Breathlessness self-management: using realist review to develop theory and work with stakeholders to co-design an implementation strategy (ID 499)
University of Hull
Funding: National Institute for Health and Care Research (NIHR), Research for Patient Benefit
(RfPB) Programme (Grant Reference Number NIHR204312). The views expressed are those of
the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care
Abstract
AimEvidence supports the benefits of breathlessness self-management interventions (SMIs) for people with long-term conditions, however implementation of SMIs is not systematic and the emphasis is usually on the individual, with little attention paid to context. We aimed to understand the factors influencing implementation of SMIs in order to develop an implementation strategy.
Method
Realist Review using five iterative stages (programme theory development, search for evidence, selection of sources, data extraction, synthesis) to develop (using sources about SMIs for any long-term condition) and test (using sources about breathlessness management) programme theories to underpin development of an implementation strategy. To facilitate understanding, theory development took the form of ‘if, then, because’ explanatory statements, grouped using the framework of self-management of long-term conditions developed by Lawless and colleagues (2021). We held three co-design workshops with stakeholders including people living with breathlessness and their carers, clinicians and commissioners, in which we discussed and refined the explanatory statements and developed an implementation strategy.
Results
32 sources informed the development of 53 theoretical ‘if, then, because’ explanatory statements about implementation relating to the following categories defined in the Lawless review: personal resources, stressors, informal social resources, formal social resources, and temporal and spatial context. Implementation of SMIs for breathlessness is impacted by the personal resources of, and the stressors on, the individual and is also greatly influenced by the following factors: how others (including family and clinicians) view and interact with them, the priorities of healthcare organisations and the wider context in which they live. Involving stakeholders in the development of this theoretical understanding laid the foundations for co-design of practical implementation resources.
Conclusion
Using Realist Review enabled integration of evidence, theory and stakeholders’ knowledge in developing an implementation strategy for breathlessness SMIs. SMI implementation strategies should address individual, family, clinician, organisational and societal factors.
This is our original work. A similar abstract has been presented at IPCRG 2024 and will be presented at ERS 2024.
Conflicts of interest: None
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