Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study

Feasibility of a behavioural health pilot... | HRB Open Research dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); const cookieDomain = window.location.hostname; const tld = buildTLD(); function buildTLD() { const domainParts = cookieDomain.split('.'); while (domainParts.length > 2) { domainParts.shift(); } return domainParts.join('.'); } function deleteCookie(cookieName) { if (!cookieName) { return; } const cookiePath = (cookieName.startsWith('retraction_warning_') || cookieName.startsWith('version_warning_')) ? '/articles/' + cookieName : '/'; // Yes, these three slightly different ways to try and remove cookies are necessary document.cookie = cookieName + '=; path=' + cookiePath + '; domain=' + cookieDomain + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; domain=.' + tld + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; document.cookie = cookieName + '=; path=' + cookiePath + '; expires=Thu, 01 Jan 1970 00:00:01 GMT;'; } function deleteGroupCookies(group) { if (!group) { return; } const domainData = OneTrust.GetDomainData(), cookies = domainData.Groups.filter(cookieGroup => cookieGroup.OptanonGroupId === group)[0].Cookies; cookies.forEach(cookie => deleteCookie(cookie.Name)); } function OptanonWrapper() { const cookieConsentGroups = []; for (group of OneTrust.GetDomainData().Groups) { cookieConsentGroups.push(group.OptanonGroupId); } OneTrust.OnConsentChanged(function(e) { const cookieConsentActiveGroups = OnetrustActiveGroups.split(',').filter(activeGroup => activeGroup); cookieConsentGroups.forEach(group => { if (!cookieConsentActiveGroups.includes(group)) { deleteGroupCookies(group); }; }); }); } window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://hrbopenresearch.org/js/vendor/ckeditor/' window.reactTheme = 'HRB'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); Skip to content HRB Open Research file_upload Submit your research search clear search menu close clear Search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Data Guidelines Prepublication Checks Production Process Article Processing Charges Finding Article Reviewers About How it Works For Reviewers National Steering Group Policies Glossary FAQs Contact Blog My Account Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://hrbopenresearch.org/articles/8-20" }, "headline": "Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular...", "datePublished": "2025-01-31T12:38:53", "dateModified": "2025-01-31T12:38:53", "author": [ { "@type": "Person", "name": "Emils Sietins" }, { "@type": "Person", "name": "Jiaran Gao" }, { "@type": "Person", "name": "Geoff McCombe" }, { "@type": "Person", "name": "John Broughan" }, { "@type": "Person", "name": "JT Treanor" }, { "@type": "Person", "name": "Janis Morissey" }, { "@type": "Person", "name": "Mary Casey" }, { "@type": "Person", "name": "Joe Gallagher" }, { "@type": "Person", "name": "Patricia Fitzpatrick" }, { "@type": "Person", "name": "Orla Doyle" }, { "@type": "Person", "name": "Timothy Frawley" }, { "@type": "Person", "name": "Gerald Mills" }, { "@type": "Person", "name": "Tim Collins" }, { "@type": "Person", "name": "Nandakumar Ravichandran" }, { "@type": "Person", "name": "Walter Cullen" } ], "publisher": { "@type": "Organization", "name": "HRB Open Research", "logo": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 566, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://hrbopenresearch.org/img/AMP/HRB_image.png", "height": 1200, "width": 127 }, "description": " Background Cardiovascular disease (CVD) is the leading cause of death worldwide and disproportionately affects individuals from low socioeconomic (LSE) areas. Self-management interventions in general practice targeted towards people from LSE areas may positively impact patients’ health. The High Risk Prevention Programme (HRPP), developed by the Ireland’s Health Service Executive (HSE), the Irish Heart Foundation and the University College Dublin School of Medicine is a behavioural self-management intervention promoting positive lifestyle changes for patients with high CVD risk. Six general practices from LSE areas in Ireland delivered the intervention. This study aimed to evaluate the acceptability and feasibility of the HRPP by employing qualitative methods to investigate the experiences of participating patients and healthcare staff. Methods Twenty-eight participants (18 patients and 10 healthcare staff) were interviewed. The intervention’s feasibility was assessed according to Braun and Clarke’s thematic analysis approach. Results Four key themes were identified among patients: (1) motivation to change health behaviours, (2) practical benefits for patients, (3) challenges experiences by patients, (4) lifestyle management and healthcare supports. Four themes were also identified among healthcare staff: (1) positive experience of the programme and its benefits, (2) logistical challenges, (3) patient engagement, (4) programme management. Conclusion The HRPP showed high levels of acceptability and feasibility. Future studies should assess this intervention’s likely effectiveness and consider scaling-up the intervention by including younger patients and by think of ways how to better manage the workload of healthcare staff responsible for delivering the intervention. The HRPP could be incorporated into the HSE’s nationwide ‘Chronic Disease Management Programme’. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://hrbopenresearch.org/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://hrbopenresearch.org/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://hrbopenresearch.org/articles/8-20/v1", "name": "Feasibility of a behavioural health pilot project in general practice..." } } ] } Home Browse Feasibility of a behavioural health pilot project in general practice... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Sietins E, Gao J, McCombe G et al. Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.12688/hrbopenres.14048.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] Emils Sietins 1 , Jiaran Gao 1 , Geoff McCombe https://orcid.org/0000-0003-4898-3459 1 , [...] John Broughan https://orcid.org/0000-0002-5084-8507 2 , JT Treanor 3 , Janis Morissey 3 , Mary Casey https://orcid.org/0000-0003-3305-0074 4 , Joe Gallagher 1 , Patricia Fitzpatrick https://orcid.org/0000-0003-2524-3677 5 , Orla Doyle 6 , Timothy Frawley 4 , Gerald Mills 7 , Tim Collins 3 , Nandakumar Ravichandran https://orcid.org/0009-0001-1199-6793 1 , Walter Cullen 1 Emils Sietins 1 , Jiaran Gao 1 , [...] Geoff McCombe https://orcid.org/0000-0003-4898-3459 1 , John Broughan https://orcid.org/0000-0002-5084-8507 2 , JT Treanor 3 , Janis Morissey 3 , Mary Casey https://orcid.org/0000-0003-3305-0074 4 , Joe Gallagher 1 , Patricia Fitzpatrick https://orcid.org/0000-0003-2524-3677 5 , Orla Doyle 6 , Timothy Frawley 4 , Gerald Mills 7 , Tim Collins 3 , Nandakumar Ravichandran https://orcid.org/0009-0001-1199-6793 1 , Walter Cullen 1 PUBLISHED 31 Jan 2025 Author details Author details 1 University College Dublin School of Medicine, Dublin, Leinster, Ireland 2 Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Leinster, Ireland 3 The Irish Heart Foundation, Dublin, Leinster, Ireland 4 University College Dublin School of Nursing Midwifery and Health Systems, Dublin, Leinster, Ireland 5 University College Dublin School of Public Health Physiotherapy and Sports Science, Dublin, Leinster, Ireland 6 University College Dublin School of Economics, Dublin, Leinster, Ireland 7 University College Dublin School of Geography, County Dublin, County Dublin, Ireland Emils Sietins Roles: Data Curation, Formal Analysis, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Jiaran Gao Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Geoff McCombe Roles: Data Curation, Formal Analysis, Methodology, Project Administration, Writing – Review & Editing John Broughan Roles: Investigation, Methodology, Project Administration, Writing – Review & Editing JT Treanor Roles: Investigation, Methodology, Project Administration, Writing – Review & Editing Janis Morissey Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing Mary Casey Roles: Writing – Review & Editing Joe Gallagher Roles: Writing – Review & Editing Patricia Fitzpatrick Roles: Writing – Review & Editing Orla Doyle Roles: Writing – Review & Editing Timothy Frawley Roles: Writing – Review & Editing Gerald Mills Roles: Writing – Review & Editing Tim Collins Roles: Conceptualization, Funding Acquisition, Project Administration, Resources, Supervision, Writing – Review & Editing Nandakumar Ravichandran Roles: Writing – Review & Editing Walter Cullen Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Cardiovascular disease (CVD) is the leading cause of death worldwide and disproportionately affects individuals from low socioeconomic (LSE) areas. Self-management interventions in general practice targeted towards people from LSE areas may positively impact patients’ health. The High Risk Prevention Programme (HRPP), developed by the Ireland’s Health Service Executive (HSE), the Irish Heart Foundation and the University College Dublin School of Medicine is a behavioural self-management intervention promoting positive lifestyle changes for patients with high CVD risk. Six general practices from LSE areas in Ireland delivered the intervention. This study aimed to evaluate the acceptability and feasibility of the HRPP by employing qualitative methods to investigate the experiences of participating patients and healthcare staff. Methods Twenty-eight participants (18 patients and 10 healthcare staff) were interviewed. The intervention’s feasibility was assessed according to Braun and Clarke’s thematic analysis approach. Results Four key themes were identified among patients: (1) motivation to change health behaviours, (2) practical benefits for patients, (3) challenges experiences by patients, (4) lifestyle management and healthcare supports. Four themes were also identified among healthcare staff: (1) positive experience of the programme and its benefits, (2) logistical challenges, (3) patient engagement, (4) programme management. Conclusion The HRPP showed high levels of acceptability and feasibility. Future studies should assess this intervention’s likely effectiveness and consider scaling-up the intervention by including younger patients and by think of ways how to better manage the workload of healthcare staff responsible for delivering the intervention. The HRPP could be incorporated into the HSE’s nationwide ‘Chronic Disease Management Programme’. READ ALL READ LESS Keywords Cardiovascular Diseases, Feasibility Studies, General Practice, Health Promotion, Primary Prevention, Qualitative Research, Vulnerable Populations Corresponding Author(s) John Broughan ( [email protected] ) Close Corresponding author: John Broughan Competing interests: No competing interests were disclosed. Grant information: This research received financial support from the Irish Heart Foundation. Copyright: © 2025 Sietins E et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Sietins E, Gao J, McCombe G et al. Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.12688/hrbopenres.14048.1 ) First published: 31 Jan 2025, 8 :20 ( https://doi.org/10.12688/hrbopenres.14048.1 ) Latest published: 31 Jan 2025, 8 :20 ( https://doi.org/10.12688/hrbopenres.14048.1 ) Introduction Cardiovascular disease (CVD) is a major contributor to reduced quality of life and is the leading cause of death, accounting for an estimated 32% of deaths worldwide (~17.9 million deaths annually) 1 , 2 . In Ireland, 28.6% (n= 8928) of deaths in 2019 were caused by diseases of the circulatory system 3 . According to the World Health Organization, prevention of noncommunicable diseases (NCDs) should be raised to priority status in the global, regional and national agenda and people-centred primary healthcare should be strengthened 4 . In addition to high blood pressure, diabetes and various lifestyle factors, low socioeconomic status (LSES) can also be associated with an increased risk of developing CVD 5 , 6 . People with LSES tend to receive poorer healthcare 7 and often have lower health literacy 8 which can lead to poorer health outcomes 9 . There is some evidence that self-management interventions could have a positive effects at managing chronic disease among people with LSES, however more studies focusing on reducing CVD risk are needed 10 . Additionally, there is a scarcity of behavioural health interventions that include people from LSES backgrounds when addressing CVD risk 11 . As NCDs (including CVDs) become a more pressing issue, Ireland’s Health Service Executive (HSE) has created a national framework for implementing behavioural change interventions in health services settings. Titled “Making Every Contact Count”, this framework encourages healthcare staff to support their patients in making healthier lifestyle and health behaviour choices 12 . This framework recognizes that most CVDs can be prevented by modifying health behaviours, including healthy diet, physical activity, and a reduction in alcohol and tobacco use 12 . The HSE also recognizes that to properly manage chronic health conditions, including CVD, patients need support from healthcare staff in the form of patient education and support for behaviour change 13 . As a result, in late 2020, a High-Risk Prevention Programme (HRPP) was developed by the Irish Heart Foundation (IHF) in association with the HSE and the University College Dublin (UCD) School of Medicine. The aim of the HRPP was to co-design and implement a self-management lifestyle behaviour change intervention for individuals at a high risk for developing CVD. The HRPP was piloted in six general practices in Ireland (four in Dublin and two in Wexford) which predominantly serve people from LSE areas. The aim of the study was to evaluate the acceptability and feasibility of the HRPP initiative by analysing the views and experiences of patients and healthcare staff who had taken part in the HRPP intervention. Methods Study setting This qualitative study was part of a larger mixed-methods study that evaluated the acceptability, feasibility, and likely effectiveness of the High Risk Prevention Programme (HRPP). A paper reporting the study’s quantitative findings has previously been published 14 . Study participants included patients and healthcare staff working at six aforementioned GP practices. These practices were selected based on geographical location and the size of the practice. Patients recruited to participate in the HRPP study were assigned to a General Practice Nurse (GPN) or Health Promotion Professional (HPP)-led one-to-one consultation programme that lasted for 6 weeks and focused on teaching patients how to self-manage their health behaviours. Summary of the HRPP intervention Patients were eligible to participate in the study if (1) they were 40 years old or older, (2) had a general medical services (GMS) or free doctor visit’s card 1 , (3) had a high risk of CVD (i.e., having hypertension, overweight/obese, physically inactive, Type 2 diabetes, high cholesterol, 10-year Q-Risk score greater than 20%) and (4) were not enrolled/had no access to an alternative lifestyle behaviour change programme. Eligible patients were contacted by the GP staff via phone inviting them to participate in the HRPP study. It was determined that 9–12 patients would be recruited at each practice. The intervention’s clinical impact was assessed by routine health tests measuring weight, height, waist circumference, blood glucose, total cholesterol, and interviews examining patients’ self-reported health behaviours, mental health, knowledge about one’s health, and motivation to live a healthier life. Patients filled out these assessments before undergoing the six-week programme (Time 1) and 12 months after completing the programme (Time 2) (see Figure 1 ) 15 . Figure 1. Timeline of HRPP intervention and it's assessments. Qualitative evaluation of the intervention The focus of this paper is to evaluate the acceptability and feasibility of the intervention by analysing qualitative interview data which was collected via semi-structured interviews with a sample of patients and healthcare staff (GPNs and General Practitioners (GPs) who took part in the intervention). The study’s method was guided by the Standards for Reporting Qualitative Research (SRQR) guidelines 16 . A purposive sampling technique was employed to recruit patients for the qualitative interviews. Selected patients who participated in the HRPP intervention were contacted by telephone, inquiring if they also wished to participate in the qualitative interviews. By employing purposive sampling of patients and healthcare staff, the aim was to focus on characteristics of a small sample of the population to answer the key research questions related to the acceptability and feasibility of the HRPP. We are not claiming that the sample that was interviewed in this study is representative of the overall population of patients who come from LSE areas and who are at risk for developing CVD; rather this