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Implementing a healthcare professional-supported digital intervention for cancer survivors in primary care: a qualitative process evaluation of Renewed

Implementing a healthcare professional-supported digital intervention for cancer survivors in primary care: a qualitative process evaluation of Renewed
Implementing a healthcare professional-supported digital intervention for cancer survivors in primary care: a qualitative process evaluation of Renewed
Background: Primary care has an important role in supporting cancer survivors, yet support is limited because of practitioners’ perceived lack of expertise and time. A digital intervention for cancer survivors could provide an efficient way for primary care staff to support cancer survivors without the need to accumulate expertise and skills to help patients make behaviour changes, providing very brief support alongside this could maximise adherence to the digital interventions. Renewed is a digital intervention combining online behaviour change advice with brief healthcare practitioner support from a nurse or healthcare assistant. Knowledge about the views and experiences of primary care staff providing support alongside a digital intervention for cancer survivors is sparse, limiting understanding of the acceptability and feasibility of this type of intervention.
Objective: To explore Supporters’ experiences of providing support to cancer survivors using Renewed, to understand potential barriers and facilitators to implementation of Renewed in practice, and investigate strengths and weaknesses of the intervention from the perspective of healthcare professionals.
Methods: This was a qualitative process evaluation, nested within a large trial evaluating Renewed. Twenty-eight semi-structured telephone interviews were conducted with nurses and healthcare assistants. Data were analysed using inductive thematic analysis.
Results: Four themes were developed during analysis which reflected factors that Supporters identified as hindering or enabling them to provide support alongside Renewed Online (Themes: Renewed Online as an acceptable digital tool with some improvements; confidence to enact the Supporter role; practicalities of delivering support alongside a digital intervention; and managing a patient-led approach). The analysis suggests that Supporters perceived that a digital intervention such as Renewed would be beneficial to support cancer survivors in primary care, and fit within current practices. However, barriers to providing support alongside a digital intervention were also identified, including concerns about how to facilitate rapport building and, in a minority, concerns about employing a non-directive approach, in which the majority of advice and support is provided through a digital intervention, with brief additional support provided by primary care staff.
Conclusion: These findings add to the literature about how best to provide support alongside digital interventions, suggesting that whilst most practitioners cope well with a non-directive approach, a minority require more training to feel confident implementing this. This study suggests that barriers to providing formal support to cancer survivors in primary care could be successfully overcome with an approach like Renewed, where a digital intervention provides most of the support and expertise, and healthcare practitioners provide the additional brief human support to maximise engagement. Strategies to maximise the chances of successful implementation for this type of intervention are discussed.
2369-1999
Smith, Jazzine
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Essery, Rosie
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Yardley, Lucy
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Richardson, Alison
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Slodkowska-Barabasz, Joanna
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Foster, Claire
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Watson, Eila
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Grimmett, Chloe
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Geraghty, Adam W. A.
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Little, Paul
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Bradbury, Katherine
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Smith, Jazzine
a340d5d6-b85e-4c7b-9c57-8826310beabc
Essery, Rosie
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Yardley, Lucy
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Richardson, Alison
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Slodkowska-Barabasz, Joanna
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Foster, Claire
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Watson, Eila
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Grimmett, Chloe
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Geraghty, Adam W. A.
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Little, Paul
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Bradbury, Katherine
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Smith, Jazzine, Essery, Rosie, Yardley, Lucy, Richardson, Alison, Slodkowska-Barabasz, Joanna, Foster, Claire, Watson, Eila, Grimmett, Chloe, Geraghty, Adam W. A., Little, Paul and Bradbury, Katherine (2022) Implementing a healthcare professional-supported digital intervention for cancer survivors in primary care: a qualitative process evaluation of Renewed. JMIR Cancer. (doi:10.2196/36364).

