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Assessment of healthcare workers' behavior in implementing a newborn screening program for congenital hypothyroidism in Perak, Malaysia. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-08-2019-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PurposeThe aim of this study is to assess healthcare workers' behavior on the congenital hypothyroidism screening program implementation based on a framework protocol and its associated factors.Design/methodology/approachA cross-sectional study was conducted using the multistage random sampling method in recruiting health clinic workers and purposive sampling techniques for hospital workers. The demographics, providers' characteristic, occupational profile, attitude, perceived behavior control (PBC), knowledge, behavioral intention and adherence to protocol were gathered using validated and reliable self-administered questionnaires.FindingsPartial intention to adhere to protocol was 25.7%. Weak attitude (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 3.32–9.06), low PBC score (AOR: 0.91, 95% CI: 0.86–0.95) and low knowledge score (AOR: 0.85, 95% CI: 0.75–0.96) were associated with partial intention to adhere to protocol. In the self-rated adherence assessment, 92.6% of participants from health clinics, 79.1% from pediatric and 61.1% from pathology were found not adhering to protocol. There was a significant association between intention and adherence to protocol.Research limitations/implicationsDocumentations and observations in assessing program implementation were limited to perform in the present study. Using self-rated instruments and focusing on healthcare workers alone did not provide a comprehensive assessment.Practical implicationsAvailability of a training module at site and regular refreshing course training should be made available to harness knowledge, attitude and behavioral perception in implementing the program activities.Originality/valueIntegrating the Logical Framework Approach in assessing program implementation and application of the Theory of Planned Behavior and Attitude, Subjective Norms, Self-Efficacy Model in this study were beneficial.
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Adekpedjou R, Haesebaert J, Stacey D, Brière N, Freitas A, Rivest LP, Légaré F. Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys. BMC Health Serv Res 2020; 20:203. [PMID: 32164669 PMCID: PMC7069220 DOI: 10.1186/s12913-020-5064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers’ level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention. Methods We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals’ clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering. Results Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5–6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one’s capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5–6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = − 0.39, P = 0.018) and working as a technician (β = − 0.41, P = 0.069) (compared to as a social worker). Conclusion Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances. Trial registration Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
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Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada. .,Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525, chemin de la Canardière, Quebec, G1J 0A4, Canada.
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Abbasgholizadeh Rahimi S, Lépine J, Croteau J, Robitaille H, Giguere AM, Wilson BJ, Rousseau F, Lévesque I, Légaré F. Psychosocial Factors of Health Professionals' Intention to Use a Decision Aid for Down Syndrome Screening: Cross-Sectional Quantitative Study. J Med Internet Res 2018; 20:e114. [PMID: 29695369 PMCID: PMC5943629 DOI: 10.2196/jmir.9036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/22/2017] [Accepted: 01/14/2018] [Indexed: 12/16/2022] Open
Abstract
Background Decisions about prenatal screening for Down syndrome are difficult for women, as they entail risk, potential loss, and regret. Shared decision making increases women’s knowledge of their choices and better aligns decisions with their values. Patient decision aids foster shared decision making but are rarely used in this context. Objective One of the most promising strategies for implementing shared decision making is distribution of decision aids by health professionals. We aimed to identify factors influencing their intention to use a DA during prenatal visit for decisions about Down syndrome screening. Methods We conducted a cross-sectional quantitative study. Using a Web panel, we conducted a theory-based survey of health professionals in Quebec province (Canada). Eligibility criteria were as follows: (1) family physicians, midwives, obstetrician-gynecologists, or trainees in these professions; (2) involved in prenatal care; and (3) working in Quebec province. Participants watched a video depicting a health professional using a decision aid during a prenatal consultation with a woman and her partner, and then answered a questionnaire based on an extended version of the theory of planned behavior, including some of the constructs of the theoretical domains framework. The questionnaire assessed 8 psychosocial constructs (attitude, anticipated regret, subjective norm, self-identity, moral norm, descriptive norm, self-efficacy, and perceived control), 7 related sets of behavioral beliefs (advantages, disadvantages, emotions, sources of encouragement or discouragement, incentives, facilitators, and barriers), and sociodemographic data. We performed descriptive, bivariate, and multiple linear regression analyses to identify factors influencing health professionals’ intention to use a decision aid. Results Among 330 health professionals who completed the survey, 310 met the inclusion criteria: family physicians, 55.2% (171/310); obstetrician-gynecologists, 33.8% (105/310); and midwives, 11.0% (34/310). Of these, 80.9% were female (251/310). Mean age was 39.6 (SD 11.5) years. Less than half were aware of any decision aids at all. In decreasing order of importance, factors influencing their intention to use a decision aid for Down syndrome prenatal screening were as follows: self-identity (beta=.325, P<.001), attitude (beta=.297, P<.001), moral norm (beta=.288, P<.001), descriptive norm (beta=.166, P<.001), and anticipated regret (beta=.099, P=.003). Underlying behavioral beliefs significantly related to intention were that the use of a decision aid would promote decision making (beta=.117, 95% CI 0.043-0.190), would reassure health professionals (beta=.100, 95% CI 0.024-0.175), and might require more time than planned for the consultation (beta=−.077, 95% CI −0.124 to −0.031). Conclusions We identified psychosocial factors that could influence health professionals’ intention to use a decision aid about Down syndrome screening. Strategies should remind them of the following: (1) using a decision aid for this purpose should be a common practice, (2) it would be expected of someone in their societal role, (3) the experience of using it will be satisfying and reassuring, and (4) it is likely to be compatible with their moral values.