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Patey AM, Amarbayan MM, Lee K, Bruce M, Bettinger JA, Pringle W, Donald M, Castillo E. Factors that influence vaccination communication during pregnancy: provider and patient perspectives using the theoretical domains framework. JBI Evid Implement 2024:02205615-990000000-00128. [PMID: 39287138 DOI: 10.1097/xeb.0000000000000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Vaccination during pregnancy is recommended but uptake is low and evidence on the topic is limited. AIMS This study aimed to identify the drivers of current behavior and barriers to change for health care practitioners (HCPs) and pregnant patients in Canada. METHODS This study is an in-depth qualitative investigation of the factors influencing HCPs' vaccination communication during pregnancy, as well as factors influencing pregnant patients' vaccination uptake in Canada using the Theoretical Domains Framework. Three data sources were used: (1) perinatal HCP interviews before COVID-19; (2) perinatal HCP interviews regarding vaccine communication after COVID-19; and (3) survey of pregnant or lactating women after COVID-19. RESULTS Forty-seven interviews and 169 participant responses were included. Perinatal HCPs reported limited information on vaccine communication or difficulty keeping up-to-date (Environmental context and resources; Knowledge; Beliefs about capabilities). HCPs lacked confidence and struggled with lack of training to address vaccine hesitancy without alienating patients (Beliefs about capabilities; Skills). Pregnant or lactating women struggled with the amount of information they felt was imposed on them, had concerns about the perceived negative consequences of vaccination, and felt pressure to understand what was best for them and their babies (Knowledge; Beliefs about consequences; Social influences). CONCLUSIONS Our study provides a theory-based approach to identify influencing factors that can be mapped to theory-based intervention components, improving the likelihood of intervention effectiveness. The study is the first step in adapting an existing intervention to improve vaccine communication during pregnancy, ultimately, increasing vaccination uptake. SPANISH ABSTRACT http://links.lww.com/IJEBH/A260.
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Affiliation(s)
- Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, ON, Canada
- Medicine, Quality and Safety, IWK Health, NS, Canada
| | - Mungunzul M Amarbayan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kate Lee
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcia Bruce
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Julie A Bettinger
- Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Wendy Pringle
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Maoliosa Donald
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eliana Castillo
- Departments of Medicine and Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
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Robak N, Broeckelmann E, Mior S, Atkinson-Graham M, Ward J, Scott M, Passmore S, Kopansky-Giles D, Tavares P, Moss J, Ladwig J, Glazebrook C, Monias D, Hamilton H, McKay D, Smolinski R, Haldeman S, Bussières A. Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF). Implement Sci Commun 2024; 5:100. [PMID: 39289772 PMCID: PMC11406944 DOI: 10.1186/s43058-024-00636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/07/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies. METHOD A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners. RESULTS Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session. CONCLUSION Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.
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Affiliation(s)
- Nicole Robak
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - Elena Broeckelmann
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - Silvano Mior
- Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Melissa Atkinson-Graham
- Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Département Chiropratique, Boulevard Des Forges, Université du Québec À , Trois-Rivières, Trois-Rivières , Canada
- Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada
| | - Jennifer Ward
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - Muriel Scott
- Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada
| | - Steven Passmore
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - Deborah Kopansky-Giles
- Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5 Floor, Toronto, ON, M5G 1V7, Canada
| | - Patricia Tavares
- Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada
| | - Jean Moss
- World Spine Care Canada, 3000 Langstaff Road Unit 15, Concord, ON, L4K 4R7, Canada
| | - Jacqueline Ladwig
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - Cheryl Glazebrook
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada
| | - David Monias
- Cross Lake Band, Cross Lake, No. 276 Pimicikamak Okimawin, P.O Box 10, Cross Lake, MB, R0B0J0, Canada
| | - Helga Hamilton
- Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada
| | - Donnie McKay
- Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada
| | - Randall Smolinski
- Cross Lake Nursing Station, Box 160 Cross Lake, Manitoba, R0B 0J0, Canada
| | - Scott Haldeman
- University of California, Irvine, Irvine, CA, 92697, USA
- World Spine Care, 17602 17 Street, Suite 102-263, Tustin, CA, 92780, USA
| | - André Bussières
- Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada.
- Département Chiropratique, Boulevard Des Forges, Université du Québec À , Trois-Rivières, Trois-Rivières , Canada.
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 Prom Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.
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McBain K, Dinh C, Haffar M, Steinberg E, Cachecho S, Bussières A, Dahan-Oliel N. Perspectives from clinicians and managers: facilitators and barriers to the uptake of rehabilitation guidance for children with arthrogryposis. Disabil Rehabil 2024; 46:4140-4156. [PMID: 37782214 DOI: 10.1080/09638288.2023.2263361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To identify the perceived facilitators and barriers among clinicians and managers about the uptake of expert guidance for rehabilitation of children with arthrogryposis multiplex congenita (AMC) in practice. METHODS Qualitative study using individual interviews, guided by the Theoretical Domains Framework (TDF), to explore beliefs and to identify facilitators and barriers to guidance uptake. Interviews were conducted with a convenience sample of 15 clinicians working with children with AMC and four pediatric clinical managers using Microsoft Teams©. Interviews were then transcribed verbatim and analyzed by four independent reviewers using deductive and inductive coding. RESULTS The TDF domains of Environmental Context and Resources, Behavioural Regulation, Reinforcement, Beliefs about Consequences, and Social Influences were shared amongst clinicians and clinical managers across North America and Europe as being relevant and influential on the target behaviour of using rehabilitation expert guidance to manage pediatric patients. Among clinicians only, the domain Memory, Attention, and Decision-Making Processes was also found relevant. Among managers only, the domain Social/Professional Role and Identity was found relevant. CONCLUSIONS Coupling shared relevant domains amongst clinicians and managers with individual supports and barriers helps to map out what is needed to promote the uptake of rehabilitation guidance at multiple levels.
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Affiliation(s)
- Kimberly McBain
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cameron Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Melanie Haffar
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Emily Steinberg
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sarah Cachecho
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Noémi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
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Wu X, Kuang Y, Guo Y, Wei N, Fan Z, Ling J. Analyzing the barriers and enablers to internet hospital implementation: a qualitative study of a tertiary hospital using TDF and COM-B framework. Front Digit Health 2024; 6:1362395. [PMID: 39175961 PMCID: PMC11340510 DOI: 10.3389/fdgth.2024.1362395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/28/2024] [Indexed: 08/24/2024] Open
Abstract
Background Internet hospitals have become an important way to improve the accessibility of medical services and promote medical equity in China. However, there is still lack of research on the behavior of medical personnel during the process of using Internet medical services, and the elements of behavior that motivate doctors to actively use or resist the use of Internet hospitals are still not fully analyzed. The study applied the Theoretical Domains Framework to examine the factors affecting the engagement of medical personnel in Internet hospitals, with the aim of guiding the design of intervention to enhance Internet hospital participation. Methods This study utilized qualitative analysis. Semi-structured questionnaires based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model was developed and administered to 40 doctors and nurses at a Grade A tertiary hospital in Guangdong Province. Data was coded and analyzed using qualitative methods including Nvivo software. Results The research displayed 19 barriers and 7 enablers for the implementation of Internet hospitals, all 14 TDF domains impacted participation with motivation cited most frequently. Despite challenges, medical personnel exhibited a generally optimistic stance towards utilization of the Internet hospital. Major barriers include the higher requirement of diagnostic ability, objective difficulties brought by online consultation to the decision-making process, limitation of time and other resources, not ideal technological and institutional environment, lack of self-efficacy and negative expectation of results in online consultation. Key enablers include patient needs and the positive impact of online care on the medical process and patient experience. Discussion This qualitative study identified a range of barriers and enablers to Internet hospital participation according to medical personnel, providing an conceptual framework to guide further research evaluating implementation strategies. Expanded research and targeted interventions design can help optimize participation in this evolving healthcare delivery model.
