Intervention Planning for the Tinnitus E-Programme 2.0, an Internet-Based Cognitive Behavioral Intervention for Tinnitus

Abstract

Purpose The purpose of this study is to comprehensively describe the intervention planning process for the Tinnitus E-Programme 2.0, an Internet-based cognitive behavioral intervention for tinnitus. Method Theory-, evidence-, and person-based approaches to intervention development were used. In Phase 1, quantitative systematic reviews were used to identify potentially effective intervention techniques and design features. Primary mixed-methods research involving adults with tinnitus explored the acceptability of the first version of the intervention. In Phase 2, person-based guiding principles highlighted key intervention design objectives and features to address needs of the intervention's target group (identified in Phase 1) to maximize its acceptability, feasibility of delivery, and effectiveness. Theory-based “behavioral analysis” and “logic modeling” comprehensively described intervention content and potential mechanisms of action. From this planning work, a prototype intervention was developed. Results The intervention design objectives outlined in the guiding principles were to (a) normalize tinnitus, (b) support users to maintain a regular relaxation practice, (c) minimize the worsening of users' tinnitus sensation, and (d) ensure the intervention is accessible to those with hearing loss. Behavioral analysis and logic modeling identified intervention processes (e.g., illness perceptions, beliefs about consequences, skills, goals) and purported mediators (acceptance of tinnitus, negative thinking, use of the cognitive skills tools for managing negative thoughts, and practicing regular relaxation) hypothesized to facilitate reductions in tinnitus symptom severity. Conclusions The guiding principles highlight key design objectives and features to consider when developing interventions for tinnitus. The logic model offers hypothesized mechanisms of action that can be tested in future process analyses.

Application of the Behavior Change Wheel Within the Context of Internet-Based Cognitive Behavioral Therapy for Tinnitus Management

“…Therefore, further work to expand the applicability and generalizability of ICBT should be undertaken. It is also important to draw inspiration from other similar interventions and smartphone applications (e.g., Aazh and Danesh, 2020;Greenwell et al, 2021;Henry et al, 2020;Mehdi et al, 2020; and how they have incorporated behavioral change elements into their development.…”

“…More recently, the Behavior Change Wheel (BCW; Michie et al, 2011) was developed following a synthesis of 19 frameworks of behavior change (Michie et al, 2014). The importance of applying the BCW has been outlined for hearing loss (e.g., Barker, Atkins, de Luignas, 2016;Coulson et al, 2016;Ekberg et al, 2020;Ferguson, et al, 2019, Maidment et al, 2020 and tinnitus interventions (Greenwell et al, 2021). Furthermore, it is advocated that such a theory-driven approach should be employed in the development and evaluation of digital health interventions to ensure that they meet the specific needs of the end users and are more likely to result in behavior change (NICE, 2020).…”