapse. The aim of the randomised controlled trial outlined in this protocol is to examine whether a digital intervention (Renewed), with or without human support, can improve quality of life in cancer survivors. Renewed provides support for increasing physical activity, managing difficult emotions, eating a healthier diet and weight management. METHODS AND ANALYSIS A randomised controlled trial is being conducted comparing usual care, access to Renewed or access to Renewed with brief human support. Cancer survivors who have had colorectal, breast or prostate cancer will be identified and invited through general practice searches and mail-outs. Participants are asked to complete baseline measures immediately after screening and will then be randomised to a study group; this is all completed on the Renewed website. The primary outcome is quality of life measured by the European Organization for Research and Treatment of Cancer QLQ-c30. Secondary outcomes include anxiety and depression, fear of cancer recurrence, general well-being, enablement and items relating to costs for a health economics analysis. Process measures include perceptions of human support, intervention usage and satisfaction, and adherence to behavioural changes. Qualitative process evaluations will be conducted with patients and healthcare staff providing support. ETHICS AND DISSEMINATION The trial has been approved by the NHS Research Ethics Committee (Reference 18/NW/0013). The results of this trial will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN96374224; Pre-results.
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Affiliation(s)
- Adele Krusche
- Department of Psychology, University of Southampton, Southampton, UK
| | | | - Teresa Corbett
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Barnett
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Biostatistics Research Group, University of Leicester, Leicester, UK
| | - Roger Bacon
- Patient and Public Involvement team for the CLASP project
| | - Dankmar Böhning
- Mathematical Sciences, University of Southampton, Southampton, UK
| | | | - Diana Eccles
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Claire Foster
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | | | - Geraldine Leydon
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
| | - Andre Müller
- Saw Swee Hock Public School of Health, National University of Singapore, Singapore
| | - Richard D Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | | | - Alison Richardson
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | - Kevin Summers
- Patient and Public Involvement team for the CLASP project
| | - Eila Watson
- School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK
| | - Laura Wilde
- Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Paul Little
- Primary Care and Population Sciences Division, University of Southampton, Southampton, UK
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16
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Abstract
PURPOSE OF REVIEW To review data supporting the use of home blood pressure monitoring (HBPM) and provide practical guidance to clinicians wishing to incorporate HBPM into their practice. RECENT FINDINGS HBPM more accurately reflects the risk of cardiovascular events than office blood pressure measurement. In addition, there is high-quality evidence that HBPM combined with clinical support improves blood pressure control. Therefore, HBPM is increasingly recommended by guidelines to confirm the diagnosis of hypertension and evaluate the efficacy of blood pressure-lowering medications. Nevertheless, HBPM use remains low due to barriers from the patient, clinician, and healthcare system level. Understanding these barriers is crucial for developing strategies to effectively implement HBPM into routine clinical practice. HBPM is a valuable adjunct to office blood pressure measurement for diagnosing hypertension and guiding antihypertensive therapy. Following recommended best practices can facilitate the successful implementation of HBPM and impact how hypertension is managed in the primary care setting.
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Firet L, de Bree C, Verhoeks CM, Teunissen DAM, Lagro-Janssen ALM. Mixed feelings: general practitioners' attitudes towards eHealth for stress urinary incontinence - a qualitative study. BMC FAMILY PRACTICE 2019; 20:21. [PMID: 30684962 PMCID: PMC6347743 DOI: 10.1186/s12875-019-0907-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 01/15/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stress urinary incontinence (SUI) is the most prevalent subtype of urinary incontinence and is a bothering condition in women. Only a minority of those with SUI consult a general practitioner (GP). EHealth with pelvic floor muscle training (PFMT) is effective in reducing incontinence symptoms and might increase access to care. The role of the GP regarding such an eHealth intervention is unknown. The aim of the study is to gain insight into the attitudes towards a PFMT internet-based, eHealth, intervention for SUI. METHODS A qualitative study was conducted. Data were collected through semi-structured interviews among purposively sampled GPs. Audio records were fully transcribed, and analysed thematically. RESULTS Thirteen GPs were interviewed, nine females and four males. Three themes emerged: appraisal of eHealth as a welcome new tool, mixed feelings about a supportive role, and eHealth is no cure-all. GPs welcomed eHealth for SUI as matching their preferences for PFMT and having advantages for patients. With eHealth as stand-alone therapy GPs were concerned about the lack of feedback, and the loss of motivation to adhere to the intervention. Therefore, GPs considered personal support important. The GP's decision to recommend eHealth was strongly influenced by a woman's motivation and her age. GPs' treatment preferences for elderly are different from those for young women with SUI; both PFMT and eHealth are perceived less suitable for older women. CONCLUSION EHealth with PFMT fits into the GPs' routine practice of SUI and adds value to it. Although there is evidence that eHealth as a stand-alone intervention is effective, GPs consider personal support important to supplement the perceived shortcomings. Probably GPs are not aware of, or convinced of the existing evidence. Training should address this issue and should also focus on common misunderstandings about regular care for women with SUI, such as the idea that PFMT is not suitable for the elderly. Improving GPs' knowledge that eHealth can be a stand-alone therapy for SUI facilitates the implementation in daily care.
