Development of theoretically informed audit and feedback: an exemplar from a complex implementation strategy to improve asthma self-management in UK primary care

Kirstie McClatchey* (Corresponding Author), Aimee Sheldon, Liz Steed, Jessica Sheringham, Steve Holmes, Meghan Preston, Francis Appiagyei, David Price, Stephanie JC. Taylor, Hilary Pinnock* (Corresponding Author), IMP2ART Programme Group.

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)
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Abstract

RATIONALE: Audit and feedback is an evidence-based implementation strategy, but studies reporting the use of theory to guide design elements are limited.

AIMS AND OBJECTIVES: Within the context of a programme of research aiming to improve the implementation of supported asthma self-management in UK primary care (IMPlementing IMProved Asthma self-management as RouTine [IMP 2 ART]), we aimed to design and develop theoretically-informed audit and feedback that highlighted supported asthma self-management provision and areas for improvement in primary care general practices.

METHOD: Aligned with the Medical Research Council (MRC) complex intervention framework, the audit and feedback was developed in three phases: (1) Development: literature and theory exploration, and prototype audit and feedback design; (2) Feasibility: eliciting feedback on the audit and feedback from general practice staff (n = 9); (3) Prepiloting: delivering the audit and feedback within the IMP 2 ART implementation strategy (incorporating patient and professional resources and an asthma review template) and eliciting clinician feedback (n = 9).

RESULTS: Audit and feedback design was guided by and mapped to existing literature suggestions and theory (e.g., Theoretical Domains Framework, Behaviour Change Technique Taxonomy). Feedback on the prototype audit and feedback confirmed feasibility but identified some refinements (a need to highlight supporting self-management and importance of asthma action plans). Prepiloting informed integration with other IMP 2 ART programme strategies (e.g., patient resources and professional education).

CONCLUSION: We conclude that a multistage development process including theory exploration and mapping, contributed to the design and delivery of the audit and feedback. Aligned with the MRC framework, the IMP 2 ART strategy (incorporating the audit and feedback) is now being tested in a UK-wide cluster randomised controlled trial.

Original languageEnglish
Pages (from-to)86-100
Number of pages15
JournalJournal of Evaluation in Clinical Practice
Volume30
Issue number1
Early online date12 Jul 2023
DOIs
Publication statusPublished - Feb 2024

Bibliographical note

Funding: The National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (Reference Number RP-PG-1016-20008). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.


Acknowledgements: We acknowledge all members of the IMP2ART group for their contributions including: Brian McKinstry, Aziz Sheikh (University of Edinburgh); Sandra Eldridge, Chris Griffiths, Chris Newby (Queen Mary University of London); Steven Julious (University of Sheffield); Deborah Fitzsimmons (University of Swansea); Ann-Louise Caress (University of Huddersfield). Dr Susan Morrow was Programme Manager during early stages of this work; Emily Healy and Lesley Gardner provided invaluable administrative support.
We are grateful to members of the IMP2ART Primary Care Respiratory Society Professional Advisory Group, coordinated by Dr Steve Holmes, and to the IMP2ART Patient and Public Involvement Group, co-ordinated by Dr Tracy Jackson. We thank the primary care general practices that participated in this study. We acknowledge the helpful advice of the Independent Programme Steering Committee chaired by Professor Robbie Foy.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Keywords

  • clinical audit
  • audit and feedback
  • primary care
  • self-management
  • asthma

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