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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels

Authors: Amanda R. McCullough, Cristín Ryan, Brenda O’Neill, Judy M. Bradley, J. Stuart Elborn, Carmel M. Hughes

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

Background

Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients’ adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).

Methods

We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients’ adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).

Results

Eight TDF domains were perceived to influence patients’ and HCPs’ behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).

Conclusions

Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.
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Literature
1.
Seitz AE, Olivier KN, Adjemian J, Holland SM, Prevots R. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest. 2012;142:432–9.CrossRefPubMedPubMedCentral
2.
3.
McCullough A, Tunney M, Quittner A, Elborn J, Bradley J, Hughes C. Treatment adherence and health outcomes in patients with bronchiectasis. BMC Pulm Med. 2014;14:107.CrossRefPubMedPubMedCentral
4.
McCullough AR, Ryan C, O’Neill B, Elborn JS, Bradley JM, Hughes CM. Interventions for enhancing adherence to treatment in adults with chronic respiratory disease: a systematic review [abstract]. Am J Respir Crit Care Med. 2014;189:A5130.
5.
6.
National Institute for Health And Clinical Excellence. Behaviour Change: The Principles for Effective Interventions. 2007.
7.
Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol. 2008;57:660–80.CrossRef
8.
Apter AJ, Wang X, Bogen DK, Rand CS, McElligott S, Polsky D, et al. Problem solving to improve adherence and asthma outcomes in urban adults with moderate or severe asthma: a randomized controlled trial. J Allergy Clin Immunol. 2011;128:516–23. e1–5.
9.
Armour C, Bosnic-Anticevich S, Brillant M, Burton D, Emmerton L, Krass I, et al. Pharmacy Asthma Care Program (PACP) improves outcomes for patients in the community. Thorax. 2007;62:496–502.
10.
Gallefoss F, Bakke PS. How does patient education and self-management among asthmatics and patients with chronic obstructive pulmonary disease affect medication? Am J Respir Crit Care Med. 1999;160:2000–5.CrossRefPubMed
11.
Hoffmann TC, Glasziou PP, Barbour V, Macdonald H. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. Br Med J. 2014;348:g1687.CrossRef
12.
Davidson K, Goldstein M, Kaplan R, Kaufman P, Knatterud G, Orleans C, et al. Evidence-based behavioural medicine: what is it and how do we achieve it? Ann Behav Med. 2003;26:161–71.
13.
Michie S, Johnston M, Abraham C, Lawton R, Parker D. Walker A, on behalf of the “Psychological Theory” group: making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14:26–33.CrossRefPubMedPubMedCentral
14.
Abraham C, Michie S. A taxonomy of behavior change techniques used in interventions. Health Psychol. 2008;27:379–87.CrossRefPubMed
15.
Murphy K, O’Connor DA, Browning CJ, French SD, Michie S, Francis JJ, et al. Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework. Implement Sci. 2014;9:31.
16.
French SD, Green SE, O’Connor DA, McKenzie JE, Francis JJ, Michie S, et al. Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012;7:38.
17.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46:81–95.
18.
Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRefPubMedPubMedCentral
19.
Kolehmainen N, Francis JJ. Specifying content and mechanisms of change in interventions to change professionals’ practice: an illustration from the Good Goals study in occupational therapy. Implement Sci. 2012;7:100.CrossRefPubMedPubMedCentral
20.
McCullough A, Tunney M, Elborn J, Bradley J, Hughes C. “All illness is personal to that individual”: a qualitative study of patients’ perspectives on treatment adherence in bronchiectasis. Heal Expect. 2014. doi:10.​1111/​hex.​12217.
21.
King N, Horrocks C. Interviews in Qualitative Research. 1st ed. London: Sage Publications Ltd; 2010.
22.
Francis JJ, Stockton C, Eccles MP, Johnston M, Cuthbertson BH, Grimshaw JM, et al. Evidence-based selection of theories for designing behaviour change interventions: using methods based on theoretical construct domains to understand clinicians’ blood transfusion behaviour. Br J Health Psychol. 2009;14:625–46.
23.
McCullough A, Tunney MM, Quittner AL, Elborn JS, Bradley JM, Hughes CM. Treatment adherence and health outcomes in patients with bronchiectasis. BMC Pulm Med. 2014;14:107.
24.
Seitz AE, Olivier KN, Steiner CA, Montes de Oca R, Holland SM, Prevots DR. Trends and burden of bronchiectasis-associated hospitalizations in the United States, 1993-2006. Chest. 2010;138:944–9.CrossRefPubMedPubMedCentral
25.
Quittner AL, Marciel KK, Salathe MA, O’Donnell AE, Gotfried MH, Ilowite JS, et al. A preliminary quality of life questionnaire-bronchiectasis: a patient-reported outcome measure for bronchiectasis. Chest. 2014;146:437.
26.
Jackson C, Eliasson L, Barber N, Weinman J. Applying COM-B to medication adherence: a suggested framework for research and interventions. Eur Heal Psychol. 2014;16:7–17.
27.
Glidewell L, Boocock S, Pine K, Campbell R, Hackett J, Gill S, et al. Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience. Implement Sci. 2013;8:118.
28.
Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA, et al. Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implement Sci. 2012;7:86.
29.
McSherry LA, Dombrowski SU, Francis JJ, Murphy J, Martin CM, O’Leary JJ, et al. “It”s a can of worms’: understanding primary care practitioners' behaviours in relation to HPV using the Theoretical Domains Framework. Implement Sci. 2012;7:73.
30.
Bussières AE, Patey AM, Francis JJ, Sales AE, Grimshaw JM, Brouwers M, et al. Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework. Implement Sci. 2012;7:82.
31.
Islam R, Tinmouth AT, Francis JJ, Brehaut JC, Born J, Stockton C, et al. A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework. Implement Sci. 2012;7:93.
32.
Zullig LL, Peterson ED, Bosworth HB. Ingredients of successful interventions to improve medication adherence. JAMA. 2013;310:2611–2.CrossRefPubMed
33.
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database of Systematic Reviews 2008; 2: CD000011.
34.
Michie S, Atkins L, West R. The behaviour change wheel: a guide to designing interventions. London, UK: Silverback publishing; 2014.
35.
Winett RA, Davy BM, Savla J, Marinik EL, Winett SG, Baugh ME, et al. Using response variation to develop more effective, personalized behavioral medicine?: evidence from the Resist Diabetes study. Transl Behav Med. 2014;4:333–8.
36.
Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW, Lapidus J, et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am J Respir Crit Care Med. 2010;181:566–77.
37.
Trupp RJ, Corwin EJ, Ahijevych KL, Nygren T. The impact of educational message framing on adherence to continuous positive airway pressure therapy. Behav Sleep Med. 2011;9:38–52.CrossRefPubMed
Metadata
Title
Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels
Authors
Amanda R. McCullough
Cristín Ryan
Brenda O’Neill
Judy M. Bradley
J. Stuart Elborn
Carmel M. Hughes
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1004-z

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