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Cunningham BJ, Rosenbaum P, Hidecker MJC. Promoting consistent use of the communication function classification system (CFCS). Disabil Rehabil 2015; 38:195-204. [DOI: 10.3109/09638288.2015.1027009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Barbara Jane Cunningham
- CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada and
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, Institute for Applied Health Sciences, McMaster University, Hamilton, Ontario, Canada and
| | - Mary Jo Cooley Hidecker
- Division of Communication Disorders, Health Science Center, University of Wyoming, Laramie, WY, USA
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752
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Backman R, Foy R, Michael BD, Defres S, Kneen R, Solomon T. The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis. Implement Sci 2015; 10:37. [PMID: 25889994 PMCID: PMC4373454 DOI: 10.1186/s13012-015-0224-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/20/2015] [Indexed: 11/28/2022] Open
Abstract
Background Central nervous system infections can have devastating clinical outcomes if not diagnosed and treated promptly. There is a documented gap between recommended and actual practice and a limited understanding of its causes. We identified and explored the reasons for this gap, focusing on points in the patient pathway most amenable to change and the development of a tailored intervention strategy to improve diagnosis and treatment. Methods Using theoretically-informed semi-structured interviews, we explored barriers and enablers to diagnosing and managing patients with suspected encephalitis, specifically performing lumbar punctures and initiating antiviral therapy within 6 h. We purposively sampled hospitals and hospital staff in the UK. We audio recorded and transcribed all interviews prior to a framework analysis. We mapped identified barriers and enablers to the patient pathway. We matched behaviour change techniques targeting clinicians to the most salient barriers and enablers and embedded them within an intervention package. Results We interviewed 43 staff in six hospitals. Clinical staff expressed uncertainty when and how to perform lumbar punctures and highlighted practical difficulties in undertaking them within busy clinical settings. Once treatment need was triggered, clinicians generally felt able to take appropriate therapeutic action, albeit within organisational and resource constraints. Matched behaviour change techniques largely targeted antecedents of treatment. These included decision support to prompt recognition, highlighting the consequences of missed diagnoses for clinicians and patients, and practical support for lumbar punctures. We subsequently devised an evidence-informed package comprising ‘core’ interventions and, to allow for local flexibility, ‘optional’ interventions. Conclusions We identified several points in the patient pathway where practice could improve, the most critical being around clinical suspicion and initial investigation. Interventions targeting professional beliefs and behaviours whilst optimising their clinical environment were amongst the most promising approaches to improve the care of suspected encephalitis. Trial registration Randomised trial registered with Controlled Trials ISRCTN06886935. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0224-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ruth Backman
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK.
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, UK.
| | - Benedict Daniel Michael
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, Fazakerly, UK.
| | - Sylviane Defres
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, L7 8XP, UK.
| | - Rachel Kneen
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,Department of Neurology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
| | - Tom Solomon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK. .,The Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, L9 7LJ, Fazakerly, UK.
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753
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Phillips CJ, Marshall AP, Chaves NJ, Jankelowitz SK, Lin IB, Loy CT, Rees G, Sakzewski L, Thomas S, To TP, Wilkinson SA, Michie S. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. J Multidiscip Healthc 2015; 8:139-46. [PMID: 25834455 PMCID: PMC4370908 DOI: 10.2147/jmdh.s78458] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.
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Affiliation(s)
- Cameron J Phillips
- Division of Pharmacy, Flinders Medical Centre, Bedford Park, SA, Australia ; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Andrea P Marshall
- Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, Southport, QLD, Australia ; Gold Coast University Hospital, Southport, QLD, Australia
| | - Nadia J Chaves
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Stacey K Jankelowitz
- Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Institute of Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ivan B Lin
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA, Australia
| | - Clement T Loy
- School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia ; Huntington Diseases Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Gwyneth Rees
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, University of Queensland, Brisbane, QLD, Australia
| | - Susie Thomas
- Physiotherapy Department, Flinders Medical Centre, Bedford Park, SA, Australia ; International Centre for Allied Health Evidence (iCAHE), School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - The-Phung To
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Shelley A Wilkinson
- Mater Research Institute, The University of Queensland, South Brisbane, QLD, Australia ; Department of Nutrition and Dietetics, Mater Health Services, South Brisbane, QLD, Australia
| | - Susan Michie
- University College London Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College, London, UK
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754
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Fiander M, McGowan J, Grad R, Pluye P, Hannes K, Labrecque M, Roberts NW, Salzwedel DM, Welch V, Tugwell P. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes. Cochrane Database Syst Rev 2015; 2015:CD004749. [PMID: 25770311 PMCID: PMC7388512 DOI: 10.1002/14651858.cd004749.pub3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a large volume of health information available, and, if applied in clinical practice, may contribute to effective patient care. Despite an abundance of information, sub-optimal care is common. Many factors influence practitioners' use of health information, and format (electronic or other) may be one such factor. OBJECTIVES To assess the effects of interventions aimed at improving or increasing healthcare practitioners' use of electronic health information (EHI) on professional practice and patient outcomes. SEARCH METHODS We searched The Cochrane Library (Wiley), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and LISA (EBSCO) up to November 2013. We contacted researchers in the field and scanned reference lists of relevant articles. SELECTION CRITERIA We included studies that evaluated the effects of interventions to improve or increase the use of EHI by healthcare practitioners on professional practice and patient outcomes. We defined EHI as information accessed on a computer. We defined 'use' as logging into EHI. We considered any healthcare practitioner involved in patient care. We included randomized, non-randomized, and cluster randomized controlled trials (RCTs, NRCTs, CRCTs), controlled clinical trials (CCTs), interrupted time series (ITS), and controlled before-and-after studies (CBAs).The comparisons were: electronic versus printed health information; EHI on different electronic devices (e.g. desktop, laptop or tablet computers, etc.; cell / mobile phones); EHI via different user interfaces; EHI provided with or without an educational or training component; and EHI compared to no other type or source of information. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risk of bias for each study. We used GRADE to assess the quality of the included studies. We reassessed previously excluded studies following our decision to define logins to EHI as a measure of professional behavior. We reported results in natural units. When possible, we calculated and reported median effect size (odds ratio (OR), interquartile ranges (IQR)). Due to high heterogeneity across studies, meta-analysis was not feasible. MAIN RESULTS We included two RCTs and four CRCTs involving 352 physicians, 48 residents, and 135 allied health practitioners. Overall risk of bias was low as was quality of the evidence. One comparison was supported by three studies and three comparisons were supported by single studies, but outcomes across the three studies were highly heterogeneous. We found no studies to support EHI versus no alternative. Given these factors, it was not possible to determine the relative effectiveness of interventions. All studies reported practitioner use of EHI, two reported on compliance with electronic practice guidelines, and none reported on patient outcomes.One trial (139 participants) measured guideline adherence for an electronic versus printed guideline, but reported no difference between groups (median OR 0.85, IQR 0.74 to 1.08). One small cross-over trial (10 participants) reported increased use of clinical guidelines when provided with a mobile versus stationary, desktop computer (mean use per shift: intervention group (IG) 3.6, standard deviation (SD) 1.7 vs. control group (CG) 2.0 (SD 1.9), P value = 0.033). One cross-over trial (203 participants) reported that using a customized versus a generic interface had little impact on practitioners' use of EHI (mean difference in adjusted end-of-study rate: 0.77 logins/month/user, 95% confidence interval (CI) CI 0.43 to 1.11). Three trials included education or training and reported increased use of EHI by practitioners following training. AUTHORS' CONCLUSIONS This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes, though it does suggest that when practitioners are provided with EHI and education or training, the use of EHI increases. We have defined use as the activity of logging into an EHI resource, but based on our findings use does not automatically translate to the application of EHI in practice. While using EHI may be an important component of evidence-based medicine, alone it is insufficient to improve patient care or clinical practices. For EHI to be applied in patient care, it will be necessary to understand why practitioners' are reluctant to apply EHI when treating people, and to determine the most effective way(s) to reduce this reluctance.
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Affiliation(s)
| | - Jessie McGowan
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1N 6N5
| | - Roland Grad
- McGill UniversityDepartment of Family Medicine3755 Cote Ste‐Catherine RoadMontrealQCCanadaH3T 1E2
| | - Pierre Pluye
- McGill UniversityDepartment of Family Medicine3755 Cote Ste‐Catherine RoadMontrealQCCanadaH3T 1E2
| | - Karin Hannes
- KU LeuvenMethodology of Educational Sciences Research GroupAndreas Vesaliusstraat 2LeuvenBelgium3000
| | - Michel Labrecque
- Centre hospitalier universitaire de Québec ‐ Hôpital St‐François d'AssiseDépartement de médecine familiale, Université Laval10, rue l"EspinayQuébecQCCanadaG1L 3L5
| | - Nia W Roberts
- University of OxfordBodleian Health Care LibrariesKnowledge Centre, ORC Research Building, Old Road CampusOxfordOxfordshireUKOX3 7DQ
| | - Douglas M Salzwedel
- University of British ColumbiaDepartment of Anesthesiology, Pharmacology and Therapeutics300C ‐ 2176 Health Sciences MallVancouverBCCanadaV6T 1Z3
| | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaONCanadaK1N 5C8
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1N 6N5
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755
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Davidoff F, Dixon-Woods M, Leviton L, Michie S. Demystifying theory and its use in improvement. BMJ Qual Saf 2015; 24:228-38. [PMID: 25616279 PMCID: PMC4345989 DOI: 10.1136/bmjqs-2014-003627] [Citation(s) in RCA: 406] [Impact Index Per Article: 45.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/27/2014] [Accepted: 01/06/2015] [Indexed: 11/03/2022]
Abstract
The role and value of theory in improvement work in healthcare has been seriously underrecognised. We join others in proposing that more informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Many professionals, including improvement practitioners, are unfortunately mystified-and alienated-by theory, which discourages them from using it in their work. In an effort to demystify theory we make the point in this paper that, far from being discretionary or superfluous, theory ('reason-giving'), both informal and formal, is intimately woven into virtually all human endeavour. We explore the special characteristics of grand, mid-range and programme theory; consider the consequences of misusing theory or failing to use it; review the process of developing and applying programme theory; examine some emerging criteria of 'good' theory; and emphasise the value, as well as the challenge, of combining informal experience-based theory with formal, publicly developed theory. We conclude that although informal theory is always at work in improvement, practitioners are often not aware of it or do not make it explicit. The germane issue for improvement practitioners, therefore, is not whether they use theory but whether they make explicit the particular theory or theories, informal and formal, they actually use.
