scholarly journals Developing a theory-informed complex intervention to improve nurse–patient therapeutic engagement employing Experience-based Co-design and the Behaviour Change Wheel: an acute mental health ward case study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047114
Author(s):  
Sarah McAllister ◽  
Alan Simpson ◽  
Vicki Tsianakas ◽  
Nick Canham ◽  
Vittoria De Meo ◽  
...  
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Design Process ◽  
Complex Interventions ◽  
Intervention Development ◽  
Behaviour Change Techniques ◽  
Service Users ◽  
Therapeutic Engagement ◽  
Behaviour Change Wheel

ObjectivesOur objectives were threefold: (1) describe a collaborative, theoretically driven approach to co-designing complex interventions; (2) demonstrate the implementation of this approach to share learning with others; and (3) develop a toolkit to enhance therapeutic engagement on acute mental health wards.Design and participantsWe describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Our case study was informed by the results of a systematic integrative review and guided by this integrated approach. We undertook 80 hours of non-participant observations, and semistructured interviews with 14 service users (7 of which were filmed), 2 carers and 12 clinicians from the same acute ward. The facilitated intervention co-design process involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development.SettingThis study was conducted over 12 months at an acute mental health organisation in England.ResultsThe co-designed Let’s Talk toolkit addressed four joint service user/clinician priorities for change: (1) improve communication with withdrawn people; (2) nurses to help service users help themselves; (3) nurses to feel confident when engaging with service users; (4) improving team relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design-behaviour change approach with service users, carers and clinicians to develop a toolkit to improve nurse–patient therapeutic engagement.ConclusionsOur theory-driven approach enhanced both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.

scholarly journals The Let's Talk toolkit: developing a theory-informed complex intervention to improve nurse-patient therapeutic engagement on an acute mental health ward by employing Experience-based Co-design and the Behaviour Change Wheel

2020 ◽  
Author(s):  
Sarah McAllister ◽  
Alan Simpson ◽  
Vicki Tsianakas ◽  
Nick Canham ◽  
Vittoria De Meo ◽  
...  
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Design Process ◽  
Complex Interventions ◽  
Intervention Development ◽  
Behaviour Change Techniques ◽  
Service Users ◽  
Therapeutic Engagement ◽  
Behaviour Change Wheel ◽  
Design Behaviour

Abstract Background Lack of high-quality nurse-patient therapeutic engagement is a longstanding problem on acute mental health wards, with a dearth of interventions to address this. A collaborative, theory-driven approach to developing and implementing complex interventions is more likely to be effective and sustainable. This paper describes an integrated co-design-behaviour change approach which developed the Let’s Talk intervention toolkit for improving the quality of therapeutic engagement on acute mental health wards. Methods We describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Fieldwork was informed by the results of a systematic integrative review and was guided by our co-design-behaviour change approach. It was conducted over 12-months at an acute mental health organisation in England. We undertook semi-structured interviews with 14 service users (seven of which were filmed), two carers and 12 clinicians, 80 hours of non-participant observations and a facilitated intervention co-design process that involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development. Results The co-designed Let’s Talk toolkit addressed four joint priorities for change: 1) improve communication with withdrawn people; 2) nurses to help service users help themselves; 3) nurses to feel confident when engaging with service users; 4) improving team relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design-behaviour change approach with service users, carers and clinicians to co-design the toolkit to improve nurse-patient therapeutic engagement. Conclusions Our theory-driven approach enhances both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.

Applying the COM-B behaviour model to overcome barriers to heart failure self-care: A practical application of a conceptual framework for the development of complex interventions (ACHIEVE study)

2020 ◽  
pp. 147451512095729
Author(s):  
Amanda Whittal ◽  
Stefan Störk ◽  
Barbara Riegel ◽  
Oliver Rudolf Herber
Keyword(s):  
Heart Failure ◽  
Behaviour Change ◽  
Complex Interventions ◽  
Self Care ◽  
Intervention Development ◽  
Heart Association ◽  
Barriers And Facilitators ◽  
Behaviour Change Techniques ◽  
Anticipated Regret ◽  
Management Interventions

Background: Effective interventions to enhance adherence to self-care recommendations in patients with heart failure have immense potential to improve health and wellbeing. However, there is substantial inconsistency in the effectiveness of existing self-management interventions, partly because they lack theoretical models underpinning intervention development. Aim: To outline how the capability, opportunity and motivation behaviour model has been applied to guide the development of a theory-based intervention aiming to improve adherence to heart failure self-care recommendations. Methods: The application of the capability, opportunity and motivation behaviour model involved three steps: (a) identification of barriers and facilitators to heart failure self-care from two comprehensive meta-studies; (b) identification of appropriate behaviour change techniques to improve heart failure self-care; and (c) involvement of experts to reduce and refine potential behaviour change techniques further. Results: A total of 119 barriers and facilitators were identified. Fifty-six behaviour change techniques remained after applying three steps of the behaviour model for designing interventions. Expert involvement ( n=39, of which 31 were patients (67% men; 45% New York Heart Association II)) further reduced and refined potential behaviour change techniques. Experts disliked some behaviour change techniques such as ‘anticipated regret’ and ‘salience of consequences’. This process resulted in a final comprehensive list consisting of 28 barriers and 49 appropriate behaviour change techniques potentially enhancing self-care that was put forward for further use. Conclusion: The application of the capability, opportunity and motivation behaviour model facilitated identifying important factors influencing adherence to heart failure self-care recommendations. The model served as a comprehensive guide for the selection and design of interventions for improving heart failure self-care adherence. The capability, opportunity and motivation behaviour model enabled the connection of heart failure self-care barriers to particular behaviour change techniques to be used in practice.

