Use of the Behaviour Change Wheel to design an intervention to improve the provision of mental wellbeing support within the audiology setting

Abstract

Objective: This study describes the development of an intervention to increase the frequency of audiologists’ asking about and providing information regarding mental wellbeing within adult audiology services.Design: The Behaviour Change Wheel (BCW), an eight-step systematic process, was followed to develop the intervention. Reports describing the first four steps are published elsewhere. This report describes the final four steps and details the intervention developed.Results: A multifaceted intervention was developed to change audiologists’ behaviours relating to providing mental wellbeing support to adults with hearing loss. Specifically, three behaviours were targeted: (1) asking clients about their mental wellbeing; (2) providing general information on the mental wellbeing impacts of hearing loss; and (3) providing personalised information on managing the mental wellbeing impacts of hearing loss. A variety of intervention functions and behaviour change techniques were incorporated into the intervention, including instruction and demonstration, information about others approval, adding objects to the environment, use of prompts/cues, and endorsement from credible sources. Conclusion: This study is the first to use the Behaviour Change Wheel to develop an intervention targeting mental wellbeing support behaviours in audiologists and confirms the usability and usefulness of the approach in a complex area of clinical care. The systematic development of the Ask, Inform, Manage, Encourage, Refer (AIMER) intervention will facilitate a thorough evaluation of its effectiveness in the next phase of this work.

Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting

“…2; see Supplemental Data Six in Supplemental Digital Content, http://links.lww. com/EANDH/B262), which align with the barriers targeted by the intervention (Bennett et al 2023a; see Supplemental File One in Supplemental Digital Content, http://links.lww.com/ EANDH/B257); including for example, "audiologists require clinical resources to assist with (i) asking about wellbeing, (ii) providing information on the wellbeing impacts of hearing loss, and (iii) providing information on wellbeing treatment/management strategies," "audiologists need to develop confidence in their ability to ask about mental wellbeing and respond with empathy when clients describe their challenges," "Audiologists need reminders/prompts to help them remember to ask clients about mental wellbeing," and "audiologists need to feel responsible for (i) asking about mental wellbeing, (ii) providing information on the mental wellbeing impacts of hearing loss, and (iii) providing information on mental wellbeing treatment/management strategies. "…”

“…In developing the AIMER intervention, we first identified barriers and facilitators affecting HHCs ability to enact the three target behaviors through focus group discussion; these included factors identified across all three areas of the COM-B: capability, opportunity, and motivation (Nickbakht et al 2022;Bennett et al 2023b). Of the 93 factors identified, 19 were selected, and the AIMER intervention was systematically designed to target these 19 barriers (Bennett et al 2023a; see Supplemental File One in Supplemental Digital Content, http://links.lww.com/ EANDH/B257).…”

“…This process also included development of a context-specific implementation protocol in partnership with a clinical partner. A description of the AIMER intervention program and implementation strategy can be found in Supplemental Data One in Supplemental Digital Content, http://links.lww.com/EANDH/B257, with full details of the development process reported in Bennett et al (2023a). In summary, Arm 1.…”

Remote Technologies to Enhance Service Delivery for Adults: Clinical Research Perspectives

“…139 The four key elements are as follows: Development (identifying the evidence base and theory); Feasibility/piloting (testing procedures, estimating recruitment/retention, calculating sample size); Evaluation (assessing clinicaland cost-effectiveness, understanding the change process); and Implementation (dissemination, monitoring, and long-term follow-up). This framework has guided some of our research, 15,115,140,141 and has been recently updated 142 to align with important aspects that have been introduced into research over the last decade. These include stakeholder engagement, 12,116,[143][144][145] identifying key uncertainties, 146,147 iterative refinement of the intervention, 15,116,144,145,148 and economic considerations.…”

“…41 We recently used the BCW to develop an intervention targeting mental well-being support behaviors in hearing healthcare clinicians, the AIMER (Ask, Inform, Manage, Encourage, Refer). 141 This multifaceted intervention was developed to change hearing healthcare clinicians' behaviors relating to provision of mental well-being support to adults with hearing loss. A follow-up study evaluated the implementation of the AIMER, guided by the RE-AIM framework 160 providing a theoretical structure for the assessment of implementation pathways, and found that after completing the AIMER program, hearing healthcare clinicians were more likely to engage in the target behaviors.…”