In a recent study published in BMC Health Services Research, Carmel M. Hughes from the Clinical and Practice Research Group, School of Pharmacy, Queen’s University Belfast in Belfast, UK and colleagues used a theoretically-driven approach to develop an intervention that would focus on changing patient adherence to treatments in bronchiectasis based on stakeholders’ own perspectives on the disease.
Bronchiectasis is an uncommon disease, most often secondary to an infectious process that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways. The condition has rising prevalence in the United States, revealing an 8.7% average increase per year in cases between 2000 and 2007. Patients with the disease experience debilitating symptoms and impaired quality of life.
There is a lack of evidence regarding the change of intervention adherence for patients with bronchiectasis. Recent guidelines highlight the need to report three aspects of interventions aiming at change behavior: (1) use of psychological theory to identify which factors have an influence in the target behavior change; (2) the active parameters of behavior change interventions and, (3) how these parameters should be presented to patients.
The Theoretical Domains Framework (TDF) can be used to define the mechanism of action and to choose behavior change techniques (BCTs) (“active ingredients”) to include in an intervention.
In the study entitled “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, behavioral change techniques and stakeholder expert panels,” the researchers used three different stages of analysis. First, they used TDF to identify which factors influence patients’ adherence behavior and identify what factors influenced healthcare professionals’ (HCPs) ability to change the adherence behavior of patients (Stage 1). The researchers then used results derived from Stage 1 analysis to select the BCTs in a specific intervention (Stage 2). Finally, the researchers subsequently used expert panels of key stakeholders (patients, HCPs and academics) to define how the proposed intervention could be delivered including format and delivery, training of HCPs and commissioning of the proposed intervention in the future (Stage 3).
The results revealed that eight TDF domains were perceived to influence patients’ and HCPs’ behaviors: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioral regulation and Nature of behaviors (Stage 1).
The intervention included a total of twelve BCTs common to patients and HCPs: Monitoring, Self-monitoring, Social support Action planning, Problem solving, Feedback, Goal/target specified, behavior/outcome, Role play Persuasive communication, Information regarding behavior/outcome, and Cognitive restructuring (Stage 2).
Participants thought that all patients should receive an individualized combination of these BCTs and should be delivered 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).
The researchers indicate that this study identified 12 theory-derived BCTs that form the intervention content. According to the researchers individually tailored content will be delivered to all patients over several face-to-face visits in secondary care.
They further suggest that future studies should focus on the development of physical materials to aid delivery of the proposed intervention prior to feasibility and pilot testing.
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