MP412THE “PERSON-BASED APPROACH” TO DEVELOPING A STRUCTURED GROUP EDUCATION PROGRAMME TO INCREASE PHYSICAL ACTIVITY IN CKD: THE PACT-PROJECT

Abstract

Introduction and Aims: Assessing patients' needs and perspectives is an essential first step in optimising acceptability and engagement with a behaviour change intervention. The "person-based approach" uses iterative qualitative research to inform the planning, development and implementation of an intervention. This study applied the "person-based approach" in order to create a theory driven and evidence based structured group education programme, designed to increase levels of physical activity (PA) in non-dialysis chronic kidney disease (CKD) patients. Methods: We applied the "person-based approach" consisting of 3 phases: 1) Intervention planning: to conceptualise the intervention using: qualitative inquiry to explore user preferences for a PA intervention (n=36, aged 26-83 years, CKD stages 1-5), consultations with experts in the field (n=9), examination of theory and evidence based approaches, and observations of current patient education programmes; 2) Intervention design: key themes were identified and refined in collaboration with a Public Patient Involvement (PPI) group (n=9) to establish guiding principles including key intervention design objectives; 3) Intervention development: 3 focus groups (n=9, aged 48-77 years CKD stages 2-4) were conducted to pre-test intervention materials. Participants' reactions to the intervention were elicited using think aloud and verbal probing techniques. Modifications were made accordingly to increase patient acceptability and engagement. Qualitative sessions were audio recorded, transcribed verbatim and thematically analysed. Results: Participants favoured a group session supported with written materials and remote individualised follow up. Education programme observations in patients with other chronic diseases indicated that this approach would be both feasible and acceptable. Objectives were designed and refined in collaboration with a PPI group and included: elicit illness perceptions offering an opportunity for experience sharing, provide general education on CKD and associated health risks with a focus on modifiable and non-modifiable risk factors; explore PA benefits and guidelines for patients with CKD and support action planning and goal setting using technology aided self-monitoring devices. Pre-testing of the intervention identified important considerations for risk communication and health promotion. This included ensuring appropriate lay language, communicating risk factors at population level, framing health information to focus on the benefits of action and emphasising practical ways to increase PA with a lesser emphasis on exercise. Conclusions: The "person-based approach" provides a systematic framework to aid the development of a behaviour change intervention. Qualitative research and consultations with patient partners was invaluable to this research and ensured that development was user-led at all stages. The next phase will be to pilot the intervention, with assessment of user experience via semi-structured interviews upon completion.