title: Implementing international sexual counselling guidelines in hospital cardiac rehabilitation: development of the CHARMS intervention using the Behaviour Change Wheel.
abstract: Decreased sexual activity and sexual problems are common among people with cardiovascular disease, negatively impacting relationship satisfaction and quality of life. International guidelines recommend routine delivery of sexual counselling to cardiac patients. The Cardiac Health and Relationship Management and Sexuality (CHARMS) baseline study in Ireland found, similar to international findings, limited implementation of sexual counselling guidelines in practice. The aim of the current study was to develop the CHARMS multi-level intervention to increase delivery of sexual counselling by healthcare professionals. We describe the methods used to develop the CHARMS intervention following the three phases of the Behaviour Change Wheel approach: understand the behaviour, identify intervention options, and identify content and implementation options. Survey (n = 60) and focus group (n = 14) data from two previous studies exploring why sexual counselling is not currently being delivered were coded by two members of the research team to understand staff's capability, opportunity, and motivation to engage in the behaviour. All potentially relevant intervention functions to change behaviour were identified and the APEASE (affordability, practicability, effectiveness, acceptability, side effects and equity) criteria were used to select the most appropriate. The APEASE criteria were then used to choose between all behaviour change techniques (BCTs) potentially relevant to the identified functions, and these BCTs were translated into intervention content. The Template for Intervention Description and Replication (TIDieR) checklist was used to specify details of the intervention including the who, what, how and where of proposed intervention delivery.
  
  
  
  Providing sexual counselling group sessions by cardiac rehabilitation staff to patients during phase III cardiac rehabilitation was identified as the target behaviour. Education, enablement, modelling, persuasion and training were selected as appropriate intervention functions. Twelve BCTs, linked to intervention functions, were identified for inclusion and translated into CHARMS intervention content.
  
  
  
  This paper details the use of Behaviour Change Wheel approach to develop an implementation intervention in an under-researched area of healthcare provision. The systematic and transparent development of the CHARMS intervention will facilitate the evaluation of intervention effectiveness and future replication and contribute to the advancement of a cumulative science of implementation intervention design.
authors.affiliation: Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland. jenny.mcsharry@nuigalway.ie.
authors.forename: J
authors.initials: J
authors.lastname: Mc Sharry
authors.affiliation: Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
authors.forename: P J
authors.initials: PJ
authors.lastname: Murphy
authors.affiliation: Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Byrne
mesh_terms: D000072038:Cardiac Rehabilitation / Q000379:methods*; D003376:Counseling / Q000379:methods*; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D038622:Internationality; D007494:Ireland; D015397:Program Evaluation / Q000379:methods*; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000628:therapy*
keywords: Behaviour change; Cardiac rehabilitation; Cardiovascular disease; Complex intervention; Implementation; Intervention development; Sexual counselling