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, QC, Canada.,Université Laval Primary Care Research Centre (CERSSPL-UL), Université Laval, Quebec, QC, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jordie Croteau
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, QC, Canada.,Quebec Support for People and Patient-Oriented Research and Trials Units, Université Laval, Quebec, QC, Canada
| | - Hubert Robitaille
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, QC, Canada.,Université Laval Primary Care Research Centre (CERSSPL-UL), Université Laval, Quebec, QC, Canada
| | - Anik Mc Giguere
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Université Laval Primary Care Research Centre (CERSSPL-UL), Université Laval, Quebec, QC, Canada.,Quebec Centre of Excellence on Aging, Laval University Research Centre on Primary Healthcare and Services, Quebec, QC, Canada
| | - Brenda J Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, QC, Canada.,Université Laval Primary Care Research Centre (CERSSPL-UL), Université Laval, Quebec, QC, Canada
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Cottrell E, Roddy E, Rathod T, Porcheret M, Foster NE. What influences general practitioners' use of exercise for patients with chronic knee pain? Results from a national survey. BMC FAMILY PRACTICE 2016; 17:172. [PMID: 27993126 PMCID: PMC5168590 DOI: 10.1186/s12875-016-0570-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022]
Abstract
Background Exercise is a recommended ‘core’ treatment for chronic knee pain (CKP), however it appears to be underused by general practitioners (GPs). While behavioural theories suggest that attitudes and beliefs influence behaviours, no single theory reliably predicts GPs’ behaviours. A theoretical analysis framework, developed from sociocognitive theories, was used to underpin investigation of the key influences associated with GPs’ use of exercise for patients with CKP, to inform future interventions to optimise GPs’ use of exercise. Methods A cross-sectional postal questionnaire survey investigated UK GPs’ reported use of exercise based on a patient case vignette. Factors influencing GPs’ exercise use (behaviour) were examined using attitude statements, free-text questions and multiple response option questions related to factors within the analysis framework. Unadjusted logistic regression analyses explored the associations between GPs’ attitudes/beliefs and behaviour. Results From a total sample of 5000 GPs, 835 (17%) returned a questionnaire. Most respondents (n = 729, 87%) reported that they would use exercise. Factors significantly associated with exercise use (OR (95% CI)) included GPs’ beliefs about their role (belief that GPs should give information on type, duration and frequency of exercise (30.71 (5.02,188.01)), beliefs about consequences (agreement that knee problems are improved by local (3.23 (1.94,5.39)) and general exercise (2.63 (1.38,5.02))), moral norm (agreement that GPs should prescribe all patients local (3.08 (1.96,4.83)) and general exercise (2.63 (1.45,4.76))), and GP-related beliefs about capabilities (prior experience of insufficient expertise to give detailed exercise information (0.50 (0.33,0.76)). Whilst perceived time limitations were not associated with exercise use (1.00 (0.33,3.01)), GPs who disagreed that they experienced time limitations were more likely to suggest general (2.17 (1.04,4.55)), or demonstrate local (2.16 (1.06,4.42)), exercises. Conclusion GPs’ attitudes and beliefs are associated with their use of exercise for patients with CKP, particularly beliefs about role, responsibilities and skills in initiating exercise, and about the efficacy of exercise. Although the low response risks response bias, these results can inform future interventions to optimise GPs’ behaviour. The role of GP uncertainty and influences on clinical decision-making need further exploration, thus an amended analysis framework is suggested, which should be tested in future research. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0570-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Trishna Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Nadine E Foster
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK
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Waddimba AC, Beckman HB, Mahoney TL, Burgess JF. The Moderating Effect of Job Satisfaction on Physicians' Motivation to Adhere to Financially Incentivized Clinical Practice Guidelines. Med Care Res Rev 2016; 74:148-177. [PMID: 26860890 DOI: 10.1177/1077558716628354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined moderating effects of professional satisfaction on physicians' motivation to adhere to diabetes guidelines associated with pay-for-performance incentives. We merged cross-sectional survey data on attitudes, from 156 primary physicians, with prospective medical record-sourced data on guideline adherence and census data on ambulatory-care population characteristics. We examined moderating effects by testing theory-driven models for satisfied versus discontented physicians, using partial least squares structural equation modeling. Results show that attitudes motivated, while norms suppressed, adherence to guidelines among discontented physicians. Separate models for satisfied versus discontented physicians revealed motivational differences. Satisfied physicians disregarded intrinsic and extrinsic influences and biases. Discontented physicians, alienated by social pressure, favored personal inclinations. To improve adherence to guidelines among discontented physicians, incentives should align with personal attitudes and incorporate promotional campaigns countering resentment of peer and organizational pressure.
