Co-designing for behaviour change: The development of a theory-informed oral-care intervention for stroke survivors

Matthew Lievesley; Rachael Powell; Daniel Carey; Sharon Hulme; Lucy O'Malley; Wendy Westoby; Jess Zadik; Audrey Bowen; Paul Brocklehurst; Craig J Smith

doi:10.1080/24735132.2022.2096291

Co-designing for behaviour change: The development of a theory-informed oral-care intervention for stroke survivors

Design Health (Abingdon). 2022 Jul 21;6(2):221-243. doi: 10.1080/24735132.2022.2096291. eCollection 2022.

Authors

Matthew Lievesley¹, Rachael Powell², Daniel Carey¹, Sharon Hulme^{3

4}, Lucy O'Malley⁵, Wendy Westoby⁶, Jess Zadik⁷, Audrey Bowen⁸, Paul Brocklehurst⁹, Craig J Smith^{4

10}

Affiliations

¹ School of Design, Northumbria University, Newcastle upon Tyne, UK.
² Division of Psychology & Mental Health, School of Health Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
³ Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.
⁴ Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Salford Royal NHS Foundation Trust, Salford, UK.
⁵ Division of Dentistry, School of Medical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
⁶ Stroke Survivor and Public Contributor in the research team, Leigh, UK.
⁷ Salford Royal NHS Foundation Trust, Salford, UK.
⁸ Geoffrey Jefferson Brain Research Centre, The Manchester Academic Health Science Centre, Northern Care Alliance & University of Manchester, Manchester, UK.
⁹ NWORTH Clinical Trials Unit, University of Bangor, Bangor, UK.
¹⁰ Division of Cardiovascular Sciences, School of Medical Sciences, Lydia Becker Institute of Immunology and Inflammation, Manchester Centre for Clinical Neurosciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.

Abstract

This article discusses how research to understand the oral care needs and experiences of stroke survivors was translated into a prototypical intervention. It addresses the challenge of how to develop service improvements in healthcare settings that are both person-centred, through the use of co-design, and also based on theory and evidence. A sequence of co-design workshops with stroke survivors, family carers, and with health and social care professionals, ran in parallel with an analysis of behavioural factors. This determined key actions which could improve mouthcare for this community and identified opportunities to integrate recognized behaviour-change techniques into the intervention. In this way, behaviour change theory, evidence from qualitative research, and experience-based co-design were effectively combined. The intervention proposed is predominantly a patient-facing resource, intended to support stroke survivors and their carers with mouth care, as they transition from hospital care to living at home. This addresses a gap in existing provision, as other published oral-care protocols for stroke are clinician-facing and concerned primarily with acute care (in the first days after a stroke). Although it draws on the experiences of a single design project, this study articulates a 'working relationship' between design practice methods and the application of behaviour change theory.

Keywords: Co-design; EBCD; behaviour change; oral-care; person-centred care; stroke care.

Grants and funding

This research was funded by the National Institute for Health Research (NIHR) (PB-PG-0815-20017) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.