Co-development of a Self-management Supportive Programme to Meet the Needs of Saudi Women with Breast Cancer: An Intervention Mapping Approach
Authors:   , Alanazi Alaa 
Published: October 2022

Introduction:Breast cancer is the most commonly diagnosed cancer among Saudi women, and over 50% of breast cancer cases in the Kingdom are detected at a late stage. Diagnosis and treatment can produce many different psychosocial issues, physical symptoms, and unmet needs. Previous studies have reported a low overall quality of life among Saudi women with breast cancer. There is evidence that self-management supportive (SMS) interventions to enable the women to take an active role in their own care have the potential to help enhance their quality of life. Yet, the provision of SMS interventions in Saudi Arabia is unknown, with a paucity of research in this area. This study contributes to the body of knowledge, aiming to systematically develop a theory- and evidence-based self-management supportive programme to meet the needs of Saudi women with breast cancer. Methodology: Given the varied physical and psychosocial difficulties faced by Saudi women with breast cancer, interventions to manage them can be considered complex. This study was informed by the six steps of the Intervention Mapping approach, as consistent with the guidance of the Medical Research Council (MRC) framework for developing and evaluating complex interventions. The needs assessment (step one) included an integrative literature review and a qualitative study to identify the needs and concerns of Saudi women with breast cancer. The findings from this influenced the subsequent steps of programme development based on the Intervention Mapping approach. In conjunction with a co-production advisory group, step two included identifying the intended outcomes and performance, and the change objectives of the proposed programme (i.e., what a participant has to learn, do or change to achieve the specified outcomes) were formulated. To achieve these objectives, evidence-based methods (i.e., the key ingredients of interventions) were selected (step three), as informed by the findings of the rapid literature review. This was followed by outlining an organised programme plan (step four), an adoption and implementation plan for the feasibility trial (step five), and finally, a preliminary evaluation plan to assess feasibility and acceptability (step six). The outcomes from each step guided the next step iteratively, and all six steps were integrated with the involvement of the co-production advisory group. Results:The needs assessment conducted through the integrative literature review and qualitative study revealed that Saudi women with breast cancer have a range of unmet physical, psychosocial, and practical needs. Although the women reported that they utilised their own personal strengths and resources (e.g., reliance on God ‘Allah’, family support) to get through their illness, they were looking for more information and support, but were reluctant to seek that. This was due to different personal, interpersonal, and organisational barriers, including low self-efficacy, language barriers when communicating with expatriate health care providers, and the present medical patriarchy. The rapid literature review identified promising behavioural techniques used in previously published interventions, such as goal setting, action planning, and adding objectives to the environment. These findings, alongside the involvement of the co-production advisory group, informed the development of a self-management programme called ‘together we have willpower’. The programme was designed to address the women's needs (e.g., managing chemotherapy-related symptoms) by using SMS strategies (e.g., goal setting, verbal persuasion of capability) and targeting individual determinants of SM behaviour (e.g., self-efficacy). The jointly facilitated nurse- and lay-led co-produced programme consisted of six 90-minute sessions, held on a weekly basis. The sessions’ intent was to develop self-management skills in groups of up to sixteen individuals based largely on social learning theory. Conclusion: This study resulted in the development of a culturally tailored, standardised self-management programme for women with breast cancer in Saudi Arabia, which has the potential to optimise the womens’ self-management skills and improve quality of life. Intervention Mapping has been found to be a useful approach for developing SMS programmes in a systematic way. It is critical to have a high level of transparency to enable future complex interventions, and for trial developers to replicate.