{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:19:14Z","timestamp":1790813954176,"version":"4.1.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Achalasia is a rare motility disorder affecting the oesophagus, leading to difficulties with eating and drinking. Participants in previous studies reported that they needed more social, clinical and behavioural support in the long-term management of achalasia. This study, therefore aimed to 1) identify the most challenging eating behaviour for people living with achalasia and 2) co-design a behaviour change intervention to help address the challenges they experience.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study used a qualitative approach involving online focus groups. The COM-B model was the theoretical framework, with behaviour change techniques (BCTs) as the active ingredients that target a mixture of capability, opportunity and\/or motivation. Three focus groups were undertaken to obtain a range of input from different people living with achalasia. Participants in this study identified the target behaviour, prioritised the different BCTs which most resonated with them to design an intervention and decided on the mode of delivery. The research team analysed the techniques that helped participants with their eating behaviour using the COM-B model as a framework to create the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The 24 participants in this study identified \u201ceating in a social setting\u201d as the target behaviour for the intervention. A workbook that can be personalised by the individual was the most suitable intervention. The workbook structure aligns with the constructs of the COM-B model. It includes reflection, activities and goal-setting sections based on what was indicated to be useful for the majority of the participants. Key techniques to overcome the challenges with eating in a social setting included social support, regulation to reduce negative emotions, goals and planning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Using a focus group approach with the COM-B model as the theoretical framework, the participants in this study developed an intervention to support people living with achalasia. In order to achieve long-term behaviour change, engagement with a personalised workbook could facilitate eating in a social setting. Future work will need to pilot the workbook to ensure it can support people to improve their quality of life and complement the ongoing care they receive from health services.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1216209","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T04:32:47Z","timestamp":1714451567000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Co-designing an intervention using the COM-B model to change an eating behaviour in people living with achalasia"],"prefix":"10.3389","volume":"11","author":[{"given":"Melika","family":"Kalantari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Hollywood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosemary","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Hashemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"5806","DOI":"10.3748\/wjg.v19.i35.5806","article-title":"Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes","volume":"19","author":"O'Neill","year":"2013","journal-title":"World J Gastroenterol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/nyas.13176","article-title":"Achalasia: from diagnosis to management","volume":"1381","author":"Vaezi","year":"2016","journal-title":"Ann N Y Acad Sci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1136\/gutjnl-2018-316089","article-title":"Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data","volume":"68","author":"Harvey","year":"2019","journal-title":"Gut"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1016\/j.cgh.2011.06.012","article-title":"The diagnosis and misdiagnosis of achalasia: it does not have to be so difficult","volume":"9","author":"Richter","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1093\/fampra\/cmn071","article-title":"Diagnostic difficulty and error in primary care\u2014a systematic review","volume":"25","author":"Kostopoulou","year":"2008","journal-title":"Fam Pract"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1111\/hex.13160","article-title":"Mapping the experiences of people with achalasia from initial symptoms to long-term management","volume":"24","author":"Kalantari","year":"2021","journal-title":"Health Expect"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2469","DOI":"10.1001\/jama.288.19.2469","article-title":"Patient self-management of chronic disease in primary care","volume":"288","author":"Bodenheimer","year":"2002","journal-title":"JAMA"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions","volume":"46","author":"Michie","year":"2013","journal-title":"Ann Behav Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"Michie","year":"2011","journal-title":"Implement Sci"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2752\/175630615X14212498964312","article-title":"Experience-based co-design and healthcare improvement: realising participatory design in the public sector","volume":"18","author":"Donetto","year":"2015","journal-title":"Des J"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1111\/j.1365-2929.2005.02200.x","article-title":"Making sense of focus groups","volume":"39","author":"Barbour","year":"2005","journal-title":"Med Educ"},{"key":"ref12","volume-title":"\u201cFocus Groups,\u201d Social Research Update Issue 19","author":"Gibbs","year":"1997"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3961\/jpmph.22.451","article-title":"Qualitative research in healthcare: necessity and characteristics","volume":"56","author":"Pyo","year":"2023","journal-title":"J Prev Med Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"6","DOI":"10.35241\/emeraldopenres.14163.2","article-title":"Going virtual: adapting in-person interactive focus groups to the online environment [version 2; 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