sample was chosen solely to explore the lived experiences relating to the research questions under study. Recruitment and interviewing of patients and healthcare staff occurred on an ongoing basis, with patients being recruited and interviewed first (between 14 th April 2021 and 14 th January 2022), followed by healthcare staff (between 22 nd March 2022 and 14 th April 2022). Semi-structured telephone interviews were conducted with both patients and healthcare staff by two researchers with previous experience in qualitative analysis. Due to the COVID-19 pandemic telephone interviews with participants were deemed as a feasible alternative to in-person interviews. The use of Zoom/MS teams was not possible due to several patients reporting difficulties using technologies. All interviews were audio-recorded, transcribed verbatim by a transcription company and anonymised by removing identifiable information related to the patient and the healthcare staff. Interview questions were open-ended, assessing both patients’ and health care providers’ experiences of the intervention. The interview administered to patients included questions such as: “Did the programme help you manage your health issues?”, “Do you think there is a need for initiatives like this in your community? ”. The interview administered to healthcare staff included questions such as: “How was the programme run in your practice?”, “How do you think patients engaged with the programme?” (see Appendix 1). Researcher characteristics and reflexivity The first author (ES) was a Research Assistant at the UCD School of Medicine and their prior academic background is in Psychology. The study team also contained other research staff and students at the UCD School of Medicine, and staff from UCD Schools of (1) Public Health, Physiotherapy and Sport Sciences, (2) Nursing, Midwifery and Health Systems, (3) Economics, and (4) Geography. Other members of the study team represented the Irish Heart Foundation, a heart health and stoke charity, as well as healthcare professionals working in health services in Ireland. The study participants were GPs and patients attending general practices involved in the HRPP. Data analysis The interview transcripts were analysed by authors JG and GM and audited by senior author WC. NVivo v12 software was used to store the transcribed interviews, perform data analysis identifying quotes for the relevant feasibility themes, and develop the coding scheme by which data was categorized into their respective themes. All members of the research team maintained reflexivity throughout data analysis by having regular meetings in which identified themes were discussed and when necessary, revised to reflect the various components of the model. Acceptability and feasibility of the intervention were assessed using the inductive thematic analysis approach designed by Braun and Clark 19 . Inductive thematic analysis enabled us to use a data-driven/bottom-up approach in analysing the transcripts to find themes that arise from the interviews with study participants. An inductive approach (as opposed to a deductive approach) was chosen to allow emergence of potentially novel themes related to intervention’s acceptability and feasibility that were not previously thought of when designing the interview topics. Ethics and consent Ethical approval was granted by the UCD Human Research Ethics Committee on March 5th, 2021 (LS-20-19-Cullen), and the study is compliant with the Declaration of Helsinki. Written informed consent was obtained from the participants (patients and healthcare staff) who agreed to participate in the interview. Results Twenty-eight participants (18 patients and 10 healthcare staff) from all six GP practices participated in the in-depth semi-structured interviews. Patient interviews From the 18 patients who were interviewed, 7 were male and 11 were female. Patients on average were 57.31 years old (SD = 8.9). Using the thematic analysis approach, four themes were identified from the interviews with patients ( Figure 2 ). Figure 2. Themes identified on patient interviews (n=18). Theme 1: Motivation to change health behaviours Patients pointed out that by participating in the HRPP, their confidence and motivation to improve their health behaviours had increased. “I was just getting into the stride of it, getting my exercise in and all of that. I suppose I had confidence with the practice nurse supporting me every week, but I have managed to keep it going myself. As I said, I am very determined to get myself back on track.” — (Patient 15). Patients also emphasized that the changes in their health behaviours was influenced by the encouragement they received from the programme and the GPN/Health Promotion Professional (HPP). “I have to say, I found it brilliant. It was the kick-start that I needed. I knew I had to make the changes, but when I got on the programme and started talking to the practice nurse, it gave me the motivation to do what I needed to do.” — (Patient 15). Theme 2: Practical benefits for patients Patients thought that their lifestyle (e.g., diet and exercise) had changed after undergoing the intervention. “I did 17,000 steps just in the garden alone on Monday, Tuesday, and Wednesday, and that was hard work because I was wheelbarrowing and everything. I never took a spray; I never stopped. Before this, I would do five minutes in the garden, then have to take the inhaler, come in for a rest, and go out again. The last three days were hard work, but I felt normal.” — (Patient 13). They also pointed out that the programme had improved their knowledge about how to better manage their health issues (e.g., blood pressure, weight, cholesterol). They also thought it was beneficial that the intervention was carried out at their local GP practice. "I thought it was very educational. You see, it suited me perfectly because it’s just up the road from me. The information was brilliant, so I found it very good. I thought it was brilliant.” — (Patient 7). One patient even reported that a member of their family had improved their health behaviour due to the patient undergoing the intervention. "I’m trying to introduce that to my daughter, like using olive oil—we use olive oil now in the house, and she also uses it. She’s healthy, but now she’s also trying to cut down on a lot of things, so it’s really worked.” — (Patient 9). Patients expressed their satisfaction with the support they received from the GPN, since most of them did not have a similar support before partaking in the intervention. “The practice nurse was great and explained everything to me, including what I should be doing better with my lifestyle, because I was put on blood pressure tablets to regulate my blood pressure. I had no idea before going to the doctor that my blood pressure was high. She started explaining to me about my diet and told me that giving up smoking about five years ago was a good start. She recommended things for me to do and to eat, and I got Vitamin B capsules, which I find great.” — (Patient 1). Patients who had experience participating in similar intervention studies in the past felt that the previous projects had poor GP involvement, lacked in comprehensiveness and did not properly follow-up patients (as opposed to the HRPP intervention). “I have done various programs over time, but not like this with a GP. Not in this way.” — (Patient 17). Theme 3: Challenges experienced by patients Some patients stated various factors for why they were not able to benefit from the programme. “It was a bad time, the way things happened, with the young one having Covid, and we all had to isolate in the house. She showed me a few exercises to do at home while we were isolating, so that was good—just a few bits and pieces. As I say, I got very heavy, and I’m still very heavy now. I’m in awful pain with my legs and can’t walk because of arthritis. It’s not healthy—I need to lose a lot of weight because I have a young lad waiting for a kidney transplant, and I could be a possible donor for him. It’s just that it was a bad time for it to happen. I probably would have gotten more done and done better if things had been different.” — (Patient 14). Furthermore, one patient said they felt let down by the intervention. “So, I have to say, I was disappointed. I engaged in it and followed everything—all the guidelines—and I didn’t lose any weight. There were no noticeable changes in me. I was strict about it because I was ready to make a change, and I still am. So, that was just disappointing.” — (Patient 17). Theme 