Using the Person-based Approach to intervention Qualitative research design: at later The RECON development Project for stages reducing cognitive decline Dr Alex Milton, Psychology
Overview 1. Introduction to the RECON project 2. The Person-based approach to intervention development - What it is - Why you might use it - How it is and will be used in RECON Page 1/10
RECON An online intervention to promote healthy behaviours that help reduce cognitive decline in cognitively healthy older adults and those with mild cognitive impairment (MCI) The issue 5-7% Prevalence of dementia in 65+ People living longer. By 2050, 16 million predicted cases in EU and 106 million globally High social and economic cost Modest delay in onset & progression could have a big impact Physical activity Buchman et al. (2012). Neurology Hillman et al. (2008). Nature Neurosci Brain training Willis et al. (2006). JAMA Hill et al. (2017). Am J Psychiatry Lampit et al. (2014). PLOSmed Healthy diet Vals-Pedret et al. (2015). JAMA Tangney et al. (2014). Neurology? Page 2/10
Person-based approach (PBA) For developing interventions. Based on >1000 interviews with users plus experience & evidence from developing successful interventions Aim: understanding and accommodating the perspectives of the people who will use the intervention in order to improve uptake, adherence and outcomes Novelty. Particular focus on the application of behaviour change components How? Interleaved with normal stages of intervention development Page 3/10
PBA Why? Theory Evidence Qualitative & quantitative Context and user specific Need to understand your users and how evidence and theory can be applied to engage, motivate and support them Application Behaviour change Solution is inductive and iterative qualitative research during planning, design & implementation. Page 4/10
PBA Intervention planning Qualitative & quantitative synthesis Try to identify similar interventions Best components for intervention Barriers & facilitators Primary qualitative research On the acceptability and feasibility of interventions, as these can generally be elicited best by open-ended, in-depth exploration of the user perspective and the implementation context Provides a working summary of user perspective and key context-specific behavioural issues that need to be addressed Page 5/10
Recon examples Objective To facilitate healthy behaviours (physical activity, brain training & healthy diet) in order to maintain cognitive functioning amongst those with and without pre-existing mild cognitive impairment (MCI). To be a sustainable and cost-effective means of supporting the necessary behaviours for the 5 year intervention duration (allowing for possible loss of digital support/contact). Essential issues to address Many older adults still have limited use of internet and digital technologies Older adults more receptive to achieving positive benefits than avoidance of risk Older adults more likely than younger to have limited/ no social network; more at risk of social isolation Page 6/10
PBA Intervention design Having described the intervention objective, the psychosocial characteristics of the target population, and the specific needs, issues and challenges relevant to this population, you can then develop Guiding principles. 1. Key intervention design objectives 2. Features of intervention that address design objectives Note Repeatedly refined with further qualitative testing Useful reference points especially for making changes Good for team agreement Page 7/10
Recon Guiding principles Issue Many older adults still have limited use of internet and digital technologies More receptive to achieving positive benefits than avoidance of risk Older adults more likely than younger to have limited/ no social network; more at risk of social isolation Design objective to address key issue Minimising dependence on technology Promoting immediate-term benefits Facilitating peer support (without assumption of existing social network) Key features for each objective - Options to print/ save key reference documents wherever possible. - Utilising non-cognitive/non-digital means of sustaining behaviour (habit formation, environmental restructuring) - Link out to existing non-digital sources of advice/ support where appropriate. - Framing activities in terms of benefits for: strength, mood, general quality of life. - Inclusion of/ link to moderated discussion/support forum - Link out to existing non-digital sources of advice/ support where available Page 8/10
PBA Intervention design Based on planning and Guiding principles, build initial materials. Refine with iterative qualitative research: -Think aloud techniques Capture immediate reaction to all aspects of intervention and allow observation of how it is used. If can, proceed iteratively. Changes are always run past the guiding principles to ensure additions are consistent with key objectives. -Longitudinal research Refined prototype used over time. This allows analysis of how users fare on their own, and introduces the element of time Page 9/10
PBA Recap Interleaved throughout intervention planning, design and implementation Key ingredients for qualitative research: -Primary qualitative research &/or Qualitative synthesis -Formulate Guiding principles -Think aloud techniques -Longitudinal research The process is iterative Page 10/10
Thank you!