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Affiliation(s)
- Anthony C Waddimba
- 1 Bassett Healthcare Network Research Institute, Cooperstown, NY, USA.,2 Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Howard B Beckman
- 3 EagleDream Health, Inc., Rochester, NY, USA.,4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Thomas L Mahoney
- 4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,5 Finger Lakes Health Systems Agency, Rochester, NY, USA
| | - James F Burgess
- 6 Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, USA.,7 Boston University School of Public Health, Boston, MA, USA
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Légaré F, Borduas F, Freitas A, Jacques A, Godin G, Luconi F, Grimshaw J. Development of a simple 12-item theory-based instrument to assess the impact of continuing professional development on clinical behavioral intentions. PLoS One 2014; 9:e91013. [PMID: 24643173 PMCID: PMC3958345 DOI: 10.1371/journal.pone.0091013] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/05/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Decision-makers in organizations providing continuing professional development (CPD) have identified the need for routine assessment of its impact on practice. We sought to develop a theory-based instrument for evaluating the impact of CPD activities on health professionals' clinical behavioral intentions. METHODS AND FINDINGS Our multipronged study had four phases. 1) We systematically reviewed the literature for instruments that used socio-cognitive theories to assess healthcare professionals' clinically-oriented behavioral intentions and/or behaviors; we extracted items relating to the theoretical constructs of an integrated model of healthcare professionals' behaviors and removed duplicates. 2) A committee of researchers and CPD decision-makers selected a pool of items relevant to CPD. 3) An international group of experts (n = 70) reached consensus on the most relevant items using electronic Delphi surveys. 4) We created a preliminary instrument with the items found most relevant and assessed its factorial validity, internal consistency and reliability (weighted kappa) over a two-week period among 138 physicians attending a CPD activity. Out of 72 potentially relevant instruments, 47 were analyzed. Of the 1218 items extracted from these, 16% were discarded as improperly phrased and 70% discarded as duplicates. Mapping the remaining items onto the constructs of the integrated model of healthcare professionals' behaviors yielded a minimum of 18 and a maximum of 275 items per construct. The partnership committee retained 61 items covering all seven constructs. Two iterations of the Delphi process produced consensus on a provisional 40-item questionnaire. Exploratory factorial analysis following test-retest resulted in a 12-item questionnaire. Cronbach's coefficients for the constructs varied from 0.77 to 0.85. CONCLUSION A 12-item theory-based instrument for assessing the impact of CPD activities on health professionals' clinical behavioral intentions showed adequate validity and reliability. Further studies could assess its responsiveness to behavior change following CPD activities and its capacity to predict health professionals' clinical performance.
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Affiliation(s)
- France Légaré
- Public Health and Practice-Changing Research Group, CHUQ Research Centre (CRCHUQ), Quebec, Quebec, Canada
| | - Francine Borduas
- Office of the Vice-Dean of Education and Continuing Professional Development, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Adriana Freitas
- Public Health and Practice-Changing Research Group, CHUQ Research Centre (CRCHUQ), Quebec, Quebec, Canada
| | - André Jacques
- Practice Enhancement Division, Collège des médecins du Québec, Montreal, Quebec, Canada
| | - Gaston Godin
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
| | - Francesca Luconi
- Continuing Health Professional Education Office, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Maffei RM, Dunn K, Zhang J, Hsu CE, Holmes JH. Understanding behavioral intent to participate in shared decision-making in medically uncertain situations. Methods Inf Med 2012; 51:301-8. [PMID: 22814528 DOI: 10.3414/me11-01-0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 05/12/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent based on the Theory of Reasoned Action (TRA) and applied to men between the ages of 45 and 70 in the context of their participation in shared decision-making (SDM) in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information that may facilitate greater understanding, efficiency and effectiveness of clinician-patient consultations. MATERIALS AND METHODS Twenty-five male subjects from the Philadelphia community participated in this study. Individual semi-structure patient interviews were conducted until data saturation was reached. Based on their review of the patient interview transcripts, researchers conducted a qualitative content analysis to identify prevalent themes and, subsequently, create a category framework. Qualitative indicators were used to evaluate respondents' experiences, beliefs, and behavioral intent relative to participation in shared decision-making during medical uncertainty. RESULTS Based on the themes uncovered through the content analysis, a category framework was developed to facilitate understanding and increase the accuracy of predictions related to an individual's behavioral intent to participate in shared decision-making in medical uncertainty. The emerged themes included past experience with medical uncertainty, individual personality, and the relationship between the patient and his physician. The resulting three main framework categories include 1) an individual's Foundation for the concept of medical uncertainty, 2) how the individual Copes with medical uncertainty, and 3) the individual's Behavioral Intent to seek information and participate in shared decision-making during times of medically uncertain situations. DISCUSSION The theme of Coping (with uncertainty) emerged as a particularly critical behavior/characteristic amongst the subjects. By understanding a subject's disposition with regard to coping, researchers were better able to make connections between a subject's prior experiences, their knowledge seeking activities, and their intent to participate in SDM. Despite having information and social support, the subjects still had to cope with the idea of uncertainty before determining how to proceed with regard to shared decision-making. In addition, the coping category reinforced the importance of information seeking behaviors and preferences for shared decision-making. CONCLUSIONS This study applies and extends the field of behavioral and health informatics to assist medical practice and decision-making in situations of medical uncertainty. More specifically, this study led to the development of a category framework that facilitates the identification of an individual's needs and motivational factors with regard to their intent to participate in shared decision-making in situations of medical uncertainty.
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Affiliation(s)
- Roxana M Maffei
- Columbia University Medical Center, New York, New York 10032, USA.
