Identifying opportunity as the barrier to ADHD drug holidays: application of the behavioural change wheel

Ibrahim, Kinda (2015) Identifying opportunity as the barrier to ADHD drug holidays: application of the behavioural change wheel. International Journal of Pharmacy Practice, 23 (Suppl_1). (doi:10.1111/ijpp.12186).

Record type: Meeting abstract

Abstract

Researchers have identified a variety of reasons for non adherence to guidelines that include individual as well as organisational factors. For example, unfamiliarity with guidelines, lack of time/resources as well as disagreement with guidelines can act as barriers to implementing recommendations.The National Institute for Health and Care Excellence recommendations on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents, call for a review of medication at least annually. Although the impact of brief periods of no treatment must be taken into account as part of the review, ‘drug holidays’ (DH) are mainly recommended if growth has been suppressed by medication. However, locally, prescribers are asked to plan two-week DHs after two years of treatment to test continuing need for medication under shared-care arrangements, which our research shows is rarely practised.The aim of this study was to identify the barriers to prescribers’ engagement with planned DHs from ADHD medication by applying a behavioural change system. The “COM-B system” was first used in order to identify barriers according to this framework’s three components; capability, opportunity, and motivation. Health professionals involved in shared-care prescribing for children and adolescents with ADHD in Berkshire were included. Transcripts from interviews with GPs (n = 8), (recruited from the NHS Berkshire cluster by posted letters and through the “snowball” technique), and secondary-care practitioners (n = 8), (recruited via a child and adolescent psychiatrist collaborator) were analysed against 14 Theoretical Framework Domains that map onto the COM-B components. The behaviour change wheel, which includes the COM-B system as the hub, was then used in order to identity possible interventions or policies, for increasing prescribers’ engagement with planned DHs, according to the component(s) in the COM-B system deemed to be relevant. This work was approved by the University of Reading Research Ethics Committee, local secondary- and primary care R&D offices. Different barriers to prescribers’ engagement with DHs from ADHD medication were identified. Capability, in terms of knowledge and physical and psychological skills was not a barrier for secondary-care practitioners but was for GPs needing more education and training about ADHD and worrying about possible withdrawal effects. Opportunity was a main barrier for both GPs and secondary-care practitioners, who cited lack of time and unavailability of educational material for families, respectively. Motivation was more complex to define for both secondary-care practitioners and GPs, with the former accepting DHs on reflection and the latter being more accepting due to worries about long-term medication side-effects as well as cost savings. On mapping these barriers to the behaviour change wheel, ‘enablement ’was identified as a key activity targeting all three components, which could feasibly increase prescribers’ engagement with planned DHs. The application of the behavioural change wheel identified a number of key barriers to prescribers’ engagement with DHs in children and adolescents with ADHD. Accordingly, ‘enablement’ was identified as a suitable behaviour change intervention. A possible example of an ‘enablement’ intervention is the creation of an educational and decision aid resource, which does not currently exist.

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