Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study

Abstract

Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.

Exploring patient acceptability of a short‐stay care pathway in hospital post arthroplasty: A theory‐informed qualitative study

“…(eight and seven interviews, respectively). The interview guide (Supporting Information: Appendix S1 ) was developed using a systematic process recommended in theory‐informed qualitative research 14 and informed by the TFA (explained further in the section on ‘Rigor’ below). The interview topic guide was designed to explore the seven constructs of the TFA.…”

“…The TFA comprises seven constructs 13 (Table 1 presents TFA constructs and definitions). The TFA has been used successfully in other (nonsurgical) contexts to identify components that could be addressed to enhance acceptability, such as nurse‐led reviews of inflammatory rheumatological conditions, postnatal exercise and infant feeding practices 14–16 . It has also been applied in a small number of surgical contexts such as maternal–foetal surgery and intravitreal injections for macular degeneration 17,18 .…”

“…The TFA has been used successfully in other (nonsurgical) contexts to identify components that could be addressed to enhance acceptability, such as nurse‐led reviews of inflammatory rheumatological conditions, postnatal exercise and infant feeding practices. 14 , 15 , 16 It has also been applied in a small number of surgical contexts such as maternal–foetal surgery and intravitreal injections for macular degeneration. 17 , 18 The TFA has not yet been used in acceptability studies relating to arthroplasty or short‐stay models of care.…”

Acceptability of, and preferences for, remote consulting during COVID-19 among older patients with two common long-term musculoskeletal conditions: findings from three qualitative studies and recommendations for practice

“…Perceived effectiveness was conceptualised a ‘secondary domain’ meaning that patients’ perceived effectiveness of remote consulting was dependant on their perceptions of self-efficacy, ethicality, burden and opportunity costs. In previous qualitative research using the TFA, we also identified affective attitudes and intervention coherence as ‘secondary domains’ [ 18 , 31 ]. The TFA has been criticised for excluding social and environmental factors [ 32 , 33 ], although we were able to incorporate wider macro and meso level influences into our model (Fig.…”

“…This study used the Theoretical Framework of Acceptability (TFA) [ 17 ], developed to inform the understanding of acceptability of complex interventions (defined for our context as a remote consultation), and consists of seven constructs (Table 2 ), and previously used to explore the acceptability of consultations [ 18 ].…”