Have you done enough piloting? Methodological insights from the ‘pre-pilot’ phases of two complex interventions (IMP2ART and TANDEM) for respiratory conditions

05 Aug 2021
Clinical Research Results Aim: Complex behavioural interventions are developed to address the challenge of influencing professional and patient management of long-term conditions, yet many interventions, are dogged by implementation issues in real world application. Enhancing the MRC framework for developing and evaluating complex interventions, we included a ‘real-world pre-pilot’ before formal piloting within the intervention development of two complex interventions:The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) programme which is developing a whole-systems implementation strategy to improve the delivery of supported asthma self-management in routine primary care, Tailored intervention for ANxiety and DEpression Management in COPD (TANDEM) which uses a cognitive behavioural approach to manage anxiety and depression before attendance at pulmonary rehabilitation in COPDMethod: Following extensive development, feasibility testing and refining, each study tested the multi-level components of their complex interventions with up to four ‘real-world sites’ to optimise design for the trial and subsequent implementation. Qualitative feedback from key stakeholders was reviewed by the intervention development groups and integrated into the final design.Results: There were many examples of lessons learnt. In IMP2ART we changed delivery of the professional education from a facilitated team e-learning module to individual access with a more openly facilitated team session. We disseminated audit and feedback reports to all staff, as opposed to via a practice contact. In TANDEM, training of respiratory professionals was made less threatening by replacing role-play with actors on day one to an individual video-recorded session on the last day of training. Greater context for the study was added to training.Conclusion: The MRC framework poses the question ‘Have you done enough piloting to be confident that the intervention can be delivered as intended?’ Real-world pre-pilots resulted in significant changes to the delivery of IMP2ART and TANDEM and should be considered before formal piloting of complex interventions. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Funding: IMP2ART (Ref: RP-PG-1016-20008); TANDEM (HTA 13/146/02). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. References and Clinical Trial Registry Information

Resource information

Respiratory conditions
  • Chronic Respiratory Disease
Type of resource
Abstract
Conference
Dublin 2021
Author(s)
Elizabeth Steed, Queen Mary University of London,