THU0741-HPR Mapping the behaviour change techniques used in a practice-based fibromyalgia self-management programme: a qualitative study
Authors: J. Pearson, K. Whale, N. Walsh, S. Derham, J. Russell, F. Cramp
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Fibromyalgia (FM) is a complex long-term condition affecting up to 5.4% of the UK population. It is associated with chronic widespread pain, fatigue, sleep and cognitive difficulties. FM can cause high levels of functional and work disability; with individuals making frequent use of healthcare resources. There is limited robust evidence for effective pharmacological treatments for FM, and current guidelines all recommend non-pharmacological interventions. Allied health professionals at the Royal National Hospital for Rheumatic Diseases (RNHRD), Bath developed the Fibromyalgia Self-Management Programme (FSMP); a non-pharmacological, multidisciplinary exercise and education group. <h3>Objectives</h3> Main aims of the FSMP are to provide condition-specific, patient centred, education and exercise advice, to support development of core, self-management skills. The FSMP comprises of 16 hours of group treatment, spread over four or six weekly sessions. Core components include education about FM, sleep, diet and lifestyle advice, hydrotherapy and stretches. The FSMP was developed clinically, with little opportunity for the clinical team to explore the mechanisms by which it is effective. To inform successful implementation beyond the RNHRD, this evaluation aimed to map the FSMP to the NICE recommended Michie<sup>1</sup>Behaviour Change Taxonomy (BCT) to determine key behaviour change components. <h3>Methods</h3> Non-participatory observations were conducted of the four and six week FSMP. Detailed notes on course content, therapist delivery, and additional content not included in the manual were recorded. Semi-structured interviews were conducted with therapists (n=4) and patients (n=9). Observations and review of the therapist manual data were deductively coded in NVIVO to the Michie Behaviour Change Taxonomy using Framework Analysis. Interview data were analysed using Theoretical Thematic Analysis. <h3>Results</h3> Review of the course manual and course observations show the FSMP coded onto 12 of the 16 main areas of the Michie Behaviour Change Taxonomy, encompassing 22 behaviour change techniques. Patients' interviews indicated significant behaviour changes as a result of attending the course; including increased activity levels, pacing, better quality sleep, and improved communication with family members. Patients reported positive changes to symptoms as a result of attending the course. Therapists highlighted four key challenges in delivering the course; fidelity between therapists, patient readiness and acceptance of FM, group management and patient fatigue while attending the programme. <h3>Conclusions</h3> The FSMP utilises a range of behaviour change techniques. Patients who attend the course make changes to their behaviour which enables them to manage their symptoms of FM more effectively. <h3>Reference</h3> [1] Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behaviour change technique taxonomy (v1) of 93 hierarchically cluster techniques: building an international consensus for the reporting of behaviour change intervention. Annals of Behavioural Medicine2013;46(1): 81–95. <h3>Disclosure of Interest</h3> None declared