Development of an educational intervention to support implementation of nasal balloon autoinflation for glue ear: a mixed methods approach

Abstract

Nasal balloon autoinflation has been found in clinical trials to be an effective, nonsurgical treatment for otitis media with effusion (OME) that is applicable to primary care where most affected children initially present. Research findings suggest that it is a feasible and safe treatment which has the potential to improve ear-related quality of life for children and families, whilst enhancing primary care management and adherence to the NICE recommended 3 month active monitoring period. However, implementing new research findings into routine clinical practice can be challenging. Whilst nasal balloon autoinflation may be effective in the context of a clinical trial, it is not clear how generaliseable it is to the normal primary care setting.

The main aim of this PhD is to facilitate wider implementation of the nasal balloon using the Normalization Process Theory to help understand how the treatment can become routinised and embedded in every day primary care practice.

A qualitative study of GPs views and experiences of primary care management of children with OME provided important information about the context for implementation. A secondary analysis of qualitative data from multiple stakeholders (GPs, nurses and parents) then identified that a high quality demonstration video would promote engagement and uptake of the nasal balloon, and thus minimize the potential burden on the GP consultation. A theory-based educational intervention (LittleEARS) was then developed, guided by the medical literature, qualitative enquiry, multi-expert knowledge, and end-user feedback. Additionally, to help facilitate better active monitoring for OME, the Two Alternative Auditory Disability and Speech Reception Test (TADAST) was further developed, evaluated and embedded within the educational intervention. A feasibility study was then conducted to assess acceptability, demand, practicality and implementation of the educational intervention in families of children with OME.

The qualitative work has provided a valuable insight into the potential barriers and facilitators for implementation of the nasal balloon for OME in child in primary care. The LittleEARS educational intervention appears to be both appropriate and potentially useful to families of children with OME during the recommended 3 month active monitoring period. However, further work is required to confirm acceptability and feasibility to the wider primary care population.

The use of Normalization Process Theory (NPT) helped towards a better understanding of the processes for implementation, and provided an appropriate theoretical framework for my research.

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Identifiers

ORCID for Jane Vennik: orcid.org/0000-0003-4602-9805

ORCID for Michael Moore: orcid.org/0000-0002-5127-4509

ORCID for Hazel Everitt: orcid.org/0000-0001-7362-8403

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