Development of a Theory-Based Intervention to Support the Discontinuation of Long-Term Benzodiazepine Receptor Agonist Use

Background: Long-term benzodiazepine receptor agonist (BZRA) use is a persistent clinical challenge in healthcare settings worldwide, despite guidelines repeatedly recommending short-term use (≤4 weeks). The aim of this thesis was to develop a theory-based intervention to support discontinuation of long-term BZRA use among willing individuals.

Methods: The thesis comprises five core chapters: (1) systematic review of brief interventions targeting long-term BZRA use in primary care; (2) qualitative interviews underpinned by the Theoretical Domains Framework (TDF) exploring behavioural determinants to the discontinuation of long-term BZRA use; (3) development of a theory-based intervention to support discontinuation of long-term use of BZRAs using a co-design approach; (4) development and validation of a TDF-based questionnaire to assess barriers and facilitators to BZRA discontinuation; (5) a content analysis of free-text responses to the questionnaire.

Results: Brief interventions were found to be more effective than usual care in reducing and discontinuing long-term BZRA use in primary care. The qualitative findings highlighted the challenging nature of BZRA discontinuation and the multitude of barriers that impacted participants’ behaviour regarding BZRA use. The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe) toolkit was developed by a co-design team that included individuals with lived experience of BZRA discontinuation. The toolkit consists of 24 behaviour change techniques (BCTs) and includes recommendations for primary care-based clinicians in operationalising each BCT in supporting willing individuals with BZRA discontinuation. The TDF-based questionnaire comprises 29 items and showed improved psychometric properties compared to a previous iteration.

Conclusion: This thesis adds to the existing literature through the development of a theory-based intervention to support discontinuation of long-term BZRA use among willing individuals. Further work is needed to refine the SAFEGUARDING-BZRAs toolkit and associated questionnaire and evaluate their usability and acceptability among patients and clinicians before proceeding to a definitive evaluation.