Supporting Behavior Change After AECOPD – Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel

Abstract

Gabriela Schmid-Mohler,1,2 Christine Hübsch,1,2 Claudia Steurer-Stey,3,4 Nico Greco,5 Macé M Schuurmans,2,6 Sonja Beckmann,1 Paul Chadwick7 *, Christian Clarenbach2,6 𪇎ntre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland; 2Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland; 3Epidemiology, Biostatistics and Prevention Institute, University Zurich, Zurich, Switzerland; 4mediX Group Practice Zurich, Zurich, Switzerland; 5Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland; 6Faculty of Medicine, University of Zurich, Zurich, Switzerland; 7Centre for Behavior Change, University College London, London, UK*These authors contributed equally to this workCorrespondence: Gabriela Schmid-Mohler, Centre of Clinical Nursing Science, University Hospital Zurich, Ramistrasse 100, Zurich, CH-8091, Switzerland, Tel [phone], Email [email protected]: After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study’s aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients’ key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence – including but not limited to patients’ perspective – and health professionals’ perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.Keywords: AECOPD, complex intervention, behavior, behavior change, intervention development

Keywords

• aecopd
• complex intervention
• behavior
• behavior change
• intervention development