The development of a digital intervention to promote timely presentation of breast cancer symptoms to a healthcare professional
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Breast cancer is the primary cause of death among women globally and in Ireland, mortality rates from breast cancer are the third highest in Europe. Early diagnosis of breast cancer is linked to more favourable outcomes and enhanced survival rates. Interventions to promote timely presentation to a healthcare professional (HCP) have the potential to increase early detection of breast cancer and therefore improve outcomes and mortality rates. The patient interval refers to i) the time taken to interpret a bodily change and ii) the time taken to act upon that change and seek help from an HCP. Decreasing the patient interval is one way to increase early detection of breast cancer. Interventions designed to decrease the patient interval to date have targeted breast awareness which has three key components: breast checking behaviour, knowledge of age-related risk and knowledge of non-lump symptoms. These interventions have been delivered through booklets and in-person consultations which are costly and time intensive to implement. The current research, the Know Breast Health intervention, takes a novel approach to decreasing the patient interval for breast cancer in two ways; it targets help-seeking behaviours as well as the components of breast awareness and delivery is through a website to provide greater reach, at lower cost. This thesis describes the development of a digital intervention to decrease the patient interval for breast cancer. The Know Breast Health intervention was developed using the Behaviour Change Wheel and the Person-Based Approach for intervention development. A literature review was conducted to understand the contributing factors to progression through the patient interval for breast cancer and a behavioural diagnosis was conducted to develop potential content for the intervention. A series of qualitative studies were conducted to produce, refine and optimise the content of the Know Breast Health intervention. A focus group study generated ideas for the intervention and assessed the acceptability of the proposed content. The results of this study were combined with the findings of the literature review and the behavioural diagnosis to create the Know Breast Health Website 1.0. A think-aloud interview study assessed the usability and acceptability of the Know Breast Health Website 1.0. This study had an iterative design allowing for multiple rounds of analysis and redesign which led to multiple iterations of the website, ending with version 4.0. The final qualitative study was a retrospective interview study where participants shared their experiences of using the Know Breast Health intervention independently. This research developed an intervention to promote timely help-seeking to an HCP upon self-discovery of a symptom of breast cancer. Health psychology methodologies were used to create a usable, acceptable and engaging intervention by incorporating target user perspectives throughout the development process, and grounding it in theory and evidence. This research was conducted and reported transparently and systematically to contribute to the growing science of intervention development.
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