Abstract
Background: Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from qualitative exploration of cervical screening in women over fifty in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service user leaflet and a short video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over fifty, and to increase sensitivity to age-related problems in cervical screening among primary care practitioners.Methods: We translated qualitative data into barriers and facilitators by recoding a primary data set, and subsequently applied the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs) based on the data set. Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide intervention content and mode of delivery.Results: Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas – clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners).Conclusion: The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.