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Gagnon MP, Labarthe J, Légaré F, Ouimet M, Estabrooks CA, Roch G, Ghandour EK, Grimshaw J. Measuring organizational readiness for knowledge translation in chronic care. Implement Sci 2011; 6:72. [PMID: 21752264 PMCID: PMC3158542 DOI: 10.1186/1748-5908-6-72] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/13/2011] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge translation (KT) is an imperative in order to implement research-based and contextualized practices that can answer the numerous challenges of complex health problems. The Chronic Care Model (CCM) provides a conceptual framework to guide the implementation process in chronic care. Yet, organizations aiming to improve chronic care require an adequate level of organizational readiness (OR) for KT. Available instruments on organizational readiness for change (ORC) have shown limited validity, and are not tailored or adapted to specific phases of the knowledge-to-action (KTA) process. We aim to develop an evidence-based, comprehensive, and valid instrument to measure OR for KT in healthcare. The OR for KT instrument will be based on core concepts retrieved from existing literature and validated by a Delphi study. We will specifically test the instrument in chronic care that is of an increasing importance for the health system. Methods Phase one: We will conduct a systematic review of the theories and instruments assessing ORC in healthcare. The retained theoretical information will be synthesized in a conceptual map. A bibliography and database of ORC instruments will be prepared after appraisal of their psychometric properties according to the standards for educational and psychological testing. An online Delphi study will be carried out among decision makers and knowledge users across Canada to assess the importance of these concepts and measures at different steps in the KTA process in chronic care. Phase two: A final OR for KT instrument will be developed and validated both in French and in English and tested in chronic disease management to measure OR for KT regarding the adoption of comprehensive, patient-centered, and system-based CCMs. Discussion This study provides a comprehensive synthesis of current knowledge on explanatory models and instruments assessing OR for KT. Moreover, this project aims to create more consensus on the theoretical underpinnings and the instrumentation of OR for KT in chronic care. The final product--a comprehensive and valid OR for KT instrument--will provide the chronic care settings with an instrument to assess their readiness to implement evidence-based chronic care.
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Affiliation(s)
- Marie-Pierre Gagnon
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada.
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Gagnon MP, Ouimet M, Godin G, Rousseau M, Labrecque M, Leduc Y, Ben Abdeljelil A. Multi-level analysis of electronic health record adoption by health care professionals: a study protocol. Implement Sci 2010; 5:30. [PMID: 20416054 PMCID: PMC2873301 DOI: 10.1186/1748-5908-5-30] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 04/23/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The electronic health record (EHR) is an important application of information and communication technologies to the healthcare sector. EHR implementation is expected to produce benefits for patients, professionals, organisations, and the population as a whole. These benefits cannot be achieved without the adoption of EHR by healthcare professionals. Nevertheless, the influence of individual and organisational factors in determining EHR adoption is still unclear. This study aims to assess the unique contribution of individual and organisational factors on EHR adoption in healthcare settings, as well as possible interrelations between these factors. METHODS A prospective study will be conducted. A stratified random sampling method will be used to select 50 healthcare organisations in the Quebec City Health Region (Canada). At the individual level, a sample of 15 to 30 health professionals will be chosen within each organisation depending on its size. A semi-structured questionnaire will be administered to two key informants in each organisation to collect organisational data. A composite adoption score of EHR adoption will be developed based on a Delphi process and will be used as the outcome variable. Twelve to eighteen months after the first contact, depending on the pace of EHR implementation, key informants and clinicians will be contacted once again to monitor the evolution of EHR adoption. A multilevel regression model will be applied to identify the organisational and individual determinants of EHR adoption in clinical settings. Alternative analytical models would be applied if necessary. RESULTS The study will assess the contribution of organisational and individual factors, as well as their interactions, to the implementation of EHR in clinical settings. CONCLUSIONS These results will be very relevant for decision makers and managers who are facing the challenge of implementing EHR in the healthcare system. In addition, this research constitutes a major contribution to the field of knowledge transfer and implementation science.
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Affiliation(s)
- Marie-Pierre Gagnon
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Faculty of Nursing Sciences, Université Laval, Québec, Canada
| | - Mathieu Ouimet
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Department of Political Science, Université Laval, Québec, Canada
| | - Gaston Godin
- Faculty of Nursing Sciences, Université Laval, Québec, Canada
| | - Michel Rousseau
- Department of Family Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Michel Labrecque
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Department of Family Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Yvan Leduc
- Department of Family Medicine, Faculty of Medicine, Université Laval, Québec, Canada
| | - Anis Ben Abdeljelil
- Research Center of the Centre Hospitalier Universitaire de Québec, Québec, Canada
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Krones T, Keller H, Becker A, Sönnichsen A, Baum E, Donner-Banzhoff N. The theory of planned behaviour in a randomized trial of a decision aid on cardiovascular risk prevention. PATIENT EDUCATION AND COUNSELING 2010; 78:169-176. [PMID: 19665340 DOI: 10.1016/j.pec.2009.06.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Revised: 06/29/2009] [Accepted: 06/29/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the feasibility and outcome of measuring the theory of planned behaviour (TPB) in patients receiving routine counselling versus counselling with a decision aid (DA) during primary care consultation on cardiovascular risk prevention. METHODS A DA was developed, based on models of shared decision-making (SDM) and the TPB. We evaluated the impact of the intervention in a randomized controlled trial. Main outcomes were previously reported. To assess the intermediate social cognitive processes and our theoretical framework, we evaluated the impact of the intervention on a TPB scale. RESULTS The TPB scale showed satisfactory measurement properties. Factor analysis (main component analysis, confirmatory model) could mostly replicate the assumptions of the model. 44% of variance of the behavioural intention to adhere to the decision after counselling was explained in linear regression models. Of the TPB components, only attitude towards the decision and moral norm were significantly more positive in the intervention. No difference was found with regard to intention to adhere to the decision. High risk resulted in higher values of the TPB components in both groups. CONCLUSION Most DAs are developed and tested without explicitly referring to a theoretical model of psychosocial processes. The TPB may serve as a useful theoretical framework. PRACTICE IMPLICATIONS Trials on DAs demonstrate positive effects on psychological outcomes of patients without leading to better objective health results. Our study might contribute to an explanation: DAs might not cause stronger adherence to decisions even though one's attitude towards the decision becomes more positive.
