背景:坚持自我管理干预在临床环境和试验中都至关重要,以确保最大的有效性。这项研究报告了行为改变轮如何用于评估自我管理行为的障碍,并制定策略以在试验环境中最大化依从性(MEL-SELF患者主导的黑色素瘤监测试验)。
方法:通过(i)使用能力,机会,动机-行为(COMB)模型由经验和审查数据提供信息,以识别依从性障碍,(Ii)将识别的障碍映射到相应的干预功能,和(iii)确定适当的行为改变技术,并使用APEASE(负担能力,实用性,有效性和成本效益,可接受性,副作用和安全性,公平)标准。
结果:目标依从性行为定义为进行彻底的皮肤自我检查并提交图像以进行远程皮肤病学检查。确定的主要障碍包括:非参与皮肤检查合作伙伴,规划不足,时间限制,低自我效能感,和技术难题。参与者的动机受到感知到的健康益处的积极影响,并受到焦虑和抑郁等情绪状态的负面影响。我们确定了以下可行的干预措施来支持依从性:教育,培训,环境结构调整,启用,说服,和激励。拟议的解决方案包括行动计划,日历调度,替代皮肤镜,优化通信,各种形式的教育资源,以提高自我效能感和动机以及优化的提醒(将在一项试验研究(SWAT)中进行评估)。
结论:行为改变轮可通过识别自我管理行为的障碍并指导制定有针对性的策略来提高临床试验的依从性。
Adherence to self-management interventions is critical in both clinical settings and trials to ensure maximal effectiveness. This study reports how the Behaviour Change Wheel may be used to assess barriers to self-management behaviours and develop strategies to maximise adherence in a trial setting (the MEL-SELF trial of patient-led melanoma surveillance).
The Behaviour Change Wheel was applied by (i) using the Capability, Opportunity, Motivation-Behaviour (COMB) model informed by empirical and review data to identify adherence barriers, (ii) mapping identified barriers to corresponding intervention functions, and (iii) identifying appropriate behaviour change techniques and developing potential solutions using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria.
The target adherence behaviour was defined as conducting a thorough skin self-examination and submitting images for teledermatology review. Key barriers identified included: non-engaged skin check partners, inadequate planning, time constraints, low self-efficacy, and technological difficulties. Participants\' motivation was positively influenced by perceived health benefits and negatively impacted by emotional states such as anxiety and depression. We identified the following feasible interventions to support adherence: education, training, environmental restructuring, enablement, persuasion, and incentivisation. Proposed solutions included action planning, calendar scheduling, alternative dermatoscopes, optimised communication, educational resources in various formats to boost self-efficacy and motivation and optimised reminders (which will be evaluated in a Study Within A Trial (SWAT)).
The Behaviour Change Wheel may be used to improve adherence in clinical trials by identifying barriers to self-management behaviours and guiding development of targeted strategies.