Refining a primary care shared decision-making aid for lifestyle change: a mixed-methods study

Abstract

Background: The important role of primary care in promoting healthy lifestyle behaviours needs informed support.

Aim: To elicit views on a 39-item shared decision-making (SDM) aid (SHARE-D) for lifestyle change and refine it to improve implementation.

Design & setting: Mixed-methods study.

Method: Health professionals, patients, and support workers, with experience of managing or a history of cardio- or cerebrovascular disease, were purposively recruited based on age, sex, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision-aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically.

Results: Substantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: 1) core content of the decision-aid; 2) barriers to use; 3) motivation for lifestyle change; and 4) primary care implementation. 'Self-reflective' questions and goal setting were viewed as essential components. The paper-based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30-item aid was considered suitable for facilitating brief conversations and promoting patient autonomy.

Conclusion: The SHARE-D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in-depth information to support implementation of a refined version. Further studies should examine its effectiveness.

Keywords: decision making, shared; general practice; lifestyle; primary care.