scholarly journals Behaviour Change for Open Science

2019 ◽  
Author(s):  
Emma Norris ◽  
Daryl Brian O'Connor
Keyword(s):  
Behaviour Change ◽  
Intervention Development ◽  
Open Science ◽  
Barriers And Facilitators ◽  
Change Strategies ◽  
Behaviour Change Wheel ◽  
Change Principles

This Editorial presents a discussion of behaviour change strategies that could be used to increase uptake of Open Science behaviours. It explores what we mean by behaviour in Open Science, barriers and facilitators of Open Science behaviours and the potential for intervention development using behaviour change principles using a case-study of the Behaviour Change Wheel.

scholarly journals Mobilizing knowledge in behaviour change to promote health; the case of the Behaviour Change Wheel

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Belanger-Gravel
Keyword(s):  
Public Health ◽  
Behaviour Change ◽  
Scientific Evidence ◽  
Intervention Development ◽  
Behaviour Change Techniques ◽  
Knowledge Mobilization ◽  
Behaviour Change Wheel ◽  
Health Practitioners ◽  
Public Health Practitioners ◽  
Behavioural Sciences

Abstract Issue/problem Over the past decades, researchers from many fields have built an impressive body of knowledge regarding behaviour change. However, the use of this knowledge for accurately designing/delivering/executing behaviour change programs is challenging for many public health practitioners. Description of the problem To support effective knowledge mobilization in behaviour change and to build a coherent and useful body of scientific evidence, leading researchers in behavioural sciences have developed and refined a number of tools for designing interventions. Among these tools, the Behaviour Change Wheel (BCW) was built on an impressive effort to synthetize available evidence regarding intervention development frameworks, behaviour change theories, and behaviour change techniques. However, studies highlighted some issues associated with the use of these methodological innovations. Working with our public health partners in the field of health communication, we realized that applying models such as the BCW is far from being mundane practices. To support optimal knowledge mobilization in behavioural sciences, we are developing a research agenda to understand perceptions and motivations of public health practitioners toward innovations such as the BCW and to develop and evaluate knowledge mobilization strategies. Results The initiative will contribute to the development of new scientific knowledge regarding mechanisms underlying effective knowledge mobilization in behaviour change and will further support the adoption of these evidence-based practices within the field of public health. Lessons Although rapidly adopted by the community of researchers, it is not clear whether or not public health practitioners would be as willing, or capable of using the BCW to design and deliver programs. Issues regarding knowledge mobilization in behaviour change should be addressed to improve the uptake of this knowledge in practice.

Developing mental health interventions

2015 ◽  
Author(s):  
Abhijit Nadkarni ◽  
Mary J. De Silva ◽  
Vikram Patel
Keyword(s):  
Mental Health ◽  
Complex Interventions ◽  
Intervention Development ◽  
Health Interventions ◽  
Theory Of Change ◽  
Complex Process ◽  
Mrc Framework ◽  
Mental Health Interventions ◽  
Structured Approach

Most mental health interventions are complex as they are made up of a number of interconnected components, acting both independently and interdependently. This inherent complexity makes the development and evaluation of such interventions a complex process. Following a structured approach to the development and evaluation of complex interventions helps ensure that the process is systematic, rigorous, and replicable. In this chapter we demonstrate how systematically conducted formative research, consistent with the MRC framework, will ensure that due consideration is given to the sociocultural and health systems context. We use the case study of an ongoing complex intervention development and evaluation program in India (PREMIUM) to illustrate the application of the development and feasibility/piloting phases of the MRC framework. We describe two complementary frameworks, the Normalization Process Theory and the Theory of Change that can be used to strengthen the MRC framework for the development of mental health interventions.

scholarly journals Facilitators and barriers to fitness bootcamp participation using the Behaviour Change Wheel

2021 ◽  
pp. 001789692110441
Author(s):  
Leo De Winter ◽  
Leslie Morrison Gutman
Keyword(s):  
Physical Activity ◽  
Behaviour Change ◽  
Intervention Development ◽  
Behaviour Change Techniques ◽  
Qualitative Research Design ◽  
Behaviour Change Wheel ◽  
The Social ◽  
Facilitators And Barriers ◽  
The Impact