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Affiliation(s)
- Xiaolong Wu
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yulin Kuang
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yonglin Guo
- School of Government, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Ning Wei
- Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, Guangdong, China
| | - Zichun Fan
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Jingru Ling
- Business School, Sun Yat-sen University, Shenzhen, Guangdong, China
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Evrard P, Henrard S, Spinewine A. Development of a Behavior-Change Intervention toward Benzodiazepine Deprescribing in Older Adults Living in Nursing Homes. J Am Med Dir Assoc 2024; 25:105053. [PMID: 38838741 DOI: 10.1016/j.jamda.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE We aimed to develop a context-specific intervention toward benzodiazepine deprescribing in nursing homes (NHs), with insights from behavior-change theories and involvement of stakeholders. DESIGN Selection of behavior change techniques (BCTs), through online survey and group discussion, followed by operationalization of these BCTs into intervention components. SETTING AND PARTICIPANTS The intervention was developed for Belgian NHs, involving various stakeholders: health care professionals (HCPs), NH administrators, and policy makers. METHODS Using the Theory and Techniques Tool, we preselected the BCTs linked to one of the 9 Theoretical Domain Framework domains identified as being the main barriers for benzodiazepine deprescribing in Belgian NHs. These were then presented to stakeholders. Based on the APEASE (Acceptability, Practicability, Effectiveness, Affordability, Side-effects, and Ethics) criteria, participants ranked BCTs through an online survey, and then performed final selection during a group discussion. Selected BCTs were operationalized into intervention components, with specific contents and methods of delivery validated by stakeholders. RESULTS Thirty-seven potential BCTs were identified. Eighteen stakeholders participated in the survey, and 7 in the group discussion. This led to the final inclusion of 9 BCTs: instruction on how to perform the behavior, information about health consequences, pros and cons, problem solving, goal setting (behavior), social comparison, restructuring physical environment, restructuring social environment, and graded tasks. These BCTs were operationalized into a 6-component intervention: process and goal setting, HCP education, physical environment adaptations, audit and feedback, NH residents' and relatives' increased awareness, and multidisciplinary work. CONCLUSION AND IMPLICATIONS Use of a theory-based approach toward intervention development has the potential to improve the probability of its feasibility and effectiveness in tackling barriers to benzodiazepine deprescribing. By doing so, we have developed a multifaceted approach with actions taken at the patient, HCP, and NH levels. Our novel 6-component intervention will be evaluated in a pilot cluster-randomized controlled trial to assess its feasibility.
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Affiliation(s)
- Perrine Evrard
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
| | - Séverine Henrard
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium; Institute of Health and Society (IRSS), UCLouvain, Brussels, Belgium
| | - Anne Spinewine
- Clinical Pharmacy and Pharmacoepidemiology Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium; Pharmacy Department, CHU UCL Namur, UCLouvain, Yvoir, Belgium
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Searant I, Brown BT, Jenkins HJ. Chiropractors' perceptions on the use of spinal radiographs in clinical practice: a qualitative study. Chiropr Man Therap 2024; 32:23. [PMID: 38909258 PMCID: PMC11193277 DOI: 10.1186/s12998-024-00547-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/18/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Radiography is commonly used in the assessment of spinal disorders, despite a lack of high-quality evidence demonstrating improved clinical outcomes or additional benefit to the patient. There is disagreement amongst chiropractors regarding the appropriate use of radiography for clinical management. This study aims to qualitatively explore chiropractors' perceptions on the use of spinal radiographs in clinical practice with respect to how they determine when to order radiographs; and how they use radiographs to inform clinical management. METHODS Online qualitative semi-structured interviews were conducted with 17 Australian chiropractors who currently manage patients with spinal disorders. Convienence, snowball, and purposive sampling strategies were used to ensure an appropriate breadth and depth of participant characterisitcs and beliefs. Interview data were recorded, transcribed and analysed using framework analysis. RESULTS Three themes were developed to describe how chiropractors determined when to order radiographs. These themes included specific findings from the clinical encounter that may inform clinical management, their perceptions of radiation risk, and the influence of clinical experience/intuition. Three themes and four subthemes were developed for how chiropractors use radiographs to inform their management. These themes explored the use of radiography for the application of chiropractic technique, as well as the role of radiographs in predicting patient prognosis, and as an educational tool to provide reassurance. CONCLUSION Australian chiropractors' decision-making around spinal radiography is diverse and can be influenced by a number of clinical and external factors. Previously unexplored uses of spinal radiography in clinical practice were highlighted. Some chiropractors reported potential benefits of radiography that are currently not supported by research evidence. Future research should address how radiographic findings are reported to patients with spinal disorders and how this could be optimised to improve patient outcomes.
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Affiliation(s)
- Isaac Searant
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Benjamin T Brown
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Hazel J Jenkins
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Song YP, Liu JL, Zong CZ, Zhang FS, Ren YF, Ching YL, Wang YX, Li WX, Zhao H, Huang YR, Gao K. A bibliometric study on trends in chiropractic research from 1920 to 2023. Complement Ther Med 2024; 82:103038. [PMID: 38582375 DOI: 10.1016/j.ctim.2024.103038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 03/25/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE An increasing body of evidence suggests a positive role of chiropractic in the treatment of neuro-musculoskeletal disorders. This study aims to explore current research hotspots and trends, providing insights into the broad prospects of this field. METHODS A bibliometric review was conducted on all chiropractic articles included in the Web of Science Core Collection before December 31, 2023. RESULTS Over the past century, the volume of research in the field of chiropractic has been fluctuating annually, with four peaks observed in total. The United States, Canada, Australia, and the United Kingdom are leading countries. Chu, Eric Chun-Pu is the author with the most publications, while Bronfort, Gert has the highest total citation count. The University of Southern Denmark has produced the most publications, while Queens University - Canada is the most central institution. The Journal of Manipulative and Physiological Therapeutics is the journal with the most publications and citations, while the Journal of the American Medical Association is the most central journal. The two most-cited articles were both authored by Eisenberg DM. Emerging keywords include "chronic pain" and "skills". The theoretical mechanisms and scientific basis of chiropractic, its clinical practice and safety, education and training, integration with other disciplines, and patient experiences and satisfaction are the frontiers and hotspots of research. CONCLUSION This study integrates bibliometric analysis to summarize the current state of research and global network centers in the field of chiropractic, further highlighting the hotspots and trends in this field. However, Individual and national rankings should be interpreted with caution due to our focus on Web of Science rather than PubMed.
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Affiliation(s)
- Yi-Ping Song
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-Li Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chen-Zhong Zong
- The Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fang-Shuo Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yan-Feng Ren
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuen-Lim Ching
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Xiao Wang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Wen-Xun Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - He Zhao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
| | - Yi-Ran Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China.
| | - Kuo Gao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
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Kisembo HN, Malumba R, Sematimba H, Ankunda R, Nalweyiso ID, Malwadde EK, Rutebemberwa E, Kasasa S, Salama DH, Kawooya MG. Understanding the factors that influence CT utilization for mild traumatic brain injury in a low resource setting - a qualitative study using the Theoretical Domains Framework. Afr J Emerg Med 2024; 14:103-108. [PMID: 38756826 PMCID: PMC11096711 DOI: 10.1016/j.afjem.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction In low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs). Objectives The primary objective was to explore IRs' beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored. Materials and Methods In-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF. Results Eleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.Identified factors within skills domain involved IRs' clinical assessment and decision-making abilities, while beliefs about capabilities and consequences encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The environmental context and resources domain addressed the availability of CT scanners and financial constraints. The knowledge domain elicited IRs' understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For memory, attention & decision processes domain, IRs adherence to guidelines and intentions to order CT scans were cited. Conclusion Using TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others.
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Affiliation(s)
- Harriet Nalubega Kisembo
- Makerere University, College of Health Sciences, School of Medicine
- Department of Radiology, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Richard Malumba
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
| | - Henry Sematimba
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
| | - Racheal Ankunda
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
| | | | - Elsie-Kiguli Malwadde
- African Centre for Global Health and Social Transformation (ACHEST), Kampala, Uganda
| | - Elizeus Rutebemberwa
- School of Public Health, Department of Health Policy & Management, Makerere University, Kampala, Uganda
| | - Simon Kasasa
- Department of Epidemiology & Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | | | - Michael Grace Kawooya
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
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Testa V, Bennett A, Jutai J, Cantor Z, Burke P, McMahon J, Carleton RN, Colman I, Fikretoglu D, Heber A, Leduc S, Heisel MJ, Thavorn K, Corsi DJ, Hatcher S. Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study. Health Promot Chronic Dis Prev Can 2023; 43:431-449. [PMID: 37991887 PMCID: PMC10753900 DOI: 10.24095/hpcdp.43.10/11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
INTRODUCTION First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. METHODS We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. RESULTS The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. CONCLUSION The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.
