279 Mapping the behaviour change techniques used in a practice-based fibromyalgia self-management programme: a qualitative study

Abstract

Background: Fibromyalgia (FM) is a complex long-term condition affecting up to 5.4% of the UK population. It is associated with chronic widespread pain, fatigue, stiffness, sleep problems, memory and concentration difficulties, and irritable bowel syndrome. FM can cause high levels of disability, with individuals making frequent use of healthcare resources, and experiencing loss of work days. There is limited robust evidence for the effectiveness of pharmacological treatments for FM with current guidelines all recommending nonpharmacological interventions. Allied health professionals at the Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust (RUHB), developed the Fibromyalgia Self-Management Programme (FSMP); a non-pharmacological, multidisciplinary exercise and education group intervention. The main aims of the FSMP are to provide condition-specific, patient centred, education and exercise advice, supporting the development of core, selfmanagement skills. The FSMP comprises 2.5 hour weekly sessions over six weeks or four hour weekly session over four weeks. Core components include education about FM, sleep hygiene, goal-setting, pacing, hydrotherapy, and dietary advice. The FSMP was developed clinically and there has been little opportunity for the clinical team to fully understand the mechanisms by which it is effective. To inform successful implementation beyond RUHB, this research aimed to map the FSMP to the NICE recommended Michie et al. behaviour change taxonomy to determine the key behaviour change components. Method(s): Non-participatory observations were conducted of the four week and six week FSMP. Detailed notes on the content of the course, therapist delivery, and any additional content not included in the manual were recorded. Subsequently, semi-structured interviews were conducted with both therapists (n=4) and patients (n=9). Observations and the review of the therapist manual data were deductively coded in NVIVO to the Michie Behaviour Change Taxonomy using Framework Analysis. Interview data were analysed using Theoretical Thematic Analysis. Result(s): The review of the course manual and observations of the course show that the FSMP coded onto 12 of the 16 main areas of the BCT, encompassing 22 behaviour change techniques. Patient's interviews indicated that they had made significant behaviour changes as a result of attending the course; including increased activity levels, pacing, better quality sleep, and improved communication with family members. Patients reported positive changes to symptoms as a result of attending the course. Therapists highlighted four key challenges in delivering the course; fidelity between therapists, patient readiness and acceptance of FM, group management and patient fatigue while attending the programme. Conclusion(s): The FSMP utilises a range of behaviour change techniques. Patients who attend the course make changes to their behaviour which enable them to manage their symptoms of FM more effectively.