Saudi Cultural Missions Theses & Dissertations
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Item Restricted A training intervention to encourage GPs to prescribe mobile health apps to improve disease management in patients with long term conditions(University of Manchester, 2025) Alkhaldi, Ohoud; Ainsworth, JohnBackground: There is growing interest in the use of mobile health (mHealth) apps to encourage health behaviours, promote self-management, and manage diseases. While there is sufficient evidence for the effectiveness of some mHealth apps, general practitioners (GPs) prescribing behaviour towards mHealth apps remain limited. The UK’s National Institute for Health and Care Excellence has recently recommended (Sleepio) a digital cognitive behaviour therapy for insomnia as an alternative to medical treatment. The potential benefits of Sleepio as opposed to medication or other more traditional therapies include cost savings to the NHS, reduced likelihood of unwanted side effects, and enhanced patient empowerment. Understanding GPs’ behaviour and perceived barriers to using Sleepio in primary care is essential to designing tailored interventions to encourage GPs to refer patients to Sleepio. Methods: The overall approach for this research was informed by guidance from the Medical Research Council on the development of complex interventions and Michie et al’s Behaviour Change Wheel (BCW). A systematic review of interventions to encourage HCPs to use mHealth apps was conducted to identify which intervention functions are most likely to produce effective change in their behaviour towards mHealth apps. Then, following the BCW steps, a sample of GPs working in Scotland were invited to complete a behavioral analysis questionnaire i.e. Capability, Opportunity, Motivation-Behaviour (COM-B) Self-Evaluation Questionnaire (N=65) to understand the barriers and facilitators and what might need to change for them to refer patients to Sleepio. Drawing on the findings of the systematic review and behavioral analysis questionnaire, a novel intervention was drafted. Multiple discussions were conducted with Sleepio team to refine the intervention design. The final intervention was implemented with 16 Scottish GPs. Results: A wide range of barriers to and facilitators of referring patients to Sleepio were identified. The intervention targeted most components of the COM-B model, with a strong focus on psychological capability, physical opportunity, automatic and reflective motivation. It involved reviewing orientation material about Sleepio, sending a visual reminder and providing technical support. When implemented with GPs, no statistically significant difference in GPs referral rates across four data points were found. However, GPs reported that their confidence level in recommending Sleepio increased significantly (Z = -3.436, P < 0.01), from a mean of 5.44 (somewhat confident) to 8.13 (very confident). Conclusion: This research applied evidence-based theory that identified the barriers and facilitators to referring patients with insomnia to Sleepio. It also has identified techniques to change GPs’ referral behaviour. The intervention was feasible, and improvements were seen in GP-reported confidence levels at recommending Sleepio. For future research, it is recommended that larger studies overcome reported barriers and strengthen enablers to examine the effectiveness of multiple intervention strategies.38 0