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Affiliation(s)
- Valerie Testa
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeffrey Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- LIFE Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary Cantor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Paramedic Service, City of Ottawa, Ottawa, Ontario, Canada
| | - Peter Burke
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - James McMahon
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Canadian Institute for Public Safety Research and Treatment, Regina, Saskatchewan, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Operational Health and Performance Section, Defence Research and Development Canada, Toronto, Ontario, Canada
| | - Alexandra Heber
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Veterans Affairs Canada, Ottawa, Ontario, Canada
| | - Shannon Leduc
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Paramedic Service, City of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marnin J Heisel
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Simon Hatcher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wibowo RA, Hartarto RB, Bhattacharjee A, Wardani DTK, Sambodo NP, Santoso Utomo P, Annisa L, Hakim MS, Sofyana M, Dewi FST. Facilitators and barriers of preventive behaviors against COVID-19 during Ramadan: A phenomenology of Indonesian adults. Front Public Health 2023; 11:960500. [PMID: 37033074 PMCID: PMC10073479 DOI: 10.3389/fpubh.2023.960500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/24/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Intercity mobility restriction, physical distancing, and mask-wearing are preventive behaviors to reduce the transmission of COVID-19. However, strong cultural and religious traditions become particular challenges in Indonesia. This study uses the Behavior Change Wheel to explore barriers and facilitators for intercity mobility restriction, physical distancing, and mask-wearing during Ramadan. Methods Semi-structured in-depth interviews with 50 Indonesian adults were conducted between 10 April and 4 June 2020. Having mapped codes into the Capacity, Opportunity, Motivation - Behavior (COM-B), and Theoretical Domain Framework (TDF) model, we conducted summative content analysis to analyze the most identified factors to preventive behaviors and proposed interventions to address those factors. Results Belief about the consequence of preventive behaviors was the most mentioned facilitator to all preventive behaviors among compliers. However, optimism as a TDF factor was commonly mentioned as a barrier to preventive behaviors among non-compliers, while environmental context and resources were the most commonly mentioned factors for intercity mobility restriction. Conclusions Public health intervention should be implemented considering the persuasion and involvement of religious and local leaders. Concerning job and economic context, policy related to the intercity mobility restriction should be reconsidered to prevent a counterproductive effect.
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Affiliation(s)
- Rakhmat Ari Wibowo
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Romi Bhakti Hartarto
- Department of Economics, Faculty of Economics and Business, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Arnab Bhattacharjee
- Edinburgh Business School, Heriot-Watt University, Edinburgh, United Kingdom
- The National Institute of Economic and Social Research, London, United Kingdom
| | - Dyah Titis Kusuma Wardani
- Department of Economics, Faculty of Economics and Business, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Novat Pugo Sambodo
- Center for Health Financing Policy and Health Insurance Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Economics, Faculty of Economics and Business, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Prattama Santoso Utomo
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Luthvia Annisa
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mohamad Saifudin Hakim
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Meida Sofyana
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Perrine E, Damiaens A, Patey AM, Grimshaw JM, Spinewine A. Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100258. [PMID: 37124470 PMCID: PMC10130691 DOI: 10.1016/j.rcsop.2023.100258] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/08/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Background Despite recommendations to deprescribe chronic benzodiazepine receptor agonists (BZRA) among older adults, the prevalence of their use in Belgian nursing homes (NHs) remains above 50%. The use of a behavioral science approach, starting with the evaluation of barriers and enablers for BZRA deprescribing, has the potential to decrease BZRA prescribing. Objectives To identify barriers and enablers for BZRA deprescribing perceived by the different stakeholders involved in nursing home care in Belgium. Methods In a purposive sample of 6 NHs, we conducted face-to-face interviews with general practitioners (GPs), and focus groups with other healthcare providers (HCPs), including nurses, pharmacists, occupational therapists, physical therapists, and with NH residents and relatives. All interviews with HCPs were analyzed through deductive thematic analysis, using the theoretical domains framework (TDF) as the coding framework. Residents' and relatives' interviews were analyzed using an inductive thematic approach. Results We interviewed 13 GPs, 35 other HCPs, 22 nursing home residents, and 5 relatives. Overall, 9 TDF domains were identified as most relevant among HCPs interviewed: Skills, Beliefs about capabilities, Goals, Memory attention and decision processes, Environmental context and resources, Social influences, Knowledge, Social/professional role and identity, and Beliefs about consequences. Five additional themes emerged from residents' and relatives' interviews: knowledge on medications used, communication with NH staff and GPs, perceived efficacy and necessity of BZRA, influence of the environment, and reluctance towards BZRA deprescribing. Some domains and themes differ between stakeholders (e.g., knowledge), while others match between groups (e.g., environmental aspects). Conclusion BZRA deprescribing is influenced by knowledge and skills gaps, automatic BZRA refilling, competing priorities, social challenges, environmental factors and poor nursing home residents involvement. Targeting these barriers will be a key step for implementation of BZRA deprescribing.
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12
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A scoping review of theories used to investigate clinician adherence to clinical practice guidelines. Int J Clin Pharm 2023; 45:52-63. [PMID: 36385205 PMCID: PMC9938823 DOI: 10.1007/s11096-022-01490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors. AIM To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps. METHOD In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed. RESULTS The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators. CONCLUSION There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.
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13
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Shapiro LM, Đình MP, Fox PM, Richard MJ, Eppler SL, Kamal RN. Barriers and Facilitators of Outcome Collection During Hand Surgery Outreach: A Quality Improvement Study. Hand (N Y) 2022; 17:1219-1227. [PMID: 33789491 PMCID: PMC9608306 DOI: 10.1177/15589447211003183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical outreach trips to low- and middle-income countries have been increasing. Outcome collection on these trips, however, has been inconsistent and often incomplete. We conducted a qualitative study of surgeons, administrators, and patients to identify the barriers and facilitators to outcome collection on hand surgery outreach trips to Hospital 175 in Ho Chi Minh City, Vietnam. METHODS A purposive sample of surgeons, administrators, and patients from Hospital 175 were interviewed about their beliefs regarding outcome collection. We used a semi-structured interview guide based on the Theoretical Domains Framework to systematically explore barriers and facilitators. Interviews were recorded, transcribed, and analyzed using content analysis. Beliefs underlying similar responses were identified and aggregated to describe barriers and facilitators of outcome measurement. RESULTS Twelve surgeons and administrative staff (3 visiting and 9 local) and 5 patients were interviewed before saturation was achieved. All stakeholders believed outcome collection on hand surgery outreach trips is important. Barriers identified were primarily related to environmental context and resources (eg, cost of returning) and memory, attention, and decision process (eg, difficulty in remembering patient follow-up intervals). The most commonly identified barriers address the distance patients live from the hospital/clinic, the resources required for them to return, and the lack of an organized system to assist in follow-up. CONCLUSIONS Multiple barriers to outcome collection exist at Hospital 175 in Vietnam. Understanding these barriers informs context-specific implementation approaches to collect outcomes on hand surgery outreach trips, which may improve the safety and quality of care provided.
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Affiliation(s)
- Lauren M. Shapiro
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
| | - Mừng Phan Đình
- Orthopedic and Trauma Institute, Ho Chi Minh City, Vietnam
| | | | | | | | - Robin N. Kamal
- Sustainable Global Surgery, Palo Alto, CA, USA
- Stanford University, Redwood City, CA, USA
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14
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A framework for understanding how midwives perceive and provide care management for pregnancies complicated by gestational diabetes or hypertensive disorders of pregnancy. Midwifery 2022; 115:103498. [PMID: 36191384 DOI: 10.1016/j.midw.2022.103498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/20/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Both gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) are common, and each are associated with adverse maternal and perinatal outcomes. Midwives may be the first point of care when these conditions arise. This study evaluated the experiences of midwives when providing care to women and people with pregnancies complicated by GDM or HDP. METHODS A mixed methods study was completed in Ontario, Canada, using a sequential, explanatory approach. A total of 144 online surveys were completed by midwives, followed by 20 semi-structured interviews that were audio recorded and transcribed verbatim. Survey data were analysed using descriptive statistics. Thematic analysis was used to generate codes from the interview data, which were mapped to the Theoretical Domains Framework (TDF), to elucidate factors that might influence management. RESULTS Most of the midwives' clinical behaviours relating to GDM or HDP were in keeping with guidelines and regulatory standards set by existing provincial standards. Six theoretical domains from the TDF appeared to influence midwives'care pathway: "Internal influences" included knowledge, skills and beliefs about capabilities; while "external influences" included social/professional role and identity, environmental context, and social influences. Interprofessional collaboration emerged as a significant factor on both the internal and external levels of influence. CONCLUSIONS We identified barriers and facilitators that may improve the experiences of midwives and clients when GDM or HDP newly arises in a pregnancy, necessitating further consultation or management by another health care provider.
