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
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
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DOI：
10.1186/s12913-015-1004-z
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发表时间：
2015-08-22
影响因子：
2.8
通讯作者：
Hughes, Carmel M.
中科院分区：
文献类型：
--
作者：
McCullough, Amanda R.;Ryan, Cristin;Hughes, Carmel M.
背景：患者对治疗的依从性低与支气管扩张症患者的健康结局较差有关。我们试图使用理论领域框架(TDF)(一个源于33个心理学理论的框架)和行为改变技术(BCT)来定义改变患者对支扩治疗依从性的干预的内容(阶段1和2)，并使用利益相关者专家小组来定义其交付(阶段3)。方法：我们对支扩患者进行了关于障碍和激励因素的半结构化访谈，焦点小组和焦点小组(或访谈)关于他们改变患者对治疗的依从性的能力。我们将这些数据编码到12个区域的TDF，以确定患者和HCP的相关区域(阶段1)。三名研究人员独立地将患者和HCP的相关领域映射到35个BCT列表，以确定纳入的两个潜在BCT列表(患者和HCP)(阶段2)。我们将这些名单提交给了三个专家小组(两个是患者，一个是来自英国各地的HC/学者)。我们询问专家小组，干预应该针对谁，以什么强度，以什么形式和环境，以及使用什么结果测量(阶段3)。结果：八个TDF领域被认为影响患者和HCP的行为：知识、技能、对能力的信念、关于后果的信念、动机、社会影响、行为规范和行为性质(阶段1)。干预包括患者和初级保健医生共有的12项行为能力测试：监测、自我监测、反馈、行动计划、解决问题、说服性沟通、指定的目标/目标：行为/结果、有关行为/结果的信息、角色扮演、社会支持和认知结构调整(阶段2)。参与者认为，这些BCT的个性化组合应该由一名工作人员在二次护理中通过几次一对一和/或小组访问向所有患者提供。疗效评估应从肺恶化、住院和生活质量(阶段3)来衡量。结论：干预内容包括12项BCT。在二次护理中，将通过几次面对面的访问，向所有患者提供这12项BCT中的个性化选择。在可行性和试验性测试之前，未来的研究应侧重于开发物理材料以帮助实施干预。如果有效，这种干预可能会改善未来支气管扩张症患者的依从性和健康结果。
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.