Developing novel evidence-based interventions to promote asthma action plan use: a cross-study synthesis of evidence from randomised controlled trials and qualitative studies

Trials

Aziz Sheikh¹  Sally Wyke³  Gaylor Hoskins⁴  Caroline Wilson²  Hilary Pinnock¹  Ruth Jepson⁵  Nicola Ring⁵ 

[1] Allergy & Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, EH8 9AG, UK;School of Nursing, Midwifery and Health, University of Stirling, Stirling, FK9 4LA, UK;College of Social Sciences, University of Glasgow, Glasgow, G12 8QF, UK;Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA, UK;School of Nursing, Midwifery and Health, University of Stirling, Stirling FK9 4LA, UK

关键词: Integration;    Qualitative synthesis;    Intervention reporting;    Intervention development;    Cross-study synthesis;    Asthma action plans;   

Others  :  1095179
DOI  :  10.1186/1745-6215-13-216

 received in 2012-05-10, accepted in 2012-10-26,  发布年份 2012

【 摘 要 】

Background

Long-standing randomised controlled trial (RCT) evidence indicates that asthma action plans can improve patient outcomes. Internationally, however, these plans are seldom issued by professionals or used by patients/carers. To understand how the benefits of such plans might be realised clinically, we previously investigated barriers and facilitators to their implementation in a systematic review of relevant RCTs and synthesised qualitative studies exploring professional and patient/carer views. Our final step was to integrate these twoseparate studies.

Methods

First, a theoretical model of action plan implementation was proposed, derived from our synthesis of 19 qualitative studies, identifying elements which, if incorporated into future interventions, could promote their use. Second, 14 RCTs included in the quantitative synthesis were re-analysed to assess the extent to which these elements were present within their interventions (that is, ‘strong’, ‘weak’ or ‘no’ presence) and with what effect. Matrices charted each element’s presence and strength, facilitating analysis of element presence and action plan implementation.

Results

Four elements (professional education, patient/carer education, (patient/carer and professional) partnership working and communication) were identified in our model as likely to promote asthma plan use. Thirteen interventions reporting increased action plan implementation contained all four elements, with two or more strongly present. One intervention reporting no effect on action plan implementation contained only weakly present elements. Intervention effectiveness was reported using a narrow range of criteria which did not fully reflect the four elements. For example, no study assessed whether jointly developed action plans increased use. Whilst important from the professional and patient/carer perspectives, the integral role of these elements in intervention delivery and their effect on study outcomes was under-acknowledged in these RCTs.

Conclusions

Our novel approach provides an evidence-base for future action plan interventions. Such interventions need to ensure all elements in our implementation model (patient/carer and professional education to support development of effective partnership working and communication) are strongly present within them and a wider range of criteria better reflecting the realities of clinical practice and living with asthma are used to measure their effectiveness. We now intend to test such a complex intervention using a cluster trial design.

