Crayton Elise, Wright Alison J, Ashworth Mark
Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, King's College London, London, UK.
Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, UK.
BMC Health Serv Res. 2018 Oct 11;18(1):772. doi: 10.1186/s12913-018-3572-1.
Medications targeting stroke risk factors have shown good efficacy, yet adherence is suboptimal. A lack of underlying theory may contribute to the ineffectiveness of eliciting or sustaining behaviour change in many existing interventions targeting medication adherence in stroke. Intervention effectiveness and implementation could be enhanced by consideration of evidence base and theory to drive development. The purpose of this study is to identify appropriate components for a theory-driven and evidence-based medication adherence intervention for stroke survivors.
The Behaviour Change Wheel (BCW), a guide to intervention development, informed our systematic process of intervention development. Our earlier systematic review had identified important determinants of medication adherence that were mapped into the Theoretical Domains Framework (TDF), with Knowledge, Beliefs about consequences and Emotions found to be more influential. Utilising the BCW facilitated selection of intervention options and behaviour change techniques (BCTs); the active ingredients within an intervention. To further refine BCT selection, APEASE criteria were employed, allowing evaluation of potential BCTs within context: The National Health Service (NHS), United Kingdom (UK).
Five intervention functions (Education, Persuasion, Training, Environmental Restructuring and Enablement) and five policy categories (Communication/marketing, Guidelines, Regulation, Environmental/social planning and Service provision) were identified as potential intervention options, underpinned by our systematic review findings. Application of APEASE criteria led to an initial pool of 21 BCTs being reduced to 11 (e.g. Habit Formation, Information about Health Consequences and Action Planning) identified as potential intervention components that would both be feasible and directly target the underlying determinants of stroke survivors' medication adherence.
Careful consideration of underlying evidence and theory to drive intervention design, facilitated by the BCW, enabled identification of appropriate intervention components. BCTs including Habit Formation, Information about Health Consequences and Self-monitoring of Behaviour were considered potentially effective and appropriate to deliver within the NHS. Having reduced the pool of potential intervention components to a manageable number, it will now be possible to explore the perceived acceptability of selected BCTs in interviews with stroke survivors and healthcare professionals. This approach to intervention development should be generalisable to other chronic conditions and areas of behaviour change (e.g. exercise adherence).
针对中风风险因素的药物已显示出良好疗效，但依从性并不理想。缺乏基础理论可能导致许多现有的针对中风患者药物依从性的干预措施在引发或维持行为改变方面效果不佳。通过考虑证据基础和理论来推动干预措施的开发，可以提高干预效果和实施效率。本研究的目的是确定针对中风幸存者的基于理论和证据的药物依从性干预措施的适当组成部分。
行为改变轮（BCW）作为干预措施开发的指南，为我们系统的干预措施开发过程提供了指导。我们早期的系统评价确定了药物依从性的重要决定因素，并将其映射到理论领域框架（TDF）中，发现知识、对后果的信念和情绪更具影响力。利用BCW有助于选择干预选项和行为改变技术（BCTs）；干预措施中的有效成分。为了进一步优化BCT的选择，采用了APEASE标准，以便在英国国家医疗服务体系（NHS）的背景下评估潜在的BCTs。
根据我们的系统评价结果，确定了五种干预功能（教育、劝说、培训、环境重组和赋能）和五种政策类别（沟通/营销、指南、监管、环境/社会规划和服务提供）作为潜在的干预选项。应用APEASE标准后，最初的21种BCTs减少到11种（如习惯养成、健康后果信息和行动计划），这些被确定为潜在的干预组成部分，既可行又能直接针对中风幸存者药物依从性的潜在决定因素。
通过BCW的帮助，仔细考虑基础证据和理论以推动干预设计，能够确定适当的干预组成部分。包括习惯养成、健康后果信息和行为自我监测在内的BCTs被认为在NHS内实施可能有效且合适。将潜在干预组成部分的范围缩小到可管理的数量后，现在可以通过与中风幸存者和医疗专业人员的访谈来探索所选BCTs的可接受性。这种干预措施开发方法应可推广到其他慢性病和行为改变领域（如运动依从性）。
