A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar

Abstract

BackgroundVisualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing.ResultsOur final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions.ConclusionsWe have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.

Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how

“…Like other intervention developers, reviews of qualitative and quantitative literature provided a starting point [65,66]. We were only able to scope the literature (which included a number of relevant systematic reviews), whereas other development teams have conducted project-specific, targeted systematic reviews to understand 'the problem' and identify causes and causal factors [66].…”

“…The intervention we developed was co-produced by researchers and practitioners in order to develop an intervention based on theory and practical know-how in a low-cost and relatively rapid way. Like other intervention developers, we did not wish the intervention to be overly "academic" or solely theory-driven [65]. There are different ways of co-producing interventions.…”

“…We developed a small core team of researchers and practitioners where equal weighting was given to the respective different knowledges (theory and know-how) to shape the intervention. Other approaches to co-production include, for example, researcher-led approaches with some input from a Patient and Public Involvement consultation group [65], and extensive stakeholder involvement via mixed methods including a Patient and Public Involvement consultation group, focus groups and interviews [66]. Whether one approach yields a different type of intervention or a more effective intervention is unknown but we suggest our project, as described here, makes a contribution to considering these issues and, if the project is implemented (as we hope it will be), to testing some of principles that might underlie development of effective and cost-effective complex interventions.…”

The Role of Images on Illness Behaviour: Interdisciplinary Theory, Evidence, and Ideas

“…This understanding is imperative to academics, health professionals and others engaged in intervention development in healthcare. In recent years there has been an increase in the use of visual communication at both the societal and population level (Williams & Cameron, 2009) and within healthcare interventions (Murray, Davis, Tai, Coulter, Grey, & Haines, 2001;Murray, Williams, Hoskins, Skar, McGhee, et al, 2016;Williams, Anderson, Barton, & McGhee, 2012) to convey complex information, influence beliefs and emotions (Williams & Cameron, 2009) and, ultimately, elicit a change in health behaviour. However, at present, the evidence base applied to the development of visual interventions is scant (Williams & Cameron, 2009).…”

“…There is growing theoretical and empirical evidence to indicate that images may influence the experience of illness, illness behaviour and health outcome (e.g., Humphris & Williams, 2014;Murray et al, 2001;Murray, Williams, Hoskins, McGhee, Gauld, & Brown, 2013;Murray et al, 2016;Styles, Williams, & Humphris, 2013;Thorne, Bultz, & Baile, 2005;Williams & Cameron, 2009). From a psychological perspective, it is known that both cognition and emotion, and their corresponding interplay, can influence behaviour.…”