Development and impact of training for health care assistants to provide a walking intervention to older adults in chronic pain

Conference: 
SAPC ASM 2016 - Dublin
Talk Code: 
EP2B.01
Presenter: 
Emma Healey
Co-authors: 
EL Healey 1, C Jinks 1, CA Chew-Graham 1, T Pincus 2, S McLachlan 1, J Maskell 1 , J McBeth 3, on behalf of the iPOPP team.
Author institutions: 
1. Keele University, 2. University of London, 3. The University of Manchester.

Problem

In recent years the role of the healthcare assistant (HCA) in general practice has developed, with the scope and nature of the HCAs’ responsibilities varying between practices, reflecting the individual needs of the practice. It is not uncommon for HCAs to be tasked with encouraging behaviour change such as smoking cessation, exercise promotion and weight management.

Physical activity levels are particularly low in older people with chronic musculoskeletal pain. An evidence synthesis and a stakeholder workshop identified and agreed the content of an intervention to promote walking in this population (the iPOPP intervention) and HCAs as the intervention deliverers. This intervention will be tested in a pilot randomised controlled trial in four general practices.

The aim of this presentation is to describe the development and impact of the iPOPP training programme specifically designed for HCAs working in general practice.

Approach

A target group analysis using a focus group with HCAs (n=4) to identify current practice and potential determinants of behaviour change required to deliver the iPOPP intervention was conducted. Data were analysed thematically and then mapped to the Theoretical Domains Framework (TDF). Training needs and techniques identified were integrated into the training, which was then delivered to six HCAs linked to the four general practices involved in the iPOPP pilot trial. All trainees completed pre- and post-training questionnaires.

Findings

In the focus group, HCAs were positive about intervention but highlighted concerns over their competence to deliver it. The key TDF domains highlighted in the analysis were skills, knowledge, environmental context and resources and beliefs about consequences. Specific training needs identified revolved around knowledge of chronic pain and role of exercise, skills associated with behaviour change techniques, engaging patients with the intervention and the ability to structure the iPOPP consultations in a brief timeframe, as were strategies for identifying and overcoming patient concerns about safety whilst walking.

In terms of the 6 HCAs trained to deliver the iPOPP intervention, the average length of time as a full-time HCA was 13.5 years, 80% (n=4) were educated to university degree level or equivalent and none of them had any previous training in the field of musculoskeletal medicine. The pre-training questionnaire responses highlighted similar training needs to those identified in the focus group. Overall the post-training questionnaire responses demonstrated a positive shift in the knowledge, confidence and skills imperative to the successful delivery of the intervention. Trainees also reported feeling confident using the iPOPP tools available to them (a pain toolkit, pedometers, goal setting sheets and walking diaries).

Consequences

Focus group data fed into the development of a training programme for HCAs, the impact of which appears promising. The feasibility and acceptability of the iPOPP intervention and HCA training is now being tested in a pilot trial.

Submitted by: 
Emma Healey
Funding acknowledgement: 
The study is funded by Arthritis Research UK (grant reference 20608). EH, CCG and CJ are part funded by the NIHR Collaborations for Leadership in Applied Health Research and Care West Midlands. The views expressed in this presentation are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health.