4: Lifestyle management and healthcare supports Most patients said that they were better able to manage their lifestyle due to the checking in and the support they received from the GPN/HPP. “I think that aspect of checking in and the support is really a good idea because making life changes like that requires that kind of support. So, I definitely think that’s a good thing to continue with” — (Patient 17). In terms of support from the healthcare staff, patients liked how the one-to-one aspect of the intervention helped them strengthen their relationship with their local GP practice. Patients also stated that while face-to-face consultations were preferable, telephone consultations were also an acceptable communication method. “Well, personally, I liked the one-to-one aspect of it and having everything explained to me on a one-to-one level—what to eat and what not to eat—and just building up that relationship with somebody to explain things to you personally.” — (Patient 2). Interviews with healthcare staff Healthcare staff consisted of four GPs, four GPNs, one Practice Manager and one Health Promotion Professional (HPP). Seven female and three male healthcare staff participated in the interviews. All the interviewed healthcare staff were delivering the PN-led intervention, except for the one HPP who was delivering the HPP-led intervention. On average, they were working 13.1 years (SD = 10.05) in their respective roles. Four themes were identified from the interviews with the healthcare staff ( Figure 3 ). Figure 3. Themes identified on healthcare staff interviews (n=10). Theme 1: Positive experience of the programme and its benefits Healthcare staff reported improvements in managing overall patient health in their practices when HRPP was introduced. Healthcare staff mentioned observing improvements in their patients’ lifestyles, diets and medication use through the programme’s education and follow-up activities. “I think the program overall has actually proved quite beneficial, not just for the patients but for us, as healthcare workers, trying to manage patients.” — (Healthcare staff 1 (GPN)). Healthcare staff also mentioned that the HRPP could leave a positive mark on the local community, in different geographic areas. “I think programs like this in communities can be extremely valuable. So, I think it’s very valuable across the community in all sorts of areas, to be honest.” — (Healthcare staff 9 (GPN)). For many healthcare staff it was the first time that they offered such an intervention to their patients. And those who had offered a similar programme before, said that the HRPP programme is unique due to it having a clear structure, having non-medical elements (e.g., diet, exercise aspects) and being rooted in the community. “I suppose the beauty of this project is that you were rooted in the community, and whenever you had the opportunity to meet the patients, you were meeting them in an environment they were used to—in their own GP clinic.” — (Healthcare staff 6 (HPP)). Theme 2: Logical challenges Recruitment difficulties due to the Covid pandemic were highlighted by the healthcare staff as one of the roadblocks for smoothly implementing the intervention. Additionally, several healthcare staff felt they did not have enough time to deliver the intervention. “It has been challenging at points, mainly because of Covid, and there are a few bottlenecks in the structure of the program, specifically around time constraints and the recruitment of patients.” — (Healthcare staff 6 (HPP)). According to the healthcare staff, in settings where the intervention was not delivered by the HPP, GPNs were the ones carrying out most of the intervention which posed a significant additional amount of work on their part, often making them feel overburdened. “I suppose there was a lot of pressure put on the practice nurse. She had to recruit patients, consent them, and then, I suppose, the admin part where she had to upload the consents and contact details before I could contact the patients. That seemed to put a lot of pressure on those practice nurses because it was additional work on top of their regular duties.” — (Healthcare staff 6 (HPP)). One of the GPNs said that they would not participate in the intervention again if they were offered to do so, due to the added workload. “If we were offered to do a similar program again in terms of research, we’d probably say no, because it took up so much time [….] As of this year, we’ve got more work than ever, and it was just one of those things that added to your workload—it took up time, involved a lot of filling in scores, uploading information, and calling people in [….]. Generally, I enjoyed it, but I probably wouldn’t sign up for it again, is the truth.” — (Healthcare staff 3 (GPN)). Theme 3: Patient engagement Most participants reported a high level of patient engagement with the programme which was enhanced through the interest and motivation generated by the GPN. “They engaged quite well. I do think that our nurse, who was the one doing it for us, did a lot of follow-ups. She kept the motivation going. I don’t know if they necessarily would have had that without her encouragement. Some probably would, others wouldn’t... I could tell she was keeping them motivated.” — (Healthcare staff 10 (GP)). However, it was noted that there were inconsistencies in participation over time. “Some really engaged well for the first six months, but then when you hit the three-month, six-month, and nine-month reviews, they’ve really fallen off, unless they are quite motivated.” — (Healthcare staff 1 (GPN)). Patient engagement in the programme was also dependent on personal characteristics such as their age, literacy, English-language proficiency and housing status, as reported by some healthcare staff members “Patients who lacked - their English was not their first language. And, on some occasions, sometimes a family member would come in with them, a daughter or a son and a lot of the education was done through the family who would have a little bit better English.... probably the most challenging group obviously was the homeless group where they don’t have options or the facilities. You know you really have to go through what is being provided for them in a certain setting and trying to get them to make a different choice. You know, have more vegetables and stuff like that but it is very difficult obviously for them” — (Healthcare staff 4 (GPN)). “I suppose by developing new ideas, they’re more aware that they can push past their own limitations, or what they perceive their limitations to be. One thing that struck me surprisingly was the level of illiteracy among patients. I think I have around 70 patients, and easily five or six of them couldn’t read at all, which just shocked me.” — (Healthcare staff 1 (GPN)). Additionally, some healthcare staff pointed out that, due to not meeting the study eligibility criteria, private patients and those without a medical or doctor visit card would not be able to access the programme. “There is a significant gap in Irish healthcare because paradoxically now if you don’t have a medical card you are excluded from the Chronic Disease Prevention Programme and from this and there isn’t another structure you can get involved in it” — (Healthcare staff 8 (GP)). Some healthcare staff pointed out that the programme should be expanded to include younger patients, which was in line with the aims of the programme from a prevention perspective “But I think that in a general way, if this was to be expanded, I think that to try to include as many younger patients as possible because I think that we are in a time now when you know obesity, cholesterol values, BPs, we are seeing all that in younger patients. So, I think there is room there for expansion in an age bracket but of course, that is all to do with resources and all the rest” — (Healthcare staff 9 (GPN)). Ideas on how to increase patient involvement in managing their health were offered by the healthcare staff. One solution proposed was to offer patients more flexible options for participating in the intervention, including choosing the best time for their appointment and weather to attend it in-person or over the phone. “To improve engagement, I think having the flexibility for patients to decide whether it’s face-to-face or virtual, and the timing of appointments, with an option for flexibility, would probably be the main things that come to mind.” — (Healthcare staff 2 (GP)). Theme 4: Programme management Most healthcare staff indicated that