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15
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Smith A, Kumar V, Cooley J, Ammendolia C, Lee J, Hogg-Johnson S, Mior S. Adherence to spinal imaging guidelines and utilization of lumbar spine diagnostic imaging for low back pain at a Canadian Chiropractic College: a historical clinical cohort study. Chiropr Man Therap 2022; 30:39. [PMID: 36114583 PMCID: PMC9479444 DOI: 10.1186/s12998-022-00447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 08/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Diagnostic imaging is useful for assessing low back pain (LBP) when a clinician suspects a specific underlying pathology. Evidence-based imaging guidelines assist clinicians in appropriately determining the need for imaging when assessing LBP. A previous study reported high adherence to three clinical guidelines, with utilization rate of 12.3% in imaging of LBP patients attending a chiropractic teaching clinic. A new imaging guideline for spinal disorders has been published and used in teaching. Thus, the aims of our study were to assess the adherence to the new guideline and X-ray utilization in new episodes of LBP. Methods We conducted a historical clinical cohort study using patient electronic health record audits at seven teaching clinics over a period of 20 months. Records of patients who were at least 18 years of age, presented with a new onset of LBP, and consented to data collection were included. Abstracted data included patient demographics, the number and type of red flags, and the decision to image. Rate of guideline adherence (proportion of those not recommended for imaging, given no red flags) and rate of image utilization were descriptively analyzed. Results We included 498 patients in this study. At least 81% of included patients had one or more red flags reported. The most commonly reported individual red flag was age ≥ 50 (43.8%) followed by pain at rest (15.7%). In those referred for imaging, age ≥ 50 (93.3%) was the most frequently reported red flag. No red flag(s) were identified in 93 patient records, and none were referred for imaging of their LBP, yielding an adherence rate of 100% (95% CI 96, 100%). A total of 17 of 498 patients were recommended for imaging for their low back pain, resulting in an imaging utilization rate of 3.4% (95% CI 1.8, 5.0%). Conclusion The imaging utilization rate was 3.4%, lower than 12.3% previously reported at a chiropractic teaching clinic. None without red flags were referred for imaging, yielding a 100%, adherence rate to current LBP imaging guidelines. Future research should consider currency of guideline, accuracy of red flags and factors influencing clinicians’ decision, when assessing imaging adherence rates.
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16
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Mather M, Pettigrew LM, Navaratnam S. Barriers and facilitators to clinical behaviour change by primary care practitioners: a theory-informed systematic review of reviews using the Theoretical Domains Framework and Behaviour Change Wheel. Syst Rev 2022; 11:180. [PMID: 36042457 PMCID: PMC9429279 DOI: 10.1186/s13643-022-02030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the barriers and facilitators to behaviour change by primary care practitioners (PCPs) is vital to inform the design and implementation of successful Behaviour Change Interventions (BCIs), embed evidence-based medicine into routine clinical practice, and improve quality of care and population health outcomes. METHODS A theory-led systematic review of reviews examining barriers and facilitators to clinical behaviour change by PCPs in high-income primary care contexts using PRISMA. Embase, MEDLINE, PsychInfo, HMIC and Cochrane Library were searched. Content and framework analysis was used to map reported barriers and facilitators to the Theoretical Domains Framework (TDF) and describe emergent themes. Intervention functions and policy categories to change behaviour associated with these domains were identified using the COM-B Model and Behaviour Change Wheel (BCW). RESULTS Four thousand three hundred eighty-eight reviews were identified. Nineteen were included. The average quality score was 7.5/11. Reviews infrequently used theory to structure their methods or interpret their findings. Barriers and facilitators most frequently identified as important were principally related to 'Knowledge', 'Environmental context and resources' and 'Social influences' TDF domains. These fall under the 'Capability' and 'Opportunity' domains of COM-B, and are linked with interventions related to education, training, restriction, environmental restructuring and enablement. From this, three key areas for policy change include guidelines, regulation and legislation. Factors least frequently identified as important were related to 'Motivation' and other psychological aspects of 'Capability' of COM-B. Based on this, BCW intervention functions of persuasion, incentivisation, coercion and modelling may be perceived as less relevant by PCPs to change behaviour. CONCLUSIONS PCPs commonly perceive barriers and facilitators to behaviour change related to the 'Capability' and 'Opportunity' domains of COM-B. PCPs may lack insight into the role that 'Motivation' and aspects of psychological 'Capability' have in behaviour change and/or that research methods have been inadequate to capture their function. Future research should apply theory-based frameworks and appropriate design methods to explore these factors. With no 'one size fits all' intervention, these findings provide general, transferable insights into how to approach changing clinical behaviour by PCPs, based on their own views on the barriers and facilitators to behaviour change. SYSTEMATIC REVIEW REGISTRATION A protocol was submitted to the London School of Hygiene and Tropical Medicine via the Ethics and CARE form submission on 16.4.2020, ref number 21478 (available on request). The project was not registered on PROSPERO.
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Affiliation(s)
- Melissa Mather
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, UK.
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.,UCL Department of Primary Care and Population Health, UCL Medical School, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK
| | - Stefan Navaratnam
- Northern Devon Healthcare NHS Trust, North Devon District Hospital, Raleigh Heights, Barnstaple, EX31 4JB, UK
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17
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Evrard P, Pétein C, Beuscart JB, Spinewine A. Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework. Implement Sci 2022; 17:41. [PMID: 35804428 PMCID: PMC9264665 DOI: 10.1186/s13012-022-01206-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Many strategies aimed at deprescribing benzodiazepine receptor agonists (BZRA) in older adults have already been evaluated with various success rates. There is so far no consensus on which strategy components increase deprescribing the most. Yet, despite an unfavourable benefit-to-risk ratio, BZRA use among older adults remains high. We systematically reviewed barriers and enablers for BZRA deprescribing in older adults. Methods Two reviewers independently screened records identified from five electronic databases—Medline, Embase, PsycINFO, CINAHL and the Cochrane library—and published before October 2020. They searched for grey literature using Google Scholar. Qualitative and quantitative records reporting data on the attitudes of older adults, caregivers and healthcare providers towards BZRA deprescribing were included. Populations at the end of life or with specific psychiatric illness, except for dementia, were excluded. The two reviewers independently assessed the quality of the included studies using the mixed-methods appraisal tool. Barriers and enablers were identified and then coded into domains of the theoretical domains framework (TDF) using a combination of deductive and inductive qualitative analysis. The most relevant TDF domains for BZRA deprescribing were then identified. Results Twenty-three studies were included 13 quantitative, 8 qualitative and 2 mixed-method studies. The points of view of older adults, general practitioners and nurses were reported in 19, 9 and 3 records, respectively. We identified barriers and enablers in the majority of TDF domains and in two additional themes: “patient characteristics” and “BZRA prescribing patterns”. Overall, the most relevant TDF domains were “beliefs about capabilities”, “beliefs about consequences”, “environmental context and resources”, “intention”, “goals”, “social influences”, “memory, attention and decision processes”. Perceived barriers and enablers within domains differed across settings and across stakeholders. Conclusion The relevant TDF domains we identified can now be linked to behavioural change techniques to help in the design of future strategies and health policies. Future studies should also assess barriers and enablers perceived by under-evaluated stakeholders (such as pharmacists, psychiatrists and health care professionals in the hospital setting). Trial registration This work was registered on PROSPERO under the title “Barriers and enablers to benzodiazepine receptor agonists deprescribing”. Registration number: CRD42020213035 Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01206-7.
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Affiliation(s)
- Perrine Evrard
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.
| | - Catherine Pétein
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France
| | - Anne Spinewine
- Clinical Pharmacy Research Group, Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium.,Pharmacy Department, CHU UCL Namur, Yvoir, Belgium
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To D, Hall A, Bussières A, French SD, Lawrence R, Pike A, Patey AM, Brake-Patten D, O'Keefe L, Elliott B, De Carvalho D. Exploring factors influencing chiropractors' adherence to radiographic guidelines for low back pain using the Theoretical Domains Framework. Chiropr Man Therap 2022; 30:23. [PMID: 35534902 PMCID: PMC9082849 DOI: 10.1186/s12998-022-00433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada. Methods We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors’ statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours. Results Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on “gut feeling” (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients’ previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation). Conclusion We identified potential influences, in six theoretical domains, on participating chiropractors’ LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00433-5.
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Affiliation(s)
- Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Rebecca Lawrence
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, ON, Canada
| | | | | | - Barbara Elliott
- Patient Engagement Partner, North Bay, ON, Canada.,Faculty of Education and Professional Studies - School of Nursing, Nipissing University, North Bay, ON, Canada
| | - Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
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Bravington A, Chen H, Dyson J, Jones L, Dalgliesh C, Bryan A, Patnick J, Macleod U. Translating qualitative data into intervention content using the Theoretical Domains Framework and stakeholder co-design: a worked example from a study of cervical screening attendance in older women. BMC Health Serv Res 2022; 22:610. [PMID: 35524217 PMCID: PMC9074234 DOI: 10.1186/s12913-022-07926-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from a qualitative exploration of cervical screening in women over 50 in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service-user leaflet and a video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over 50, and to increase sensitivity to age-related problems in screening among primary care practitioners. METHODS Secondary coding of a qualitative data set to extract barriers and facilitators of cervical screening attendance. Barrier and facilitator statements were categorised using the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs). Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide the design of intervention content and mode of delivery. RESULTS Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas - clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners). CONCLUSION The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.