Record type: Article

Abstract

Background: Primary care has an important role in supporting cancer survivors, yet support is limited because of practitioners’ perceived lack of expertise and time. A digital intervention for cancer survivors could provide an efficient way for primary care staff to support cancer survivors without the need to accumulate expertise and skills to help patients make behaviour changes, providing very brief support alongside this could maximise adherence to the digital interventions. Renewed is a digital intervention combining online behaviour change advice with brief healthcare practitioner support from a nurse or healthcare assistant. Knowledge about the views and experiences of primary care staff providing support alongside a digital intervention for cancer survivors is sparse, limiting understanding of the acceptability and feasibility of this type of intervention.
Objective: To explore Supporters’ experiences of providing support to cancer survivors using Renewed, to understand potential barriers and facilitators to implementation of Renewed in practice, and investigate strengths and weaknesses of the intervention from the perspective of healthcare professionals.
Methods: This was a qualitative process evaluation, nested within a large trial evaluating Renewed. Twenty-eight semi-structured telephone interviews were conducted with nurses and healthcare assistants. Data were analysed using inductive thematic analysis.
Results: Four themes were developed during analysis which reflected factors that Supporters identified as hindering or enabling them to provide support alongside Renewed Online (Themes: Renewed Online as an acceptable digital tool with some improvements; confidence to enact the Supporter role; practicalities of delivering support alongside a digital intervention; and managing a patient-led approach). The analysis suggests that Supporters perceived that a digital intervention such as Renewed would be beneficial to support cancer survivors in primary care, and fit within current practices. However, barriers to providing support alongside a digital intervention were also identified, including concerns about how to facilitate rapport building and, in a minority, concerns about employing a non-directive approach, in which the majority of advice and support is provided through a digital intervention, with brief additional support provided by primary care staff.
Conclusion: These findings add to the literature about how best to provide support alongside digital interventions, suggesting that whilst most practitioners cope well with a non-directive approach, a minority require more training to feel confident implementing this. This study suggests that barriers to providing formal support to cancer survivors in primary care could be successfully overcome with an approach like Renewed, where a digital intervention provides most of the support and expertise, and healthcare practitioners provide the additional brief human support to maximise engagement. Strategies to maximise the chances of successful implementation for this type of intervention are discussed.

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Implementing Renewed_HCP Process Evaluation - Accepted Manuscript
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Accepted/In Press date: 16 March 2022
Published date: 1 April 2022
Additional Information: Acknowledgments The authors would like to thank the health care professionals who were interviewed for this study. The National Institute for Health Research (NIHR) recognizes and values the role of patient data, securely accessed and stored, both in underpinning and leading to improvements in research and care. The authors would also like to thank all the Patient and Public Involvement members who helped provide critical review and editing of the manuscript drafts: Tamsin Burford, Geoff Sharman, Lesley Turner, and Roger Bacon. JS was funded by the NIHR (NIHR-INF-0026; Doctoral Research Fellow) for this research project. The views expressed are those of the authors and not necessarily those of the National Health Service, NIHR, or Department of Health and Social Care. LY is an NIHR Senior Investigator, and her research program is partly supported by NIHR Applied Research Collaboration–West, NIHR Health Protection Research Unit for Behavioral Science and Evaluation, and the NIHR Southampton Biomedical Research Center. AR is an NIHR Senior Investigator, and her research program is partly supported by the NIHR Applied Research Collaboration Wessex.

Identifiers

Local EPrints ID: 455633
URI: http://eprints.soton.ac.uk/id/eprint/455633
ISSN: 2369-1999
PURE UUID: ac686f03-bfda-4d97-a912-bd1af367a9b4
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X
ORCID for Alison Richardson: ORCID iD orcid.org/0000-0003-3127-5755
ORCID for Claire Foster: ORCID iD orcid.org/0000-0002-4703-8378
ORCID for Chloe Grimmett: ORCID iD orcid.org/0000-0002-7540-7206
ORCID for Adam W. A. Geraghty: ORCID iD orcid.org/0000-0001-7984-8351
ORCID for Katherine Bradbury: ORCID iD orcid.org/0000-0001-5513-7571

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Date deposited: 29 Mar 2022 16:47
Last modified: 08 Jun 2022 01:43

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Contributors

Author: Jazzine Smith
Author: Rosie Essery
Author: Lucy Yardley ORCID iD
Author: Joanna Slodkowska-Barabasz
Author: Claire Foster ORCID iD
Author: Eila Watson
Author: Chloe Grimmett ORCID iD
Author: Paul Little

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