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Affiliation(s)
- Tanja Krones
- Department of Family Practice, University of Marburg, Germany & Bioethics-Clinical Ethics, University of Marburg, Baldingerstrasse, 35033 Marburg, Germany.
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Légaré F, Brouillette MH. Shared decision-making in the context of menopausal health: Where do we stand? Maturitas 2009; 63:169-75. [DOI: 10.1016/j.maturitas.2009.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 01/25/2009] [Indexed: 10/21/2022]
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Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, Hall W, Tett SE. Systematic Review of Interventions to Improve Prescribing. Ann Pharmacother 2009; 43:502-13. [DOI: 10.1345/aph.1l488] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To update 2 comprehensive reviews of systematic reviews on prescribing interventions and identify the latest evidence about the effectiveness of the interventions. Data Sources: Systematic searches for English-language reports of experimental and quasi-experimental research were conducted in PubMed(1951–May 2007). EMBASE (1974–March 2008), International Pharmaceutical Abstracts (1970–March 2008), and 11 other bibliographic databases of medical, social science, and business research. Following an initial title screening process and after selecting 6 specific intervention categories (identified from the previous reviews) in community settings, 2 reviewers independently assessed abstracts and then full studies for relevance and quality and extracted relevant data using formal assessment and data extraction tools. Results were then methodically incorporated into the findings of the 2 earlier reviews of systematic reviews. Data Selection And Synthesis: Twenty-nine of 26,314 articles reviewed were assessed to be of relevant, high-quality research. Audit and feedback, together with educational outreach visits, were the focus of the majority of recent, high-quality research into prescribing interventions. These interventions were also the most effective in improving prescribing practice. A smaller number of studies included a patient-mediated intervention; this intervention was not consistently effective. There is insufficient recent research into manual reminders to confidently update earlier reviews and there remains insufficient evidence to draw conclusions regarding the effectiveness of local consensus processes or multidisciplinary teams. Conclusions: Educational outreach as well as audit and feedback continue to dominate research into prescribing interventions. These 2 prescribing interventions also most consistently show positive results. Much less research is conducted into other types of interventions and there is still very little effort to systematically test why interventions do or do not work.
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Affiliation(s)
- Remo Ostini
- School of Pharmacy, The University of Queensland, Brisbane, Australia
| | - Desley Hegney
- UQ/Blue Care Research & Practice Development Centre, School of Nursing & Midwifery, The University of Queensland
| | | | - Margaret Williamson
- Research and Development, National Prescribing Service Ltd., Surry Hills, Australia
| | - Judith M Mackson
- Education and Quality Assurance Program, National Prescribing Service Ltd
| | - Karin Gurman
- Education and Quality Assurance Program, National Prescribing Service Ltd
| | - Wayne Hall
- School of Population Health, The University of Queensland
| | - Susan E Tett
- Faculty of Health Sciences, The University of Queensland
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Frosch DL, Légaré F, Mangione CM. Using decision aids in community-based primary care: a theory-driven evaluation with ethnically diverse patients. PATIENT EDUCATION AND COUNSELING 2008; 73:490-6. [PMID: 18771875 PMCID: PMC2892794 DOI: 10.1016/j.pec.2008.07.040] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2007] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the effects of informational brochures and video decision aids about cancer screening on patient intention to engage in shared decision-making and its predictors in a racially diverse sample. METHODS Participants were recruited from 13 community-based primary care practices serving racially and ethnically diverse patients in predominately economically disadvantaged neighborhoods. Participants completed theory-based measures assessing attitudes, perceived social norms, self-efficacy and intentions for working with their physician to make a cancer screening decision after reviewing a brochure or video decision aid, but before seeing the physician. A post-questionnaire assessed screening decisions and participant knowledge. RESULTS Participants who reviewed a video decision aid had higher knowledge and were more likely to want to be the primary decision-maker. They reported lower perceived social norms, self-efficacy and intentions to work with their physicians than participants who reviewed a brochure. Participants who decided against cancer screening reported lower intentions to work with their physician in making a decision and were less likely to report having spoken with their physician about screening. CONCLUSION Participants who opted against cancer screening after reviewing a brochure or decision aid were less likely to discuss their decision with their physician. The tendency toward autonomous decision-making was stronger among participants who reviewed a video decision aid.
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Affiliation(s)
- Dominick L Frosch
- Department of Medicine, Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, CA 90024, United States.
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Desroches S, Gagnon MP, Tapp S, Légaré F. Implementing shared decision-making in nutrition clinical practice: a theory-based approach and feasibility study. Implement Sci 2008; 3:48. [PMID: 18986527 PMCID: PMC2612694 DOI: 10.1186/1748-5908-3-48] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 11/05/2008] [Indexed: 01/08/2023] Open
Abstract
Background There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior. Methods Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval. Discussion The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings. It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.
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Affiliation(s)
- Sophie Desroches
- Centre de recherche du Centre Hospitalier Universitaire de Québec (CHUQ), Hôpital St-François d'Assise, 45, rue Leclerc, Québec, G1L 3L5, Canada.
