Skip to main content

Table 2 Barriers to integrating and embedding the intervention

From: RESTORE: an exploratory trial of a web-based intervention to enhance self-management of cancer-related fatigue: findings from a qualitative process evaluation

Factor

Examples

Empirical evidence

The agent:

Intervention does not seem relevant

Participant did not consider their fatigue level sufficiently high to require intervention.

It wouldn’t have been that helpful because I wasn’t … it (fatigue) wasn’t that often. It wasn’t as though every day I had, it was a struggle, not like for some people … I wasn’t affected as bad as some people. (Robert)

The intervention did not offer anything novel or innovative. Information was not deemed useful.

I just thought it was an extension of the booklet, I didn’t see it in any other way. (Georgina)

Participant engaged as a research volunteer in a trial and was not looking for strategies to manage fatigue symptoms or significant personal benefit from involvement in the study.

I wouldn’t say that I was expecting to gain a lot of insights into how to deal with the fatigue, more a sense of somebody out there is needing people for this [study] and I’ll be helpful. (Emma)

Intervention requires skills that user does not have (or are limited)

Participant dislikes/distrusts IT/online nature of intervention/lacks confidence to use IT/internet.

I’ve just got basic skills because I’ve never really, I’m not somebody that really sits in front of the computer. I’ve never been one of them. (Iris)

The context:

Intervention is not easy to fit in to daily life

Using the intervention was too much to do at a time when participant is fatigued.

Sometimes I couldn’t be bothered … it was just making the effort to go on and do it. (Angela)

Accessing intervention requires additional ‘work’ or making adjustments to routine.

My home computer had broken … so I had to do it using the work computer and I’d only just gone back to work and I wasn’t working very many hours so I had to tag it on either, come in early and do it at the beginning of my working day or tag into the end of my working day. (Laura)

Participants found it difficult to accommodate or ‘fit in’ using the intervention on a day-to-day basis.

Int: One of the suggestions was to keep a fatigue diary, is this something that you did?

Res: No I didn’t on the basis I was too busy (Sylvia)

The object:

Intervention has unintended negative impact

Using the intervention is a reminder of cancer/being a cancer survivor.

And I think I might also feel, I’m concentrating, the more I concentrate on this, the more I would almost be looking for symptoms? And I suppose it’s also that sense of wanting to kind of move on from it as much as possible … it would be a daily reminder and I think that might be at because of where I am … it was five years ago that I had the diagnosis and I had the surgery. (Emma)

Interaction with the intervention makes participant question if they are really fatigued.

I tell you what was a little bit, made me feel a little bit funny … was that knowing that some people were a lot worse than me, I thought have I just been wimping here (laughs). (Angela)