Objective: Despite its importance for mental and physical health, many adults fail to meet current physical activity recommendations. Furthermore, most adults who begin a physical activity programme revert to being less active or even inactive within the first 6 months. Fitness bootcamps represent a potential intervention for improving physical activity in healthy adults. However, no study to date has examined the influences on long-term participation in fitness bootcamps, which is the first step to developing an effective intervention. Using the Behaviour Change Wheel (BCW) framework, this study identified the facilitators and barriers to long-term (1 year or more) fitness bootcamp participation, which were then linked to behaviour change techniques (BCTs) to facilitate intervention development. Design: Qualitative research design. Setting: Data collection occurred in England. Method: Interviews were conducted with 15 long-term fitness bootcamp participants. Results: Thematic analysis revealed 17 facilitators and 6 barriers to long-term fitness bootcamp participation. Participants highlighted the importance of facilitators such as convenience, being outdoors and enjoyment. The social environment, including having a positive instructor and supportive group members, was further noted as a key influence on participation. While long-term participants faced occasional barriers to their routine such as physical injury, bad weather and competing events, the impact of these could be minimised through appropriate BCTs such as ‘demonstration of the behaviour’ and ‘restructuring the social/physical environment’. Conclusion: Findings from this study highlight the importance of social and environmental factors to promoting long-term fitness bootcamp participation and the inclusion of social and physical environmental restructuring as key intervention components.

scholarly journals Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
M. A. Arden ◽  
M. Hutchings ◽  
P. Whelan ◽  
S. J. Drabble ◽  
D. Beever ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Development Strategy ◽  
Treatment Adherence ◽  
Behaviour Change ◽  
Multidisciplinary Team ◽  
Treatment Plan ◽  
Controlled Trial ◽  
Intervention Development ◽  
Evidence Base ◽  
Behaviour Change Techniques

Abstract Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

scholarly journals A co-production approach guided by the Behaviour Change Wheel to develop an intervention for reducing sedentary behaviour after stroke

2020 ◽  
Author(s):  
Jennifer Hall ◽  
Sarah Morton ◽  
Jessica Hall ◽  
David J Clarke ◽  
Claire F Fitzsimons ◽  
...  
Keyword(s):  
Sedentary Behaviour ◽  
Behaviour Change ◽  
Intervention Development ◽  
Inpatient Setting ◽  
Stroke Survivors ◽  
Behaviour Change Wheel ◽  
Target Behaviour ◽  
Service Staff ◽  
Stroke Services ◽  
Production Approach

Abstract Background: Stroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke.Methods: A series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two stroke services (England and Scotland). Workshop format was informed by the Behaviour Change Wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development.Findings: Co-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers, and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience. Conclusions: To our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

scholarly journals M223. EXPLORING YOUR PERSONAL IDENTITY: USING USER-CENTRED-DESIGN FOR THE DEVELOPMENT OF A NEW INTERVENTION FOR SERVICE USERS WITH COMPLEX MENTAL HEALTH NEEDS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S220-S221
Author(s):  
Lisette Van der Meer ◽  
Tessa Jonker ◽  
Charlotte Wunderink ◽  
Jaap van Weeghel ◽  
Marieke (Gerdina) Pijnenborg ◽  
...  
Keyword(s):  
Mental Health ◽  
Design Process ◽  
Mental Health Professionals ◽  
Psychosocial Intervention ◽  
Health Needs ◽  
Service Users ◽  
Personal Recovery ◽  
Mental Health Needs ◽  
User Centred Design ◽  
Starting Point

Abstract Background Introduction: As a human being we give meaning to our stories, in relation to the social and physical context. For people with severe and complex mental health needs, who have been dependent on (intensive) residential psychiatric support for a long time, it is possible that talents and qualities disappear because this part of their identity has been buried under a long psychiatric history. This can result in people’s identity becoming limited to ‘patient’, and the experience of life as meaningless. Objectives For these service-users, few interventions aimed at personal recovery are available that match their cognitive and communicative skills. In this project, we developed a new psychosocial intervention to stimulate self-reflection and personal recovery. Methods The development of the intervention took place through a “user-centred-design process” (UCD). UCD is an iterative design process in which the needs and wishes of the user are the starting point, and they remain central in the product design circle. Throughout the whole design process, service users, significant others, mental health professionals, peer support workers, artists, and researchers collaborate in order to design a first testable prototype. For each step of design process, we organized focus group meetings and brainstorm sessions with all stakeholders as well as individual interviews with service users. Based on the input in these meetings and interviews, the design was adapted. This was done for each consecutive step, which made the whole design process iterative by nature. Results A new psychosocial intervention entitled “This Is Me” was developed as a “journey of discovery” through the lives of service users at both verbal and non-verbal levels. From the UCD process four basic principles underlying the intervention were disentangled that have been incorporated in the intervention: 1) “gaining new experiences”, 2) “attention for (self)stigma”, 3) “equal treatment as a person”, 4) “uniqueness of the individual”. This resulted in an intervention in which service-users, together with a teammate, engage in new experiences. Moreover, they are prompted to reflect on these experiences upon their return. With this process, we aim to support people in (re)discovering roles, talents and characteristics to broaden the identity from ‘patienthood’ to ‘personhood’. Discussion Conclusions: UCD was a useful method for the development of a new psychosocial intervention targeting identity for people with complex mental health needs. The process resulted into new knowledge about factors that are important in the (re)development of identity. In addition, we will present the first results of a pilot study in which we assessed the feasibility and effectiveness of the intervention.

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