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

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posted on 2022-07-25, 10:20 authored by Tomas Lynch

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.

Funding

Clement Archer Scholarship CC BY-NC-SA

History

First Supervisor

Dr. Cathal Cadogan

Second Supervisor

Prof. Cristín Ryan

Third Supervisor

Prof. Judith Strawbridge

Comments

Submitted for the Award of Doctor of Philosophy to the Royal College of Surgeons in Ireland, 2022

Published Citation

Lynch T,. Development of a Theory-Based Intervention to Support the Discontinuation of Long-Term Benzodiazepine Receptor Agonist Use [PhD Thesis] Dublin: Royal College of Surgeons in Ireland; 2022

Degree Name

  • Doctor of Philosophy (PhD)

Date of award

2022-06-01

Programme

  • Doctor of Philosophy (PhD)

Research Area

  • Population Health and Health Services

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