Optimising stakeholder engagement during intervention planning and development using the Person-Based Approach: the example of an online FeNO-guided asthma management intervention in primary care.

This paper is a detailed methodological analysis of how the PBA approach was used as part of the DEFINE programme, in the planning and development of a behavioural intervention to support the use of Fractional Exhaled Nitric Oxide (FeNO) in informing asthma management in primary care asthma reviews. It offers detailed research insights into how using the PBA approach facilitates the development of methodologies for stakeholder engagement and intervention development research, in line with the recent MRC framework. Two stakeholder workshops were organised during the intervention planning and development phases. The patient stakeholders were diverse in age, gender, and asthma severity, while the clinical stakeholders were diverse in clinical role and level of experience using FeNO. The research team mapped how the stakeholders' feedback complemented the core research team-based activities during the two stages of intervention planning and development, and what the outcomes of such engagement were. The five PBA intervention development activities in which stakeholderswere involved were: (1) Understanding target behaviours; (2) Identifying how to promote engagement with target behaviours; (3) Ensuring anticipated mechanisms of action are taken into account in planning intervention components; (4) Developing intervention content; and (5) Identifying the best intervention content and implementation. Outcomes of involving stakeholder in the 5 intervention development activities were: in depth interpretation on the qualitative work,new barriers and facilitators to the target behaviour of adoption and use of FeNO test during asthma reviews, and optimisation of intervention materials through in-depth tailoring of the online training and patient leaflet.