title: Defining the content and delivery of an intervention to Change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the Theoretical Domains Framework, behavioural change techniques and stakeholder expert panels.
abstract: BACKGROUND
  Low patient adherence to treatment is associated with poorer health outcomes in bronchiectasis. We sought to use the Theoretical Domains Framework (TDF) (a framework derived from 33 psychological theories) and behavioural change techniques (BCTs) to define the content of an intervention to change patients' adherence in bronchiectasis (Stage 1 and 2) and stakeholder expert panels to define its delivery (Stage 3).
  
  
  METHODS
  We conducted semi-structured interviews with patients with bronchiectasis about barriers and motivators to adherence to treatment and focus groups or interviews with bronchiectasis healthcare professionals (HCPs) about their ability to change patients' adherence to treatment. We coded these data to the 12 domain TDF to identify relevant domains for patients and HCPs (Stage 1). Three researchers independently mapped relevant domains for patients and HCPs to a list of 35 BCTs to identify two lists (patient and HCP) of potential BCTs for inclusion (Stage 2). We presented these lists to three expert panels (two with patients and one with HCPs/academics from across the UK). We asked panels who the intervention should target, who should deliver it, at what intensity, in what format and setting, and using which outcome measures (Stage 3).
  
  
  RESULTS
  Eight TDF domains were perceived to influence patients' and HCPs' behaviours: Knowledge, Skills, Beliefs about capability, Beliefs about consequences, Motivation, Social influences, Behavioural regulation and Nature of behaviours (Stage 1). Twelve BCTs common to patients and HCPs were included in the intervention: Monitoring, Self-monitoring, Feedback, Action planning, Problem solving, Persuasive communication, Goal/target specified:behaviour/outcome, Information regarding behaviour/outcome, Role play, Social support and Cognitive restructuring (Stage 2). Participants thought that an individualised combination of these BCTs should be delivered to all patients, by a member of staff, over several one-to-one and/or group visits in secondary care. Efficacy should be measured using pulmonary exacerbations, hospital admissions and quality of life (Stage 3).
  
  
  CONCLUSIONS
  Twelve BCTs form the intervention content. An individualised selection from these 12 BCTs will be delivered to all patients over several face-to-face visits in secondary care. Future research should focus on developing physical materials to aid delivery of the intervention prior to feasibility and pilot testing. If effective, this intervention may improve adherence and health outcomes for those with bronchiectasis in the future.
authors: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK. amccullo@bond.edu.au.|Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia. amccullo@bond.edu.au.
authors: Amanda R
authors: AR
authors: McCullough
authors: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK. c.ryan@qub.ac.uk.
authors: Cristín
authors: C
authors: Ryan
authors: Northern Ireland Clinical Research Facility, Queen's University Belfast and The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, Belfast City Hospital, Belfast, UK. b.oneill@ulster.ac.uk.
authors: Brenda
authors: B
authors: O'Neill
authors: Northern Ireland Clinical Research Facility, Queen's University Belfast and The Wellcome Trust-Wolfson Northern Ireland Clinical Research Facility, Belfast City Hospital, Belfast, UK. jm.bradley@ulster.ac.uk.
authors: Judy M
authors: JM
authors: Bradley
authors: Centre for Infection and Immunity, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK. s.elborn@qub.ac.uk.
authors: J Stuart
authors: JS
authors: Elborn
authors: Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK. c.hughes@qub.ac.uk.
authors: Carmel M
authors: CM
authors: Hughes
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D001987:Bronchiectasis / Q000188:drug therapy; D036861:Delivery, Obstetric; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009042:Motivation; D011247:Pregnancy; D011582:Psychological Theory; D036301:Qualitative Research; D011788:Quality of Life