most of the programme’s management was done by GPNs. “I would say it was a semi-team effort, in that probably myself and our nurse, who was organising and doing most of the work for it, did really the bulk of it.” — (Healthcare staff 2 (GP)). Participants reported using a mix of strategies to engage with patients, which involved both virtual and face-to-face contact. “I think the majority would prefer face-to-face and maybe find that they engage better in that format rather than virtually. There were some patients who initially declined to take part because they weren’t keen on the virtual aspect of it at all.” — (Healthcare staff 2 (GP)). They also highlighted the importance of engaging patients in their healthcare and fostering communication between GP and patient during patient visits, which previously was overlooked and lacking. These were also key factors in enhancing patient health awareness and improving patient management. “It’s a really great avenue to capture them, engage with them, and have an open conversation about their health, then empower them with knowledge going forward.” — (Healthcare staff 6 (HPP)). Discussion Key findings Our study aimed to investigate the feasibility and acceptability of a novel behavioural health self-management pilot project entitled the High Risk Prevention Programme (HRPP) in general practice setting for patients who come from low socioeconomic (LSE) areas and are at a high risk for developing cardiovascular disease (CVD). Based on our findings, the pilot HRPP was feasible and acceptable with both patients rand healthcare staff reporting positive experiences of participating in the intervention. During the interview, 17 out of 18 patients reported positive self-perceived lifestyle changes, in terms of eating healthier, exercising more and even positively affecting the health behaviours of other family members. Besides collecting qualitative data from a selected number of participants, quantitative data was collected from all patients pre and post intervention to assess the likely effectiveness of the HRPP programme. Comparison with existing literature The HRPP fills a gap in the current literature, providing an intervention that addresses CVD-risk among participants from LSE areas. A key aspect of our intervention, highlighted during the interviews was the improved communication and strengthened relationship between the patient and healthcare staff. Furthermore, patients reported increased motivation to engage in positive health behaviours as a direct result of the encouragement and support received during the intervention. Past studies show that improved patient-provider relationship can increase patient satisfaction, engagement in their healthcare and yield better outcomes regarding managing chronic disease 20 , 21 . Several healthcare staff in our study pointed out that the intervention added additional workload to their practice, especially overburdening GPNs. Our findings are in line with the current literature that described lack of time and resources as one of the barriers for successful implementation of health interventions/research in a general practice setting 22 , 23 . If the HRPP is implemented at a larger scale, GPN workload must be acknowledged. Previous studies show that GP healthcare staff would be more willing to participate in research studies if their participation was monetarily incentivized 24 , 25 . GPNs could receive payment for their participation in carrying out the intervention and/or their participation in the HRPP could be incorporated into their daily work schedule. In this pilot project, the Health Promotion Professional (HPP) was involved in delivering the intervention in three GP practices. However, future upscaling of the intervention could incorporate additional HPPs in other GP practices to alleviate the work of GPNs. Methodological challenges To our knowledge, this study is one of the first to investigate the feasibility of a novel behavioural health self-management intervention targeting patients at a high risk for developing CVD who come from LSE areas. Self-management interventions delivered at GP practices offer a convenient setting for implementing targeted self-management interventions. Our study provides evidence of high perceived acceptability and feasibility. Several unique challenges were identified with the study population and with implementing the intervention. Patients for whom English was not their first language and/or who lacked literacy skills were hard to reach and often an additional family member had to be present during the intervention sessions to function as the interpreter between the healthcare staff and the patient. Homelessness posed additional challenges in delivering appropriate intervention content to patients. For example, some discussion points (e.g., eating more fruits or vegetables) cannot be easily accomplished by those with limited access to fresh and healthy food and cooking facilities. Additionally, those without a medical card were unable to participate in the intervention. Although medical cards in Ireland are issued to individuals who have low socioeconomic status, there are several people who, due to various reasons, are unable to obtain a medical card 26 . It is estimated that about 31% of individuals eligible for a medical card in Ireland do not have it 26 . Due to Covid-19 restrictions interviews had to be carried out by telephone. While research shows that telephone interviews tend to be shorter and lack depth compared to email or in-person interviews 27 , previous research highlights that there are no significant differences between telephone and face-to-face interviews 28 . Respondent bias might have occurred during the patient interviews because patients are attending their regular healthcare setting, and the intervention was carried out by the healthcare staff that provides regular healthcare to the patients. Their familiarity might have exacerbated respondent bias and thus affected the reliability of our findings. Implications for policy and practice Based on the recommendations received by study participants, the HRPP intervention could be implemented at a larger scale in additional Irish GP practices and future research should investigate the acceptability, feasibility and likely effectiveness of similar interventions targeting other chronic diseases and patients with different demographic characteristics. For example, during the interviews, healthcare staff expressed their wish to provide the intervention to younger patients to enhance the preventive aspect of the HRPP. Research shows that CVD risk is increasing in younger people, thus expansion of the intervention to those under the age of 50 is welcome 29 . In fact, a second iteration of the HRPP has recently commenced and on this basis, it includes patients from the age of 18 years. The findings from this study can also inform future policy and practice. Our study could pave the way for future research investigating the feasibility and likely effectiveness of similar self-management behavioural health programmes situated in GP practices. The self-management of chronic diseases has been championed by the HSE as a tool that should be implemented in a variety of healthcare fields, including GP practices when addressing CVD 30 . The second iteration of the HRPP previously mentioned has also capitalised on this by establishing itself within the new infrastructure and intersectoral work in place from the development of Community Healthcare Networks and Sláintecare Healthy Communities. In this version of the HRPP, Irish Heart Foundation-employed Health Promotion Workers based within Community Specialist Teams link with GPs in local catchment areas to recruit patients that are suitable for the HRPP via GP referral systems. Future interventions could also target other chronic diseases included in the HSE’s ‘Chronic Disease Management Programme’ such as Type 2 diabetes, asthma and chronic obstructive pulmonary disease. Conclusion The behavioural health High Risk Prevention Programme implemented in six GP practices in Ireland, targeting patients from low socioeconomic areas, with a high risk for cardiovascular disease, indicated high feasibility and acceptability among patients and healthcare staff. Data availability Underlying data The transcripts for this study cannot be shared under any circumstance with persons not named on approved ethical review documentation (including being shared publicly in a data repository). While deidentified to the greatest possible