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Affiliation(s)
- Frank Davidoff
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | | | - Laura Leviton
- Robert Wood Johnson Foundation, Princeton, New Jersey, USA
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756
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Moher D, Avey M, Antes G, Altman DG. The National Institutes of Health and guidance for reporting preclinical research. BMC Med 2015; 13:34. [PMID: 25775278 PMCID: PMC4332445 DOI: 10.1186/s12916-015-0284-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/26/2015] [Indexed: 12/31/2022] Open
Abstract
The quality of reporting clinical and preclinical research is not optimal. Reporting guidelines can help make reports of research more complete and transparent, thus increasing their value and making them more useful to all readers. Getting reporting guidelines into practice is complex and expensive, and involves several stakeholders, including prospective authors, peer reviewers, journal editors, guideline developers, and implementation scientists. Working together will help ensure their maximum uptake and penetration. We are all responsible for helping to ensure that all research is reported so completely that it is of value to everybody. Please see related article: http://dx.doi.org/10.1186/s12916-015-0266-y.
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Affiliation(s)
- David Moher
- />Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital – General Campus, 501 Smyth Road, Room L1288, Ottawa, ON K1H 8L6 Canada
- />Department of Epidemiology and Community Medicine, University of Ottawa, Roger Guindon Hall, Room 3105, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Marc Avey
- />Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital – General Campus, 501 Smyth Road, Room L1288, Ottawa, ON K1H 8L6 Canada
| | - Gerd Antes
- />German Cochrane Centre, University Medical Center, Freiburg, Germany
| | - Douglas G Altman
- />Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Botnar Research Centre Windmill Road, Oxford, OX3 7LD UK
- />UK EQUATOR Centre, University of Oxford, Oxford, UK
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757
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Chaves NJ, Cheng AC, Runnegar N, Kirschner J, Lee T, Buising K. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 2015; 44:568-74. [PMID: 25083531 DOI: 10.1111/imj.12373] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antimicrobial stewardship programmes aim to optimise use of antibiotics and are now mandatory in all Australian hospitals. AIM We aimed to identify barriers to and enablers of appropriate antimicrobial prescribing among hospital doctors. METHODS Two paper-based and one web-based surveys were administered at three Australian university teaching hospitals from March 2010 to May 2011. The 18-item questionnaire recorded doctors’ level of experience, their knowledge regarding the use of common antimicrobials and their attitudes regarding antimicrobial prescribing. Local survey modifications allowed inclusion of specific questions on: infections in intensive care unit patients, clinical microbiology and use of local guidelines. RESULTS The respondents (n = 272) were comprised of 96 (35%) registrars, 67 (25%)residents, 57 (21%) interns and 47 (17%) consultant hospital doctors. Forty-one per cent were working in a medical specialty. Identified barriers included: gaps in antimicrobial prescribing knowledge (especially among interns), a lack of awareness about which antimicrobials were restricted and a reliance on senior colleagues to make antimicrobial prescribing decisions. Enablers of optimal prescribing included: an acknowledgement of the need for assistance in prescribing and reported readiness to consult national prescribing guidelines. These results were used to help guide and prioritise interventions to improve prescribing practices. CONCLUSION A transferable knowledge and attitudes survey tool can be used to highlight barriers and facilitators to optimal hospital antimicrobial prescribing in order to inform tailored antimicrobial stewardship interventions.
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758
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Bussières AE, Al Zoubi F, Quon JA, Ahmed S, Thomas A, Stuber K, Sajko S, French S. Fast tracking the design of theory-based KT interventions through a consensus process. Implement Sci 2015; 10:18. [PMID: 25880218 PMCID: PMC4330935 DOI: 10.1186/s13012-015-0213-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 01/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains. METHODS Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention. RESULTS Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients' treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors. CONCLUSIONS A multifaceted KT educational intervention targeting chiropractors' management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.
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Affiliation(s)
- André E Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada.
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada.
| | - Fadi Al Zoubi
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada.
| | - Jeffrey A Quon
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
- Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Sara Ahmed
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada.
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada.
- Clinical Epidemiology, McGill University Health Center, Montréal, QC, Canada.
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada.
- Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada.
- Center for Medical Education, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Kent Stuber
- Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada.
| | | | - Simon French
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada.
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759
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Gnich W, Bonetti D, Sherriff A, Sharma S, Conway DI, Macpherson LMD. Use of the theoretical domains framework to further understanding of what influences application of fluoride varnish to children's teeth: a national survey of general dental practitioners in Scotland. Community Dent Oral Epidemiol 2015; 43:272-81. [PMID: 25656749 DOI: 10.1111/cdoe.12151] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 12/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite recent improvements in the oral health of Scotland's population, the persistence of childhood dental caries underscores a need to reduce the disease burden experienced by children living in Scotland. Application of fluoride varnish (FV) to children's teeth provides an evidence-based approach to achieving this goal. Despite policy, health service targets and professional recommendations supporting application, not all children receive FV in line with guidance. The objective of this study was to use the theoretical domains framework (TDF) to further an understanding of what may influence fluoride varnish application (FVA) in General Dental Practice in Scotland. METHODS A postal questionnaire assessing current behaviour (frequency of FVA) and theoretical domains (TDs) was sent to all General Dental Practitioners (GDPs) in Scotland. Correlations and linear regression models were used to examine the association between FVA and the TDs. RESULTS One thousand and ninety (53.6%) eligible GDPs responded. Respondents reported applying FV more frequently to increased risk and younger children (aged 2-5 years). Higher scores in eight TDs (Knowledge, Social/professional role and identity, Beliefs about consequences, Motivation and goals, Environmental context and resources, Social influences, Emotion and Behavioural regulation) were associated with greater frequency of FVA. Four beliefs in particular appear to be driving GDPs' decision to apply FV (recognizing that FVA is a guideline recommended behaviour (Knowledge), that FVA is perceived as an important part of the GDPs' professional role (Professional role/identity), that FV is something parents want for their children (Social influences) and that FV is something GDPs really wanted to do (Emotion). CONCLUSIONS The findings of this study support the use of the TDF as a tool to understand GDPs application of FV and suggest that a multifaceted intervention, targeting dental professionals and families, and more specifically those domains and items associated with FVA may have the greatest likelihood of influencing the evidence-based behaviour.
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Affiliation(s)
- Wendy Gnich
- Community Oral Health Section, Faculty of Medicine, Glasgow Dental School, University of Glasgow, Glasgow, UK
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760
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Affiliation(s)
- Debbe Thompson
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
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761
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Elouafkaoui P, Bonetti D, Clarkson J, Stirling D, Young L, Cassie H. Is further intervention required to translate caries prevention and management recommendations into practice? Br Dent J 2015; 218:E1. [DOI: 10.1038/sj.bdj.2014.1141] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/09/2022]
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762
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Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK. Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat 2015; 149:331-42. [PMID: 25555831 DOI: 10.1007/s10549-014-3255-5] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 12/20/2014] [Indexed: 12/18/2022]
Abstract
Research has shown that recent post-treatment breast cancer survivors face significant challenges around physical activity as they transition to recovery. This review examined randomized controlled trials targeting physical activity behavior change in breast cancer survivors <5 years post-treatment and described (1) characteristics of interventions for breast cancer survivors as well as (2) effect size estimates for these studies. A systematic search was conducted following PRISMA guidelines with Medline, PubMed, PsycINFO, CINAHL, and Scopus databases. Data were abstracted for primary intervention strategies and other details (e.g., setting, duration, theory use). A subgroup analysis was conducted to assess intensity of exercise supervision/monitoring and intervention effectiveness. The search produced 14 unique behavior intervention trials from the US and abroad published 2005-2013. The mean sample size was 153 participants per study. All interventions included moderate-intensity activities plus various behavioral change strategies. Most interventions were partially or entirely home based. The overall standardized mean difference was 0.47 (0.23, 0.67) with p < 0.001. Most interventions were effective in producing short-term behavior changes in physical activity, but varied greatly relative to intervention strategies and intensity of supervision/monitoring. Highly structured interventions tended to produce larger behavior change effects overall, but many larger effect sizes came from interventions supported by phone counseling or e-mail. We observed that 'more' may not be better in terms of direct supervision/monitoring in physical activity behavior interventions. This may be important in exploring less resource-intensive options for effective behavior change strategies for recent post-treatment survivors.
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Affiliation(s)
- Shirley M Bluethmann
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, 7000 Fannin, Suite 2560, Houston, TX, 77030, USA,
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763
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Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, Brownson RC. A Framework for Enhancing the Value of Research for Dissemination and Implementation. Am J Public Health 2015; 105:49-57. [PMID: 25393182 PMCID: PMC4265905 DOI: 10.2105/ajph.2014.302206] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 11/04/2022]
Abstract
A comprehensive guide that identifies critical evaluation and reporting elements necessary to move research into practice is needed. We propose a framework that highlights the domains required to enhance the value of dissemination and implementation research for end users. We emphasize the importance of transparent reporting on the planning phase of research in addition to delivery, evaluation, and long-term outcomes. We highlight key topics for which well-established reporting and assessment tools are underused (e.g., cost of intervention, implementation strategy, adoption) and where such tools are inadequate or lacking (e.g., context, sustainability, evolution) within the context of existing reporting guidelines. Consistent evaluation of and reporting on these issues with standardized approaches would enhance the value of research for practitioners and decision-makers.
