Exploring mechanisms of behavior change for healthcare professionals in cough and secretion management in ALS

To explore healthcare professionals’ experiences managing cough and secretion problems in Amyotrophic Lateral Sclerosis (ALS). A qualitative study was completed with 23 individuals participating in four focus groups. Data was analyzed using reflexive thematic analysis and COM-B and theoretical domains framework (TDF) behavior change frameworks. This study found that roles, responsibilities, and expectations needed to be clearly defined and that building relationships was important to support care delivery. Barriers identified included limited access to specialist care, equipment, and opportunities to gain knowledge and skills. A structured clinical assessment was highlighted to enable good-quality care. Data mapped most commonly to the environmental context/resources, knowledge, skills (TDF), and physical capability (COM-B) behavior change domains. Cough and secretion management in ALS is complex due to the multifaceted nature of the disease. This study emphasizes the need for future development of clinical interventions to support care. People living with Amyotrophic Lateral Sclerosis (ALS) frequently have issues with breathing, swallowing, drooling, and cough weakness. There is limited existing knowledge to tell healthcare professionals how to manage these problems and to date there is no research looking at healthcare professionals’ experiences managing these. This study aimed to understand how healthcare professionals in the UK manage cough and secretion problems in people with ALS, what challenges they face and how care can be improved. Four focus groups were completed with 23 healthcare staff. The study found that the roles and responsibilities of healthcare staff needed to be clearly defined and that building relationships was important to support care. Several barriers were identified such as limited access to specialist care, equipment, and opportunities to gain knowledge and skills. Understanding the key problems was noted to be key to providing the right cough and secretion management for people with ALS. We concluded that managing these issues in ALS is complicated as the disease is variable. To provide the best care to people living with ALS we need to develop new tools to support healthcare staff to make decisions around treatment.