Development and usability testing of a very brief intervention for personalised cancer risk assessment to promote behaviour change in primary care

Problem

Up to 40% of cases of cancer are potentially attributable to lifestyle factors such as smoking, alcohol, diet, weight and physical activity. However, research has shown that many individuals are unaware of this and cancer is rarely mentioned in discussions about lifestyle in primary care. Our aim was to develop a very brief intervention incorporating cancer risk which could be implemented within primary care.

Approach

We first developed a prototype intervention following a literature review and pilot work with patients and healthcare professionals (HCPs). The intervention included a website where individuals could see their personalised cancer risk and a leaflet incorporating behaviour change techniques chosen on the basis of evidence of effectiveness, contextual relevance and practical feasibility. We then conducted focus groups and interviews with 66 HCPs involved in delivering prevention activities in primary care and community settings using normalisation process theory to explore the overall format, content and length of the prototype intervention, and any barriers and facilitators to its incorporation into practice. The focus groups/interviews were audio-recorded and analysed using framework analysis in Nvivo. We used the findings to refine the intervention before inviting the focus group/interview participants to complete an online usability test and provide further feedback via an online questionnaire incorporating a modified version of the NoMAD checklist.

Findings

Suggested changes to the intervention included: signposting to local services and websites for additional information; simple wording and labelling of personalised cancer risk; the opportunity for patients to re-visit the website; the ability to print a summary to give to the patient; and inclusion of images to help with completion of the risk questionnaire. Twenty-two participants completed the usability testing and online questionnaire. All felt the risk questions and information in the leaflet were clear, and it would be easy to collect the risk information. 91% felt the intervention would enable discussion about cancer risk and facilitate setting targets and believed it had potential to be easily integrated into NHS Health Checks. 95% reported the website was easy to use and found the risk presentation to be clear and thought it had the potential to help encourage lifestyle changes within primary care. However, only 36% agreed it could be delivered within 5 minutes and only 45% that there would be sufficient resources to support its incorporation. Free-text comments included suggestions to further refine the calculation of alcohol consumption.

Consequences

We have used existing literature and normalisation process theory to develop an intervention that is acceptable to healthcare professionals and potentially feasible for use in primary care. Further work is now needed to assess the feasibility and potential effectiveness in practice.