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Affiliation(s)
- Gila Neta
- Gila Neta is with Implementation Science, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD. Russell E. Glasgow is with Department of Family Medicine and Colorado Health Outcomes Research Program University of Colorado, Denver. Christopher R. Carpenter is with Washington University School of Medicine, Division of Emergency Medicine, St Louis, MO. Jeremy M. Grimshaw is with Clinical Epidemiology Program, Ottawa Hospital Research Institute, and Department of Medicine, University of Ottawa, Ontario. Borsika A. Rabin is with Department of Family Medicine, School of Medicine, University of Colorado, and CRN Cancer Communication Research Center, Institute for Health Research, Kaiser Permanente Colorado, Denver. Maria E. Fernandez is with Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston. Ross C. Brownson is with Prevention Research Center in St Louis, Brown School, Washington University in St Louis, and Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine
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764
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Managing patients on bisphosphonates: The practice of primary care dentists before and after the publication of national guidance. Br Dent J 2014; 217:E25. [DOI: 10.1038/sj.bdj.2014.1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/08/2022]
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765
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Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, Fuld J, Nolte E. Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAvailable evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.ObjectivesThis study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.Data sourcesWe searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.MethodsWe conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.ResultsA total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.LimitationsWe only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.ConclusionsThe design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | | | - Martin Roland
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine, London, UK
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767
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Use of the theoretical domains framework to develop an intervention to improve physical therapist management of the risk of falls after discharge. Phys Ther 2014; 94:1660-75. [PMID: 25035266 DOI: 10.2522/ptj.20130412] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Older adults have an increased risk of falls after discharge from the hospital. Guidelines to manage this risk of falls are well documented but are not commonly implemented. The aim of this case report is to describe the novel approach of using the Theoretical Domains Framework (TDF) to develop an intervention to change the clinical behavior of physical therapists. CASE DESCRIPTION This project had 4 phases: identifying the evidence-practice gap, identifying barriers and enablers that needed to be addressed, identifying behavior change techniques to overcome the barriers, and determining outcome measures for evaluating behavior change. OUTCOMES The evidence-practice gap was represented by the outcome that few patients who had undergone surgery for hip fracture were recognized as having a risk of falls or had a documented referral to a community agency for follow-up regarding the prevention of falls. Project aims aligned with best practice guidelines were established; 12 of the 14 TDF domains were considered to be relevant to behaviors in the project, and 6 behavior change strategies were implemented. Primary outcome measures included the proportion of patients who had documentation of the risk of falls and were referred for a comprehensive assessment of the risk of falls after discharge from the hospital. DISCUSSION A systematic approach involving the TDF was useful for designing a multifaceted intervention to improve physical therapist management of the risk of falls after discharge of patients from an acute care setting in South Australia, Australia. This framework enabled the identification of targeted intervention strategies that were likely to influence health care professional behavior. Early case note audit results indicated that positive changes were being made to reduce the evidence-practice gap.
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768
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Phase IV implementation studies. The forgotten finale to the complex intervention methodology framework. Ann Am Thorac Soc 2014; 11 Suppl 2:S118-22. [PMID: 24559024 DOI: 10.1513/annalsats.201308-259rm] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The complex intervention methodology framework defines the iterative process for developing and evaluating complex interventions in healthcare, but advice on implementation research was not included until the 2008 update. Our recent systematic review of implementation studies identified significant problems with reporting standards, including inconsistent terminology and crucial information that was missing or unclear. Introduction of reporting checklists has standardized the reporting of randomized controlled trials and other types of studies, and there is a need for similar guidance for reporting implementation studies. Key standards might include an explicit evidence base from a randomized controlled trial or guideline recommendation; recruitment to the clinical service, not the research; at least some outcomes at the population level using routinely collected data; and a description of the setting and the process of implementing the service. The complex intervention framework currently illustrates a cycle of development and evaluation, which includes implementation as a final step. We propose that the research underpinning implementation should be visualized as a second interrelated cycle. Just as the "phase III cycle" includes the iterative steps of development and piloting, a similar process may be needed to translate the intervention into a practical service that can be tested in a phase IV implementation study.
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769
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Asimakopoulou K, Newton JT. The contributions of behaviour change science towards dental public health practice: a new paradigm. Community Dent Oral Epidemiol 2014; 43:2-8. [PMID: 25327392 DOI: 10.1111/cdoe.12131] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 09/04/2014] [Indexed: 11/27/2022]
Abstract
Conventional behavioural models, such as social cognition models, to improve oral health have been proposed for a long time but have failed to consistently explain reliable amounts of variability in human behaviours relevant to oral health. This paper introduces current work from the behavioural sciences aiming to better understand the process through which behaviour change may take place. Given the shortcomings seen so far in attempts to explain behaviour through traditional models it is proposed that a new approach is adopted. This commentary outlines this new approach, grounded in current work by mainstream behaviour change experts. We propose that attempts to use unreliable theoretical models to explain and predict oral health behaviour should now be replaced by work following this new paradigm.
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Affiliation(s)
- Koula Asimakopoulou
- Unit of Social and Behavioural Sciences, Dental Institute, King's College London, London, UK
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770
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Barnett KN, Bennie M, Treweek S, Robertson C, Petrie DJ, Ritchie LD, Guthrie B. Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (ClinicalTrials.gov registration NCT01602705). Implement Sci 2014; 9:133. [PMID: 25304255 PMCID: PMC4201916 DOI: 10.1186/s13012-014-0133-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/19/2014] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND High-risk prescribing in primary care is common and causes considerable harm. Feedback interventions have small/moderate effects on clinical practice, but few trials explicitly compare different forms of feedback. There is growing recognition that intervention development should be theory-informed, and that comprehensive reporting of intervention design is required by potential users of trial findings. The paper describes intervention development for the Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) study, a pragmatic three-arm cluster randomised trial in 262 Scottish general practices. METHODS The NHS chose to implement a feedback intervention to utilise a new resource, new Prescribing Information System (newPIS). The development phase required selection of high-risk prescribing outcome measures and design of intervention components: (1) educational material (the usual care comparison), (2) feedback of practice rates of high-risk prescribing received by both intervention arms and (3) a theory-informed behaviour change component to be received by one intervention arm. Outcome measures, educational material and feedback design, were developed with a National Health Service Advisory Group. The behaviour change component was informed by the Theory of Planned Behaviour and the Health Action Process Approach. A focus group elicitation study and an email Delphi study with general practitioners (GPs) identified key attitudes and barriers of responding to the prescribing feedback. Behaviour change techniques were mapped to the psychological constructs, and the content was informed by the results of the elicitation and Delphi study. RESULTS Six high-risk prescribing measures were selected in a consensus process based on importance and feasibility. Educational material and feedback design were based on current NHS Scotland practice and Advisory Group recommendations. The behaviour change component was resource constrained in development, mirroring what is feasible in an NHS context. Four behaviour change interventions were developed and embedded in five quarterly rounds of feedback targeting attitudes, subjective norms, perceived behavioural control and action planning (2×). CONCLUSIONS The paper describes a process which is feasible to use in the resource-constrained environment of NHS-led intervention development and documents the intervention to make its design and implementation explicit to potential users of the trial findings. TRIAL REGISTRATION ClinicalTrials.gov: NCT01602705.
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Affiliation(s)
- Karen N Barnett
- />Centre of Population Health Sciences, University of Edinburgh Medical Quad, Teviot Place, Edinburgh EH8 9AG UK
| | - Marion Bennie
- />Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, The John Arbuthnott Building, 161 Cathedral Street, Glasgow, G4 ORE UK
| | - Shaun Treweek
- />Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Christopher Robertson
- />Department of Mathematics and Statistics, University of Strathclyde, Livingstone Tower 26 Richmond Street, Glasgow, G1 1XH UK
| | - Dennis J Petrie
- />Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Victoria, 3010 Australia
| | - Lewis D Ritchie
- />Centre of Academic Primary Care, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD UK
| | - Bruce Guthrie
- />Quality, Safety and Informatics Research Group, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF UK
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771
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Manca DP, Aubrey-Bassler K, Kandola K, Aguilar C, Campbell-Scherer D, Sopcak N, O'Brien MA, Meaney C, Faria V, Baxter J, Moineddin R, Salvalaggio G, Green L, Cave A, Grunfeld E. Implementing and evaluating a program to facilitate chronic disease prevention and screening in primary care: a mixed methods program evaluation. Implement Sci 2014; 9:135. [PMID: 25293785 PMCID: PMC4194415 DOI: 10.1186/s13012-014-0135-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objectives of this paper are to describe the planned implementation and evaluation of the Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care (BETTER 2) program which originated from the BETTER trial. The pragmatic trial, informed by the Chronic Care Model, demonstrated the effectiveness of an approach to Chronic Disease Prevention and Screening (CDPS) involving the use of a new role, the prevention practitioner. The desired goals of the program are improved clinical outcomes, reduction in the burden of chronic disease, and improved sustainability of the health-care system through improved CDPS in primary care. METHODS/DESIGN The BETTER 2 program aims to expand the implementation of the intervention used in the original BETTER trial into communities across Canada (Alberta, Ontario, Newfoundland and Labrador, the Northwest Territories and Nova Scotia). This proactive approach provides at-risk patients with an intervention from the prevention practitioner, a health-care professional. Using the BETTER toolkit, the prevention practitioner determines which CDPS actions the patient is eligible to receive, and through shared decision-making and motivational interviewing, develops a unique and individualized 'prevention prescription' with the patient. This intervention is 1) personalized; 2) addressing multiple conditions; 3) integrated through linkages to local, regional, or national resources; and 4) longitudinal by assessing patients over time. The BETTER 2 program brings together primary care providers, policy/decision makers and researchers to work towards improving CDPS in primary care. The target patient population is adults aged 40-65. The reach, effectiveness, adoption, implementation, maintain (RE-AIM) framework will inform the evaluation of the program through qualitative and quantitative methods. A composite index will be used to quantitatively assess the effectiveness of the prevention practitioner intervention. The CDPS actions comprising the composite index include the following: process measures, referral/treatment measures, and target/change outcome measures related to cardiovascular disease, diabetes, cancer and associated lifestyle factors. DISCUSSION The BETTER 2 program is a collaborative approach grounded in practice and built from existing work (i.e., integration not creation). The program evaluation is designed to provide an understanding of issues impacting the implementation of an effective approach for CDPS within primary care that may be adapted to become sustainable in the non-research setting.
