Refining a primary care shared decision- making aid for lifestyle change: a mixed- methods study

Background: The important role of primary care in promoting healthy lifestyle behaviours needs informed support.Aim: To elicit views on a 39 -item shared decision-making (SDM) aid (SHARE -D) for lifestyle change and refine it to improve implementation.Design & setting: Mixed-methods study.Method: Health professionals, patients, and support workers, with experience of managing or a history of cardio-or cerebrovascular disease, were purposively recruited based on age, sex, and urban/rural location (n = 34). Participants completed a survey, rating the importance of including each item in a decision -aid, designed for use by patients with health professionals, and suggesting modifications. Semi-structured interviews (n = 30/34) were conducted and analysed thematically.Results: Substantial agreement was observed on rating item inclusion. Based on survey and interview data, 9/39 items were removed; 13 were amended. Qualitative themes were: 1) core content of the decision -aid; 2) barriers to use; 3) motivation for lifestyle change; and 4) primary care implementation. 'Self-reflective' questions and goal setting were viewed as essential components. The paper -based format, length, clarity, and time required were barriers to its use. Optional support considered within the aid was seen as important to motivate change. A digital version, integrated into patient record systems was regarded as critical to implementation. A revised 30 -item aid was considered suitable for facilitating brief conversations and promoting patient autonomy.Conclusion: The SHARE -D decision aid for healthy lifestyle change appears to have good content validity and acceptability. Survey and interview data provided in -depth information to support implementation of a refined version. Further studies should examine its effectiveness.