Abstract
BackgroundThe Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice. This study describes the use of intervention mapping (IM) in the design of a theory-driven, group-based complex intervention to support self-management (SM) of patients with osteoarthritis (OA) and chronic low back pain (CLBP) in Ireland’s primary care health system.MethodsThe six steps of the IM protocol were systematically applied to develop the self-management of osteoarthritis and low back pain through activity and skills (SOLAS) intervention through adaptation of the Facilitating Activity and Self-management in Arthritis (FASA) intervention. A needs assessment including literature reviews, interviews with patients and physiotherapists and resource evaluation was completed to identify the programme goals, determinants of SM behaviour, consolidated definition of SM and required adaptations to FASA to meet health service and patient needs and the evidence. The resultant SOLAS intervention behavioural outcomes, performance and change objectives were specified and practical application methods selected, followed by organised programme, adoption, implementation and evaluation plans underpinned by behaviour change theory.ResultsThe SOLAS intervention consists of six weekly sessions of 90-min education and exercise designed to increase participants’ physical activity level and use of evidence-based SM strategies (i.e. pain self-management, pain coping, healthy eating for weight management and specific exercise) through targeting of individual determinants of SM behaviour (knowledge, skills, self-efficacy, fear, catastrophizing, motivation, behavioural regulation), delivered by a trained physiotherapist to groups of up to eight individuals using a needs supportive interpersonal style based on self-determination theory. Strategies to support SOLAS intervention adoption and implementation included a consensus building workshop with physiotherapy stakeholders, development of a physiotherapist training programme and a pilot trial with physiotherapist and patient feedback.ConclusionsThe SOLAS intervention is currently being evaluated in a cluster randomised controlled feasibility trial. IM is a time-intensive collaborative process, but the range of methods and resultant high level of transparency is invaluable and allows replication by future complex intervention and trial developers.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0418-2) contains supplementary material, which is available to authorized users.
Highlights
The Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice
The primary aims of this study were to use the intervention mapping (IM) process to develop a complex group-based SM intervention (SOLAS: self-management of osteoarthritis and low back pain through activity and skills) for Ireland’s primary care physiotherapy service through adaptation of an existing evidence-based programme (Facilitating Activity and Self-management in Arthritis (FASA) [35]) which would serve as a prototype and to address factors related to its implementation in a planned feasibility trial [36] set in the publicly-funded Health Service Executive Primary Community and Continuing Care (PCCC) physiotherapy services of Dublin, Kildare and Wicklow on the east coast of Ireland serving a population of 1.6 million [37]
Semi-structured interviews The main themes from the manager interviews related to the Theoretical Domains Framework (TDF) domains environmental context and resources, skills, intention to support staff to set up group SM programmes and positive beliefs about the consequences of such programmes for patients and staff
Summary
The Medical Research Council framework provides a useful general approach to designing and evaluating complex interventions, but does not provide detailed guidance on how to do this and there is little evidence of how this framework is applied in practice. This study describes the use of intervention mapping (IM) in the design of a theory-driven, group-based complex intervention to support self-management (SM) of patients with osteoarthritis (OA) and chronic low back pain (CLBP) in Ireland’s primary care health system. Clinical guidelines endorse patient education about the underlying chronic condition and support for self-management (SM) behaviours, including physical activity [4,5,6,7], with SM programmes being championed in many health systems [8,9,10] internationally, but there has been minimal implementation in primary care in Ireland [11]. The successful implementation of a standardised, evidence-based clinical and cost-effective group programme to support SM for patients with chronic musculoskeletal pain is a key priority for primary care physiotherapy in Ireland [9]; a potential intervention must first be demonstrated to be credible, feasible and implementable within this challenging health service context prior to widespread adoption
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