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      Developing theoretically underpinned primary care resources for patients with asthma: an exemplar from the IMP 2ART trial

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          Abstract

          Aim:

          This article reports on the development of patient resources for the IMPlementing IMProved Asthma self-management as RouTine (IMP 2ART) programme that aimed to encourage patients to attend asthma reviews (invitation letters), encourage patients to enquire about asthma action plans (posters), and equip patients with the knowledge to manage their asthma (information website).

          Background:

          To improve supported asthma self-management in UK primary care, the IMP 2ART programme developed a whole-systems approach (patient resources, professional education, and organisational strategies).

          Methods:

          Linked to behaviour change theory, we developed a range of patient resources for primary care general practices (an information website, invitation letters to invite patients for asthma reviews, and posters to encourage asthma action plan ownership). We elicited qualitative feedback on the resources from people living with asthma in the UK ( n = 17). In addition, we conducted an online survey with volunteers in the UK-wide REgister for Asthma researCH (REACH) database to identify where they source asthma information, whether their information needs are met, and what information would be useful ( n = 95).

          Findings:

          Following feedback gathered from the interviews and the online survey, we refined our patient resources for the IMP 2ART programme. Refinements included highlighting the seriousness of asthma, enhancing trustworthiness, and including social support resources. We also made necessary colour and formatting changes to the resources. In addition, the patient resources were updated following the COVID-19 pandemic. The multi-stage development process enabled us to refine and optimise the patient resources. The IMP 2ART strategy is now being tested in a UK-wide cluster RCT (ref: ISRCTN15448074).

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          Most cited references21

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          The behaviour change wheel: A new method for characterising and designing behaviour change interventions

          Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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            The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions.

            CONSORT guidelines call for precise reporting of behavior change interventions: we need rigorous methods of characterizing active content of interventions with precision and specificity. The objective of this study is to develop an extensive, consensually agreed hierarchically structured taxonomy of techniques [behavior change techniques (BCTs)] used in behavior change interventions. In a Delphi-type exercise, 14 experts rated labels and definitions of 124 BCTs from six published classification systems. Another 18 experts grouped BCTs according to similarity of active ingredients in an open-sort task. Inter-rater agreement amongst six researchers coding 85 intervention descriptions by BCTs was assessed. This resulted in 93 BCTs clustered into 16 groups. Of the 26 BCTs occurring at least five times, 23 had adjusted kappas of 0.60 or above. "BCT taxonomy v1," an extensive taxonomy of 93 consensually agreed, distinct BCTs, offers a step change as a method for specifying interventions, but we anticipate further development and evaluation based on international, interdisciplinary consensus.
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              Qualitative data analysis for applied policy research

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                Author and article information

                Journal
                Prim Health Care Res Dev
                Prim Health Care Res Dev
                PHC
                Primary Health Care Research & Development
                Cambridge University Press (Cambridge, UK )
                1463-4236
                1477-1128
                2024
                20 September 2024
                : 25
                : e35
                Affiliations
                [ 1 ]Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London , London, UK
                [ 2 ]Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh , Edinburgh, UK
                [ 3 ]Department of Applied Health Research, University College London , London, UK
                [ 4 ] The Park Medical Practice , Shepton Mallet, UK
                [ 5 ]Severn School of Primary Care, Health Education England (South West) , Bristol, UK
                [ 6 ]School of Health and Related Research, University of Sheffield , Sheffield, UK
                Author notes
                Corresponding author: Hilary Pinnock; Email: hilary.pinnock@ 123456ed.ac.uk
                Author information
                https://orcid.org/0000-0002-1270-7738
                https://orcid.org/0000-0002-6188-3607
                https://orcid.org/0000-0003-3468-129X
                https://orcid.org/0000-0003-2190-3068
                https://orcid.org/0000-0002-9854-3868
                https://orcid.org/0000-0001-5445-9413
                https://orcid.org/0000-0003-3240-6729
                https://orcid.org/0000-0001-7454-6354
                https://orcid.org/0000-0002-5976-8386
                Article
                S1463423624000197
                10.1017/S1463423624000197
                11464803
                39300749
                4a099afa-2d03-4062-a841-e4f9852d4345
                © The Author(s) 2024

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 09 August 2023
                : 04 January 2024
                : 08 May 2024
                Page count
                Figures: 2, Tables: 2, References: 27, Pages: 9
                Categories
                Development

                asthma,asthma education,patient education,patient resources

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