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Affiliation(s)
- Lotte Firet
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands.
| | - Chrissy de Bree
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Carmen M Verhoeks
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Doreth A M Teunissen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary and Community Care, Unit Gender in Primary and Transmural Care, Radboud university medical center, Geert Grooteplein 21, 6500, HB, Nijmegen, the Netherlands
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Morrissey EC, Glynn LG, Casey M, Walsh JC, Molloy GJ. New self-management technologies for the treatment of hypertension: general practitioners' perspectives. Fam Pract 2018; 35:318-322. [PMID: 29088438 DOI: 10.1093/fampra/cmx100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Digital health interventions, such as those that can be delivered via smartphone applications (apps) or wireless blood pressure monitors, offer a new, scalable and potentially cost-effective way to improve hypertension self-management. In Ireland, as is common in the UK, the majority of hypertension management occurs in general practice. Therefore, it is crucial to investigate how general practitioners (GPs) feel about and engage with the growth of these new methods of self-management of blood pressure. AIM To explore GPs' perspectives of self-management technology to support medication adherence and blood pressure control in patients with hypertension. DESIGN AND SETTING This was a qualitative interview study based in the West of Ireland. Ten GPs who were purposively sampled participated in semi-structured interviews. Thematic analysis was carried out on the data. RESULTS Three major themes were identified: current reach and future potential, empowerment and responsibility. CONCLUSIONS GPs could see the benefit of using these technologies, such as more accurate blood pressure data and potential to engage patients in self-management. Concerns relating to the increased workload associated with a potentially unmanageable quantity of information and an increase in healthcare use among the 'worried well' also emerged strongly from the data.
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Affiliation(s)
- Eimear C Morrissey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Liam G Glynn
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Monica Casey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jane C Walsh
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Bradbury K, Morton K, Band R, van Woezik A, Grist R, McManus RJ, Little P, Yardley L. Using the Person-Based Approach to optimise a digital intervention for the management of hypertension. PLoS One 2018; 13:e0196868. [PMID: 29723262 PMCID: PMC5933761 DOI: 10.1371/journal.pone.0196868] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 04/20/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND For behaviour-change interventions to be successful they must be acceptable to users and overcome barriers to behaviour change. The Person-Based Approach can help to optimise interventions to maximise acceptability and engagement. This article presents a novel, efficient and systematic method that can be used as part of the Person-Based Approach to rapidly analyse data from development studies to inform intervention modifications. We describe how we used this approach to optimise a digital intervention for patients with hypertension (HOME BP), which aims to implement medication and lifestyle changes to optimise blood pressure control. METHODS In study 1, hypertensive patients (N = 12) each participated in three think-aloud interviews, providing feedback on a prototype of HOME BP. In study 2 patients (N = 11) used HOME BP for three weeks and were then interviewed about their experiences. Studies 1 and 2 were used to identify detailed changes to the intervention content and potential barriers to engagement with HOME BP. In study 3 (N = 7) we interviewed hypertensive patients who were not interested in using an intervention like HOME BP to identify potential barriers to uptake, which informed modifications to our recruitment materials. Analysis in all three studies involved detailed tabulation of patient data and comparison to our modification criteria. RESULTS Studies 1 and 2 indicated that the HOME BP procedures were generally viewed as acceptable and feasible, but also highlighted concerns about monitoring blood pressure correctly at home and making medication changes remotely. Patients in study 3 had additional concerns about the safety and security of the intervention. Modifications improved the acceptability of the intervention and recruitment materials. CONCLUSIONS This paper provides a detailed illustration of how to use the Person-Based Approach to refine a digital intervention for hypertension. The novel, efficient approach to analysis and criteria for deciding when to implement intervention modifications described here may be useful to others developing interventions.