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Affiliation(s)
- Alison Bravington
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
| | - Hong Chen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, UK
| | - Lesley Jones
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | | | | | - Julietta Patnick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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20
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. Patients with low back pain presenting for chiropractic care who want diagnostic imaging are more likely to receive referral for imaging: a cross-sectional study. Chiropr Man Therap 2022; 30:16. [PMID: 35379281 PMCID: PMC8978373 DOI: 10.1186/s12998-022-00425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is unclear if the use of imaging for low back pain (LBP) is impacted by patient beliefs. This study aimed to: (1) describe beliefs about the importance of imaging and whether patients wanted imaging when presenting for chiropractic care for LBP; (2) describe associations between baseline patient characteristics and imaging beliefs and whether patients wanted imaging; and (3) determine whether patients who believed imaging to be important in the management of LBP, or who wanted to receive imaging, were more likely to receive an imaging referral. METHODS Cross-sectional observational data was collected between November 2016 to December 2019 from 10 primary care chiropractic clinics in Denmark. Consecutive patients aged 18 or older and presenting with a new episode of LBP were included (N = 2818). Beliefs about the importance of imaging (two questions) and whether imaging was wanted (one question) were collected at the initial visit, together with baseline participant characteristics and whether an imaging referral was provided. Associations between imaging beliefs/desire to receive imaging and participant characteristics were explored using multivariable logistic regression analysis. The relationships between imaging beliefs and desire to receive imaging with subsequent imaging referral were assessed using multivariable logistic regression analysis adjusted for pre-selected confounder variables. RESULTS Approximately one third of participants believed imaging to be important for the management of LBP (29.5% (95%CI 27.8, 31.3) or 41.5% (95%CI 39.6, 43.3) depending on the two imaging beliefs questions). Approximately one quarter (26.1%, 95%CI 24.5, 27.7) of participants wanted to receive an imaging referral. Participants were more likely to believe in the importance of imaging or want an imaging referral if they had a longer duration of LBP, history of previous imaging for LBP, or a lower completed education level. Participants who wanted imaging at the initial consult were more likely to receive an imaging referral (Odds ratio; 95%CI 1.6; 1.2, 2.1). CONCLUSIONS Approximately one third of patients presenting for chiropractic care in Denmark believed imaging to be important in the management of LBP. One quarter wanted imaging at the initial consult. Patients' desire for imaging appeared to impact the use of diagnostic imaging.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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21
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Dahan-Oliel N, Cachecho S, Fąfara A, Lacombe F, Samargian A, Bussières A. Expert guidance for the rehabilitation of children with arthrogryposis: protocol using an integrated knowledge translation approach. RESEARCH INVOLVEMENT AND ENGAGEMENT 2022; 8:5. [PMID: 35183264 PMCID: PMC8857823 DOI: 10.1186/s40900-022-00336-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/13/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a group of rare congenital disorders characterized by multiple joint contractures present at birth. Contractures can affect different body areas and impact activities of daily living, mobility and participation. Although early rehabilitation is crucial to promote autonomy and participation in children with AMC, empirical evidence to inform best practice is scarce and clinical expertise hard to develop due to the rarity of AMC. Preliminary research involving stakeholders in AMC (youth with AMC, parents, and clinicians) identified priorities in pediatric rehabilitation. Scoping reviews on these priorities showed a lack of high quality evidence related to rehabilitation in AMC. The objective of this project is to provide rehabilitation expert guidance on the assessment and treatment of children with AMC in the areas of muscle and joint function, pain, mobility and self-care, participation and psychosocial wellbeing. METHODS An integrated knowledge translation approach will be used throughout the project. Current rehabilitation practices in AMC will be identified using a clinician survey. Using the Grading of Recommendations, Assessment, Development and Evaluations framework (GRADE) approach, a panel of interdisciplinary expert clinicians, patient and family representatives, and researchers will develop expert guidance on the assessment and treatment for pediatric AMC rehabilitation based on findings from the scoping reviews and survey results. Consensus on the guidance statements will be sought using a modified Delphi process with a wider panel of international AMC experts, and statements appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Theoretical facilitators and barriers toward implementing clinical guidance into practice will be identified among rehabilitation clinicians and managers to inform the design of dissemination and implementation strategies. DISCUSSION This multi-phase project will provide healthcare users and providers with research-based, expert guidance for the rehabilitation of children with AMC and will contribute to family-centered practice.
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Affiliation(s)
- Noémi Dahan-Oliel
- Shriners Hospital for Children, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | | | - Alicja Fąfara
- Institute of Physiotherapy, Jagiellonian University, Kraków, Poland
| | | | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
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22
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Abed H, Burke M, Fenlon MR, Scambler S, Scott SE. Dentists' perspectives on denture provision after radiotherapy for head and neck cancer: an exploratory study using the theoretical domains framework. Br Dent J 2021:10.1038/s41415-021-3668-6. [PMID: 34887552 DOI: 10.1038/s41415-021-3668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Introduction Patients are often keen to replace their missing teeth after radiotherapy for head and neck cancer (HNC), yet such replacement does not always take place.Aims This study aimed to investigate the influences on dentists' provision of dentures for patients treated with radiotherapy for HNC, including whether risk of osteoradionecrosis (ORN) is a factor influencing intention to provide dentures.Methods An online cross-sectional survey including a case scenario, self-reported behaviour and measures of factors (selected using the theoretical domains framework) that may affect dentists' decisions was completed by general dental practitioners (n = 150) and HNC multidisciplinary team dentists (n = 25) in England.Results Dentists' reluctance to provide dentures for HNC patients post-radiotherapy was often due to concerns about dry mouth and radiation caries rather than risk of ORN. Knowledge of guidelines and beliefs about consequences were independently associated with dentists' intention to replace missing teeth with dentures.Conclusion The likelihood of replacing missing teeth with dentures increased with awareness of clinical guidance on the use of dentures in HNC and that denture provision would have positive consequences that outweigh the costs.
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Affiliation(s)
- Hassan Abed
- Department of Basic and Clinical Oral Sciences, Faculty of Dentistry, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Mary Burke
- Department of Sedation and Special Care Dentistry, Guy´s and St Thomas´ Foundation Trust, London, UK
| | - Michael R Fenlon
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, London, UK
| | - Sasha Scambler
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, London, UK
| | - Suzanne E Scott
- Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, London, UK
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23
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Jenkins HJ, Kongsted A, French SD, Jensen TS, Doktor K, Hartvigsen J, Hancock M. What are the effects of diagnostic imaging on clinical outcomes in patients with low back pain presenting for chiropractic care: a matched observational study. Chiropr Man Therap 2021; 29:46. [PMID: 34814923 PMCID: PMC8611826 DOI: 10.1186/s12998-021-00403-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background Evidence suggests that diagnostic imaging for low back pain does not improve care in the absence of suspicion of serious pathology. However, the effect of imaging use on clinical outcomes has not been investigated in patients presenting to chiropractors. The aim of this study was to determine if diagnostic imaging affects clinical outcomes in patients with low back pain presenting for chiropractic care. Methods A matched observational study using prospective longitudinal observational data with one year follow up was performed in primary care chiropractic clinics in Denmark. Data was collected from November 2016 to December 2019. Participants included low back pain patients presenting for chiropractic care, who were either referred or not referred for diagnostic imaging during their initial visit. Patients were excluded if they were less than 18 years old, had a diagnosis of underlying pathology, or had previous imaging relevant to their current clinical presentation. Coarsened exact matching was used to match participants referred for diagnostic imaging with participants not referred for diagnostic imaging on baseline variables including participant demographics, pain characteristics, and clinical history. Mixed linear and logistic regression models were used to assess the effect of imaging on back pain intensity and disability at two-weeks, three-months, and one-year, and on global perceived effect and satisfaction with care at two-weeks. Results 2162 patients were included, with 24.1% referred for imaging. Near perfect balance between matched groups was achieved for baseline variables except age and leg pain. Participants referred for imaging had slightly higher back pain intensity at two-weeks (0.4, 95%CI: 0.1, 0.8) and one-year (0.4, 95%CI: 0.0, 0.7), and disability at two-weeks (5.7, 95%CI: 1.4, 10.0), but the changes are unlikely to be clinically meaningful. No difference between groups was found for the other outcome measures. Similar results were found when sensitivity analysis, adjusted for age and leg pain intensity, was performed. Conclusions Diagnostic imaging did not result in better clinical outcomes in patients with low back pain presenting for chiropractic care. These results support that current guideline recommendations against routine imaging apply equally to chiropractic practice.
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Affiliation(s)
- Hazel J Jenkins
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia.
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Simon D French
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
| | - Tue Secher Jensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark.,Diagnostic Centre - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Klaus Doktor
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Mark Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Rm 347, 17 Wally's Walk, Sydney, 2109, Australia
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24
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Shoesmith E, Huddlestone L, Lorencatto F, Shahab L, Gilbody S, Ratschen E. Supporting smoking cessation and preventing relapse following a stay in a smoke-free setting: a meta-analysis and investigation of effective behaviour change techniques. Addiction 2021; 116:2978-2994. [PMID: 33620737 DOI: 10.1111/add.15452] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions. METHODS Systematic review and meta-analyses of studies of adult smokers aged ≥ 18 years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥ 25% of all interventions). RESULTS Thirty-seven studies (intervention n = 9041, control n = 6195) were included: 23 RCTs (intervention n = 6593, control n = 5801); three non-randomized trials (intervention n = 845, control n = 394) and 11 cohort studies (n = 1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4 weeks-18 months) found an overall effect in favour of intervention [risk ratio (RR) = 1.27, 95% confidence interval (CI) = 1.08-1.49, I2 = 42%]. Nine BCTs (including 'pharmacological support', 'goal-setting (behaviour)' and 'social support') were characterized as 'promising' in terms of probable effectiveness and feasibility. CONCLUSIONS A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18 months post-discharge.
