Co-production of an evidence based, patient-centred communication guide delivered by physiotherapists to improve self-management support for older people with complex multiple long-term conditions and their carers in the home setting

Background Older people with complex multiple long-term conditions (MLTCs) have poorer quality of life, increased mortality, and higher use of health care services and costs. Self-management support (SMS), support for patients and carers to learn the skills and knowledge to manage their health conditions, offers a possible solution. Physiotherapists are well placed to provide SMS; however, in practice the delivery of SMS by physiotherapists is variable. Aims and Objectives To co-produce an evidence based, patient-centred SMS communication guide delivered by physiotherapists to improve SMS for older people with complex MLTCs and their carers in the home setting. Methods Fourteen month mixed qualitative methods study. Using maximum variation sampling we will recruit 12 older people aged 60 years and over with complex MLTCs receiving physiotherapy in the home setting and their carers. We will seek to include individuals living in areas of deprivation and those from ethnic minorities. Eight physiotherapists from two community teams in two regions of England will be recruited. We will initially conduct 12 weeks of ethnographic fieldwork (observations, interviews and focus groups) in Southampton and then move to West Boscombe. Up to three observations for each patient and carer dyad of how physiotherapists deliver SMS in practice over time will be conducted. Fieldnotes will focus on types of SMS provided, how these are discussed and factors inhibiting or promoting delivery of SMS in practice. At the end of each observation, we will interview patients and carers to understand how the SMS provided met their needs, preferences, and values and any challenges they still face. Following the last observation, we will ask their suggestions for content, format, and outcomes of a patient-centred SMS communication guide. We will use a reflexive thematic analysis approach to analyse the qualitative data and combine this with self-management and behaviour change theory to develop patient/carer vignettes to structure discussions in two online focus groups with the physiotherapists from each team. The vignettes will be used to facilitate discussion of experiences of providing SMS and suggestions for content, format, and outcomes of a patient-centred SMS communication guide. Synthesis of the qualitative data will be combined with existing evidence to develop an evidence based, theoretically informed patient-centred SMS communication guide and online training module for physiotherapists. The intervention will be co-produced in two online mixed stakeholder workshops with 3 older people with complex MLTCs, 2 carers, 3 physiotherapists and 2 physiotherapy managers. The training module and use of the patient-centred SMS communication guide will be refined through observations and interviews with 4 physiotherapists and 4 patients/carers. Anticipated Impact and Dissemination The aim is to develop a co-produced evidence based, patient-centred communication guide delivered by physiotherapists to improve self-management support for older people with complex MLTCs and their carers in the home setting. The findings will inform a subsequent application for funding to evaluate the feasibility and acceptability of the intervention. Dissemination includes an online stakeholder event, publications, conference presentation, and final report.