【 授权许可】

   
2012 Ring et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O’Donnell C, Ong BN, Rapley T, Rogers A, May C: Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med 2010, 8:63-72. BioMed Central Full Text
• [2]Glasgow RE, McKay HG, Piette JD, Reynolds KD: The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns 2001, 44:119-127.
• [3]Global Initiative for Asthma (GINA): Global Strategy for Asthma Management and Prevention. GINA, Washington; 2011. http://www.ginasthma.org webcite
• [4]Ring N, Pinnock H, Wilson C, Hoskins G, Jepson R, Wyke S, Sheikh A: Understanding what we mean: Linguistic analysis of asthma plan terminology. Prim Care Respir J 2011, 20:170-177.
• [5]Gibson P, Powell H, Coughlan J, Wilson A, Abramson M, Haywood P, Bauman A, Hensley MJ, Walters EH: Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2003, 1:CD001117.
• [6]Sulaiman N, Barton C, Abramson M, Liaw T, Harris C, Chondros P, Dharmage S, Clarke D: Factors associated with ownership and use of written asthma action plans in North-West Melbourne. Prim Care Respir J 2004, 13:211-217.
• [7]Wiener-Ogilvie S, Pinnock H, Huby G, Sheikh A, Partridge MR, Gillies J: Do practices comply with key recommendations of the British Asthma Guideline? If not, why not? Prim Care Respir J 2007, 16:369-377.
• [8]Ring N, Malcolm C, Wkye S, MacGillivary S, Dixon D, Hoskins G, Pinnock H, Sheikh A: Promoting the use of Personal Asthma Action Plans: a systematic review. Prim Care Respir J 2007, 16:271-283.
• [9]Glasgow NJ, Ponsonby A-L, Yates R, Beilby J, Dugdale P: Proactive asthma care in childhood: general practice based randomised controlled trial. Brit Med J 2003, 327:659-665.
• [10]Ring N, Jepson R, Hoskins G, Wilson C, Pinnock H, Sheikh A, Wyke S: Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature. Patient Educ Couns 2011, 85:e131-e143.
• [11]Homer C, Forbes P, Horvitz L, Peterson L, Wypij D, Heinrich P: Impact of a quality improvement program on care and outcomes for children with asthma. Arch Pediatr Adolesc Med 2005, 159:464-469.
• [12]Kemple T, Rogers C: A mailed personalised self-management plan improves attendance and increases patients' understanding of asthma. Prim Care Respir J 2003, 12:110-114.
• [13]Khan M, O’Meara M, Stevermuer T, Henry R: Randomised controlled trial of asthma education after discharge from an emergency department. J Paediatri Child H 2004, 40:674-677.
• [14]Gillies J, Sheikh A, Wiener-Ogilvie S, Huby G, Pinnock H, Partridge MR: Describing compliance with and identifying barriers and facilitators to the implementation of SIGN 63 (The British Guideline for the Management of Asthma) in a rural health board. Chief Scientist Office, Edinburgh; 2006. Report No.: CZG/2/186
• [15]Hoskins G, McCowan C, Donnan P, Friend J, Osman L: Results of a national asthma campaign survey of primary care in Scotland. Int J Qual H Care 2005, 17:209-215.
• [16]Tan NC, Tay IH, Ngoh A, Tan M: A qualitative study of factors influencing family physicians’ prescription of the Written Asthma Action Plan in primary care in Singapore. Singapore Med J 2009, 50:160-164.
• [17]Harden A, Garcia J, Oliver S, Rees R, Shepherd J, Brunton G, Oakley A: Applying systematic review methods to studies of people’s views: an example from public health research. J Epidemiol Commun H 2004, 58:794-800.
• [18]Thomas J, Harden A, Oakley A, Oliver S, Sutcliffe K, Rees R, Brunton G, Kavanagh J: Integrating qualitative research with trials in systematic reviews. BMJ 2004, 328:1010-1012.
• [19]Ring N, Ritchie K, Mandava L, Jepson R: A guide to synthesising qualitative research for researchers undertaking health technology assessments and systematic reviews. NHS Quality Improvement Scotland and University of Stirling, Edinburgh; 2011.
• [20]Cote J, Bowie D, Robichaud P, Parent J-G, Battisti L, Boulet L-P: Evaluation of two different educational interventions for adult patients consulting with acute asthma exacerbation. Am J Crit Care Med 2001, 163:1415-1419.
• [21]Rasmussen L, Phanareth K, Nolte H, Backer V: Internet-based monitoring of asthma: a long term, randomised clinical study of 300 asthmatic subjects. J Allergy Clin Immunol 2005, 115:1137-1141.
• [22]Clark N, Gong M, Schork A, Kaciroti N, Evans D, Roloff D, Hurwitz M, Maiman LA, Mellins RB: Long-term effects of asthma education for physicians on patient satisfaction and use of health services. Eur Resp J 2000, 16:15-21.
• [23]Adams R, Boath K, Homan S, Campbell D, Ruffin R: A randomised trial of peak-flow and symptom-based action plans in adults with moderate-to-severe asthma. Respirol 2001, 6:297-304.
• [24]Osman L, Calder C, Goddan D, Friend J, McKenzie L, Legge J, Douglas JG: A randomised trial of self-management planning for adult patients admitted to hospital with acute asthma. Thorax 2002, 57:869-74.
• [25]Garrett J, Mercer Fenwick J, Taylor G, Mitchell E, Stewart J, Rea H: Prospective controlled evaluation of the effect of a community based asthma education centre in a multi-racial working class neighbourhood. Thorax 1994, 49:976-983.
• [26]Heard A, Richards I, Alpers J, Pilotto L, Smith B, Black J: Randomised controlled trial of general practice based asthma clinics. Med J Aust 1999, 171:68-71.
• [27]Morice A, Wrench C: The role of the asthma nurse in treatment compliance and self-management following hospital admission. Respir Med 2001, 95:851-856.
• [28]Yoon R, McKenzie D, Bauman A, Miles D: Controlled trial evaluation of an asthma education programme for adults. Thorax 1993, 48:1110-1115.
