G. Hoskins
Achieving Good Outcomes for Asthma Living (GOAL): Mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma
Hoskins, G.; Williams, B.; Abhyankar, P.; Donnan, P.; Duncan, E.; Pinnock, H.; Pol, M.; Rauchhaus, P.; Taylor, A.; Sheikh, A.
Authors
B. Williams
P. Abhyankar
P. Donnan
E. Duncan
H. Pinnock
M. Pol
P. Rauchhaus
A. Taylor
A. Sheikh
Abstract
Background
Despite being a core component of self-management, goal setting is rarely used in routine care. We piloted a primary care, nurse-led intervention called Achieving Good Outcomes for Asthma Living (GOAL) for adults with asthma. Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review.
Methods
The 18-month mixed methods feasibility cluster pilot trial stratified and then randomised practices to deliver usual care (UC) or a goal-setting intervention (GOAL). Practice asthma nurses and adult patients with active asthma were invited to participate. The primary outcome was asthma-specific quality of life. Semi-structured interviews with a purposive patient sample (n = 14) and 10 participating nurses explored GOAL perception. The constructs of normalisation process theory (NPT) were used to analyse and interpret data.
Results
Ten practices participated (five in each arm), exceeding our target of eight. However, only 48 patients (target 80) were recruited (18 in GOAL practices). At 6 months post-intervention, the difference in mean asthma-related quality of life (mAQLQ) between intervention and control was 0.1 (GOAL 6.20: SD 0.76 (CI 5.76–6.65) versus UC 6.1: SD 0.81 (CI 5.63–6.57)), less than the minimal clinically important difference (MCID) of 0.5. However, change from baseline was stronger in the intervention group: at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control. Costs were higher in the intervention group by £22.17.
Routine review with goal setting was considered more holistic, enhancing rapport and enabling patients to become active rather than passive participants in healthcare. However, time was a major barrier for nurses, who admitted to screening out patient goals they believed were unrelated to asthma.
Conclusions
The difference in AQLQ score from baseline is larger in the intervention arm than the control, indicating the intervention may have impact if appropriately strengthened. The GOAL intervention changed the review dynamic and was well received by patients, but necessitated additional time, which was problematic in the confines of the traditional nurse appointment. Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster randomised controlled trial.
The trial was registered on the ISRCTN register (ISRCTN 18912042) on 26th June 2012.
Citation
Hoskins, G., Williams, B., Abhyankar, P., Donnan, P., Duncan, E., Pinnock, H., Pol, M., Rauchhaus, P., Taylor, A., & Sheikh, A. (2016). Achieving Good Outcomes for Asthma Living (GOAL): Mixed methods feasibility and pilot cluster randomised controlled trial of a practical intervention for eliciting, setting and achieving goals for adults with asthma. Trials, 17(1), Article 584. https://doi.org/10.1186/s13063-016-1684-7
Journal Article Type | Article |
---|---|
Acceptance Date | Nov 5, 2016 |
Online Publication Date | Dec 8, 2016 |
Publication Date | 2016 |
Deposit Date | Oct 17, 2017 |
Publicly Available Date | Oct 17, 2017 |
Journal | Trials |
Print ISSN | 1745-6215 |
Electronic ISSN | 1745-6215 |
Publisher | BMC |
Peer Reviewed | Peer Reviewed |
Volume | 17 |
Issue | 1 |
Article Number | 584 |
DOI | https://doi.org/10.1186/s13063-016-1684-7 |
Keywords | Asthma, complex interventions, goal setting, mixed methods, pilot cluster RCT, Self-management |
Public URL | http://researchrepository.napier.ac.uk/Output/837554 |
Contract Date | Oct 17, 2017 |
Files
Achieving Good Outcomes for Asthma Living (GOAL)...
(842 Kb)
PDF
Publisher Licence URL
http://creativecommons.org/licenses/by/4.0/
Copyright Statement
© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Downloadable Citations
About Edinburgh Napier Research Repository
Administrator e-mail: repository@napier.ac.uk
This application uses the following open-source libraries:
SheetJS Community Edition
Apache License Version 2.0 (http://www.apache.org/licenses/)
PDF.js
Apache License Version 2.0 (http://www.apache.org/licenses/)
Font Awesome
SIL OFL 1.1 (http://scripts.sil.org/OFL)
MIT License (http://opensource.org/licenses/mit-license.html)
CC BY 3.0 ( http://creativecommons.org/licenses/by/3.0/)
Powered by Worktribe © 2024
Advanced Search