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Affiliation(s)
- Donna Patricia Manca
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton T6G 2T4, Alberta, Canada.
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772
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Martin L, de van der Schueren MAE, Blauwhoff-Buskermolen S, Baracos V, Gramlich L. Identifying the Barriers and Enablers to Nutrition Care in Head and Neck and Esophageal Cancers. JPEN J Parenter Enteral Nutr 2014; 40:355-66. [DOI: 10.1177/0148607114552847] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/02/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Lisa Martin
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, the Netherlands
- Department of Nutrition, Sports and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | | | - Vickie Baracos
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, the Netherlands
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada
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773
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Wilkinson SA, Brodribb WE, Upham S, Janamian T, Nicholson C, Jackson CL. Primary care of women after gestational diabetes mellitus: mapping the evidence-practice gap. Med J Aust 2014; 201:S74-7. [PMID: 25047888 DOI: 10.5694/mja14.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 05/23/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the extent to which preventive activities, including the ordering of an oral glucose tolerance test (OGTT) between 6 and 12 weeks of birth, are integrated into women's primary care postpartum visits after a gestational diabetes mellitus (GDM)-affected pregnancy. DESIGN AND SETTING Prospective survey and retrospective chart audit of general practices that provide maternity shared care in south-east Queensland, July 2011 to June 2012. PARTICIPANTS General practitioners (n = 38) and medical records of women to whom they provided care (n = 43 women). MAIN OUTCOME MEASURES GPs' awareness and knowledge of GDM guidelines and delivery of postpartum preventive care. RESULTS The response rate for the survey/chart audit was 47%. All respondents recommended an OGTT between 6 and 12 weeks; a variety of guidelines informed practice; and weight, blood pressure and infant feeding practices were regularly checked. Mental health status and diet and exercise were discussed less consistently. CONCLUSIONS GPs surveyed knew guidelines around the timing and type of test for women who have experienced GDM, and the audit demonstrated that this knowledge is translated into practice. Adherence to preventive screening and advice was less consistent. This problem may exist due to the absence of a systems approach to care, resulting in a lost opportunity to systematically reduce the incidence of type 2 diabetes and promote the wellbeing of women and their infants.
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Affiliation(s)
| | - Wendy E Brodribb
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia
| | - Susan Upham
- Centre of Research Excellence in Primary Health Care Microsystems, University of Queensland, Brisbane, QLD, Australia
| | - Tina Janamian
- Centre of Research Excellence in Primary Health Care Microsystems, University of Queensland, Brisbane, QLD, Australia
| | - Caroline Nicholson
- Mater-UQ Centre for Primary Healthcare Innovation, Mater Health Services, Brisbane, QLD, Australia
| | - Claire L Jackson
- Discipline of General Practice, University of Queensland, Brisbane, QLD, Australia
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774
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Davis R, Campbell R, Hildon Z, Hobbs L, Michie S. Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psychol Rev 2014; 9:323-44. [PMID: 25104107 PMCID: PMC4566873 DOI: 10.1080/17437199.2014.941722] [Citation(s) in RCA: 561] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 07/02/2014] [Indexed: 01/04/2023]
Abstract
Interventions to change health-related behaviours typically have modest effects and may be more effective if grounded in appropriate theory. Most theories applied to public health interventions tend to emphasise individual capabilities and motivation, with limited reference to context and social factors. Intervention effectiveness may be increased by drawing on a wider range of theories incorporating social, cultural and economic factors that influence behaviour. The primary aim of this paper is to identify theories of behaviour and behaviour change of potential relevance to public health interventions across four scientific disciplines: psychology, sociology, anthropology and economics. We report in detail the methodology of our scoping review used to identify these theories including which involved a systematic search of electronic databases, consultation with a multidisciplinary advisory group, web searching, searching of reference lists and hand searching of key behavioural science journals. Of secondary interest we developed a list of agreed criteria for judging the quality of the theories. We identified 82 theories and 9 criteria for assessing theory quality. The potential relevance of this wide-ranging number of theories to public health interventions and the ease and usefulness of evaluating the theories in terms of the quality criteria are however yet to be determined.
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Affiliation(s)
- Rachel Davis
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Zoe Hildon
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Lorna Hobbs
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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775
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Skolarus TA, Hawley ST. Prostate cancer survivorship care in the Veterans Health Administration. Fed Pract 2014; 31:10-17. [PMID: 30369784 PMCID: PMC6201257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The burden of prostate cancer among Veterans is substantial with over 200,000 survivors and 12,000 new diagnoses annually. Most men live with rather than die from this common and expensive disease making prostate cancer survivorship care especially important. In addition, the symptom burden after prostate cancer treatment can be substantial, last well into survivorship and lead to reduced quality of life and greater use of services. For these reasons, it is increasingly recognized that cancer survivorship care is similar to chronic disease management in requiring a combination of primary care providers and cancer specialists to deliver care over long periods of time. Because of its leadership in chronic disease care and the proportion of older men served, the Veterans Health Administration (VHA) is well positioned to become one of the national leaders in prostate cancer survivorship care. However, best practices and portfolios of quality indicators for prostate cancer survivorship care remain underdeveloped. More broadly, there is a limited consensus about who (primary care providers or prostate cancer specialists - urologists, radiation and medical oncologists) has primary responsibility for prostate cancer surveillance, and who manages the often substantial and lingering treatment-related side effects. Unclear roles and regional variation in the VHA cancer specialist workforce also complicate delivery of quality survivorship care. Ultimately, the design and implementation of tools to facilitate the delivery of optimal cancer survivorship care in VHA rests upon understanding how responsibility for survivorship care is managed and the barriers to quality survivorship care. Due to the expanding population of Veteran prostate cancer survivors, improving their quality of survivorship care through effective use of the VHA's provider workforce and latest telemedicine initiatives has potential to transform the national efficiency and effectiveness of cancer specialty care delivery.
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Affiliation(s)
- Ted A. Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan
- Division of Oncology, Department of Urology, University of Michigan
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan
| | - Sarah T. Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, University of Michigan
- Department of Internal Medicine, University of Michigan
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776
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Hirschhorn AD, Kolt GS, Brooks AJ. A multicomponent theory-based intervention improves uptake of pelvic floor muscle training before radical prostatectomy: a 'before and after' cohort study. BJU Int 2014; 113:383-92. [PMID: 24053154 PMCID: PMC4155862 DOI: 10.1111/bju.12385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the effect of a multicomponent theory-based intervention, incorporating patient information guides, an evidence summary, audit and feedback processes and a provider directory, in the provision/receipt of preoperative pelvic floor muscle training (PFMT) among patients undergoing radical prostatectomy. SUBJECTS AND METHODS Over an 18-month period (9 months before and 9 months after the intervention), we measured the provision/receipt of preoperative PFMT using surveys of patients undergoing radical prostatectomy at one public hospital (n = 32) and two private hospitals (n = 107) in Western Sydney, Australia, as well as practice audits of associated public sector (n = 4) and private sector (n = 2) providers of PFMT. Self-report urinary incontinence was assessed 3 months after radical prostatectomy using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Form (ICIQ-UI Short Form). RESULTS There was a significant increase in the proportion of survey respondents receiving preoperative PFMT post-intervention (post-intervention: 42/58 respondents, 72% vs pre-intervention: 37/81 respondents, 46%, P = 0.002). There was a corresponding significant increase in provision of preoperative PFMT by private sector providers (mean [sd] post-intervention: 16.7 [3.7] patients/month vs pre-intervention: 12.1 [3.6] patients/month, P = 0.018). Respondents receiving preoperative PFMT had significantly better self-report urinary incontinence at 3 months after radical prostatectomy than those who did not receive preoperative PFMT (mean [sd] ICIQ-UI Short Form sum-scores: 6.2 [5.0] vs 9.2 [5.8], P = 0.002). CONCLUSIONS The intervention increased the provision/receipt of preoperative PFMT among patients undergoing radical prostatectomy. Additional component strategies aimed at increasing the use of public sector providers may be necessary to further improve PFMT receipt among patients undergoing radical prostatectomy in the public hospital system.
