Developing a person-based intervention to improve treatment adherence in patients with peripheral arterial disease using the perceptions and practicalities approach
File(s)
Author(s)
Lampridou, Smaragda
Type
Thesis or dissertation
Abstract
Peripheral arterial disease (PAD) is a condition in which fatty deposits build up inside arteries, affecting 20% of people aged over 60 in the UK. More than 50% of symptomatic patients will experience a major cardiovascular event, or amputation within five years. Although the National Institute for Health and Care Excellence (NICE) guidelines recommend pharmacotherapy (antiplatelet and lipid-lowering agents), smoking cessation and exercise, adherence to these is low, and there are no effective strategies to improve this. This PhD aimed to develop a person-based behavioural intervention to support PAD treatment adherence, using the Person-Based Approach and the Perceptions and Practicalities Approach. The project was completed in three phases. Stage 1- Planning: A scoping review of available adherence-promoting interventions (n=15) to identify current interventions and their components. Semi-structured qualitative interviews with patients with PAD (n=15), their relatives (n=4), and clinicians (n=18) to identify adherence barriers and facilitators. A Freedom of Information Request to explore the availability and structure of PAD services (n=82) in England. Stage 2- Design: A data triangulation exercise to identify key adherence influences. ‘Guiding principles’ were developed to inform the required characteristics of the intervention, and behaviour change techniques that could address the identified influences were selected. A ‘logic model’ was developed to describe the intervention's mechanism of action. Three rounds of co-design workshops with patients with PAD and their relatives (n=29) were undertaken to develop the intervention prototype, a booklet entitled PAD&Me. Stage 3 - Optimisation: Think-aloud interviews with newly diagnosed patients (n=12) were conducted to refine the intervention based on user feedback. The co-designed PAD&Me booklet intervention aims to address common misconceptions about their disease and treatment, overcome identified barriers, and set goals to support behaviour change. Future research is needed to assess the feasibility and effectiveness of this intervention before its implementation in usual practice.
Version
Open Access
Date Issued
2026-04-06
Date Awarded
2026-08-01
Copyright Statement
Attribution-NonCommercial 4.0 International Licence (CC BY-NC)
License URL
Advisor
Wells, Mary
Davies, Alun Huw
Judah, Gaby
Sponsor
National Institute for Health Research (Great Britain)
Grant Number
303308
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)