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Affiliation(s)
- Emily Shoesmith
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Lisa Huddlestone
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | | | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Elena Ratschen
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
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25
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Sorondo D, Delpierre C, Côté P, Salmi LR, Cedraschi C, Taylor-Vaisey A, Lemeunier N. Determinants of clinical practice guidelines' utilization for the management of musculoskeletal disorders: a scoping review. BMC Musculoskelet Disord 2021; 22:507. [PMID: 34074285 PMCID: PMC8170973 DOI: 10.1186/s12891-021-04204-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 11/23/2022] Open
Abstract
Context Many clinical practice guidelines have been developed for the management of musculoskeletal disorders (MSDs). However, there is a gap between evidence-based knowledge and clinical practice, and reasons are poorly understood. Understanding why healthcare providers use clinical practice guidelines is essential to improve their implementation, dissemination, and adherence. Aim To identify determinants of clinical practice guidelines’ utilization by health care providers involved in the assessment and management of MSDs. Method A scoping review of the literature was conducted. Three databases were searched from inception to March 2021. Article identification, study design, methodological quality, type of healthcare providers, MSDs, barriers and facilitators associated with guidelines’ utilization were extracted from selected articles. RESULTS: 8671 citations were retrieved, and 43 articles were selected. 51% of studies were from Europe, and most were quantitative studies (64%) following a cross-sectional design (88%). Almost 80% of articles dealt with low back pain guidelines, and the most studied healthcare providers were general practitioners or physiotherapists. Five main barriers to guideline utilization were expressed by providers: 1) disagreement between recommendations and patient expectations; 2) guidelines not specific to individual patients; 3) unfamiliarity with “non-specific” term, or with the bio psychosocial model of MSDs; 4) time consuming; and 5) heterogeneity in guideline methods. Four main facilitators to guideline utilization were cited: 1) clinician’s interest in evidence-based practice; 2) perception from clinicians that the guideline will improve triage, diagnosis and management; 3) time efficiency; and 4) standardized language. Conclusion Identifying modifiable determinants is the first step in developing implementation strategies to improve guideline utilization in clinical practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04204-w.
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Affiliation(s)
- Delphine Sorondo
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France. .,Institut Franco-Européen de Chiropraxie, 72 chemin de la Flambère-31,300, Toulouse, France.
| | - Cyrille Delpierre
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Louis-Rachid Salmi
- Univ. Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health, F-33000, Bordeaux, France.,CHU de Bordeaux, Pôle de santé publique, Service d'Information Médicale, F-33000, Bordeaux, France
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, University of Geneva, Geneva, Switzerland.,Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada.,Centre for Disability Prevention and Rehabilitation at Ontario Tech University and the Canadian Memorial Chiropractic College, Oshawa and Toronto, Ontario, Canada
| | - Nadège Lemeunier
- UMR1295, Toulouse III University, Inserm, Equipe EQUITY, Equipe constitutive du CERPOP, Toulouse, France.,Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
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26
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Longtin C, Décary S, Cook CE, Tousignant-Laflamme Y. What does it take to facilitate the integration of clinical practice guidelines for the management of low back pain into practice? Part 2: A strategic plan to activate dissemination. Pain Pract 2021; 22:107-112. [PMID: 33998767 DOI: 10.1111/papr.13032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
Low back pain (LBP) is the leading cause of disability worldwide among all musculoskeletal disorders despite an intense focus in research efforts. Researchers and decision makers have produced multiple clinical practice guidelines for the rehabilitation of LBP, which contain specific recommendations for clinicians. Adherence to these recommendations may have several benefits, such as improving the quality of care for patients living with LBP, by ensuring that the best evidence-based care is being delivered. However, clinicians' adherence to recommendations from these guidelines is low and numerous implementation barriers and challenges, such as complexity of information and sheer volume of guidelines have been documented. In a previous paper, we performed a systematic review of the literature to identify high-quality clinical practice guidelines on the management of LBP, and developed a concise yet comprehensive infographic that summarizes the recommendations from these guidelines. Considering the wealth of scientific evidence, passive dissemination alone of this research knowledge is likely to have limitations to help clinicians implement these recommendations into routine practice. Thus, an active and engaging dissemination strategy, aimed at improving the implementation and integration of specific recommendations into practice is warranted. In this paper, we argue that a conceptual framework, such as the theoretical domains framework, could facilitate the implementation of these recommendations into clinical practice. Specifically, we present a systematic approach that could serve to guide the development of a theory-informed knowledge translation intervention as a means to overcome implementation challenges in rehabilitation of LBP.
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Affiliation(s)
- Christian Longtin
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
| | - Chad E Cook
- Department of Orthopedics, Duke University, Durham, North Carolina, USA
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, University of Shebrooke, Sherbrooke, Quebec, Canada.,Research Centre of the CHUS, CIUSSS de l'Estrie-CHUS, Sherbrooke, Quebec, Canada
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27
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Parthipan S, Bowles C, de Luca K, Jenkins H. The association between guideline adherent radiographic imaging by chiropractic students and the diagnostic yield of clinically significant findings. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2021; 65:66-75. [PMID: 34035542 PMCID: PMC8128328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Radiographic guidelines aim to increase the diagnostic yield of clinically relevant imaging findings whilst minimising risk. This study assessed the appropriateness of radiographic referrals made by student chiropractors and explored the association between guideline appropriate imaging and clinically significant radiographic findings. METHODS Radiographic referral and report findings (n=437) from 2018 were extracted from Macquarie University chiropractic clinics. Appropriateness of radiographic referrals was assessed according to current radiographic guidelines. Radiographic findings were assessed for clinical significance. The association between guideline appropriate radiographic referral and clinically significant radiographic findings was assessed using logistic regression analysis and odds ratios were estimated. RESULTS The proportion of guideline appropriate imaging was 55.8% (95%CI: 51.2-60.4). An association between guideline appropriate radiographs and clinically significant findings was found (OR: 2.2; 95%CI: 1.3-4.1). CONCLUSIONS Approximately half of all radiographic referrals made by chiropractic students were guideline concordant. Guideline appropriate imaging was associated with an increase in clinically significant radiographic findings.
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Affiliation(s)
| | - Chris Bowles
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Katie de Luca
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Hazel Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia
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28
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Kisembo HN, Nassanga R, Ameda FA, Ocan M, Kinengyere AA, Abdirahaman SO, Malumba R, Salama DH, Kawooya MG. Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol. BJR Open 2021; 3:20210004. [PMID: 35855474 PMCID: PMC9264334 DOI: 10.1259/bjro.20210004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging. Methods The protocol will be guided by the Joanna Briggs Institute Reviewers' Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts' opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan - Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives. Conclusion The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient. Advances in knowledge Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase.Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).
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Affiliation(s)
| | - Ritah Nassanga
- Department of Radiology, School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Faith Ameda Ameda
- Department of Radiology, School of Medicine, College of Health Sciences, Kampala, Uganda
| | | | | | - Sahal Omal Abdirahaman
- Department of Radiology, School of Medicine, College of Health Sciences, Kampala, Uganda
| | - Richard Malumba
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
| | | | - Michael Grace Kawooya
- Ernest cook Ultrasound Research and Education Institute, Mengo Hospital, Kampala, Uganda
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Newlands R, Duncan E, Presseau J, Treweek S, Lawrie L, Bower P, Elliott J, Francis J, MacLennan G, Ogden M, Wells M, Witham MD, Young B, Gillies K. Why trials lose participants: A multitrial investigation of participants' perspectives using the theoretical domains framework. J Clin Epidemiol 2021; 137:1-13. [PMID: 33727134 DOI: 10.1016/j.jclinepi.2021.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To use the Theoretical Domains Framework (TDF) to identify barriers and enablers to participant retention in trials requiring questionnaire return and/or attendance at follow-up clinics. STUDY DESIGN AND SETTING We invited participants (n = 607) from five pragmatic effectiveness trials, who missed at least one follow-up time point (by not returning a questionnaire and/or not attending a clinic visit), to take part in semistructured telephone interviews. The TDF informed both data collection and analysis. To establish what barriers and enablers most likely influence the target behavior the domain relevance threshold was set at >75% of participants mentioning the domain. RESULTS Sixteen participants (out of 25 showing interest) were interviewed. Overall, seven theoretical domains were identified as both barriers and enablers to the target behaviors of attending clinic appointments and returning postal questionnaires. Barriers frequently reported in relation to both target behaviours stemmed from participants' knowledge, beliefs about their capabilities and the consequences of performing (or not performing) the behavior. Two domains were identified as salient for questionnaire return only: goals; and memory, attention and decision-making. Emotion was identified as relevant for clinic attendance only. CONCLUSION This is the first study informed by behavioural science to explore trial participants' accounts of trial retention. Findings will serve as a guiding framework when designing trials to limit barriers and enhance enablers of retention within clinical trials.