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Affiliation(s)
- Katherine Bradbury
- University of Southampton, Academic unit of psychology, University of Southampton, Southampton, United Kingdom
| | - Katherine Morton
- University of Southampton, Academic unit of psychology, University of Southampton, Southampton, United Kingdom
| | - Rebecca Band
- University of Southampton, Academic unit of psychology, University of Southampton, Southampton, United Kingdom
| | - Anne van Woezik
- Rotterdam University of Applied Science, Healthcare technology, Rotterdam University of Applied Science, Rotterdam, Netherlands
| | - Rebecca Grist
- Brighton, School of Applied Social Science, Falmer, Brighton, United Kingdom
| | - Richard J. McManus
- University of Oxford, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Paul Little
- University of Southampton, Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Lucy Yardley
- University of Southampton, Academic unit of psychology, University of Southampton, Southampton, United Kingdom
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Morrissey EC, Casey M, Glynn LG, Walsh JC, Molloy GJ. Smartphone apps for improving medication adherence in hypertension: patients' perspectives. Patient Prefer Adherence 2018; 12:813-822. [PMID: 29785096 PMCID: PMC5957057 DOI: 10.2147/ppa.s145647] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Digital interventions, such as smartphone applications (apps), are becoming an increasingly common way to support medication adherence and self-management in chronic conditions. It is important to investigate how patients feel about and engage with these technologies. The aim of this study was to explore patients' perspectives on smartphone apps to improve medication adherence in hypertension. METHODS This was a qualitative study based in the West of Ireland. Twenty-four patients with hypertension were purposively sampled and engaged in focus groups. Thematic analysis on the data was carried out. RESULTS Participants ranged in age from 50 to 83 years (M=65 years) with an equal split between men and women. Three major themes were identified in relation to patients' perspectives on smartphone apps to improve medication adherence in hypertension: "development of digital competence," "rules of engagement," and "sustainability" of these technologies. CONCLUSION These data showed that patients can identify the benefits of a medication reminder and recognize that self-monitoring their blood pressure could be empowering in terms of their understanding of the condition and interactions with their general practitioners. However, the data also revealed that there are concerns about increasing health-related anxiety and doubts about the sustainability of this technology over time. This suggests that the current patient perspective of smartphone apps might be best characterized by "ambivalence."
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Affiliation(s)
- Eimear C Morrissey
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
- mHealth Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
- Correspondence: Eimear C Morrissey, School of Psychology, National University of Ireland Galway, University Road, Galway H91EV56, Ireland, Tel +11 353 87 670 8518, Email
| | - Monica Casey
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Liam G Glynn
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Jane C Walsh
- mHealth Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Gerard J Molloy
- Medication Adherence Across the Lifespan Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
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Band R, Bradbury K, Morton K, May C, Michie S, Mair FS, Murray E, McManus RJ, Little P, Yardley L. Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach. Implement Sci 2017; 12:25. [PMID: 28231840 PMCID: PMC5324312 DOI: 10.1186/s13012-017-0553-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/09/2017] [Indexed: 01/16/2023] Open
Abstract
Background This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Person-Based Approach to intervention development emphasises the use of qualitative research to ensure that the intervention is acceptable, persuasive, engaging and easy to implement. Methods Our intervention planning process comprised two parallel, integrated work streams, which combined theory-, evidence- and person-based elements. The first work stream involved collating evidence from a mixed methods feasibility study, a systematic review and a synthesis of qualitative research. This evidence was analysed to identify likely barriers and facilitators to uptake and implementation as well as design features that should be incorporated in the HOME BP intervention. The second work stream used three complementary approaches to theoretical modelling: developing brief guiding principles for intervention design, causal modelling to map behaviour change techniques in the intervention onto the Behaviour Change Wheel and Normalisation Process Theory frameworks, and developing a logic model. Results The different elements of our integrated approach to intervention planning yielded important, complementary insights into how to design the intervention to maximise acceptability and ease of implementation by both patients and health professionals. From the primary and secondary evidence, we identified key barriers to overcome (such as patient and health professional concerns about side effects of escalating medication) and effective intervention ingredients (such as providing in-person support for making healthy behaviour changes). Our guiding principles highlighted unique design features that could address these issues (such as online reassurance and procedures for managing concerns). Causal modelling ensured that all relevant behavioural determinants had been addressed, and provided a complete description of the intervention. Our logic model linked the hypothesised mechanisms of action of our intervention to existing psychological theory. Conclusion Our integrated approach to intervention development, combining theory-, evidence- and person-based approaches, increased the clarity, comprehensiveness and confidence of our theoretical modelling and enabled us to ground our intervention in an in-depth understanding of the barriers and facilitators most relevant to this specific intervention and user population. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0553-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Band
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Katherine Bradbury
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Katherine Morton
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Susan Michie
- UCL Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, Scotland
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Little
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Centre for Clincial and Community Applications of Health Psychology, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
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