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15
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Farmer AP, Légaré F, Turcot L, Grimshaw J, Harvey E, McGowan JL, Wolf F. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2008:CD004398. [PMID: 18646106 DOI: 10.1002/14651858.cd004398.pub2] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Printed educational materials (PEMs) are widely used passive dissemination strategies to improve knowledge, awareness, attitudes, skills, professional practice and patient outcomes. Traditionally they are presented in paper formats such as monographs, publication in peer-reviewed journals and clinical guidelines and appear to be the most frequently adopted method for disseminating information. OBJECTIVES To determine the effectiveness of PEMs in improving process outcomes (including the behaviour of healthcare professionals) and patient outcomes. To explore whether the effect of characteristics of PEMs (e.g., source, content, format, mode of delivery, timing/frequency, complexity of targeted behaviour change) can influence process outcomes (including the behaviour of healthcare professionals and patient outcomes). SEARCH STRATEGY The following electronic databases were searched up to July 2006: (a) The EPOC Group Specialised Register (including the database of studies awaiting assessment (see 'Specialised Register'under 'Group Details'); (b) The Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Abstracts of Reviews of Effectiveness; (c) MEDLINE, EMBASE, CINAHL and CAB Health. An updated search of MEDLINE was done in March 2007. SELECTION CRITERIA We included randomised controlled trials (RCTs) , controlled clinical trials (CCT), controlled before and after studies (CBAs) and interrupted time series analyses (ITS) that evaluated the impact of printed educational materials on healthcare professionals' practice and/or patient outcomes. There was no language restriction. Any objective measure of professional performance (sch as number of tests ordered, prescriptions for a particular drug), or patient health outcomes (e.g., blood pressure, number of caesarean sections) were included. DATA COLLECTION AND ANALYSIS Four reviewers undertook data abstraction independently using a modified version of the EPOC data collection checklist. Any disagreement was resolved by discussion among the reviewers and arbitrators. Statistical analysis was based upon consideration of dichotomous process outcomes, continuous process outcomes, patient outcome dichotomous measures and patient outcome continuous measures. We presented the results for all comparisons using a standard method of presentation where possible. We reported separately for each study the median effect size for each type of outcome, and the median of these effect sizes across studies. MAIN RESULTS Twenty-three studies were included for this review. Evidence from this review showed that PEMs appear to have small beneficial effects on professional practice. RCTs comparing PEMs to no intervention observed an absolute risk difference median: +4.3% on categorical process outcomes (e.g., x-ray requests, prescribing and smoking cessation activities) (range -8.0% to +9.6%, 6 studies), and a relative risk difference +13.6% on continuous process outcomes (e.g., medication change, x-rays requests per practice) (range -5.0% to +26.6%, 4 studies). These findings are similar to those reported for the ITS studies, although significantly larger effect sizes were observed (relative risk difference range from 0.07% to 31%). In contrast, the median effect size was -4.3% for patient outcome categorical measures (e.g., screening, return to work, quit smoking) (range -0.4% to -4.6%, 3 studies)). Two studies reported deteriorations in continuous patient outcome data (e.g., depression score, smoking cessation attempts) of -10.0% and -20.5%. One study comparing PEMs with educational workshops observed minimal differences. Two studies comparing PEMs and education outreach did not have statistically significant differences between the groups. It was not possible to explore potential effect modifiers across studies. AUTHORS' CONCLUSIONS The results of this review suggest that when compared to no intervention, PEMs when used alone may have a beneficial effect on process outcomes but not on patient outcomes. Despite this wide of range of effects reported for PEMs, clinical significance of the observed effect sizes is not known. There is insufficient information about how to optimise educational materials. The effectiveness of educational materials compared to other interventions is uncertain.
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Affiliation(s)
- Anna P Farmer
- Department of Agricultural, Food and Nutritional Science and The Centre for Health Promotion Studies, University of Alberta, 4-10 Agricultural and Forestry Centre, Edmonton, Alberta, Canada, T6H 4J1.
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Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals' intentions and behaviours: a systematic review of studies based on social cognitive theories. Implement Sci 2008; 3:36. [PMID: 18631386 PMCID: PMC2507717 DOI: 10.1186/1748-5908-3-36] [Citation(s) in RCA: 601] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/16/2008] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND There is an important gap between the implications of clinical research evidence and the routine clinical practice of healthcare professionals. Because individual decisions are often central to adoption of a clinical-related behaviour, more information about the cognitive mechanisms underlying behaviours is needed to improve behaviour change interventions targeting healthcare professionals. The aim of this study was to systematically review the published scientific literature about factors influencing health professionals' behaviours based on social cognitive theories. These theories refer to theories where individual cognitions/thoughts are viewed as processes intervening between observable stimuli and responses in real world situations. METHODS We searched psycINFO, MEDLINE, EMBASE, CIHNAL, Index to theses, PROQUEST dissertations and theses and Current Contents for articles published in English only. We included studies that aimed to predict healthcare professionals' intentions and behaviours with a clear specification of relying on a social cognitive theory. Information on percent of explained variance (R(2)) was used to compute the overall frequency-weighted mean R(2) to evaluate the efficacy of prediction in several contexts and according to different methodological aspects. The cognitive factors most consistently associated with prediction of healthcare professionals' intention and behaviours were documented. RESULTS Seventy eight studies met the inclusion criteria. Among these studies, 72 provided information on the determinants of intention and 16 prospective studies provided information on the determinants of behaviour. The theory most often used as reference was the Theory of Reasoned Action (TRA) or its extension the Theory of Planned Behaviour (TPB). An overall frequency-weighted mean R(2) of 0.31 was observed for the prediction of behaviour; 0.59 for the prediction of intention. A number of moderators influenced the efficacy of prediction; frequency-weighted mean R(2) varied from 0.001 to 0.58 for behaviour and 0.19 to 0.81 for intention. CONCLUSION Our results suggest that the TPB appears to be an appropriate theory to predict behaviour whereas other theories better capture the dynamic underlying intention. In addition, given the variations in efficacy of prediction, special care should be given to methodological issues, especially to better define the context of behaviour performance.