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Affiliation(s)
- Andrew D Hirschhorn
- School of Science and Health, University of Western Sydney, Penrith; Westmead Private Physiotherapy Services, NSW, Australia
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777
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Gould NJ, Lorencatto F, Stanworth SJ, Michie S, Prior ME, Glidewell L, Grimshaw JM, Francis JJ. Application of theory to enhance audit and feedback interventions to increase the uptake of evidence-based transfusion practice: an intervention development protocol. Implement Sci 2014; 9:92. [PMID: 25070404 PMCID: PMC4243714 DOI: 10.1186/s13012-014-0092-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/03/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Audits of blood transfusion demonstrate around 20% transfusions are outside national recommendations and guidelines. Audit and feedback is a widely used quality improvement intervention but effects on clinical practice are variable, suggesting potential for enhancement. Behavioural theory, theoretical frameworks of behaviour change and behaviour change techniques provide systematic processes to enhance intervention. This study is part of a larger programme of work to promote the uptake of evidence-based transfusion practice. OBJECTIVES The objectives of this study are to design two theoretically enhanced audit and feedback interventions; one focused on content and one on delivery, and investigate the feasibility and acceptability. METHODS Study A (Content): A coding framework based on current evidence regarding audit and feedback, and behaviour change theory and frameworks will be developed and applied as part of a structured content analysis to specify the key components of existing feedback documents. Prototype feedback documents with enhanced content and also a protocol, describing principles for enhancing feedback content, will be developed. Study B (Delivery): Individual semi-structured interviews with healthcare professionals and observations of team meetings in four hospitals will be used to specify, and identify views about, current audit and feedback practice. Interviews will be based on a topic guide developed using the Theoretical Domains Framework and the Consolidated Framework for Implementation Research. Analysis of transcripts based on these frameworks will form the evidence base for developing a protocol describing an enhanced intervention that focuses on feedback delivery. Study C (Feasibility and Acceptability): Enhanced interventions will be piloted in four hospitals. Semi-structured interviews, questionnaires and observations will be used to assess feasibility and acceptability. DISCUSSION This intervention development work reflects the UK Medical Research Council's guidance on development of complex interventions, which emphasises the importance of a robust theoretical basis for intervention design and recommends systematic assessment of feasibility and acceptability prior to taking interventions to evaluation in a full-scale randomised study. The work-up includes specification of current practice so that, in the trials to be conducted later in this programme, there will be a clear distinction between the control (usual practice) conditions and the interventions to be evaluated.
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Affiliation(s)
- Natalie J Gould
- Centre for Health Services Research, City University London, London, UK.
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778
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Lazure P, Bartel RC, Biller BMK, Molitch ME, Rosenthal SM, Ross JL, Bernsten BD, Hayes SM. Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology. BMC Health Serv Res 2014; 14:319. [PMID: 25060235 PMCID: PMC4123497 DOI: 10.1186/1472-6963-14-319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 07/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF. METHODS This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques. RESULTS The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain. CONCLUSIONS The TDF categorization of the needs assessment findings allowed recommendation of appropriate behavior change techniques for each underlying determinant, and facilitated communication and understanding of the identified issues to a broader audience. This approach provides a means for health education researchers to categorize gaps and challenges identified through educational needs assessments, and facilitates the application of these findings by educators and knowledge translators, by linking the gaps to recommended behavioral change techniques.
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Affiliation(s)
- Patrice Lazure
- AXDEV Group Inc,, 210-8, Place du Commerce, Brossard, QC J4W 3H2, Canada.
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779
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Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations. Health Care Manag (Frederick) 2014; 33:183-204. [DOI: 10.1097/hcm.0000000000000014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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780
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Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, Altman DG, Hirst A, Hoey J, Palepu A, Schulz KF, Moher D. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ 2014; 348:g3804. [PMID: 24965222 PMCID: PMC4070413 DOI: 10.1136/bmj.g3804] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the completeness of reporting of health research is related to journals' endorsement of reporting guidelines. DESIGN Systematic review. DATA SOURCES Reporting guidelines from a published systematic review and the EQUATOR Network (October 2011). Studies assessing the completeness of reporting by using an included reporting guideline (termed "evaluations") (1990 to October 2011; addendum searches in January 2012) from searches of either Medline, Embase, and the Cochrane Methodology Register or Scopus, depending on reporting guideline name. STUDY SELECTION English language reporting guidelines that provided explicit guidance for reporting, described the guidance development process, and indicated use of a consensus development process were included. The CONSORT statement was excluded, as evaluations of adherence to CONSORT had previously been reviewed. English or French language evaluations of included reporting guidelines were eligible if they assessed the completeness of reporting of studies as a primary intent and those included studies enabled the comparisons of interest (that is, after versus before journal endorsement and/or endorsing versus non-endorsing journals). DATA EXTRACTION Potentially eligible evaluations of included guidelines were screened initially by title and abstract and then as full text reports. If eligibility was unclear, authors of evaluations were contacted; journals' websites were consulted for endorsement information where needed. The completeness of reporting of reporting guidelines was analyzed in relation to endorsement by item and, where consistent with the authors' analysis, a mean summed score. RESULTS 101 reporting guidelines were included. Of 15,249 records retrieved from the search for evaluations, 26 evaluations that assessed completeness of reporting in relation to endorsement for nine reporting guidelines were identified. Of those, 13 evaluations assessing seven reporting guidelines (BMJ economic checklist, CONSORT for harms, PRISMA, QUOROM, STARD, STRICTA, and STROBE) could be analyzed. Reporting guideline items were assessed by few evaluations. CONCLUSIONS The completeness of reporting of only nine of 101 health research reporting guidelines (excluding CONSORT) has been evaluated in relation to journals' endorsement. Items from seven reporting guidelines were quantitatively analyzed, by few evaluations each. Insufficient evidence exists to determine the relation between journals' endorsement of reporting guidelines and the completeness of reporting of published health research reports. Journal editors and researchers should consider collaborative prospectively designed, controlled studies to provide more robust evidence. SYSTEMATIC REVIEW REGISTRATION Not registered; no known register currently accepts protocols for methodology systematic reviews.
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Affiliation(s)
- Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
| | - Erica Weinstein
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
| | - Fatemeh Yazdi
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Justin Thielman
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, UK
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - John Hoey
- Population and Public Health Initiative, Queen's University, Kingston, ON, Canada, K7L 3N6
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y9 Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Kenneth F Schulz
- International Clinical Sciences Support Center, FHI 360, Durham, NC 27713, USA
| | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
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781
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Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior. Public Health Nutr 2014; 18:1028-35. [PMID: 24946833 DOI: 10.1017/s1368980014001220] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. DESIGN A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. SETTING The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. SUBJECTS Parents of 307 pre-school children (3-5 years old). RESULTS Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=-0·133, P=0·009), autonomy (standardized β=-0·118, P=0.014), attitude about negative effects of vegetables (standardized β=-0·118, P=0·015) and descriptive norms (standardized β=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. CONCLUSIONS The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.
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782
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Heslehurst N, Newham J, Maniatopoulos G, Fleetwood C, Robalino S, Rankin J. Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework. Obes Rev 2014; 15:462-86. [PMID: 24629076 DOI: 10.1111/obr.12160] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 01/19/2023]
Abstract
Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change.
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Affiliation(s)
- N Heslehurst
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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783
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Frykman M, Hasson H, Muntlin Athlin Å, von Thiele Schwarz U. Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department: a comparative case study. BMC Health Serv Res 2014; 14:218. [PMID: 24885212 PMCID: PMC4050988 DOI: 10.1186/1472-6963-14-218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 05/02/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. METHODS A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. RESULTS The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. CONCLUSIONS The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.
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Affiliation(s)
- Mandus Frykman
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, 171 77 Stockholm, Sweden
- Centre for Epidemiology and Community Medicine (CES), Stockholm County Council, P.O. Box 1497, 171 29 Stockholm, Sweden
| | - Åsa Muntlin Athlin
- School of Nursing, University of Adelaide, SA 5005 Adelaide, Australia
- Department of Medical Sciences, Uppsala University, Uppsala University Hospital, 751 85 Uppsala, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, 751 22 Uppsala, Sweden
- Department of Emergency Care, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Ulrica von Thiele Schwarz
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, 171 77 Stockholm, Sweden
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784
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Cane J, Richardson M, Johnston M, Ladha R, Michie S. From lists of behaviour change techniques (BCTs) to structured hierarchies: comparison of two methods of developing a hierarchy of BCTs. Br J Health Psychol 2014; 20:130-50. [PMID: 24815766 DOI: 10.1111/bjhp.12102] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 04/01/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Behaviour change technique (BCT) Taxonomy v1 is a hierarchically grouped, consensus-based taxonomy of 93 BCTs for reporting intervention content. To enhance the use and understanding of BCTs, the aims of the present study were to (1) quantitatively examine the 'bottom-up' hierarchical structure of Taxonomy v1, (2) identify whether BCTs can be reliably mapped to theoretical domains using a 'top-down' theoretically driven approach, and (3) identify any overlap between the 'bottom-up' and 'top-down' groupings. METHODS AND DESIGN The 'bottom-up' structure was examined for higher-order groupings using a dendrogram derived from hierarchical cluster analysis. For the theory-based 'top-down' structure, 18 experts sorted BCTs into 14 theoretical domains. Discriminant Content Validity was used to identify groupings, and chi-square tests and Pearson's residuals were used to examine the overlap between groupings. RESULTS Behaviour change techniques relating to 'Reward and Punishment' and 'Cues and Cue Responses' were perceived as markedly different to other BCTs. Fifty-nine of the BCTs were reliably allocated to 12 of the 14 theoretical domains; 47 were significant and 12 were of borderline significance. Thirty-four of 208 'bottom-up' × 'top-down' pairings showed greater overlap than expected by chance. However, only six combinations achieved satisfactory evidence of similarity. CONCLUSIONS The moderate overlap between the groupings indicates some tendency to implicitly conceptualize BCTs in terms of the same theoretical domains. Understanding the nature of the overlap will aid the conceptualization of BCTs in terms of theory and application. Further research into different methods of developing a hierarchical taxonomic structure of BCTs for international, interdisciplinary work is now required. Statement of contribution What is already known on this subject? Behaviour change interventions are effective in improving health care and health outcomes. The 'active' components of these interventions are behaviour change techniques and over 93 have been identified. Taxonomies of behaviour change techniques require structure to enable potential applications. What does this study add? This study identifies groups of BCTs to aid the recall of BCTs for intervention coding and design. It compares two methods of grouping--'bottom-up' and theory-based 'top-down'--and finds a moderate overlap. Building on identified BCT groups, it examines relationships between theoretical domains and BCTs.