extent, the study transcripts contain details (e.g., accounts of unique characteristics and experiences) that would have a high risk of breaching the participants’ privacy and confidentiality. Anonymous and aggregated details regarding the numbers of participants that took part in the study and their basic characteristics will be publicly shared as these details do not compromise privacy and confidentiality and were agreed to by participants that signed study consent forms. Extended data Zenodo: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study. https://doi.org/10.5281/zenodo.14364057 31 . This project contains the following extended data: - Appendix 1 - SRQR checklist Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgments We would like to acknowledge support from University College Dublin’s School of Medicine and College of Health and Agricultural Sciences, the Health Services Executive, Ireland East Hospital Group, and the Health Research Board for supporting this project. Footnotes 1 General Medical Services (GMS) or free doctor’s visit card can be obtained by persons who live in the Republic of Ireland and who have a low income. Possession of these cards allow patients to access free healthcare from certain healthcare providers who have entered into a contract with the Ireland’s Health Service Executive 17 Citizens Information. GP services to medical card holders [updated 16 February 2020; cited 2023 June 6]. Available from: https://www.citizensinformation.ie/en/health/health-services/gp-and-hospital-services/gp-services-to-medical-card-holders/#:~:text=General%20Practitioners%20(GPs)%20provide%20services,(HSE)%20to%20provide%20services 18 , Irish Government Economic and Evaluation Services. General Medical Services Scheme. Dublin: Irish Government Economic and Evaluation Services; 2016. Faculty Opinions recommended References 1. World Health Organization: Cardiovascular Disease. [cited 2023 14 February]. Reference Source 2. GBD 2017 DALYs and HALE Collaborators: Global, regional, and national Disability-Adjusted Life-Years (DALYs) for 359 diseases and injuries and Healthy Life Expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392 (10159): 1859–1922. PubMed Abstract | Publisher Full Text | Free Full Text 3. Central Statistics Office: Vital Statistics Annual Report 2019. Deaths 2019, 2019. Reference Source 4. World Health Organization: Global action plan for the prevention and control of noncommunicable diseases 2013-2020. Geneva, Switzerland, 2013. Reference Source 5. Center for Disease Control and Prevention: Know your risk of heart disease 2019. [cited 2023 24 February]. Reference Source 6. Schultz WM, Kelli HM, Lisko JC, et al. : Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation. 2018; 137 (20): 2166–2178. PubMed Abstract | Publisher Full Text | Free Full Text 7. Robbins JM, Webb DA: Hospital admission rates for a racially diverse low-income cohort of patients with diabetes: the Urban Diabetes Study. Am J Public Health. 2006; 96 (7): 1260–1264. PubMed Abstract | Publisher Full Text | Free Full Text 8. O’Connor T: Health literacy in Ireland: benchmarking the present State of the Art and examining future challenges and opportunities. National Adult Literacy Agency, 2012. Reference Source 9. DeWalt DA, Berkman ND, Sheridan S, et al. : Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 2004; 19 (12): 1228–1239. PubMed Abstract | Publisher Full Text | Free Full Text 10. Van Hecke A, Heinen M, Fernández-Ortega P, et al. : Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status. J Adv Nurs. 2017; 73 (4): 775–793. PubMed Abstract | Publisher Full Text 11. Siabani S, Leeder SR, Davidson PM: Barriers and facilitators to self-care in Chronic Heart Failure: a meta-synthesis of qualitative studies. Springerplus. 2013; 2 (1): 320. PubMed Abstract | Publisher Full Text | Free Full Text 12. Health Service Executive: Making every contact count: a Health Behaviour Change Framework and Implementation Plan for Health Professionals in the Irish Health Service. Health Service Executive, 2016. Reference Source 13. Health Service Executive: Resources for people living with a Long-term Health Condition. [cited 2023 24 February]. Reference Source 14. Broughan J, Sietiņš E, Treanor JT, et al. : Preventing Cardiovascular Disease in at-risk patients: results of a pilot behavioural health programme in general practice. Eur J Gen Pract. 2024; 30 (1): 2413106. PubMed Abstract | Publisher Full Text | Free Full Text 15. Broughan J, Sietins E, Treanor J editors., et al. : Effectiveness of a general practice-based behaviour change program for patients at risk for Cardiovascular Disease: preliminary findings. 2023 AUDGPI ICGP Joint ASM; Galway, Ireland: AUDGPI, 2023. 16. O’Brien BC, Harris IB, Beckman TJ, et al. : Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014; 89 (9): 1245–1251. PubMed Abstract | Publisher Full Text 17. Citizens Information: GP services to medical card holders. [updated 16 February 2020; cited 2023 June 6]. Reference Source 18. Irish Government Economic and Evaluation Services: General Medical Services Scheme. Dublin: Irish Government Economic and Evaluation Services, 2016. 19. Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol. 2006; 3 (2): 77–101. Publisher Full Text 20. Kaplan SH, Greenfield S, Ware JE Jr: Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989; 27 (3 Suppl): S110–S127. PubMed Abstract | Publisher Full Text 21. Kaplan SH, Greenfield S, Gandek B, et al. : Characteristics of physicians with participatory decision-making styles. Ann Intern Med. 1996; 124 (5): 497–504. PubMed Abstract | Publisher Full Text 22. Mc Hugh S, O’Keeffe J, Fitzpatrick A, et al. : Diabetes care in Ireland: a survey of General Practitioners. Prim Care Diabetes. 2009; 3 (4): 225–231. PubMed Abstract | Publisher Full Text 23. Orleans CT, George LK, Houpt JL, et al. : Health promotion in primary care: a survey of U.S. family practitioners. Prev Med. 1985; 14 (5): 636–647. PubMed Abstract | Publisher Full Text 24. Salmon P, Peters S, Rogers A, et al. : Peering through the barriers in GPs' explanations for declining to participate in research: the role of professional autonomy and the economy of time. Fam Pract. 2007; 24 (3): 269–75. PubMed Abstract | Publisher Full Text 25. Pearl A, Wright S, Gamble G, et al. : Randomised trials in general practice--a New Zealand experience in recruitment. N Z Med J. 2003; 116 (1186): U681. PubMed Abstract 26. Keane C, Regan M, Walsh B: Failure to take-up public healthcare entitlements: evidence from the Medical Card system in Ireland. Soc Sci Med. 2021; 281 : 114069. PubMed Abstract | Publisher Full Text 27. McCoyd JLM, Kerson TS: Conducting intensive interviews using email: a serendipitous comparative opportunity. Qual Soc Work. 2006; 5 (3): 389–406. Publisher Full Text 28. Sturges JE, Hanrahan KJ: Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res. 2004; 4 (1): 107–118. Publisher Full Text 29. Andersson C, Vasan RS: Epidemiology of Cardiovascular Disease in young individuals. Nat Rev Cardiol. 2018; 15 (4): 230–240. PubMed Abstract | Publisher Full Text 30. Health Service Executive: Self-management support for long-term health conditions. [cited 2023 24 February]. Reference Source 31. Zenodo: Feasibility of a behavioural health pilot project in general practice for patients with high Cardiovascular Disease risk: a qualitative study. Extended Data. http://www.doi.org/10.5281/zenodo.14364058 Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Jan 2025 ADD YOUR COMMENT Comment Author details Author details 1 University College Dublin School of Medicine, Dublin, Leinster, Ireland 2 Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Leinster, Ireland 3 The Irish Heart Foundation, Dublin, Leinster, Ireland 4 University College Dublin School of Nursing Midwifery and Health Systems, Dublin, Leinster, Ireland 5 University College Dublin School of Public Health Physiotherapy and Sports Science, Dublin, Leinster, Ireland 6 University College Dublin School of Economics, Dublin, Leinster, Ireland 7 University College Dublin School of Geography, County Dublin, County Dublin, Ireland Emils Sietins Roles: Data Curation, Formal Analysis, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing Jiaran Gao Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Geoff McCombe Roles: Data Curation, Formal Analysis, Methodology, Project Administration, Writing – Review & Editing John Broughan Roles: Investigation, Methodology, Project Administration, Writing – Review & Editing JT Treanor Roles: Investigation, Methodology, Project Administration, Writing – Review & Editing Janis Morissey Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing Mary Casey Roles: Writing – Review & Editing Joe Gallagher Roles: Writing – Review & Editing Patricia Fitzpatrick Roles: Writing – Review & Editing Orla Doyle Roles: Writing – Review & Editing Timothy Frawley Roles: Writing – Review & Editing Gerald Mills Roles: Writing – Review & Editing Tim Collins Roles: Conceptualization, Funding Acquisition, Project Administration, Resources, Supervision, Writing – Review & Editing Nandakumar Ravichandran Roles: Writing – Review & Editing Walter Cullen Roles: Conceptualization, Funding Acquisition, Methodology, Project Administration, Resources, Supervision, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research received financial support from the Irish Heart Foundation. Article Versions (1) version 1 Published: 31 Jan 2025, 8:20 https://doi.org/10.12688/hrbopenres.14048.1 Copyright © 2025 Sietins E et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Sietins E, Gao J, McCombe G et al. Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.12688/hrbopenres.14048.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 31 Jan 2025 Views 0 Cite How to cite this report: Oborevwori E. Reviewer Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r48733 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-48733 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Sep 2025 Elohor Oborevwori , Johns Hopkins Bloomberg School of Public Health, Baltimore, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15425.r48733 This qualitative study examines the acceptability and feasibility of the High Risk Prevention Programme (HRPP) for cardiovascular disease prevention in Irish general practices serving low socioeconomic populations. While the research addresses an important clinical question using appropriate qualitative methodology, several ... Continue reading READ ALL This qualitative study examines the acceptability and feasibility of the High Risk Prevention Programme (HRPP) for cardiovascular disease prevention in Irish general practices serving low socioeconomic populations. While the research addresses an important clinical question using appropriate qualitative methodology, several critical methodological limitations compromise scientific rigor. Critical Issues (Must Address): 1. Patients interviewed about their own healthcare providers' intervention face inherent pressure for socially desirable responses. This fundamental threat to validity is acknowledged but not adequately addressed. Authors must explicitly discuss this as a major limitation and interpret findings with appropriate caution. 2. The HRPP intervention lacks sufficient detail for replication. Missing elements include session content, theoretical framework, staff training protocols, and standardization procedures across practices. This severely limits the study's scientific contribution. 3. The analytical process lacks detail for scientific scrutiny. Missing information includes coding procedures, inter-rater reliability methods, data saturation assessment, and theme validation beyond "auditing by senior author." Major Concerns (Substantial Revision Required): 4. Exclusive reliance on telephone interviews is inadequately justified. Authors dismiss documented limitations without implementing mitigation strategies or discussing impacts on data depth. 5. Purposive sampling lacks transparency regarding selection criteria, response rates, and potential selection bias implications. 6. Introduction fails to adequately position work within existing evidence on self-management interventions for CVD in similar populations. Moderate Issues: 7. Current limitations section inadequately addresses methodological constraints, pandemic context effects, and generalizability concerns. 8. Conclusions exceed evidence given methodological limitations. Claims about acceptability and feasibility require tempering given significant implementation challenges identified. Technical Improvements: Several qualitative reporting standards are missing including interview duration data, transcript validation procedures, and enhanced reflexivity statements. Assessment: The study employs fundamentally sound qualitative methods for an important research question, but critical methodological flaws—particularly respondent bias and analytical opacity—prevent it from meeting scientific publication standards. Substantial improvements in methodological transparency, bias acknowledgment, and analytical rigor are essential for scientific soundness. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Oborevwori E. Reviewer Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r48733 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-48733 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Foley T. Reviewer Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r45583 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-45583 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 25 Feb 2025 Tony Foley , Department of General Practice, University College Cork, Cork, Ireland Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15425.r45583 Many thanks for the opportunity to review this interesting paper, focusing on the acceptability and feasibility of a behavioural self-management intervention for patients with high cardiovascular risk. This paper is well-written, conventionally structured and easy to follow. ... Continue reading READ ALL Many thanks for the opportunity to review this interesting paper, focusing on the acceptability and feasibility of a behavioural self-management intervention for patients with high cardiovascular risk. This paper is well-written, conventionally structured and easy to follow. A few suggestions might be considered by the study authors. 1. Introduction section - consider a brief review of the literature around self-management interventions, flagging what has been effective and what has not been proven to be effective. 2. Introduction section - I think a brief explanation of the activities/schedule within the HRPP would help the reader here. 3. Methods section - how were the interview questions developed? Was any type of framework employed to guide the development of the guide? 4. Results section - for both groups of interviewees, what was the duration on interviews? 5. Results section - Was COREQ used to report the findings? 6. Results section - was there overlap/triangulation of findings from the two subgroups? 7. Results section - I note a general agreement between interviewees on the various themes. Were there any divergent views? 8. Discussion section - typo line 4 - ...'rand'... 9. Discussion section - in the Intro here, consider the statement that '...pilot HRPP was feasible and acceptable with both patients rand healthcare staff reporting positive experiences of participating in the intervention.'...you have reported that there were challenges too. Does this statement require qualification? What about the additional workload and need for remuneration? 10. Methodological challenges - I think the statement '...no significant differences between telephone and face-to-face interviews' require clarification. There is a significant body of research on this. What was done to mitigate any negative effects? 11. Methodological challenges- what was done to mitigate respondent bias? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: General Practice, Qualitative Research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Foley T. Reviewer Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r45583 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-45583 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 31 Jan 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 31 Jan 25 read read Tony Foley , University College Cork, Cork, Ireland Elohor Oborevwori , Johns Hopkins Bloomberg School of Public Health, Baltimore, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Oborevwori E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2025 | for Version 1 Elohor Oborevwori , Johns Hopkins Bloomberg School of Public Health, Baltimore, USA 0 Views copyright © 2025 Oborevwori E. