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Chronic Headache Education and Self-Management Study (CHESS): a process evaluation.

David R Ellard1,2, Vivien P Nichols3, Frances E Griffiths4

  • 1Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. d.r.ellard@warwick.ac.uk.

BMC Neurology
|January 7, 2023
PubMed
Summary

The Chronic Headache Education and Self-Management Study (CHESS) intervention did not show positive effects despite high fidelity. Further research is needed to understand how to effectively help individuals manage chronic headache disorders.

Keywords:
Behaviour change interventionChronic headacheFidelityMixed methodsProcess evaluation

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Area of Science:

  • Neurology
  • Public Health
  • Behavioral Science

Background:

  • The Chronic Headache Education and Self-Management Study (CHESS) was a multicentre randomised trial.
  • It evaluated a group education and self-management support intervention against usual care for chronic headache disorders.
  • This process evaluation aimed to understand the lack of positive effects from the CHESS intervention.

Purpose of the Study:

  • To explore potential explanations for the negative outcomes of the CHESS intervention.
  • To investigate the realization of causal assumptions underpinning the intervention.
  • To understand participant and staff experiences within the trial.

Main Methods:

  • A mixed-methods approach was used for the process evaluation.
  • Data collection included context, reach, recruitment, dose delivered/received, fidelity, and participant/staff experiences.
  • Qualitative data were analyzed to assess the intervention's causal assumptions.

Main Results:

  • The CHESS trial recruited a large, diverse, and representative sample.
  • Intervention delivery and fidelity were high, but attendance (dose received) was lower than expected.
  • While participants enjoyed the groups, there was limited evidence that the intervention's causal assumptions were met, with modest changes in headache management behaviors.

Conclusions:

  • Despite planned delivery, the reasons for the CHESS trial's negative outcome remain unclear.
  • A lack of evidence for planned behavior change and disparities in participant engagement may offer insights.
  • More research is needed to effectively support individuals with chronic headache disorders.