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
Respiratory conditions
  • Chronic Respiratory Disease
Type of resource
Dublin 2021
Elizabeth Steed, Queen Mary University of London,
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