Refining a primary care shared decision-making aid for lifestyle change: a mixed-methods study

Neil Heron; Seán R O’Connor; Frank Kee; David R Thompson; Margaret Cupples; Michael Donnelly

doi:10.3399/BJGPO.2021.0100

Article Figures & Data

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Table 1. Interview schedule

1. Can you tell me about any experience you have of discussing lifestyle changes with a healthcare professional, a friend or family member? (Patient)

2. Can you tell me about any experience you have of using a ‘discussion tool’ or a ‘shared decision aid’?

3. What would your expectations of such a tool be?

4. Are these expectations met by the SHARE-D aid?

5. What parts of the SHARE-D tool did you like?

6. What would you want to change about the SHARE-D aid?

7. Did you learn anything new from the SHARE-D aid? Were there any surprises?

8. Is there anything else you would like the SHARE-D aid to include?

9. How do you think using the aid might affect lifestyle behaviours like physical activity and diet?

10. What do you think about the activities and questions included in the SHARE-D aid?

11. What would help people to remember what was discussed after using the SHARE-D aid?

12. How confident would you be that people using the aid could stick to any lifestyle decisions made when using the SHARE-D aid?

13. Who do you think is best placed to use the SHARE-D aid?

14. What do you think is the best setting for the SHARE-D aid to be used?

15. What do you think is the best format for the SHARE-D aid?

16. What would the benefits and disadvantages be of an online version of the SHARE-D aid?

17. What do you think about how long the conversation guided by the SHARE-D aid should be?

18. Is there anything else you would like to say about the SHARE-D aid?

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Table 2. Participant characteristics

Characteristic	Health professionals (n = 19), n	Patients and support workers (n = 15), n^a	Total sample (n = 34), n
Age, years
18–34	4	0	4
35–54	8	3	11
55–64	5	7	12
≥65	2	5	7
Sex
Male	7	6	13
Female	12	9	21
Location
Urban	8	9	17
Semi-rural/rural	11	6	17
Profession
GP	12	—	12
Cardiac physiotherapist	5	—	5
Practice nurse	1	—	1
Cardiovascular medicine physician	1	—	1
Condition^b
Heart disease	—	9	9
Stroke/TIA	—	3	3

^aFour support workers were included; one of whom also had a previous cardiovascular event. ^bHeart disease or TIA/stroke. TIA = transient ischaemic attack.

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Table 3. Overall level of agreement on inclusion of each item (n = 39) in the SHARE-D aid

Category	Overall agreement on inclusion of each item, %	Overall agreement on inclusion (Randolph’s K)	95% CI	Level of agreement^a	P value
Overall agreement for sample (n = 34)	74.9	0.62	0.54 to 0.71	Substantial	0.001
Health professional agreement (n = 19)	76.4	0.68	0.60 to 0.76	Substantial	0.001
Patient and support worker agreement (n = 15)	73.4	0.58	0.47 to 0.65	Moderate	0.001

Level of agreement based on the following categories: <0: poor agreement; 0.0–0.20: slight agreement; 0.21–0.40: fair agreement; 0.41–0.60: moderate agreement; 0.61–0.80: substantial agreement; 0.81–1.0: almost perfect agreement.

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Table 4. Selected participant quotes related to each theme identified based on analysis of qualitative interview data (n = 30 interviews)

Views of participants	Related theme	Supporting quote(s)
Should ensure conversations were ‘routine and non-personalised’	Theme 1. Core content of the decision aid	‘I like that you can speak about the need to make changes, but can back this up with the advice from guidelines, you know, it’s not just me saying this. Patients understand who NICE [National Institute for Health and Care Excellence] are and are willing to listen to this.’ (Health professional 9, female)
Participants in favour of ensuring that there was a ‘quick pathway’ through the aid; continuity of care could be difficult; patients’ readiness to make lifestyle changes may vary over time; and identifying those willing to engage could be difficult	Theme 2. Barriers to use	‘… there could be a role for a longer version used where time allowed, or if used outside of a typical 10-minute primary care consultation.’ (GP 7, female) ‘I would think going back would be good, you could use it [the appointment] to check what you are or have been doing, but I guess you might not see the same doctor and you would just be starting again with someone else.’ (Patient 3, male) ‘Going through the tool without any engagement from the patient could be time consuming, unnecessary, and even detrimental to other aspects of care’ (Health professional 3, female) ‘... even in two or three minutes you might sometimes have an impact [on patients] but usually the ability to spend time to do this is restricted, or is restricted if patients really are only there for you to send them off with their tablets.’ (GP 4, male)
Information could help prepare people for change, but more support might be needed to motivate them	Theme 3. Motivating factors for lifestyle change	‘... I know what the benefits are, but it’s the next steps that are important, I think actually sticking to changes is much harder, and there is always something getting in the way.‘ (Patient 5, female)
Even brief information could be useful to patients at a later time	Theme 4. Implementation in primary care	‘… people might not be ready to make changes at that moment, but they need to be reassured about the safety of slowly starting to exercise.’ (Patient support worker 2, male)
Patients could go through the aid themselves, prior to a consultation	—	‘I think sending a link to the tool [before an appointment] could be very useful, when you have spoken to the patient about the issues, you could use that opportunity to follow up on that quite quickly. It makes me think about text-messaging systems we use for patients.’ (GP 3, female)

Supplementary Data

BJGPO.2021.0100_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.

BJGPO.2021.0100_Supp.pdf -
Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.