• [29]Salisbury C, Francis C, Rogers C, Parry K, Thomas H, Chadwick S, Turton P: A randomised controlled trial of clinics in secondary schools for adolescents with asthma. Brit J Gen Prac 2002, 52:988-996.
• [30]Campbell F, Johnson M, Messina J, Guillaume L, Goyder E: Behavioural interventions for weight management in pregnancy: a systematic review of quantitative and qualitative data. BMC Public Health 2011, 11:49. BioMed Central Full Text
• [31]Medical Research Council: Developing and evaluating complex interventions: new guidance. MRC, London; 2008.
• [32]Ring N, Jepson R, Ritchie K: Methods of synthesising qualitative research studies for health technology assessment. Int J Tech Assess H Care 2011, 27:384-390.
• [33]Baxter S, Killoran A, Kelly MP, Goyder E: Synthesising diverse evidence: the use of primary qualitative data analysis methods and logic models in public health reviews. Public Health Nurs 2010, 124:99-106.
• [34]Thomas J, Harden A: Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol 2008, 8:45. BioMed Central Full Text
• [35]Dixon-Woods M, Cavers D, Agarwal S, Annandale E, Arthur A, Harvey J, Hsu R, Katbama S, Olsen R, Smith L, Riley R, Sutton AJ: Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Med Res Methodol 2006, 6:35-47. BioMed Central Full Text
• [36]Dixon-Woods M, Fitzpatrick R, Roberts K: Including qualitative research in systematic reviews: opportunities and problems. J Eval Clin Pract 2001, 7:125-133.
• [37]Dixon-Woods M, Agarwal S, Jones D, Young B, Sutton A: Synthesising qualitative and quantitative evidence: a review of possible methods. J Health Ser Res Pol 2005, 10:45-53.
• [38]Noblit GW, Hare RD: Meta-ethnography: synthesising qualitative studies. Sage, London; 1988.
• [39]Cooper HM: Scientific guidelines for conducting integrative research reviews. Rev Educ Res 1982, 52:291-302.
• [40]Guo J, Whittemore R, He G-P: The relationship between diabetes self-management and metabolic control in youth with type 1 diabetes: an integrative review. J Adv Nurs 2011, 67:2294-2310.
• [41]Whittemore R, Knafl K: The integrative review: updated methodology. J Adv Nurs 2005, 52:546-553.
• [42]British Thoracic Society, Scottish Intercollegiate Guidelines Network, Healthcare Improvement Scotland: British Guideline on the Management of Asthma: a national clinical guideline. In Scottish Intercollegiate Guidelines Network and British Thoracic Society. 4th edition. SIGN, Edinburgh; 2012.
• [43]Pinnock H, Fletcher M, Holmes S, Keeley D, Leyshon J, Price D, Russell R, Versnel J, Wagstaff B: Setting the standard for routine asthma consultations: a discussion of the aims, process and outcomes of reviewing people with asthma. Prim Care Respir J 2010, 19:75-83.
• [44]O’Cathain A, Nicholl J, Murphy E: Structural issues affecting mixed methods studies in health research: a qualitative study. BMC Med Res Methodol 2009, 9:82. BioMed Central Full Text
• [45]O'Cathain A, Murphy E, Nicholl J: Three techniques for integrating data in mixed method studies. Brit Med J 2010, 341:1147-1150.
• [46]Campbell M, Fitzpatrick R, Haines A, Kinmonth AL, Sandercock P, Spiegelhalter D, Tyrer P: Framework for design and evaluation of complex interventions to improve health. BMJ 2000, 321:694-696.
• [47]Michie S, Abraham C: Interventions to change health behaviours: evidence-based or evidence-inspired? Psychol Health 2004, 19:29-49.
• [48]Medical Research Council: A framework for development and evaluation of RCTs for complex interventions to improve health. MRC, London; 2000.
• [49]NHS Confederation, British Medical Association: New GMS Contract 2003: Investing in general practice. NHS Confederation; BMA, London; 2007.
• [50]Campbell N, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F, Guthrie B, Lester H, Wilson P, Kinmonth AL: Designing and evaluating complex interventions to improve health care. BMJ 2007, 334:455-459.
• [51]Abraham C, Michie S: A taxonomy of behaviour change techniques used in interventions. H Psychol 2008, 27:379-387.
• [52]Glasziou P, Meats E, Heneghan C, Shepperd S: What is missing from descriptions of treatment in trials and reviews? BMJ 2008, 336:1472-1474.
• [53]Sudre P, Jacquemet S, Uldry C, Perneger T: Objectives, methods and content of patient education programmes for adults with asthma: systematic review of studies published between 1979–1998. Thorax 1999, 54:681-687.
• [54]Boutron I, Moher D, Altman D, Schultz KF, Ravaud P: Extending the CONSORT statement to randomised trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008, 148:295-309.
• [55]Boutron I, Moher D, Altman DG, Schultz KF, Ravaud P: Methods and processes of the CONSORT group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med 2008, 148:w60-w66.
• [56]Glasziou P, Chalmers I, Altman D, Bastian H, Boutron I, Brice A, Jamtvedt G, Farmer A, Ghersi D, Groves T, Heneghan C, Hill S, Lewin S, Michie S, Perera R, Pomeroy V, Tilson J, Shepperd S, Williams JW: Taking healthcare interventions from trial to practice. BMJ 2010, 10:3852.
• [57]Perera R, Heneghan C, Yudkin P: A graphical method for depicting randomised trials of complex interventions. BMJ 2007, 334:127-129.
• [58]Zwarenstein M, Treweek S, Gagnier J, Altman D, Tunis S, Haynes B, Oxman AD, Moher D, CONSORT group, Pragmatic Trials in Healthcare (Practihc) group: Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008, 337:a2390.
• [59]Glasgow RE, Klesges LM, Dzewaltowski DA, Estabrooks PA, Vogt TM: Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. H Educ Res 2006, 21:688-694.
• [60]McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K: Getting evidence into practice: the meaning of context. J Adv Nurs 2001, 38:94-104.