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Affiliation(s)
- James Cane
- School of Psychology, Keynes College, University of Kent, Canterbury, UK
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785
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Thomas A, Menon A, Boruff J, Rodriguez AM, Ahmed S. Applications of social constructivist learning theories in knowledge translation for healthcare professionals: a scoping review. Implement Sci 2014; 9:54. [PMID: 24885925 PMCID: PMC4040365 DOI: 10.1186/1748-5908-9-54] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 05/01/2014] [Indexed: 11/15/2022] Open
Abstract
Background Use of theory is essential for advancing the science of knowledge translation (KT) and for increasing the likelihood that KT interventions will be successful in reducing existing research-practice gaps in health care. As a sociological theory of knowledge, social constructivist theory may be useful for informing the design and evaluation of KT interventions. As such, this scoping review explored the extent to which social constructivist theory has been applied in the KT literature for healthcare professionals. Methods Searches were conducted in six databases: Ovid MEDLINE (1948 – May 16, 2011), Ovid EMBASE, CINAHL, ERIC, PsycInfo, and AMED. Inclusion criteria were: publications from all health professions, research methodologies, as well as conceptual and theoretical papers related to KT. To be included in the review, key words such as constructivism, social constructivism, or social constructivist theories had to be included within the title or abstract. Papers that discussed the use of social constructivist theories in the context of undergraduate learning in academic settings were excluded from the review. An analytical framework of quantitative (numerical) and thematic analysis was used to examine and combine study findings. Results Of the 514 articles screened, 35 papers published between 1992 and 2011 were deemed eligible and included in the review. This review indicated that use of social constructivist theory in the KT literature was limited and haphazard. The lack of justification for the use of theory continues to represent a shortcoming of the papers reviewed. Potential applications and relevance of social constructivist theory in KT in general and in the specific studies were not made explicit in most papers. For the acquisition, expression and application of knowledge in practice, there was emphasis on how the social constructivist theory supports clinicians in expressing this knowledge in their professional interactions. Conclusions This scoping review was the first to examine use of social constructivism in KT studies. While the links between social constructivism and KT have not been fully explored, the Knowledge to Action framework has strong constructivist underpinnings that can be used in moving forward within the broader KT enterprise.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
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786
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Shaw RL, Larkin M, Flowers P. Expanding the evidence within evidence-based healthcare: thinking about the context, acceptability and feasibility of interventions. ACTA ACUST UNITED AC 2014; 19:201-3. [DOI: 10.1136/eb-2014-101791] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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787
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Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K. Development of a behaviour change intervention: a case study on the practical application of theory. Implement Sci 2014; 9:42. [PMID: 24708880 PMCID: PMC3983864 DOI: 10.1186/1748-5908-9-42] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/25/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Use of theory in implementation of complex interventions is widely recommended. A complex trial intervention, to enhance self-management support for people with osteoarthritis (OA) in primary care, needed to be implemented in the Managing Osteoarthritis in Consultations (MOSAICS) trial. One component of the trial intervention was delivery by general practitioners (GPs) of an enhanced consultation for patients with OA. The aim of our case study is to describe the systematic selection and use of theory to develop a behaviour change intervention to implement GP delivery of the enhanced consultation. METHODS The development of the behaviour change intervention was guided by four theoretical models/frameworks: i) an implementation of change model to guide overall approach, ii) the Theoretical Domains Framework (TDF) to identify relevant determinants of change, iii) a model for the selection of behaviour change techniques to address identified determinants of behaviour change, and iv) the principles of adult learning. Methods and measures to evaluate impact of the behaviour change intervention were identified. RESULTS The behaviour change intervention presented the GPs with a well-defined proposal for change; addressed seven of the TDF domains (e.g., knowledge, skills, motivation and goals); incorporated ten behaviour change techniques (e.g., information provision, skills rehearsal, persuasive communication); and was delivered in workshops that valued the expertise and professional values of GPs. The workshops used a mixture of interactive and didactic sessions, were facilitated by opinion leaders, and utilised 'context-bound communication skills training.' Methods and measures selected to evaluate the behaviour change intervention included: appraisal of satisfaction with workshops, GP report of intention to practise and an assessment of video-recorded consultations of GPs with patients with OA. CONCLUSIONS A stepped approach to the development of a behaviour change intervention, with the utilisation of theoretical frameworks to identify determinants of change matched with behaviour change techniques, has enabled a systematic and theory-driven development of an intervention designed to enhance consultations by GPs for patients with OA. The success of the behaviour change intervention in practice will be evaluated in the context of the MOSAICS trial as a whole, and will inform understanding of practice level and patient outcomes in the trial.
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Affiliation(s)
- Mark Porcheret
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
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788
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Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJC, Crone MR. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci 2014; 9:33. [PMID: 24641907 PMCID: PMC4000005 DOI: 10.1186/1748-5908-9-33] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To be able to design effective strategies to improve healthcare professionals' implementation behaviors, a valid and reliable questionnaire is needed to assess potential implementation determinants. The present study describes the development of the Determinants of Implementation Behavior Questionnaire (DIBQ) and investigates the reliability and validity of this Theoretical Domains Framework (TDF)-based questionnaire. METHODS The DIBQ was developed to measure the potential behavioral determinants of the 12-domain version of the TDF (Michie et al., 2005). We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Confirmatory factor analysis was used to examine whether the predefined structure of the TDF-based questionnaire was supported by the data. Cronbach's alpha was calculated to assess internal consistency reliability of the questionnaire, and domains' discriminant validity was investigated. RESULTS We developed an initial questionnaire containing 100 items assessing 12 domains. Results obtained from confirmatory factor analysis and Cronbach's alpha resulted in the final questionnaire consisting of 93 items assessing 18 domains, explaining 63.3% of the variance, and internal consistency reliability values ranging from .68 to .93. Domains demonstrated good discriminant validity, although the domains 'Knowledge' and 'Skills' and the domains 'Skills' and 'Social/professional role and identity' were highly correlated. CONCLUSIONS We have developed a valid and reliable questionnaire that can be used to assess potential determinants of healthcare professional implementation behavior following the theoretical domains of the TDF. The DIBQ can be used by researchers and practitioners who are interested in identifying determinants of implementation behaviors in order to be able to develop effective strategies to improve healthcare professionals' implementation behaviors. Furthermore, the findings provide a novel validation of the TDF and indicate that the domain 'Environmental context and resources' might be divided into several environment-related domains.
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Affiliation(s)
- Johanna M Huijg
- Clinical, Health and Neuropsychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
| | - Winifred A Gebhardt
- Clinical, Health and Neuropsychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
| | - Elise Dusseldorp
- Netherlands Organization for Applied Scientific Research (TNO), Leiden, Wassenaarseweg 56, Leiden, The Netherlands
| | - Marieke W Verheijden
- Netherlands Organization for Applied Scientific Research (TNO), Leiden, Wassenaarseweg 56, Leiden, The Netherlands
| | | | - Barend JC Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, The Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, The Netherlands
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789
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Wilkinson SA, McCray S, Beckmann M, Parry A, McIntyre HD. Barriers and enablers to translating gestational diabetes guidelines into practice. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1833] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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790
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Murphy K, O'Connor DA, Browning CJ, French SD, Michie S, Francis JJ, Russell GM, Workman B, Flicker L, Eccles MP, Green SE. Understanding diagnosis and management of dementia and guideline implementation in general practice: a qualitative study using the theoretical domains framework. Implement Sci 2014; 9:31. [PMID: 24581339 PMCID: PMC4015883 DOI: 10.1186/1748-5908-9-31] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/21/2014] [Indexed: 01/22/2023] Open
Abstract
Background Dementia is a growing problem, causing substantial burden for patients, their families, and society. General practitioners (GPs) play an important role in diagnosing and managing dementia; however, there are gaps between recommended and current practice. The aim of this study was to explore GPs’ reported practice in diagnosing and managing dementia and to describe, in theoretical terms, the proposed explanations for practice that was and was not consistent with evidence-based guidelines. Methods Semi-structured interviews were conducted with GPs in Victoria, Australia. The Theoretical Domains Framework (TDF) guided data collection and analysis. Interviews explored the factors hindering and enabling achievement of 13 recommended behaviours. Data were analysed using content and thematic analysis. This paper presents an in-depth description of the factors influencing two behaviours, assessing co-morbid depression using a validated tool, and conducting a formal cognitive assessment using a validated scale. Results A total of 30 GPs were interviewed. Most GPs reported that they did not assess for co-morbid depression using a validated tool as per recommended guidance. Barriers included the belief that depression can be adequately assessed using general clinical indicators and that validated tools provide little additional information (theoretical domain of ‘Beliefs about consequences’); discomfort in using validated tools (‘Emotion’), possibly due to limited training and confidence (‘Skills’; ‘Beliefs about capabilities’); limited awareness of the need for, and forgetting to conduct, a depression assessment (‘Knowledge’; ‘Memory, attention and decision processes’). Most reported practising in a manner consistent with the recommendation that a formal cognitive assessment using a validated scale be undertaken. Key factors enabling this were having an awareness of the need to conduct a cognitive assessment (‘Knowledge’); possessing the necessary skills and confidence (‘Skills’; ‘Beliefs about capabilities’); and having adequate time and resources (‘Environmental context and resources’). Conclusions This is the first study to our knowledge to use a theoretical approach to investigate the barriers and enablers to guideline-recommended diagnosis and management of dementia in general practice. It has identified key factors likely to explain GPs’ uptake of the guidelines. The results have informed the design of an intervention aimed at supporting practice change in line with dementia guidelines, which is currently being evaluated in a cluster randomised trial.
