French, Blandine
(2021)
Awareness of ADHD in primary care.
PhD thesis, University of Nottingham.
Abstract
Despite ADHD impacting around 5% of children in the UK, GPs are ill-equipped to deal with this disorder. Over half of children with ADHD will continue experiencing symptoms into adulthood, and untreated and undiagnosed ADHD can strongly impact individuals throughout their lifetime. It is therefore vital that individuals access treatment and diagnosis at an early stage. The diagnosis pathway for ADHD is very complex. Specialist services in secondary care are responsible for ADHD diagnosis, most often following a referral from the patient’s GP. Without such referral, access to diagnosis and, in turn, access to care is often impossible. GPs' accurate understanding and awareness of ADHD is therefore primordial. Studies investigating GPs’ awareness of ADHD have found that GPs are ill-equipped to deal with individuals with ADHD, demonstrating a lack of knowledge and training, the presence of stigmas and misconceptions and a lack of clarity about their role. These barriers impact GPs’ ability to recognise ADHD in their patients and therefore referring to specialist services for assessment and treatment.
To address some of these issues, these doctoral studies aim to raise GPs’ awareness and knowledge of ADHD through a targeted online training resource. In the first instance, this thesis sought to investigate the gaps and barriers in GPs’ understanding of ADHD. These findings facilitated the development of an online psycho-education programme tailored for GPs. The second aim was to evaluate the efficiency and usability of this programme.
This thesis included three phases using mixed-methodologies:
- A systematic review and qualitative interviews with GP trainees, GPs, patients and healthcare professionals were conducted to investigates barriers in GPs’ understanding of ADHD.
- These findings informed the development of a 45-minute online psycho-education programme. This programme was co-produced with GPs, and a usability study was conducted to assess the accessibility of the programme.
- A pilot Randomised Control Trial (RCT) and interviews were then conducted with GPs to assess the program's efficiency. A brief evaluation of long-term impacts and implementation was also conducted.
The development of an online intervention was informed by evidence from a literature review, and Chapter one provides an overview of GPs’ role and pathway to care in the UK. Through a systematic review, the first study explores the barriers and facilitators of GPs' understanding of ADHD. To further investigate the gaps in GPs’ understanding, the second study explores interviews with key stakeholders in the ADHD in primary care - patients, secondary care professionals, GP trainees and GPs. Findings from the first two studies were inputted into the development of the online resource for GPs. The usability of this co-produced resource was assessed through a usability and feasibility study. This led to the final and primary study, which explores an online psycho-education resource's efficiency through a pilot RCT. Preliminary findings on long-term implementation and impact of the research were also collated.
This thesis demonstrates the many gaps in primary care understanding of ADHD and evaluates the use of a psycho-educational programme in addressing these gaps. The contribution of the studies and the implication of the findings are discussed. Considerations over the development process, the impact on primary care and implications for future research are also presented.
GPs’ knowledge of ADHD was improved by developing an online psycho-education programme resulting in increased understanding of the pathways to care and reduced stigma. Lack of identification and recognition of ADHD in GPs can be remediated by GPs completing a short 45-minute online course, in turn improving patients’ access to care.
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