Background/Purpose: Fibromyalgia (FM) is a complex long-term condition that affects up to 5.4% of the UK population. It is associated with chronic widespread pain, fatigue, stiffness, sleep problems, memory and concentration difficulties, and irritable bowel syndrome. FM can cause significant levels of disability, with individuals frequently using healthcare resources, and experiencing loss of work days. There is a lack of robust evidence for the effectiveness of pharmacological treatments for FM, with current guidelines all recommending non-pharmacological interventions. Allied Health Professionals at the Royal National Hospital for Rheumatic Diseases, Bath, UK, developed the manualised Fibromyalgia Self-Management Programme (FSMP); a non-pharmacological, multidisciplinary exercise and education group intervention. The main aims of the FSMP are to provide condition-specific, patient centred, education and exercise advice, supporting the development of core, self-management skills. The FSMP comprises 2.5 hour weekly sessions over six weeks or 4 hour weekly sessions over four weeks. Core components include education about FM, sleep hygiene, goal-setting, pacing, hydrotherapy, and dietary advice. As the FSMP was developed clinically there has been little opportunity for the clinical team to fully understand the mechanisms by which it is effective. To inform successful widespread implementation, this research aimed to map the FSMP to the Michie Behaviour Change Taxonomy (BCT) to determine the mechanisms that facilitate the patient’s ability to self-manage FM.

Methods: Non-participatory observations were conducted of the four week and six week FSMP. Comprehensive field notes on the content of the course, therapist delivery, and any additional content not included in the manual were recorded. Subsequently, semi-structured interviews were conducted with both therapists (n=4) and patients (n=9). Observations and the review of the therapist manual data were deductively coded in NVIVO to the BCT using Framework Analysis. Interview data were analysed using Theoretical Thematic Analysis.

Results: Review of the course manual and session observations showed that the FSMP coded onto 12 of the 16 main areas of the taxonomy, encompassing 22 behaviour change techniques. Patient’s interviews indicated that they had made substantial behaviour changes as a result of attending the course including; increased activity levels; pacing; better quality sleep and improved communication with family members. Patients reported positive changes to symptoms as a result of attending the course. Therapists highlighted four key challenges in delivering the course; fidelity between therapists; patient readiness and acceptance of FM; group management; and patient fatigue while attending the programme.

Conclusion: The FSMP uses a range of behaviour change techniques. Patients who attended the course made changes to their behaviour, which enabled them to manage their symptoms of FM more effectively.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-qualitative-study-mapping-the-behaviour-change-techniques-used-in-a-practice-based-fibromyalgia-self-management-programme/