Abstract
BackgroundThe important role of primary care in promoting healthy lifestyle behaviours needs informed support.AimTo elicit views on a 39-item shared decision-making (SDM) aid (SHARE-D) for lifestyle change and refine it to improve implementation.Design & settingMixed-methods study.MethodHealth professionals, patients, and support workers, with experience of managing or a history of cardio- or cerebrovascular disease, were purposively recruited based on age, sex, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision-aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically.ResultsSubstantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: 1) core content of the decision-aid; 2) barriers to use; 3) motivation for lifestyle change; and 4) primary care implementation. ‘Self-reflective’ questions and goal setting were viewed as essential components. The paper-based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30-item aid was considered suitable for facilitating brief conversations and promoting patient autonomy.ConclusionThe SHARE-D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in-depth information to support implementation of a refined version. Further studies should examine its effectiveness.
Highlights
IntroductionRoutine consultations in primary care settings present an important opportunity to target lifestyle behaviours[1].Current UK guidelines recommend that we identify patients who are not sufficiently active and offer support to encourage behaviour change[2]
How this fits in Shared decision-making can ensure that patients’ individual care needs and preferences are met
There is limited evidence about using these approaches for promoting behaviour change, or how they could work best in general practice. This mixed-methods study explored the views of patients and health professionals on an existing decision-making aid
Summary
Routine consultations in primary care settings present an important opportunity to target lifestyle behaviours[1].Current UK guidelines recommend that we identify patients who are not sufficiently active and offer support to encourage behaviour change[2]. Lifestyle advice can be of particular benefit to patients with established cardiovascular disease risk factors, including physical inactivity, poor diet and obesity[3,4,5,6]. These factors are infrequently discussed with patients in routine practice[7]. The COM-B framework informed the design and development of SHARE-D[27], a questionnairebased aid, designed to facilitate shared decision making around lifestyle modification in patients with increased cardiovascular risk factors and to identify constraints and support that may be needed for making changes to diet and physical activity. The important role of primary care in promoting healthy lifestyle behaviours needs informed support
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