Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council framework.
OBJECTIVE
To apply the UK Medical Research Council (MRC) framework for development and evaluation of trials of complex interventions to a primary healthcare intervention to promote secondary prevention of coronary heart disease.


METHODS
Case report of intervention development.


METHODS
First, literature relating to secondary prevention and lifestyle change was reviewed. Second, a preliminary intervention was modeled, based on literature findings and focus group interviews with patients (n = 23) and staff (n = 29) from 4 general practices. Participants' experiences of and attitudes toward key intervention components were explored. Third, the preliminary intervention was pilot-tested in 4 general practices. After delivery of the pilot intervention, practitioners evaluated the training sessions, and qualitative data relating to experiences of the intervention were collected using semistructured interviews with staff (n = 10) and patient focus groups (n = 17).


RESULTS
Literature review identified 3 intervention components: a structured recall system, practitioner training, and patient information. Initial qualitative data identified variations in recall system design, training requirements (medication prescribing, facilitating behavior change), and information appropriate to the prospective study participants. Identifying detailed structures within intervention components clarified how the intervention could be tailored to individual practice, practitioner, and patient needs while preserving the theoretical functions of the components. Findings from the pilot phase informed further modeling of the intervention, reducing administrative time, increasing practical content of training, and omitting unhelpful patient information.


CONCLUSIONS
Application of the MRC framework helped to determine the feasibility and development of a complex intervention for primary care research.
Byrne
Molly
M
Department of Psychology, National University of Ireland, Galway, Ireland. molly.byrne@nuigalway.ie
Cupples
Margaret E
ME
Smith
Susan M
SM
Leathem
Claire
C
Corrigan
Mairead
M
Byrne
Mary C
MC
Murphy
Andrew W
AW