Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals’ experiences

Abstract

Objectives Successful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years. Methods Fourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis. Results The following five main themes were identified: ‘exciting but daunting’ reflected the mixture of excitement and anxiety in intervention training and delivery; ‘skills practice and demonstrations were essential’ captured the value of learning and practising together, even though the process could be uncomfortable; ‘an individual approach to a standardized intervention’ showed how tutors negotiated adherence to the manual with delivery using their own words; ‘becoming a better practitioner’ described how participation enhanced tutors’ wider clinical practice; and ‘pragmatic and flexible’ highlighted practical adaptations to facilitate training and intervention roll out. Conclusion These insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients.

Acceptability of a brief fatigue intervention for inflammatory arthritis: a qualitative process evaluation

“…The RHPs became more confident about the (often new to them) interventional approach and content as they delivered more sessions. These findings support earlier fatigue studies [ 17 ] and literature reporting a positive relationship between health professional self-efficacy and patient outcomes [ 18 ], highlighting the importance that a positive training experience and on-going support might have on health professional self-efficacy and, in turn, patient outcomes.…”

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

“…The key qualitative findings from the RAFT programme trial presented here have been previously published. 80…”

“…it's difficult to think about things that could maybe be cut out to make it quicker because I think actually the benefit of it has been that all of the areas have been covered. INT11 80 This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/.…”