Implementing international sexual counselling guidelines in hospital cardiac rehabilitation: development of the CHARMS intervention using the Behaviour Change Wheel.

J Mc Sharry,M Byrne,P J Murphy

doi:10.1186/s13012-016-0493-4

J Mc Sharry, M Byrne + Show 1 more

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https://doi.org/10.1186/s13012-016-0493-4

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Abstract

BackgroundDecreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff’s capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.ResultsProviding sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.ConclusionsThis paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0493-4) contains supplementary material, which is available to authorized users.

Highlights

Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life
This paper describes the methods used to develop the Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention to increase the provision of sexual counselling to cardiac rehabilitation patients in Ireland following the Behaviour Change Wheel (BCW) approach
We identified the setting for our implementation intervention through a system-level consideration of the most sustainable method of delivery within Irish healthcare and by incorporating the views of patients, general practitioners and cardiac rehabilitation staff elicited during the CHARMS baseline studies [32]

Summary

Introduction

Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. Changing healthcare professional behaviour to implement evidence-based guidelines into routine practice is a major challenge within the time and resource constraints of the healthcare system. Implementation interventions, to improve the update of evidence into practice, can be understood as multi-level interventions that require patient, provider, system and environmental level change [6]. Implementing evidence into practice often requires intervention at the provider level to support healthcare professionals to modify established patterns of care. At an environmental level, the widespread adoption of new practices requires the development of policy frameworks that embed implementation at a national or international level

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