‘I just thought that it was such an impossible thing’: A qualitative study of barriers and facilitators to discontinuing long‐term use of benzodiazepine receptor agonists using the Theoretical Domains Framework

Abstract

Introduction: Existing interventions to reduce long-term benzodiazepine receptor agonist (BZRA) use lack theoretical underpinning and detailed descriptions. This creates difficulties in understanding how interventions work and how to replicate them in practice. The Theoretical Domains Framework (TDF) can be used to identify behaviour change determinants to target during intervention development. Objective: To explore barriers and facilitators to discontinuing BZRA use from the perspective of both current and previous long-term BZRA users. Design/Setting and Participants: Semistructured TDF-based interviews were conducted with community-based individuals with current or previous experience of long-term BZRA use. Data were recorded, transcribed and analysed using the framework method. Results: Twenty-eight individuals were interviewed. Despite commonalities in perceived barriers/facilitators to discontinuing BZRA use within individual TDF domains, individual participants had different experiences of identified determinants of BZRA discontinuation. For example, both similarities and differences existed within and between each participant group in terms of knowledge of the appropriate duration of BZRA use ('Knowledge' domain) and experience of withdrawal symptoms ('Reinforcement' domain). Compared to previous users, current users typically anticipated more barriers to discontinuing BZRA use and fewer positive consequences of discontinuation. Conclusion: This study reports on barriers and facilitators to discontinuing BZRA use from the perspectives of current and previous long-term users. The findings highlight the challenging nature of BZRA discontinuation and a multitude of barriers that impact participants' behaviour regarding BZRA use. Future work will involve developing a theorybased intervention to support BZRA discontinuation in primary care.

Supporting safe and gradual reduction of long‐term benzodiazepine receptor agonist use: Development of the SAFEGUARDING‐BZRAs toolkit using a codesign approach

“…This is attributable to individuals' unique experiences of BZRA use (e.g., reasons for initiating and maintaining BZRA use) and the range of barriers that can impact on individuals attempting discontinuation of long‐term BZRA use. 16 This is consistent with previous research on mental health service users' experiences of discontinuing psychotropic medication. 32 The collection of BCTs within the toolkit offers a library of options for individuals and clinicians to use as part of an active partnership in developing a gradual dosage reduction strategy that should include regular monitoring and support.…”

“…The comprehensive nature of the toolkit and its inclusion of multiple BCTs are reflective of the challenging nature of BZRA discontinuation as a target behaviour. This is attributable to individuals' unique experiences of BZRA use (e.g., reasons for initiating and maintaining BZRA use) and the range of barriers that can impact on individuals attempting discontinuation of long‐term BZRA use 16 . This is consistent with previous research on mental health service users' experiences of discontinuing psychotropic medication 32 .…”

“…24 The codesign approach was guided by previous research and followed established principles of authentic participation and collaboration. 25 The initial qualitative component of the intervention development process is reported in a separate publication 16 and summarized briefly below. This paper focuses on the process of mapping theoretical domains to BCTs and selecting and operationalizing BCTs as part of an intervention.…”

“…The initial qualitative component of the intervention development process is reported in a separate publication 16 and summarized briefly below. This paper focuses on the process of mapping theoretical domains to BCTs and selecting and operationalizing BCTs as part of an intervention.…”

“… 12 The second phase focused on incorporating an appropriate theory base into the intervention's development by using the Theoretical Domains Framework (TDF) to explore behavioural determinants of discontinuing long‐term BZRA use from a service user perspective. 16 The TDF is an integrated framework of 33 behaviour change theories. It comprises domains that are considered mediators (i.e., barriers, facilitators) of behaviour change.…”