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Affiliation(s)
| | - Denise A O'Connor
- School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, VIC 3004, Australia.
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791
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Treweek S, Bonetti D, Maclennan G, Barnett K, Eccles MP, Jones C, Pitts NB, Ricketts IW, Sullivan F, Weal M, Francis JJ. Paper-based and web-based intervention modeling experiments identified the same predictors of general practitioners' antibiotic-prescribing behavior. J Clin Epidemiol 2014; 67:296-304. [PMID: 24388292 DOI: 10.1016/j.jclinepi.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/10/2013] [Accepted: 09/24/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To evaluate the robustness of the intervention modeling experiment (IME) methodology as a way of developing and testing behavioral change interventions before a full-scale trial by replicating an earlier paper-based IME. STUDY DESIGN AND SETTING Web-based questionnaire and clinical scenario study. General practitioners across Scotland were invited to complete the questionnaire and scenarios, which were then used to identify predictors of antibiotic-prescribing behavior. These predictors were compared with the predictors identified in an earlier paper-based IME and used to develop a new intervention. RESULTS Two hundred seventy general practitioners completed the questionnaires and scenarios. The constructs that predicted simulated behavior and intention were attitude, perceived behavioral control, risk perception/anticipated consequences, and self-efficacy, which match the targets identified in the earlier paper-based IME. The choice of persuasive communication as an intervention in the earlier IME was also confirmed. Additionally, a new intervention, an action plan, was developed. CONCLUSION A web-based IME replicated the findings of an earlier paper-based IME, which provides confidence in the IME methodology. The interventions will now be evaluated in the next stage of the IME, a web-based randomized controlled trial.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Debbie Bonetti
- Dental Health Services Research Unit, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Graeme Maclennan
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Karen Barnett
- Centre for Population Health Sciences, University of Edinburgh, Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK
| | - Martin P Eccles
- Institute of Health & Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Nigel B Pitts
- Dental Institute, Kings College London, Strand, London WC2R 2LS, UK
| | - Ian W Ricketts
- School of Computing, University of Dundee, Queen Mother Building, Dundee DD1 4HN, UK
| | - Frank Sullivan
- Quality, Safety & Informatics Research Group, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - Mark Weal
- School of Electronics and Computer Science, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Jill J Francis
- School of Health Sciences, City University London, Northampton Square, London EC1V 0HB, UK
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792
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Murphy A, Szumilas M, Rowe D, Landry K, Martin-Misener R, Kutcher S, Gardner D. Pharmacy students' experiences in provision of community pharmacy mental health services. Can Pharm J (Ott) 2014; 147:55-65. [PMID: 24494016 DOI: 10.1177/1715163513514170] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little information is available describing the pharmacy student's experience working in community practice with people with lived experience of mental illness. Students' perspectives as observers, learners, technical staff and future pharmacists are important. OBJECTIVE To gain a better understanding of the pharmacy student experience in community pharmacy-based service provision to people with lived experience of mental illness. METHODS We conducted a qualitative study using interpretive description and application of the Theoretical Domains Framework. Focus groups were held with third- and fourth-year undergraduate pharmacy students from one Canadian university. RESULTS Two student focus groups were held in the fall of 2012 with 11 students (7 third year and 4 fourth year), 6 women and 5 men, mean age 24.5 (range, 21 to 30) years, averaging 3.2 years (range, 2 weeks to 7 years) of cumulative, mostly part-time, community pharmacy experience. Three broad themes emerged from the pharmacy student experience: (1) business tension; (2) roles, responsibilities and relationships; and (3) stigma. Students discussed their own roles, responsibilities and relationships in a pluralistic identity experience (i.e., pharmacy student, technician, future pharmacist). Application of the Theoretical Domains Framework demonstrated numerous influences on behaviour. CONCLUSIONS From the students' description of community pharmacy-based care of people with lived experience of mental illness, significant issues exist with current practices and behaviours. Advancing the role of pharmacists and pharmacy students to meet the needs of people with mental illness will require strategies to address multifactorial influences on behaviour.
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Affiliation(s)
- Andrea Murphy
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Magdalena Szumilas
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Denise Rowe
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Kathryn Landry
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Ruth Martin-Misener
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - Stan Kutcher
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
| | - David Gardner
- College of Pharmacy (Murphy, Gardner), Dalhousie University, Halifax, Nova Scotia
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793
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Huijg JM, Gebhardt WA, Crone MR, Dusseldorp E, Presseau J. Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research. Implement Sci 2014; 9:11. [PMID: 24423394 PMCID: PMC3896680 DOI: 10.1186/1748-5908-9-11] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/11/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To improve the implementation of innovations in healthcare settings, it is important to understand factors influencing healthcare professionals' behaviors. We aimed to develop a generic questionnaire in English and in Dutch assessing the 14 domains of behavioral determinants from the revised TDF (Cane et al., 2012) that can be tailored to suit different targets, actions, contexts, and times of interest, and to investigate questionnaire items' discriminant content validity. METHODS We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Nineteen judges allocated 79 items to one or more TDF domains. One-sample t-tests were used to examine the discriminant content validity of each item, i.e., whether items measured intended domains or whether items measured a combination of domains. RESULTS We identified items judged to discriminately measure 11 out of 14 domains. Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains. CONCLUSIONS We have developed a questionnaire in English and in Dutch able to discriminately assess the majority of TDF domains. The results partly support Cane et al.'s (2012) 14-domain validation of the TDF and suggest that Michie et al.'s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire. The identified items provide a robust basis for developing a questionnaire to measure TDF-based determinants of healthcare professionals' implementation behaviors to suit different targets, actions, contexts, and times. Future research should investigate the concurrent and predictive validity and reliability of such a questionnaire in practice.
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Affiliation(s)
- Johanna M Huijg
- Clinical, Health, and Neuropsychology, Leiden University, Leiden, Wassenaarseweg 52, the Netherlands
| | - Winifred A Gebhardt
- Clinical, Health, and Neuropsychology, Leiden University, Leiden, Wassenaarseweg 52, the Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, the Netherlands
| | - Elise Dusseldorp
- Netherlands Organization for Applied Scientific Research (TNO), Wassenaarseweg 56, Leiden, the Netherlands
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
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794
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Understanding practice: the factors that influence management of mild traumatic brain injury in the emergency department--a qualitative study using the Theoretical Domains Framework. Implement Sci 2014; 9:8. [PMID: 24418161 PMCID: PMC3895840 DOI: 10.1186/1748-5908-9-8] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 08/12/2013] [Indexed: 11/25/2022] Open
Abstract
Background Mild traumatic brain injury is a frequent cause of presentation to emergency departments. Despite the availability of clinical practice guidelines in this area, there is variation in practice. One of the aims of the Neurotrauma Evidence Translation program is to develop and evaluate a targeted, theory- and evidence-informed intervention to improve the management of mild traumatic brain injury in Australian emergency departments. This study is the first step in the intervention development process and uses the Theoretical Domains Framework to explore the factors perceived to influence the uptake of four key evidence-based recommended practices for managing mild traumatic brain injury. Methods Semi-structured interviews were conducted with emergency staff in the Australian state of Victoria. The interview guide was developed using the Theoretical Domains Framework to explore current practice and to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. Results A total of 42 participants (9 Directors, 20 doctors and 13 nurses) were interviewed over a seven-month period. The results suggested that (i) the prospective assessment of post-traumatic amnesia was influenced by: knowledge; beliefs about consequences; environmental context and resources; skills; social/professional role and identity; and beliefs about capabilities; (ii) the use of guideline-developed criteria or decision rules to inform the appropriate use of a CT scan was influenced by: knowledge; beliefs about consequences; environmental context and resources; memory, attention and decision processes; beliefs about capabilities; social influences; skills and behavioral regulation; (iii) providing verbal and written patient information on discharge was influenced by: beliefs about consequences; environmental context and resources; memory, attention and decision processes; social/professional role and identity; and knowledge; (iv) the practice of providing brief, routine follow-up on discharge was influenced by: environmental context and resources; social/professional role and identity; knowledge; beliefs about consequences; and motivation and goals. Conclusions Using the Theoretical Domains Framework, factors thought to influence the management of mild traumatic brain injury in the emergency department were identified. These factors present theoretically based targets for a future intervention.
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795
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Taylor NJ, Sahota P, Sargent J, Barber S, Loach J, Louch G, Wright J. Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study. Int J Behav Nutr Phys Act 2013; 10:142. [PMID: 24373301 PMCID: PMC3895739 DOI: 10.1186/1479-5868-10-142] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 11/28/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Interventions that make extensive use of theory tend to have larger effects on behaviour. The Intervention Mapping (IM) framework incorporates theory into intervention design, implementation and evaluation, and was applied to the development of a community-based childhood obesity prevention intervention for a multi-ethnic population. Methods IM was applied as follows: 1) Needs assessment of the community and culture; consideration of evidence-base, policy and practice; 2) Identification of desired outcomes and change objectives following identification of barriers to behaviour change mapped alongside psychological determinants (e.g. knowledge, self-efficacy, intention); 3) Selection of theory-based methods and practical applications to address barriers to behaviour change (e.g., strategies for responsive feeding); 4) Design of the intervention by developing evidence-based interactive activities and resources (e.g., visual aids to show babies stomach size). The activities were integrated into an existing parenting programme; 5) Adoption and implementation: parenting practitioners were trained by healthcare professionals to deliver the programme within Children Centres. Results HAPPY (Healthy and Active Parenting Programme for Early Years) is aimed at overweight and obese pregnant women (BMI > 25); consists of 12 × 2.5 hr. sessions (6 ante-natal from 24 weeks; 6 postnatal up to 9 months); it addresses mother’s diet and physical activity, breast or bottle feeding, infant diet and parental feeding practices, and infant physical activity. Conclusion We have demonstrated that IM is a feasible and helpful method for providing an evidence based and theoretical structure to a complex health behaviour change intervention. The next stage will be to assess the impact of the intervention on behaviour change and clinical factors associated with childhood obesity. The HAPPY programme is currently being tested as part of a randomised controlled feasibility trial.
