Article type
Year
Abstract
Introduction: Patient mediated interventions are one possible strategy to bridge the gap between research and clinical practice. With extensive input from patients and health professionals, we developed a patient resource about COPD. The resource summarises Cochrane treatment reviews, and suggests questions to ask a doctor to prompt consideration of evidence. A trial showed that the resource had little effect on health outcomes at 3 months. Process measures suggested that virtually all intervention participants read the resource, but less than half questioned their doctor and very few changed treatment.
Objectives: We aimed to identify barriers to patient use of the resource, focussing on reading the resource and asking a doctor the suggested questions.
Methods: To identify a range of barriers, maximum variation purposive sampling and in-depth interviews were used. In phase 1, open interviews and grounded analysis produced categories relating to COPD management and use of the resource. In phase 2, barriers were explored in detail through more structured interviews and analysis, drawing on concepts from the theory of planned behaviour. Pictorial vignettes were used throughout to improve recall. Analyses were performed using QSR NUD.IST 4. All participants were sent a summary of findings and asked whether their views were reflected.
Results: See table opposite. All participants said they had read from the resource, but the extent of reading varied. Social norms, external factors and PBC (perceived behavioural control) appeared largely positive or neutral. Both positive and negative attitudes to reading were identified. While some participants asked doctors about topics from the resource, they did not form intentions to ask the suggested questions. No serious barriers were found in PBC or external factors, but attitudes and social norms were negative.
Conclusions: High rates of reading were consistent with the few barriers identified in this study, though negative attitudes to new information limited reading for some participants. Low rates of question-asking can be explained by negative attitudes to the suggested questions (with no positive outcomes recognised) and mismatches between suggested questions and social norms of the consultation. For greater success, patient mediated interventions may need to overcome or circumvent these barriers.
Objectives: We aimed to identify barriers to patient use of the resource, focussing on reading the resource and asking a doctor the suggested questions.
Methods: To identify a range of barriers, maximum variation purposive sampling and in-depth interviews were used. In phase 1, open interviews and grounded analysis produced categories relating to COPD management and use of the resource. In phase 2, barriers were explored in detail through more structured interviews and analysis, drawing on concepts from the theory of planned behaviour. Pictorial vignettes were used throughout to improve recall. Analyses were performed using QSR NUD.IST 4. All participants were sent a summary of findings and asked whether their views were reflected.
Results: See table opposite. All participants said they had read from the resource, but the extent of reading varied. Social norms, external factors and PBC (perceived behavioural control) appeared largely positive or neutral. Both positive and negative attitudes to reading were identified. While some participants asked doctors about topics from the resource, they did not form intentions to ask the suggested questions. No serious barriers were found in PBC or external factors, but attitudes and social norms were negative.
Conclusions: High rates of reading were consistent with the few barriers identified in this study, though negative attitudes to new information limited reading for some participants. Low rates of question-asking can be explained by negative attitudes to the suggested questions (with no positive outcomes recognised) and mismatches between suggested questions and social norms of the consultation. For greater success, patient mediated interventions may need to overcome or circumvent these barriers.