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This qualitative study examines the acceptability and feasibility of the High Risk Prevention Programme (HRPP) for cardiovascular disease prevention in Irish general practices serving low socioeconomic populations. While the research addresses an important clinical question using appropriate qualitative methodology, several critical methodological limitations compromise scientific rigor. Critical Issues (Must Address): 1. Patients interviewed about their own healthcare providers' intervention face inherent pressure for socially desirable responses. This fundamental threat to validity is acknowledged but not adequately addressed. Authors must explicitly discuss this as a major limitation and interpret findings with appropriate caution. 2. The HRPP intervention lacks sufficient detail for replication. Missing elements include session content, theoretical framework, staff training protocols, and standardization procedures across practices. This severely limits the study's scientific contribution. 3. The analytical process lacks detail for scientific scrutiny. Missing information includes coding procedures, inter-rater reliability methods, data saturation assessment, and theme validation beyond "auditing by senior author." Major Concerns (Substantial Revision Required): 4. Exclusive reliance on telephone interviews is inadequately justified. Authors dismiss documented limitations without implementing mitigation strategies or discussing impacts on data depth. 5. Purposive sampling lacks transparency regarding selection criteria, response rates, and potential selection bias implications. 6. Introduction fails to adequately position work within existing evidence on self-management interventions for CVD in similar populations. Moderate Issues: 7. Current limitations section inadequately addresses methodological constraints, pandemic context effects, and generalizability concerns. 8. Conclusions exceed evidence given methodological limitations. Claims about acceptability and feasibility require tempering given significant implementation challenges identified. Technical Improvements: Several qualitative reporting standards are missing including interview duration data, transcript validation procedures, and enhanced reflexivity statements. Assessment: The study employs fundamentally sound qualitative methods for an important research question, but critical methodological flaws—particularly respondent bias and analytical opacity—prevent it from meeting scientific publication standards. Substantial improvements in methodological transparency, bias acknowledgment, and analytical rigor are essential for scientific soundness. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Oborevwori E. Peer Review Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r48733) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-48733 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Foley T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 25 Feb 2025 | for Version 1 Tony Foley , Department of General Practice, University College Cork, Cork, Ireland 0 Views copyright © 2025 Foley T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Many thanks for the opportunity to review this interesting paper, focusing on the acceptability and feasibility of a behavioural self-management intervention for patients with high cardiovascular risk. This paper is well-written, conventionally structured and easy to follow. A few suggestions might be considered by the study authors. 1. Introduction section - consider a brief review of the literature around self-management interventions, flagging what has been effective and what has not been proven to be effective. 2. Introduction section - I think a brief explanation of the activities/schedule within the HRPP would help the reader here. 3. Methods section - how were the interview questions developed? Was any type of framework employed to guide the development of the guide? 4. Results section - for both groups of interviewees, what was the duration on interviews? 5. Results section - Was COREQ used to report the findings? 6. Results section - was there overlap/triangulation of findings from the two subgroups? 7. Results section - I note a general agreement between interviewees on the various themes. Were there any divergent views? 8. Discussion section - typo line 4 - ...'rand'... 9. Discussion section - in the Intro here, consider the statement that '...pilot HRPP was feasible and acceptable with both patients rand healthcare staff reporting positive experiences of participating in the intervention.'...you have reported that there were challenges too. Does this statement require qualification? What about the additional workload and need for remuneration? 10. Methodological challenges - I think the statement '...no significant differences between telephone and face-to-face interviews' require clarification. There is a significant body of research on this. What was done to mitigate any negative effects? 11. Methodological challenges- what was done to mitigate respondent bias? Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise General Practice, Qualitative Research I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Foley T. Peer Review Report For: Feasibility of a behavioural health pilot project in general practice for patients with high cardiovascular disease risk: A qualitative study [version 1; peer review: 2 approved with reservations] . HRB Open Res 2025, 8 :20 ( https://doi.org/10.21956/hrbopenres.15425.r45583) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-20/v1#referee-response-45583 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with HRB Open Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Feasibility of a behavioural health pilot...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://hrbopenresearch.org/articles/8-20/v1" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://hrbopenresearch.org/articles/8-20/v1&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://hrbopenresearch.org/articles/8-20/v1" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Sietins E et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://hrbopenresearch.org/articles/8-20/v1/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://hrbopenresearch.org/articles/8-20", templates : { twitter : "Feasibility of a behavioural health pilot project in general.... Sietins E et al., published by " + "@HRBOpenRes" + ", https://hrbopenresearch.org/articles/8-20/v1" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/14048/15425") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "15425"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "46345": 0, "45578": 0, "46346": 0, "45579": 0, "46347": 0, "45580": 0, "48268": 0, "46348": 0, "45581": 0, "48269": 0, "46349": 0, "45582": 0, "48270": 0, "46350": 0, "48271": 0, "45583": 12, "46351": 0, "45584": 0, "48272": 0, "46352": 0, "45585": 0, "48273": 0, "46353": 0, "45586": 0, "48274": 0, "46354": 0, "45587": 0, "48275": 0, "48276": 0, "46229": 0, "48277": 0, "46230": 0, "46231": 0, "46232": 0, "46233": 0, "46234": 0, "46235": 0, "46236": 0, "46237": 0, "46238": 0, "48948": 0, "48949": 0, "48950": 0, "48951": 0, "48952": 0, "48953": 0, "49210": 0, "48954": 0, "49211": 0, "48955": 0, "49212": 0, "48956": 0, "49213": 0, "48957": 0, "49214": 0, "45758": 0, "49215": 0, "45759": 0, "49216": 0, "45760": 0, "49217": 0, "45761": 0, "49218": 0, "45762": 0, "49219": 0, "45763": 0, "45764": 0, "45765": 0, "45766": 0, "45767": 0, "48733": 6, "46069": 0, "46070": 0, "46071": 0, "46072": 0, "46073": 0, "46074": 0, "46075": 0, "46076": 0, "46077": 0, "46078": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "c0ae386d-444a-4974-9864-c84a2a27da56"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); Are you a HRB-funded researcher? Submission to HRB Open Research is open to all HRB grantholders or people working on a HRB-funded/co-funded grant on or since 1 January 2017. Sign up for information about developments, publishing and publications from HRB Open Research. First Name * You must provide your first name Last Name * You must provide your last name Email * You must provide a valid email address Institution You must provide an institution. Submit Thank you! We'll keep you updated on any major new updates to HRB Open Research HRB Open Research Browse How to Publish About Contact RSS Cookie Notice Privacy Notice Legal Submit Your Research © F1000 Research Limited and its licensors ISSN 2515-4826 | Legal background var F1000platform = new F1000.Platform({ name: "hrb", displayName: "HRB Open Research", hostName: "hrbopenresearch.org", id: "5", editorialEmail: "[email protected]", infoEmail: "[email protected]" }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); }); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a024eaa4fa250db4',t:'MTc3OTg4MzgyOA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();