A feasibility study to assess a co-designed behaviour change intervention to support people living with achalasia
Authors: Kalantari M , Hollywood A , Lim R , Hashemi M 
Published: April 2024

Abstract

Introduction
Achalasia is a rare oesophageal condition that affects the motility of the oesophageal body and the relaxation of the lower oesophageal sphincter. Even the most effective treatments are unlikely to be curative. The main goal of medical treatments and interventions are mitigation of symptoms. The medical interventions are pharmacologic, endoscopic and surgical treatments to achieve symptom relief. As all medical treatments only help to alleviate symptoms, it is important for people living with achalasia to use non-pharmacological interventions to manage their condition.

Aim
This study aimed to evaluate the feasibility of recruitment and assess the acceptability of a co-designed behaviour change intervention, targeting eating in a social setting for people living with achalasia.

Methods
The mixed-method study used pre- and post-intervention questionnaires and semi-structured post-intervention interviews. Achalasia Action (a UK-based support group) emailed members the study information and participants contacted the researcher to take part. The intervention was a workbook designed collaboratively by the researchers and people living with achalasia, with strategies built on the COM-B model (Capability, Opportunity, Motivation).[1] Participants were given up to two months to complete the workbook. The interview was optional and it was an opportunity for participants to give further feedback on the intervention. Quantitative measures were subjected to descriptive analysis reporting recruitment and retention rates, and self-reported changes in eating behaviours. Qualitative data were analysed descriptively using the APEASE criteria (Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side-effects/safety, and Equity).[2]

Results
The study aimed to recruit 20 participants, and this target was achieved, resulting in a 100% recruitment rate. However, the post-intervention questionnaires were completed by only 10 participants, indicating a 50% retention rate from baseline. Quantitative measures demonstrated an improvement in confidence and enjoyment levels while eating in a social setting post-intervention and a decrease in symptoms such as pain, regurgitation, stress and anxiety. Qualitative feedback (n=5) on the intervention described enhanced social support and improved symptom management of achalasia in a social setting. Furthermore, the intervention met the APEASE criteria, indicating its usability and acceptability.

Conclusion
The recruitment success of this study underscores the feasibility of involving people living with achalasia in intervention research. However, with a retention rate of only 50% at follow-up, it is evident that future studies should consider recruiting a larger baseline sample to ensure the target is achieved. The study acknowledges that the sample size was small and limits the generalisability of the findings. However, this is a characteristic typical of feasibility studies; therefore, the study is designed to assess the feasibility of recruitment and implementing a co-designed intervention rather than drawing conclusions on its efficacy. The positive outcomes of the co-designed intervention highlights the importance of user involvement in developing interventions. The intervention demonstrated the potential to support people living with achalasia in eating in a social setting. The co-designed intervention has significant practical implications by providing healthcare professionals and support groups with a feasible, effective method to enhance the social eating experience of people living with achalasia, potentially improving their overall quality of life.

References
1. Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science. 2011;6:1–2.
2. Michie S, Atkins L, West R. The Behaviour Change Wheel: A Guide to Designing Interventions. Great Britain: Silverback Publishing, 2014.