Allied Health Professionals, Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, UK.
Population Health Sciences, University of Bristol, Bristol, UK.
BMC Health Serv Res. 2021 Mar 22;21(1):264. doi: 10.1186/s12913-021-06275-w.
The National Institute for Health and Care Excellence (NICE) recommend that men on androgen deprivation therapy (ADT) for prostate cancer should receive supervised exercise to manage the side-effects of treatment. However, these recommendations are rarely implemented into practice. Community-based exercise professionals (CBEPs) represent an important target group to deliver the recommendations nationally, yet their standard training does not address the core competencies required to work with clinical populations, highlighting a need for further professional training. This paper describes the development of a training package to support CBEPs to deliver NICE recommendations.
Development of the intervention was guided by the Medical Research Council guidance for complex interventions and the Behaviour Change Wheel. In step one, target behaviours, together with their barriers and facilitators were identified from a literature review and focus groups with CBEPs (n = 22) and men on androgen deprivation therapy (n = 26). Focus group outputs were mapped onto the Theoretical Domains Framework (TDF) to identify theoretical constructs for change. In step two, behaviour change techniques and their mode of delivery were selected based on psychological theories and evidence to inform intervention content. In step three, the intervention was refined following delivery and subsequent feedback from intervention recipients and stakeholders.
Six modifiable CBEPs target behaviours were identified to support the delivery of the NICE recommendations. Nine domains of the TDF were identified as key determinants of change, including: improving knowledge and skills and changing beliefs about consequences. To target the domains, we included 20 BCTs across 8 training modules and took a blended learning approach to accommodate different learning styles and preferences. Following test delivery to 11 CBEPs and feedback from 28 stakeholders, the training package was refined.
Established intervention development approaches provided a structured and transparent guide to intervention development. A training package for CBEPs was developed and should increase trust amongst patients and health care professionals when implementing exercise into prostate cancer care. Furthermore, if proven effective, the development and approach taken may provide a blueprint for replication in other clinical populations where exercise has proven efficacy but is insufficiently implemented.
英国国家卫生与临床优化研究所（NICE）建议，接受雄激素剥夺疗法（ADT）治疗前列腺癌的男性应接受监督下的运动，以控制治疗的副作用。然而，这些建议很少在实践中得到实施。社区运动专业人员（CBEPs）是在全国范围内实施这些建议的重要目标群体，但他们的标准培训并未涵盖与临床人群合作所需的核心能力，这突显了进一步进行专业培训的必要性。本文描述了一种培训包的开发，以支持 CBEPs 实施 NICE 建议。
该干预措施的开发遵循复杂干预措施的医学研究委员会指南和行为改变轮。在第一步中，从文献综述和 CBEPs（n=22）和接受雄激素剥夺疗法的男性（n=26）的焦点小组中确定了目标行为及其障碍和促进因素。焦点小组的产出被映射到理论领域框架（TDF）上，以确定行为改变的理论结构。在第二步中，根据心理理论和证据选择行为改变技术及其传递方式，以提供干预内容。在第三步中，根据干预接受者和利益相关者的反馈对干预进行了改进。
确定了六项可修改的 CBEPs 目标行为，以支持实施 NICE 建议。确定了 TDF 的九个关键领域，这些领域是变化的关键决定因素，包括：提高知识和技能以及改变对后果的信念。为了针对这些领域，我们在 8 个培训模块中纳入了 20 个 BCT，并采用混合学习方法来适应不同的学习风格和偏好。在对 11 名 CBEPs 进行测试并从 28 名利益相关者处获得反馈后，对培训包进行了改进。
既定的干预措施开发方法为干预措施的开发提供了一个结构化和透明的指南。为 CBEPs 开发了培训包，如果被证明有效，该开发和方法可能为在其他已证明运动有效的但实施不足的临床人群中复制提供蓝图。
