Abstract

Background and Aim
Supported self-management equips people with asthma with the tools and education to manage their condition, but implementation in Primary Care remains low. The IMP²ART (IMPlementing IMProved Asthma self-management as RouTine) trial aimed to deliver whole-system change across patient, professional, and organisational levels. The introductory workshop was the facilitator’s first – and sometimes only - contact with the practice team and helped anchor the intervention within the surgery. Designed pre-pandemic for in-person delivery, workshops were adapted for online delivery. This PhD research uses video-based analysis to examine staff busyness and resistance in online facilitation and how facilitators respond.
Methods
Descriptive data from all 65 workshops were collected. Eight workshops were purposively sampled across facilitators and time points across the trial, and analysed inductively using video-based multimodal analysis, attending to verbal and non-verbal conduct, participation and facilitator strategies.
Results
Almost three-quarters of workshops (n=47) were scheduled during the lunch break. Time pressure was acknowledged and sometimes utilised as a camaraderie building strategy (e.g. the clinically-experienced facilitators empathised with QOF-related pressures). Participant visibility was constrained as participants attended from shared team rooms or without webcams; in one workshop with 33 attendees only 2 were visible. In some workshops some participants appeared to be disengaged, e.g. with unrelated documents that were being worked on visible in the glasses of one participant, whilst in other cases what appeared to be a distraction proved to be participants optimising their surroundings to engage better with the workshop. Where present, resistance tended to be covert and expressed through humour. Facilitators re-engaged participants by addressing them by name or inviting input from specific job roles. Facilitators drew out contributions verbally or via ‘chat’ and adapted their communication style to each practice team.
Conclusions
Our findings suggest that online delivery reveals more general facilitation workshops challenges, both concealing and sometimes revealing disengagement. Busyness was both an obstacle and a connecting device, with facilitators deploying significant real-time skill. More broadly, the findings raise questions about how such support is scheduled for an already pressured workforce.