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Affiliation(s)
- Rumana Newlands
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Eilidh Duncan
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; School of Psychology, University of Ottawa, Ottawa, Canada
| | - Shaun Treweek
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Louisa Lawrie
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Jim Elliott
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK; Public Partner
| | - Jill Francis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Graeme MacLennan
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Margaret Ogden
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK; Public Partner
| | - Mary Wells
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Katie Gillies
- Health Services Research Unit, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Verville L, Dc PC, Grondin D, Dc SM, Kay R. The development and evaluation of an online educational tool for the evidence-based management of neck pain by chiropractic teaching faculty. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:95-105. [PMID: 33175979 PMCID: PMC7958658 DOI: 10.7899/jce-19-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/13/2020] [Accepted: 04/04/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To develop an online, interactive educational tool to deliver an evidence-based clinical practice guideline to faculty members at a Canadian chiropractic college. Second, to evaluate the learning, design, and engagement constructs of the tool in a sample of chiropractic faculty members. METHODS Using an integrated knowledge translation methodology and the Knowledge to Action Framework, we developed an evidence-based online learning tool. The context of the tool focused on a clinical practice guideline on the management of neck pain. We evaluated the learning, design, and engagement constructs in a sample of faculty members and residents using the Learning Object Evaluation Scale for Students. Participants were also asked to provide suggestions for improvement of the tool. RESULTS Sixteen participants completed the evaluation. Most (68.8%) participants were chiropractors, 75% were male and 56% were between the ages of 25 and 44 years. At least 75% of participants agreed that the learning, design, and engagement constructs of the learning tool were adequate. The open-ended suggestions unveiled 3 pedagogical themes, relating to multimedia, thinking skills, and learner control, within the tool that could benefit from further development. These themes informed recommendations to improve the tool. CONCLUSION Our online, interactive, module-based learning tool has sound pedagogical properties. Further research is needed to determine if its use is associated with a change in knowledge.
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Patey AM, Grimshaw JM, Francis JJ. Changing behaviour, 'more or less': do implementation and de-implementation interventions include different behaviour change techniques? Implement Sci 2021; 16:20. [PMID: 33632274 PMCID: PMC7905859 DOI: 10.1186/s13012-021-01089-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. METHODS Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson's chi-squared (χ2), Yates' continuity correction and Fisher's exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. RESULTS Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation (Χ2(2, n=178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution (Χ2(2, n=178) = 14.561, p = .0001; Yates' continuity correction); Monitoring of behaviour by others without feedback (Χ2(2, n=178) = 16.187, p = .000057; Yates' continuity correction); and Restructuring social environment (p = .000273; Fisher's 2-sided exact test). CONCLUSIONS There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.
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Affiliation(s)
- Andrea M. Patey
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - Jeremy M. Grimshaw
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5 Canada
| | - Jill J. Francis
- School of Health Sciences, City, University of London, 10 Northampton Square, London, EC1V 0HB UK
- Centre of Implementation Research, Ottawa Hospital Research Institute – General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
- School of Health Sciences, University of Melbourne, Melbourne, Victoria 3010 Australia
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Ly A, Zemek R, Wright B, Zwicker J, Schneider K, Mikrogianakis A, Conradi A, Johnson D, Clark B, Barlow K, Burey J, Kolstad A, Yeates KO. "What is the actual goal of the pathway?": examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework. BMC Health Serv Res 2021; 21:119. [PMID: 33546684 PMCID: PMC7863464 DOI: 10.1186/s12913-021-06110-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/21/2021] [Indexed: 01/17/2023] Open
Abstract
Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.
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Affiliation(s)
- Anh Ly
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Roger Zemek
- Department of Pediatrics, University of Ottawa, 75 Laurier Avenue East, Ottawa, Ontario, K1N 6N5, Canada
| | - Bruce Wright
- Department of Pediatrics, University of Alberta, 3-513 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada
| | - Jennifer Zwicker
- University of Calgary, School of Public Policy, 906 8th Avenue SW, Calgary, Alberta, T2P 1H9, Canada
| | - Kathryn Schneider
- University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Angelo Mikrogianakis
- Department of Pediatrics, McMaster University, 1280 Main Street, Hamilton, Ontario, L8S 4K1, Canada
| | - Alf Conradi
- Department of Pediatrics, University of Alberta, 4-539 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 2R7, Canada
| | - David Johnson
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, Calgary, T3B 6A8, Canada
| | - Brenda Clark
- Department of Pediatrics, University of Alberta, 10230 111 Avenue, Edmonton, Alberta, T5G 0B7, Canada
| | - Karen Barlow
- University of Queensland, Child Health Research Centre, Brisbane, QLD, 4072, Australia
| | - Joseph Burey
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, Ontario, N9B 3P4, Canada
| | - Ash Kolstad
- University of Calgary, Faculty of Kinesiology, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Keith Owen Yeates
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Timlin D, Giannantoni B, McCormack JM, Polito A, Ciarapica D, Azzini E, Giles M, Simpson EEA. Comparison of barriers and facilitators of MIND diet uptake among adults from Northern Ireland and Italy. BMC Public Health 2021; 21:265. [PMID: 33530965 PMCID: PMC7852355 DOI: 10.1186/s12889-021-10307-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/21/2021] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. Methods This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. Results Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. Conclusions Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
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Affiliation(s)
| | - Barbara Giannantoni
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | | | - Angela Polito
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Donatella Ciarapica
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Elena Azzini
- CREA - Council for Agricultural Research and Economics Research Centre for Food and Nutrition, Via Ardeatina, 546, 00178, Rome, Italy
| | - Melanie Giles
- Psychology Research Institute, Ulster University, Coleraine, UK
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De Carvalho D, Bussières A, French SD, Wade D, Brake-Patten D, O'Keefe L, Elliott B, Budgell K, O'Reilly S, To D, Hall A. Knowledge of and adherence to radiographic guidelines for low back pain: a survey of chiropractors in Newfoundland and Labrador, Canada. Chiropr Man Therap 2021; 29:4. [PMID: 33461555 PMCID: PMC7812732 DOI: 10.1186/s12998-020-00361-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/20/2020] [Indexed: 12/19/2022] Open
Abstract
Background Low back pain (LBP) rarely requires routine imaging of the lumbar spine in the primary care setting, as serious spinal pathology is rare. Despite evidence-based clinical practice guidelines recommending delaying imaging in the absence of red flags, chiropractors commonly order imaging outside of these guidelines. The purpose of this study was to survey chiropractors to determine the level of knowledge, adherence to, and beliefs about, clinical practice guidelines related to the use of lumbar radiography for LBP in Newfoundland and Labrador (NL), Canada. Methods A cross-sectional survey of chiropractors in NL (n = 69) was conducted between May and June 2018, including questions on demographics, awareness of radiographic guidelines, and beliefs about radiographs for LBP. We assessed behavioural simulation using clinical vignettes to determine levels of adherence to LBP guideline recommendations. Results The response rate was 77% (n = 53). Half of the participants stated they were aware of current radiographic guideline recommendations, and one quarter of participants indicated they did not use guidelines to inform clinical decisions. The majority of participants agreed that x-rays of the lumbar spine are useful for patients with suspected pathology, are indicated when a patient is non-responsive to 4 weeks of conservative treatment for LBP, and when there are neurological signs associated with LBP. However, a small proportion indicated that there is a role for full spine x-rays (~ 21%), x-rays to evaluate patients with acute LBP (~ 13%), and that patient expectations play a role in decision making (4%). Adherence rate to radiographic guidelines measured using clinical vignettes was 75%. Conclusions While many chiropractors in this sample reported being unsure of specific radiographic guidelines, the majority of respondents adhered to guideline recommendations measured using clinical vignettes. Nonetheless, a small proportion still hold beliefs about radiographs for LBP that are discordant with current radiographic guidelines. Future research should aim to determine barriers to guideline uptake in this population in order to design and evaluate tailored knowledge translation strategies to reduce unnecessary LBP imaging. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-020-00361-2.