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Affiliation(s)
- Gaston Godin
- Canada Research Chair on Behaviour and Health, Laval University, Québec, Canada
| | - Ariane Bélanger-Gravel
- Research Group on Behaviour and Health, Faculty of Nursing, Laval University, Québec, Canada
| | - Martin Eccles
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
- Department of Medicine, University of Ottawa, Ontario, Canada
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Légaré F, Elwyn G, Fishbein M, Frémont P, Frosch D, Gagnon MP, Kenny DA, Labrecque M, Stacey D, St-Jacques S, van der Weijden T. Translating shared decision-making into health care clinical practices: proof of concepts. Implement Sci 2008; 3:2. [PMID: 18194521 PMCID: PMC2265300 DOI: 10.1186/1748-5908-3-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 01/14/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is considerable interest today in shared decision-making (SDM), defined as a decision-making process jointly shared by patients and their health care provider. However, the data show that SDM has not been broadly adopted yet. Consequently, the main goal of this proposal is to bring together the resources and the expertise needed to develop an interdisciplinary and international research team on the implementation of SDM in clinical practice using a theory-based dyadic perspective. METHODS Participants include researchers from Canada, US, UK, and Netherlands, representing medicine, nursing, psychology, community health and epidemiology. In order to develop a collaborative research network that takes advantage of the expertise of the team members, the following research activities are planned: 1) establish networking and on-going communication through internet-based forum, conference calls, and a bi-weekly e-bulletin; 2) hold a two-day workshop with two key experts (one in theoretical underpinnings of behavioral change, and a second in dyadic data analysis), and invite all investigators to present their views on the challenges related to the implementation of SDM in clinical practices; 3) conduct a secondary analyses of existing dyadic datasets to ensure that discussion among team members is grounded in empirical data; 4) build capacity with involvement of graduate students in the workshop and online forum; and 5) elaborate a position paper and an international multi-site study protocol. DISCUSSION This study protocol aims to inform researchers, educators, and clinicians interested in improving their understanding of effective strategies to implement shared decision-making in clinical practice using a theory-based dyadic perspective.
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Affiliation(s)
- France Légaré
- Centre hospitalier universitaire de Québec, Hôpital St-François D'Assise, Unité de recherche évaluative, 10 rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - Glyn Elwyn
- Department of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park CF 14 4YS, UK
| | - Martin Fishbein
- Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104, USA
| | - Pierre Frémont
- Centre hospitalier universitaire de Québec, Hôpital St-François D'Assise, Unité de recherche évaluative, 10 rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - Dominick Frosch
- UCLA Med-GIM & HSR, BOX 951736, 911 Broxton, Los Angeles, CA 90095-1736, USA
| | - Marie-Pierre Gagnon
- Centre hospitalier universitaire de Québec, Hôpital St-François D'Assise, Unité de recherche évaluative, 10 rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - David A Kenny
- Department of Psychology, University of Connecticut, 406 Babbidge Road Unit 1020 Storrs, CT 06269-1020, USA
| | - Michel Labrecque
- Centre hospitalier universitaire de Québec, Hôpital St-François D'Assise, Unité de recherche évaluative, 10 rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth, Room RGN 3247A Ottawa, ON K1H 8M5, Canada
| | - Sylvie St-Jacques
- Centre hospitalier universitaire de Québec, Hôpital St-François D'Assise, Unité de recherche évaluative, 10 rue de l'Espinay, Québec, Québec, G1L 3L5, Canada
| | - Trudy van der Weijden
- Department of General Practice/School of Public Health and Primary Care Caphri, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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Godin G, Beaulieu D, Touchette JS, Lambert LD, Dodin S. Intention to encourage complementary and alternative medicine among general practitioners and medical students. Behav Med 2007; 33:67-77. [PMID: 17711808 DOI: 10.3200/bmed.33.2.67-79] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The authors' goal was to identify factors explaining intention to encourage a patient to follow complementary and alternative medicine (CAM) treatment among general practitioners (GPs), fourth-year medical students, and residents in family medicine. They surveyed 500 GPs and 904 medical students via a self-administered mailed questionnaire that they based on the Theory of Planned Behavior. Respondents expressed a neutral level of intention to encourage CAM approach. Variables explaining 75% of variance of intention of all participants were: moral norm, beta=0.34, p<.0001; perceived behavioral control, beta=0.29, p<.0001; attitude, beta=0.22, p<.0001; descriptive norm, beta=0.13, p<.0001; and professional status, (GPs, beta=-0.07, p<.0001; residents, beta=-0.07, p<.0001). Facilitating conditions and developing a better perception of control over perceived obstacles could help enhance health-care practitioners' intentions to use CAM. Also, a clear position on the part of the medical community would help to define a professional norm in line with the moral norm.
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Affiliation(s)
- Gaston Godin
- The Faculty of Nursing, Laval University, Quebec, Canada.
