Award Title: Co-design of a tailored intervention to support pressure ulcer prevention behaviours by older patients and their lay carers in community settings (C-PrUP)
Funder: Department of Health and Social Care

Abstract: Aim   To co-design a theoretically-underpinned, healthcare professional (HCP) mediated, tailored intervention to support housebound older patients and their lay carers to adhere to pressure ulcer (PU) prevention behaviours.   Objectives    Assess current practice and identify adherence/non-adherence with PU prevention guidance with older housebound patients and their lay carers  Assess barriers and facilitators to key behaviours that reduce the risk of PU  Co-design with patients, lay carers and HCPs an intervention to support patients and lay carers to adhere to best practice in PU prevention   Background   PUs are localised injuries to the skin and underlying tissues that incur a substantial financial burden on the health service, absorbing approximately 4% of the annual NHS budget. Over 19% of patients receiving care in their own home will suffer from a PU at any time, resulting in increased hospital admissions, morbidity and mortality and decreased quality of life. PU prevention is a priority for patients, carers, HCPs and commissioners. Clinical partners and Patient and Public Involvement and Engagement (PPIE) representatives want to know what can be done differently to reduce incidence. Since HCP visits to housebound patients are increasingly limited, there is greater reliance on self-care and support from lay carers.  Methods and timeline  This project is Stage 1 of a three-stage research plan.  Stage 1 includes two Phases    Phase 1 Theoretically informed qualitative interviews to understand barriers and facilitators of adherence to PU prevention behaviours by older housebound patients and their lay carers (Months 1-12). We will investigate what people actually do and why they do what they do. Data will be analysed to identify barriers and facilitators to PU prevention behaviours, and charted against the domains of the Theoretical Domains Framework (TDF).  Phase 2 Co-design of a theoretically informed, HCP mediated, tailored intervention to support adherence to PU prevention behaviours (Months 12-18). The TDF domains identified will be used to select appropriate Behaviour Change Techniques (BCTs). The co-design group of patients, lay carers and HCPs will translate BCTs into practical ideas before consensus is reached on modes of delivery. Prototypes will be developed and assessed against established criteria.   Anticipated impact and dissemination  Impact at this stage is involvement of an underserved community in the co-design of an intervention to reduce the risk of PUs. Dissemination will be through conference presentations, information accessible to patients and the public (including YouTube films and twitter accounts), and a study-specific Twitter and web presence.  Subsequent to this project, the trajectory to improved care will be:  Stage 2: Feasibility testing and refinement of proposed intervention and feasibility trial (2022-2024)  Stage 3: Randomised controlled trial to investigate effectiveness and cost-effectiveness of the intervention (2024-2027).  By reducing PU risk, patient comfort, safety and quality of life will improve, as will knowledge, skills and confidence of lay carers. A conservative estimate based on local data suggests that a 5% reduction in severe PUs would mean that 66 individuals would be prevented from needless suffering, with a cost saving of approximately £800,000 in one locality alone.

Lay Abstract: We aim to change patient and lay carer health behaviours to reduce the risk of pressure ulcer (PU) (often known as a bedsore) development. We will develop a toolkit informed by theory and evidence. Around half a million people in the UK develop a PU each year. PUs reduce health and wellbeing and are costly for the NHS.  We will work with older people living at home and their lay carers, an often-underserved group. Our study is important because i) our population is ageing and for most of the time responsibility for PU prevention activities rests with themselves and their family and ii) we do not yet know the best ways to help this group minimise their risk of PU development.   We will systematically use the stages of psychological theory which we know are effective in getting people to change embedded health behaviours. Firstly, we will interview adult patients (65 years and over) with limited mobility (often described as being housebound) who are at risk of PUs and their lay carers (unpaid carers, most often family members). We will ask i) what PU prevention advice and information they have been given (e.g. moving around, changing position, healthy eating, checking their skin) and ii) how, why and how much they follow this advice.   Secondly, findings from these interviews will inform development of a toolkit to help patients and lay carers follow advice to reduce the risk of PU and change existing health behaviours. We will co-design the toolkit with patients, lay carers and healthcare professionals. It will be adaptable according to patient and lay carer needs. It may include, for example, videos, leaflets and reminders. We know that co-design is most likely to result in a toolkit that is acceptable, fit for purpose and used. The benefits to patients at this stage include:    addressing a question that has been identified as important by patients, lay carers, health practitioners and policy makers  co-designing an intervention acceptable to end-users, implemented in practice and that supports a personalised/needs-driven provision.   Patient and public involvement and engagement (PPIE) has been integral to developing this application and will continue throughout the study.  We have visited people who are at risk of PUs, and their lay carers, consulted with the Portsmouth Carers Centre and worked in partnership with PPIE co-applicants who have relevant experience. All agree this is an important research question. They have contributed to study design and how best to be inclusive throughout the study.  We will share findings widely through social media, publications, conferences and events, aimed at lay, practitioner and policy maker audiences. Next steps are to test out the toolkit locally and then more widely in a trial to assess its effect.

Research Activity Codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: SKIN