Development of a behaviour change intervention to support provider identification of work-related asthma in primary care (The PURSUIT study – development phase)
One in four working adults with asthma has symptoms caused or worsened by their job, yet primary care doctors miss the diagnosis roughly half the time. This project aims to close that gap. Work-related asthma—triggered by inhaled dusts, chemicals, or fumes on the job—is avoidable if caught early, but UK patients wait an average of four years for a correct diagnosis. Those delays cost the NHS an estimated £1 billion per decade and hit lower-skilled trades hardest. The problem is not a lack of guidelines; it is that primary care clinicians rarely follow them. The researchers will develop a behaviour change intervention—a set of practical tools and prompts—designed to make it routine for GPs and nurses to ask patients about their jobs and symptoms. Over 24 months, they will interview patients and clinicians, identify what blocks or enables diagnosis, and refine the intervention through focus groups. If the intervention works, it could shift a quiet failure of primary care into a standard practice. Earlier diagnosis means patients can avoid the exposures making them sick, preserving lung function, keeping their jobs, and reducing long-term health costs.
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Background Work-related asthma (WRA) comprises occupational asthma (OA: caused by inhaling respiratory sensitisers at work) and work-exacerbated asthma (WEA: asthma worsened by conditions at work). WRA is avoidable, but remains common and affects 25% of working adults with asthma; there are social gradients in both risk and health outcomes, with those in lower skilled trades affected disproportionately. Early diagnosis and avoidance of causative exposures leads to more favourable health and employment outcomes, and all major UK-oriented asthma guidelines recommend that primary healthcare professionals (HCP) ask patients about work-relatedness of symptoms and their occupation, and refer those with high-risk of WRA to a specialist. However, WRA goes underdiagnosed by as much as 50% and there are significant delays in diagnosis (mean=4 years in UK) with substantial health and social care costs, which for OA in the UK are estimated at £1 billion per decade. Delays and missed diagnoses have been attributed in major part to lack of adherence to guidelines by primary HCPs. Aim of research To develop, refine and describe (in terms of function, content and usability) a multi-component behaviour change intervention (BCI), aimed at increasing the identification of WRA in primary care populations by changing the clinical behaviour of primary HCPs. Methods We intend to follow the established and standardised approach to multi-component BCI development based upon the behaviour change wheel (BCW) and its principal model of behaviour COM-B, in 5 steps. Step 1: qualitative interviews with up to 20 patients with WRA and up to 20 primary HCPs respectively, analysed thematically using the theoretical domains framework, to understand barriers and enablers of identification of WRA; step 2: coding of barriers and enablers and mapping according to COM-B categories and corresponding BCW functions and policy categories; step 3: identification of a selection of discrete behaviour change techniques (BCT); step 4: refinement of BCTs using thematic analysis of qualitative focus groups with up to 10 patients and up to 10 HCPs respectively, to explore shared or disparate views on utility; step 5: final selection of BCTs for the multi-component BCI by a research and stakeholder team, utilising APEASE criteria, discussion and consensus. Formal PPIE events have informed this application, and will be embedded at 6-monthly intervals throughout the study, to inform recruitment, study materials, critical interpretation of data, and dissemination. Timelines for delivery The study will take 24 months to complete, commencing 1/5/2025. Dissemination and anticipated impact We will present a final report and briefing note for key stakeholders and two peer-reviewed publications. We will collaborate with our PPIE group to establish feasible, specific and measurable effectiveness outcomes for a pilot hybrid implementation trial. An effective BCI, once implemented and evaluated, would lead to rapid patient benefit: increased HCP adherence to asthma guidelines will likely increase identification of WRA and reduce diagnostic delays. Thus, patients are likely to achieve earlier avoidance of causative exposures, and experience better health and employment outcomes (eg. preservation of lung function, medication use, asthma severity, mental and physical health status, absenteeism, income reduction, job loss).
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