Improving communication between older people and primary care staff: development of a behaviour change intervention

Student thesis: Phd


Background: Older people, aged 65+, with multiple long-term conditions (MLTC) can experience breakdowns in communication with primary care staff. These breakdowns can threaten their physical and psychological safety. Efforts to improve communication have traditionally focused on changing the behaviour of staff but patient involvement in healthcare interactions is also important. Thus, the aim of this project was to develop a behaviour change intervention to empower older people with MLTC, improve their communication with primary care staff and reduce risks to their patient safety. Methods: An evidence-, theory- and person-based approach was used to plan, design and develop the intervention. Research, comprising a systematic review of the existing qualitative literature (12 studies) and an in-depth interview study (28 patient participants), was conducted to better understand communication between patients and staff, including the barriers to and enablers of communication and what might need to change for this to improve. A series of intervention design workshops were held with stakeholders (patients, carers, staff and other experts) to determine what the intervention should focus on and how objectives could be achieved. Drawing on these discussions and behaviour change theory, a novel intervention was drafted. This was then revised through a cognitive interview study (15 patient participants), which involved four rounds of data collection, analysis and intervention modification. Results: A wide range of barriers to and enablers of healthcare communication were identified for older people with MLTC, including barriers that may not be possible to change through a patient-focused intervention. Prioritised topics concerned patients': 1) knowledge about staff and services and what is important to communicate, 2) skills to prepare for an interaction, convey information and express concerns, and 3) confidence to speak up and ask questions. These were addressed within a booklet for patients, and supported by a guide to the intervention for staff. The content, layout and style of the booklet were optimised based on feedback from potential users. Conclusions: This project has brought together and expanded the evidence-base regarding barriers to and enablers of healthcare communication for older people with MLTC. It has identified ways to change communication behaviour that are acceptable to both patients and staff, and are considered useful and useable. The intervention will undergo further development and be evaluated to determine whether it empowers patients, improves communication and reduces risks to patient safety.
Date of Award1 Aug 2022
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorPeter Bower (Supervisor), Sarah Peters (Supervisor) & Thomas Blakeman (Supervisor)


  • Aged
  • Meta-ethnography
  • Systematic review
  • Older people
  • Aged 80 and over
  • General practice
  • Patient safety
  • Patient involvement
  • Professional-patient relations
  • Primary health care
  • Multimorbidity
  • Health communication
  • Qualitative research

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