Development and description of a theory-driven, evidence-based, complex intervention to improve adherence to treatment for tuberculosis in the UK: the IMPACT study
Development and description of a theory-driven, evidence-based, complex intervention to improve adherence to treatment for tuberculosis in the UK: the IMPACT study
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DOI：
10.1080/21642850.2023.2277289
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发表时间：
2024-12-31
影响因子：
2.7
通讯作者：
Lipman，Marc C. I.
中科院分区：
文献类型：
--
作者：
Jones，Annie S. K.;Horne，Rob;Lipman，Marc C. I.
结核病(TB)对患者来说是一个巨大的治疗负担，需要至少6个月的多种药物的抗结核治疗(ATT)。确保良好遵守ATT是全球结核病战略的核心，包括高收入、低结核病发病率(HILI)环境中的战略。为了使依从性干预措施成功和可交付，它们需要解决影响患者和提供者行为的个人和环境因素。目的本文描述了应用理论和研究证据来为英国成人结核病患者支持ATT依从性的影响手动干预的设计过程。我们综合了形成性研究的结果(定性和定量的范围回顾以及患者和护理人员的访谈)，并以临床观察、文献综述和医疗保健提供者访谈为补充。调查结果与指导性理论框架(认知和实用性方法)相对应，并付诸实施，以设计干预内容和内容。咨询了相关利益相关者的干预发展小组(IDG)，以使干预适应当地的临床环境。结果影响干预的务实、可交付的组成部分和内容包括：(1)增强的、结构化的风险评估，以系统地识别不遵守的风险因素，并提供当地适应的指导，以缓解这些风险；以及(2)关于结核病及其治疗的患者教育材料(动画视频和互动患者手册)，以传达治疗需求并解决常见问题。结论使用基于理论和证据的方法，结合利益相关者的意见，我们开发了一种多成分、务实、手动的干预措施，解决了患者在当地服务资源内遵守ATT的个人障碍，以提高英国结核病服务机构对ATT的遵从性。
BackgroundTuberculosis (TB) has a significant treatment burden for patients, requiring at least six months of anti-TB treatment (ATT) with multiple medicines. Ensuring good adherence to ATT is central to global TB strategies, including those in high-income, low-TB incidence (HILI) settings. For adherence interventions to be successful and deliverable, they need to address the personal and environmental factors influencing patient and provider behaviour.PurposeThis paper describes the application of theory and research evidence to inform the design process of the IMPACT manualised intervention to support ATT adherence for adults with TB disease in the United Kingdom (UK). It also provides a full description of the resulting intervention.MethodsWe synthesised findings from our formative research (qualitative and quantitative scoping reviews and patient and carer interviews) and supplemented these with clinic observations, a literature review, and healthcare provider interviews. Findings were mapped to the guiding theoretical framework (Perceptions and Practicalities Approach) which was operationalised to design the intervention components and content. An Intervention Development Group (IDG) of relevant stakeholders were consulted to adapt the intervention to local clinical settings.ResultsThe pragmatic, deliverable components and content for the IMPACT intervention included: (1) an enhanced, structured, risk assessment to systematically identify risk factors for non-adherence plus locally-adapted guidance to mitigate these; and (2) patient educational materials (an animated video and interactive patient booklet) about TB and its treatment, to communicate the need for treatment and address common concerns.ConclusionsUsing a theory– and evidence– based approach incorporating stakeholder input, we have developed a multi-component, pragmatic, manualised intervention, which addresses patients’ personal barriers to adherence within local service resources to improve adherence to ATT within UK TB services.