Developing and testing a web‐based intervention to encourage early help‐seeking in people with symptoms associated with lung cancer

Abstract

The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.

Evaluation of a web-based, tailored intervention to encourage help-seeking for lung cancer symptoms: a randomised controlled trial

“…Eliciting salient, relevant beliefs in a given context requires careful consideration and wording. 40 Our approach drew on previous research on reasons for delayed help-seeking in lung cancer 27 and it is possible that not all salient beliefs were identified, as previous research has relied on retrospective reports of events leading up to diagnosis, which can be subject to bias. 41,42 Another important consideration is that the TPB postulates that not only belief strength but also the value the individual places on this belief influence intention.…”

“…Moreover, there are a variety of different approaches to (health) behaviour change, including learning and cognitive theories, stage models, affectbased approaches and social cognition theories. 46 The TPB was selected following a systematic and rigorous mapping process, 27 however employing a different theoretical basis may lead to different outcomes.…”

“…Our choice of these two factors was based on extant literature as outlined above, as well as extensive user engagement work. 27 The website involves:…”

“…More detail about the website is published elsewhere. 27 Note that our website targeted processes in the appraisal interval (through tailored information about symptoms) and the help-seeking interval (by addressing beliefs about help-seeking), although the intervention was not developed specifically based on the Model of Pathways to Treatment. 23…”

“…26 Research indicates that help-seeking for lung cancer symptoms is often influenced by beliefs. 8,12,24,27 For example, people with lung cancer report delaying help-seeking because they hold fatalistic beliefs about the treatability of lung cancer, because they fear blame and stigma due to smoking, 10,24 or because of perceived difficulties due to limited availability of appointments. 25 These findings suggest beliefs about the outcomes of helpseeking, normative beliefs about its acceptability and beliefs around the perceived level of control of the behaviour may play a role.…”