title: Achieving Good Outcomes for Asthma Living (GOAL): mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma.
abstract: Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review.
  
  
  
  The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data.
  
  
  
  Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76-6.65) versus UC 6.1: SD 0.81 (CI 5.63-6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17. Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma.
  
  
  
  The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial.
  
  
  
  ISRCTN18912042 . Registered on 26 June 2012.
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, Scotland, UK. gaylor.hoskins@stir.ac.uk.
authors.forename: Gaylor
authors.identifier: 0000-0002-8393-2342
authors.initials: G
authors.lastname: Hoskins
authors.affiliation: School of Nursing, Midwifery and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh, EH11 4BN, Scotland.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
authors.affiliation: Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, FK9 4LA, Scotland, UK.
authors.forename: Purva
authors.initials: P
authors.lastname: Abhyankar
authors.affiliation: Tayside Clinical Trials Unit, Level 10 Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Donnan
authors.affiliation: Nursing, Midwifery and Allied Health Professions Research Unit, School of Health Sciences, University of Stirling, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF, Scotland, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Duncan
authors.affiliation: Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.affiliation: Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
authors.forename: Marjon
authors.initials: M
authors.lastname: van der Pol
authors.affiliation: Tayside Clinical Trials Unit, Level 10 Ninewells Hospital and Medical School, Dundee, DD1 9SY, Scotland, UK.
authors.forename: Petra
authors.initials: P
authors.lastname: Rauchhaus
authors.affiliation: Faculty of Health Sciences and Sport, University of Stirling, Pathfoot Building, Stirling, FK9 4LA, Scotland, UK.
authors.forename: Anne
authors.initials: A
authors.lastname: Taylor
authors.affiliation: Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Medical School Doorway 3, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000175:diagnosis / Q000451:nursing* / Q000503:physiopathology / Q000523:psychology; D001291:Attitude of Health Personnel; D003142:Communication; D017281:Cost of Illness; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D010358:Patient Participation; D019555:Physician-Nurse Relations; D010865:Pilot Projects; D059017:Primary Care Nursing; D011320:Primary Health Care; D036301:Qualitative Research; D011788:Quality of Life; D012606:Scotland; D012648:Self Care; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asthma; Complex interventions; Goal setting; Mixed methods; Pilot cluster RCT; Self-management