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Doi SAR, Amigo MF. Nurses' intentions to wear gloves during venipuncture procedures: a behavioral psychology perspective. Infect Control Hosp Epidemiol 2007; 28:747-50. [PMID: 17520556 DOI: 10.1086/517978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 10/19/2006] [Indexed: 11/04/2022]
Abstract
Registered nurses working at a teaching hospital in Kuwait were surveyed to assess the psychosocial variables associated with their intention to comply with glove-wearing recommendations. Perceived consequences and normative beliefs, as well as sex and years of nursing experience, significantly influenced their behavioral intentions, suggesting that improvements in intention to comply are more likely to come from practical demonstrations that show nurses the potential outcomes of both using and not using gloves.
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Affiliation(s)
- Suhail A R Doi
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Australia.
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Evaluation of Healthcare IT Applications: The User Acceptance Perspective. ADVANCED COMPUTATIONAL INTELLIGENCE PARADIGMS IN HEALTHCARE-2 2007. [DOI: 10.1007/978-3-540-72375-2_4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Gravel K, Légaré F, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: a systematic review of health professionals' perceptions. Implement Sci 2006; 1:16. [PMID: 16899124 PMCID: PMC1586024 DOI: 10.1186/1748-5908-1-16] [Citation(s) in RCA: 463] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 08/09/2006] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared decision-making is advocated because of its potential to improve the quality of the decision-making process for patients and ultimately, patient outcomes. However, current evidence suggests that shared decision-making has not yet been widely adopted by health professionals. Therefore, a systematic review was performed on the barriers and facilitators to implementing shared decision-making in clinical practice as perceived by health professionals. METHODS Covering the period from 1990 to March 2006, PubMed, Embase, CINHAL, PsycINFO, and Dissertation Abstracts were searched for studies in English or French. The references from included studies also were consulted. Studies were included if they reported on health professionals' perceived barriers and facilitators to implementing shared decision-making in their practices. Shared decision-making was defined as a joint process of decision making between health professionals and patients, or as decision support interventions including decision aids, or as the active participation of patients in decision making. No study design was excluded. Quality of the studies included was assessed independently by two of the authors. Using a pre-established taxonomy of barriers and facilitators to implementing clinical practice guidelines in practice, content analysis was performed. RESULTS Thirty-one publications covering 28 unique studies were included. Eleven studies were from the UK, eight from the USA, four from Canada, two from The Netherlands, and one from each of the following countries: France, Mexico, and Australia. Most of the studies used qualitative methods exclusively (18/28). Overall, the vast majority of participants (n = 2784) were physicians (89%). The three most often reported barriers were: time constraints (18/28), lack of applicability due to patient characteristics (12/28), and lack of applicability due to the clinical situation (12/28). The three most often reported facilitators were: provider motivation (15/28), positive impact on the clinical process (11/28), and positive impact on patient outcomes (10/28). CONCLUSION This systematic review reveals that interventions to foster implementation of shared decision-making in clinical practice will need to address a broad range of factors. It also reveals that on this subject there is very little known about any health professionals others than physicians. Future studies about implementation of shared decision-making should target a more diverse group of health professionals.
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Affiliation(s)
- Karine Gravel
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada
| | - France Légaré
- Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada
- Department of Family Medicine, Université Laval, Québec, Canada
| | - Ian D Graham
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Gagnon MP, Sánchez E, Pons JMV. From recommendation to action: psychosocial factors influencing physician intention to use Health Technology Assessment (HTA) recommendations. Implement Sci 2006; 1:8. [PMID: 16722600 PMCID: PMC1459199 DOI: 10.1186/1748-5908-1-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Accepted: 03/31/2006] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. The selected recommendations were prioritisation systems for patients on waiting lists for two surgical procedures: hip and knee replacement and cataract surgery. METHODS Determinants of physician intention to use HTA recommendations for patient prioritisation were assessed by a questionnaire based upon the Theory of Interpersonal Behaviour. A total of 96 physicians from two medical specialties (ophthalmology and orthopaedic surgery) responded to the questionnaire (response rate 44.2%). A multiple analysis of variance (MANOVA) was performed to assess differences between medical specialties on the set of theoretical variables. Given the main effect difference between specialties, two regression models were tested separately to assess the psychosocial determinants of physician intention to use HTA recommendations for the prioritisation of patients on waiting lists for surgical procedures. RESULTS Factors influencing physician intention to use HTA recommendations differ between groups of specialists. Intention to use the prioritisation system for patients on waiting lists for cataract surgery among ophthalmologists was related to attitude towards the behaviour, social norms, as well as personal normative beliefs. Intention to use HTA recommendations for patient prioritisation for hip and knee replacement among orthopaedic surgeons was explained by: perception of conditions that facilitated the realisation of the behaviour, personal normative beliefs, and habit of using HTA recommendations in clinical work. CONCLUSION This study offers a model to assess factors influencing the intention to adopt recommendations from health technology assessment into professional practice. Results identify determinant factors that should be considered in the elaboration of strategies to support the implementation of evidence-based practice, with respect to emerging health technologies and modalities of practice. However, it is important to emphasise that behavioural determinants of evidence-based practice vary according to the specific technology considered. Evidence-based implementation of HTA recommendations, as well as other evidence-based practices, should build on a theoretical understanding of the complex forces that shape the practice of healthcare professionals.
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Affiliation(s)
| | - Emília Sánchez
- Catalan Agency for Health Technology Assessment and Research (CAHTAR), Barcelona, Spain
| | - Joan MV Pons
- Catalan Agency for Health Technology Assessment and Research (CAHTAR), Barcelona, Spain
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