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Affiliation(s)
- Natalie J Taylor
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Trust, Bradford BD9 6RJ, UK.
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796
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Duane S, Callan A, Galvin S, Murphy AW, Domegan C, O’Shea E, Cormican M, Bennett K, O’Donnell M, Vellinga A. Supporting the improvement and management of prescribing for urinary tract infections (SIMPle): protocol for a cluster randomized trial. Trials 2013; 14:441. [PMID: 24359543 PMCID: PMC3880352 DOI: 10.1186/1745-6215-14-441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/09/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The overuse of antimicrobials is recognized as the main selective pressure driving the emergence and spread of antimicrobial resistance in human bacterial pathogens. Urinary tract infections (UTIs) are among the most common infections presented in primary care and empirical antimicrobial treatment is currently recommended. Previous research has identified that a substantial proportion of Irish general practitioners (GPs) prescribe antimicrobials for UTIs that are not in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The aim of this trial is to design, implement and evaluate the effectiveness of a complex intervention on GP antimicrobial prescribing and adult (18 years of age and over) patients' antimicrobial consumption when presenting with a suspected UTI. METHODS/DESIGN The Supporting the Improvement and Management of Prescribing for urinary tract infections (SIMPle) study is a three-armed intervention with practice-level randomization. Adult patients presenting with suspected UTIs in primary care will be included in the study.The intervention integrates components for both GPs and patients. For GPs the intervention includes interactive workshops, audit and feedback reports and automated electronic prompts summarizing recommended first-line antimicrobial treatment and, for one intervention arm, a recommendation to consider delayed antimicrobial treatment. For patients, multimedia applications and information leaflets are included. Thirty practices will be recruited to the study; laboratory data indicate that 2,038 patients will be prescribed an antimicrobial in the study. The primary outcome is a change in prescribing of first-line antimicrobials for UTIs in accordance with the Guidelines for Antimicrobial Prescribing in Primary Care in Ireland. The study will take place over 15 months with a six-month intervention period. Data will be collected through a remote electronic anonymized data-extraction system, a text-messaging system and GP and patient interviews and surveys. The intervention will be strengthened by the implementation of a social marketing framework and an economic evaluation. TRIAL REGISTRATION This intervention is registered at ClinicalTrials.gov, ID NCT01913860.
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Affiliation(s)
- Sinead Duane
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Aoife Callan
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Sandra Galvin
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Christine Domegan
- Department of Marketing, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Eamon O’Shea
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
- Irish Centre for Social Gerontology, National University of Ireland, Galway, Ireland
| | - Martin Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Martin O’Donnell
- Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Akke Vellinga
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
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797
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Burton AE, Shaw RL, Gibson JM. 'I'd like to know what causes it, you know, anything I've done?' Are we meeting the information and support needs of patients with macular degeneration? A qualitative study. BMJ Open 2013; 3:e003306. [PMID: 24202055 PMCID: PMC3822314 DOI: 10.1136/bmjopen-2013-003306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To examine patients' experiences of information and support provision for age-related macular degeneration (AMD) in the UK. STUDY DESIGN Exploratory qualitative study investigating patient experiences of healthcare consultations and living with AMD over 18 months. SETTING Specialist eye clinics at a Birmingham hospital. PARTICIPANTS 13 patients diagnosed with AMD. MAIN OUTCOME MEASURES Analysis of patients' narratives to identify key themes and issues relating to information and support needs. RESULTS Information was accessed from a variety of sources. There was evidence of clear information deficits prior to diagnosis, following diagnosis and ongoing across the course of the condition. Patients were often ill informed and therefore unable to self-advocate and recognise when support was needed, what support was available and how to access support. CONCLUSIONS AMD patients have a variety of information needs that are variable across the course of the condition. Further research is needed to determine whether these experiences are typical and identify ways of translating the guidelines into practice. Methods of providing information need to be investigated and improved for this patient group.
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Affiliation(s)
- A E Burton
- Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, UK
| | - R L Shaw
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - J M Gibson
- School of Life and Health Sciences, Aston University, Birmingham, UK
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798
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Taylor N, Lawton R, Slater B, Foy R. The demonstration of a theory-based approach to the design of localized patient safety interventions. Implement Sci 2013; 8:123. [PMID: 24131864 PMCID: PMC3854455 DOI: 10.1186/1748-5908-8-123] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence of unsafe care in healthcare systems globally. Interventions to implement recommended practice often have modest and variable effects. Ideally, selecting and adapting interventions according to local contexts should enhance effects. However, the means by which this can happen is seldom systematic, based on theory, or made transparent. This work aimed to demonstrate the applicability, feasibility, and acceptability of a theoretical domains framework implementation (TDFI) approach for co-designing patient safety interventions. METHODS We worked with three hospitals to support the implementation of evidence-based guidance to reduce the risk of feeding into misplaced nasogastric feeding tubes. Our stepped process, informed by the TDF and key principles from implementation literature, entailed: involving stakeholders; identifying target behaviors; identifying local factors (barriers and levers) affecting behavior change using a TDF-based questionnaire; working with stakeholders to generate specific local strategies to address key barriers; and supporting stakeholders to implement strategies. Exit interviews and audit data collection were undertaken to assess the feasibility and acceptability of this approach. RESULTS Following audit and discussion, implementation teams for each Trust identified the process of checking the positioning of nasogastric tubes prior to feeding as the key behavior to target. Questionnaire results indicated differences in key barriers between organizations. Focus groups generated innovative, generalizable, and adaptable strategies for overcoming barriers, such as awareness events, screensavers, equipment modifications, and interactive learning resources. Exit interviews identified themes relating to the benefits, challenges, and sustainability of this approach. Time trend audit data were collected for 301 patients over an 18-month period for one Trust, suggesting clinically significant improved use of pH and documentation of practice following the intervention. CONCLUSIONS The TDF is a feasible and acceptable framework to guide the implementation of patient safety interventions. The stepped TDFI approach engages healthcare professionals and facilitates contextualization in identifying the target behavior, eliciting local barriers, and selecting strategies to address those barriers. This approach may be of use to implementation teams and policy makers, although our promising findings confirm the need for a more rigorous evaluation; a balanced block evaluation is currently underway.
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Affiliation(s)
- Natalie Taylor
- Australian Institute of Health Innovation, Faculty of Medicine, Level 1, AGSM Building, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, Lupton Place, Leeds, UK
| | - Beverley Slater
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, UK
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799
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Mortimer D, French SD, McKenzie JE, O'Connor DA, Green SE. Economic evaluation of active implementation versus guideline dissemination for evidence-based care of acute low-back pain in a general practice setting. PLoS One 2013; 8:e75647. [PMID: 24146767 PMCID: PMC3795707 DOI: 10.1371/journal.pone.0075647] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice. METHODS Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone. RESULTS The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that--irrespective of willingness to pay (WTP)--we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination. CONCLUSIONS Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.
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Affiliation(s)
- Duncan Mortimer
- Centre for Health Economics, Monash University, Clayton, Victoria, Australia
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800
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Glidewell L, Boocock S, Pine K, Campbell R, Hackett J, Gill S, Wilkie M. Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience. Implement Sci 2013; 8:118. [PMID: 24098920 PMCID: PMC3851734 DOI: 10.1186/1748-5908-8-118] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 09/27/2013] [Indexed: 11/13/2022] Open
Abstract
Background Patients in control of their own haemodialysis report better outcomes than those receiving professional controlled care in a hospital setting, even though home and hospital haemodialysis are largely equivalent from mechanical and physiological perspectives. Shared Haemodialysis Care (SHC) describes an initiative in which hospital haemodialysis patients are supported by dialysis staff to become as involved as they wish in their own care; and can improve patient safety, satisfaction and may reduce costs. We do not understand why interventions to support self-management in other conditions have variable effects or how to optimise the delivery of SHC. The purpose of this study was to identify perceived patient and professional (nurses and healthcare assistants) barriers to the uptake of SHC, and to use these data to identify intervention components to optimise care. Methods Individual semi-structured interviews with patients and professionals were conducted to identify barriers and facilitators. Data were coded to behavioural theory to identify solutions. A national UK learning event with multiple stakeholders (patients, carers, commissioners and professionals) explored the salience of these barriers and the acceptability of solutions. Results A complex intervention strategy was designed to optimise SHC for patients and professionals. Interviews were conducted with patients (n = 15) and professionals (n = 7) in two hospitals and three satellite units piloting SHC. Data from patient and professional interviews could be coded to behavioural theory. Analyses identified key barriers (knowledge, beliefs about capabilities, skills and environmental context and resources). An intervention strategy that focuses on providing, first, patients with information about the shared nature of care, how to read prescriptions and use machines, and second, providing professionals with skills and protected time to teach both professionals/patients, as well as providing continual review, may improve the implementation of SHC and be acceptable to stakeholders. Conclusions We have developed an intervention strategy to improve the implementation of SHC for patients and professionals. While this intervention strategy has been systematically developed using behavioural theory, it should be rigorously tested in a subsequent effectiveness evaluation study prior to implementation to ensure that shared haemodialysis care can be delivered equitably, efficiently and safely for all patients.
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Affiliation(s)
- Liz Glidewell
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, UK.
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