Why? What? How? Using an Intervention Mapping approach to develop a personalised intervention to improve adherence to photoprotection in patients with Xeroderma Pigmentosum

Abstract

Background: Intervention Mapping (IM) is a systematic approach for developing theory-based interventions across a variety of contexts and settings. This paper describes the development of a complex intervention designed to reduce the dose of ultraviolet radiation (UVR) reaching the face of adults with Xeroderma Pigmentosum (XP), by improving photoprotection. XP is a genetic condition that without extreme UVR photoprotection, leads to high risk of developing skin cancer. Methods: The IM protocol of 6 steps was applied, involving comprehensive mixed-methods formative research. Key stakeholders (XP clinical staff and Patient and Public Involvement Panel), were instrumental at every step. Behaviour change methods were informed by the IM taxonomy, therapeutic approaches (e.g. ACT, CBT) and coded according to the taxonomy of behaviour change techniques (version 1). Results: We designed a personalised modular intervention to target psychosocial determinants of photoprotective activities that influence the amount of UVR reaching the face. Content was developed to target determinants of motivation to protect and factors preventing the enactment of behaviours. Participants received personalised content addressing determinants/barriers most relevant to them, as well as core 'behaviour-change' material, considered important for all (e.g. SMART goals). Core and personalised content was delivered via 7 one-to-one sessions with a trained facilitator using a manual and purpose designed materials: Magazine; text messages; sunscreen application video; goal-setting tools (e.g. UVR dial and face protection guide); activity sheets. Novel features included use of ACT-based values to enhance intrinsic motivation, targeting of emotional barriers to ARTICLE HISTORY

Outlining an Acceptance and Commitment Therapy approach to treatment non‐adherence

“…Pragmatic repetition of the behaviour in consistent contexts (Lally & Gardner, 2013) may then transfer the behaviour to a habit elicited automatically in the presence of the necessary cues. Indeed, one recent approach to non-adherence to photoprotection in xeroderma pigmentosum included a focus on values within more traditional strategies to facilitate habit formation (e.g., action planning; Walburn et al, 2020). Alongside planning of when and where a specific photoprotection activity would be enacted, participants placed photos of value-related content (e.g., photos of travel destinations aligning with value of being adventurous) next to their photoprotective sunscreen as a visual prompt.…”

Supporting adjuvant endocrine therapy adherence in women with breast cancer: the development of a complex behavioural intervention using Intervention Mapping guided by the Multiphase Optimisation Strategy

“…Using factorial trials to evaluate multiple intervention components, as suggested by the MOST framework, is a relatively new approach in health services research. We made adaptations to IM based on time available and to include important considerations guided by MOST [ 28 , 31 ]. Strengths of our approach include applying an established intervention development method within the MOST framework, and the systematic reporting of the intervention development process.…”

“…It consists of six stages that cover designing, implementing and evaluating an intervention, and it promotes relevant stakeholder engagement throughout development [28]. IM has previously been used to develop interventions targeting adherence [29][30][31] and women with breast cancer [32,33].…”

Improving photoprotection in adults with xeroderma pigmentosum: personalisation and tailoring in the ‘XPAND’ intervention

“…The XPAND intervention For a full description of the development and content of the XPAND intervention, please refer to our companion paper (Walburn et al, 2020). Briefly, XPAND involved 7, one-toone sessions delivered in person (sessions 1 and 6) or via Skype (sessions 2-5 and 7) by a trained facilitator.…”

“…motivation, barriers and facilitators; phase I) that could be targeted to achieve change in the planned intervention (phase II). Outcomes of this formative research (Anderson, Walburn, & Morgan, 2017 ; Anderson, Walburn, & Morgan, 2019 ; Morgan, Anderson, Walburn, Weinman, & Sarkany, 2019 ; Sainsbury et al, 2018b ; Walburn et al, 2019a ; Walburn, Anderson, & Morgan, 2019c ) and the development of the intervention content based on phase I findings (Walburn et al, 2020 ) are reported separately. Briefly, this phase of research resulted in the establishment of 17 evidence statements around which the intervention would be designed and confirmed that, not only did adherence to photoprotection recommendations vary widely, so did the number and pattern of correlates of behaviour, lending further support to the a-priori decision that the planned intervention should be tailored.…”