Empathico - The Development of an Intervention to train Primary Care Practitioners in Empathy and Optimism

Talk Code: 
Kirsten Smith
Kirsten A Smith, Felicity L Bishop, Mary Steele, Jane Vennik, Stephanie Hughes, Leanne Morrison, Emily Lyness, Mohana Ratnapalan, Jennifer Bostock, Christian Mallen, Geraldine Leydon, Jeremy Howick, Lucy Yardley, Hazel Everitt, Paul Little
Author institutions: 
University of Southampton, University of Bristol, University of Oxford, Keele University

Short presentation


Evidence suggests that empathy and optimism can be employed in healthcare consultations to improve outcomes for patients - however, healthcare practitioners (HCPs) face barriers when applying them. This project aimed to develop a digital intervention that could provide appropriate, effective and acceptable training in empathy and optimism to primary care HCPs to improve outcomes for patients with osteoarthritis.


The rigorous Person-Based Approach (PBA; Yardley et al. 2015), which incorporates theory, evidence and qualitative research, was used to develop the intervention. This involved:

1. A meta-ethnography on patients’ and practitioners’ views on communication in osteoarthritis consultations to discover barriers and facilitators to effective consultations.

2. Two secondary analyses to identify which features of empathy and optimism training were effective:

• On 7 interventions that trained HCPs in empathy.

• On 22 interventions that aimed to increase patients’ positive outcome expectancies.

3. A qualitative telephone interview study - twenty HCPs (including GPs, nurse practitioners, physiotherapists) were interviewed to explore views of empathy and optimism in consultations and training. Interviews were transcribed and analysed using inductive thematic analysis.

This work informed the intervention’s guiding principles, behavioural analysis and logic model.


Based on this foundation, using the PBA, the ‘Empathico’ digital intervention was iteratively developed. Fifteen ‘Think-aloud’ interviews were conducted with HCPs to help optimise acceptability, feasibility and likelihood of behaviour change. Patients (n=15) provided feedback on simulated videos of an ‘Empathico’ consultation versus a neutral consultation to ensure their concerns were addressed (in addition to PPI guidance). A ‘Table of Changes’ approach was used to modify the intervention: comments on each webpage were tabulated, negative comments and positive comments were compared, and solutions developed in accordance with the guiding principles. For example, participants did not like the terms used in one of the modules, ‘professional’ and ‘cool’, so the team changed this to ‘attentive’ with ‘increasing expressions of empathy’, which conveyed our message more successfully. Iterative modifications like these resulted in more positive and fewer negative comments, resulting in a highly acceptable intervention.

A final study was conducted, checking that the intervention would be acceptable for independent use. Five HCPs, who were given access to Empathico for 1-2 weeks, participated in a telephone interview discussing their experience. Feedback was mostly positive, resulting in only a few small final optimizations to Empathico.


Using this rigorous approach, we were able to create a digital intervention for HCPs with strong, evidence-based training in empathy and optimism. We addressed potential barriers to engagement with Empathico and improved its likelihood of success. The development phase of the project is now complete and entering a feasibility trial phase.

Yardley, L. et al. (2015). The person-based approach to intervention development: application to digital health-related behavior change interventions. JMIR, 17(1), e30.


Submitted by: 
Kirsten Smith
Funding acknowledgement: 
The EMPATHICA trial is supported by a National Institute for Health Research (NIHR) School for Primary Care Research (project number 389). The Primary Care Department is a member of the NIHR School for Primary Care Research and supported by NIHR Research funds. MR is an NIHR School for Primary Care Research funded ACF. CDM is funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The research programme of LY and LM is partly supported by the NIHR Southampton Biomedical Research Centre (BRC). This paper presents independent research funded by the National Institute of Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, HEE or the Department of Health. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.