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Affiliation(s)
- Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, New South Wales, Australia
| | | | | | | | - Barbara Elliott
- Patient Engagement Partner, North Bay, ON, Canada.,Faculty of Education and Professional Studies - School of Nursing, Nipissing University, North Bay, ON, Canada
| | | | - Sara O'Reilly
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Sharma S, Traeger AC, Reed B, Hamilton M, O'Connor DA, Hoffmann TC, Bonner C, Buchbinder R, Maher CG. Clinician and patient beliefs about diagnostic imaging for low back pain: a systematic qualitative evidence synthesis. BMJ Open 2020; 10:e037820. [PMID: 32830105 PMCID: PMC7451538 DOI: 10.1136/bmjopen-2020-037820] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Overuse of diagnostic imaging for patients with low back pain remains common. The underlying beliefs about diagnostic imaging that could drive overuse remain unclear. We synthesised qualitative research that has explored clinician, patient or general public beliefs about diagnostic imaging for low back pain. DESIGN A qualitative evidence synthesis using a thematic analysis. METHODS We searched MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to 17 June 2019. Qualitative studies that interviewed clinicians, patients and/or general public exploring beliefs about diagnostic imaging for low back pain were included. Four review authors independently extracted data and organised these according to themes and subthemes. We used the Critical Appraisal Skills Programme tool to critically appraise included studies. To assess confidence in review findings, we used the GRADE-Confidence in the Evidence from Reviews of Qualitative Research method. RESULTS We included 69 qualitative studies with 1747 participants. Key findings included: Patients and clinicians believe diagnostic imaging is an important test to locate the source of low back pain (33 studies, high confidence); patients with chronic low back pain believe pathological findings on diagnostic imaging provide evidence that pain is real (12 studies, moderate confidence); and clinicians ordered diagnostic imaging to reduce the risk of a missed diagnosis that could lead to litigation, and to manage patients' expectations (12 studies, moderate confidence). CONCLUSION Clinicians and patients can believe that diagnostic imaging is an important tool for locating the source of non-specific low back pain. Patients may underestimate the harms of unnecessary imaging tests. These beliefs could be important targets for intervention. PROSPERO REGISTRATION NUMBER CRD42017076047.
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Affiliation(s)
- Sweekriti Sharma
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrian C Traeger
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Reed
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Melanie Hamilton
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Denise A O'Connor
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Malvern, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris G Maher
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet). Public Health Nutr 2020; 24:1657-1670. [PMID: 32799963 PMCID: PMC8094434 DOI: 10.1017/s1368980020001445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40-55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. DESIGN This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. SETTING Northern Ireland. PARTICIPANTS Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. RESULTS Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. CONCLUSIONS This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.
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Grimshaw JM, Patey AM, Kirkham KR, Hall A, Dowling SK, Rodondi N, Ellen M, Kool T, van Dulmen SA, Kerr EA, Linklater S, Levinson W, Bhatia RS. De-implementing wisely: developing the evidence base to reduce low-value care. BMJ Qual Saf 2020; 29:409-417. [PMID: 32029572 PMCID: PMC7229903 DOI: 10.1136/bmjqs-2019-010060] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/11/2019] [Accepted: 01/13/2020] [Indexed: 01/30/2023]
Abstract
Choosing Wisely (CW) campaigns globally have focused attention on the need to reduce low-value care, which can represent up to 30% of the costs of healthcare. Despite early enthusiasm for the CW initiative, few large-scale changes in rates of low-value care have been reported since the launch of these campaigns. Recent commentaries suggest that the focus of the campaign should be on implementation of evidence-based strategies to effectively reduce low-value care. This paper describes the Choosing Wisely De-Implementation Framework (CWDIF), a novel framework that builds on previous work in the field of implementation science and proposes a comprehensive approach to systematically reduce low-value care in both hospital and community settings and advance the science of de-implementation.The CWDIF consists of five phases: Phase 0, identification of potential areas of low-value healthcare; Phase 1, identification of local priorities for implementation of CW recommendations; Phase 2, identification of barriers to implementing CW recommendations and potential interventions to overcome these; Phase 3, rigorous evaluations of CW implementation programmes; Phase 4, spread of effective CW implementation programmes. We provide a worked example of applying the CWDIF to develop and evaluate an implementation programme to reduce unnecessary preoperative testing in healthy patients undergoing low-risk surgeries and to further develop the evidence base to reduce low-value care.
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Affiliation(s)
- Jeremy M Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kyle R Kirkham
- Department of Anesthesia and Pain Management-Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Women's College Hospital, Toronto, Ontario, Canada
| | - Amanda Hall
- Primary Healthcare Research Institute, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Shawn K Dowling
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, Switzerland
| | - Moriah Ellen
- Department of Health Systems Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Tijn Kool
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Simone A van Dulmen
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Gelderland, The Netherlands
| | - Eve A Kerr
- Department of Internal Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Stefanie Linklater
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - R Sacha Bhatia
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
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Anekwe DE, Milner SC, Bussières A, de Marchie M, Spahija J. Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework. J Physiother 2020; 66:120-127. [PMID: 32307308 DOI: 10.1016/j.jphys.2020.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 09/19/2019] [Accepted: 03/09/2020] [Indexed: 01/18/2023] Open
Abstract
QUESTION From the perspective of intensive care unit (ICU) clinicians, what are the barriers to and facilitators of implementing early mobilisation? DESIGN A qualitative study using focus groups, with analysis using the Theoretical Domains Framework. PARTICIPANTS Physicians, nurses, respiratory therapists and physiotherapists from the ICUs of three university-affiliated hospitals in Montreal, Canada. METHODS Four focus group meetings were conducted with 33 participating ICU clinicians. Two researchers independently performed thematic content analysis on verbatim transcriptions of the audio recordings using the Theoretical Domains Framework. RESULTS Data saturation was reached after the third focus group. Thirty-six barriers were categorised in 13 domains of the Theoretical Domains Framework. The key barriers to early mobilisation were: lack of conviction and knowledge regarding the available evidence about early mobilisation; lack of attention to the provision of optimal care; poor communication; the unpredictable nature of the ICU; and limited staffing, equipment, time and clinical knowledge. Twenty-five facilitators categorised in ten TDF domains were also identified. These included individual-level facilitators (intrinsic motivation, positive outcome expectations, conscious effort to mobilise early, good planning/coordination, the presence of ICU champions, and expert support by a physiotherapist) and organisational-level facilitators (reminder system, pro-early mobilisation culture, implementation of an early mobilisation protocol, and improved ICU organisation). CONCLUSIONS A broad array of barriers to and facilitators of early mobilisation in the ICU were identified in this study. Clinicians can consider whether these barriers and facilitators are operating in their ICU. These may inform the design of tailored knowledge translation interventions to promote early mobilisation in the ICU.
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Affiliation(s)
- David E Anekwe
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; CIUSSS-NÎM, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Canada
| | - Siobhan C Milner
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Michel de Marchie
- Department of Adult Critical Care, CIUSSS West-Central Montreal, Jewish General Hospital, Montreal, Canada
| | - Jadranka Spahija
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada; CIUSSS-NÎM, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montreal, Canada; Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), CISSS Laval - Hôpital Juif de Réadaptation, Laval, Canada.
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van der Wouden CH, Paasman E, Teichert M, Crone MR, Guchelaar HJ, Swen JJ. Assessing the Implementation of Pharmacogenomic Panel-Testing in Primary Care in the Netherlands Utilizing a Theoretical Framework. J Clin Med 2020; 9:jcm9030814. [PMID: 32192029 PMCID: PMC7141350 DOI: 10.3390/jcm9030814] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Despite overcoming many implementation barriers, pharmacogenomic (PGx) panel-testing is not routine practice in the Netherlands. Therefore, we aim to study pharmacists' perceived enablers and barriers for PGx panel-testing among pharmacists participating in a PGx implementation study. Here, pharmacists identify primary care patients, initiating one of 39 drugs with a Dutch Pharmacogenetic Working Group (DPWG) recommendation and subsequently utilizing the results of a 12 gene PGx panel test to guide dose and drug selection. Pharmacists were invited for a general survey and a semi-structured interview based on the Tailored Implementation for Chronic Diseases (TICD) framework, aiming to identify implementation enablers and barriers, if they had managed at least two patients with actionable PGx results. In total, 15 semi-structured interviews were performed before saturation point was reached. Of these, five barrier themes emerged: (1) unclear procedures, (2) undetermined reimbursement for PGx test and consult, (3) insufficient evidence of clinical utility for PGx panel-testing, (4) infrastructure inefficiencies, and (5) HCP PGx knowledge and awareness; and two enabler themes: (1) pharmacist perceived role in delivering PGx, and (2) believed clinical utility of PGx. Despite a strong belief in the beneficial effects of PGx, pharmacists' barriers remain, an these hinder implementation in primary care.
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Affiliation(s)
- Cathelijne H. van der Wouden
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Ellen Paasman
- Community Pharmacy De Klipper, 2692 AH ‘s Gravenzande, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Matty R. Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Henk-Jan Guchelaar
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jesse J. Swen
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Leiden Network for Personalised Therapeutics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Correspondence: ; Tel.: +31-(0)71-526-2790
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Brassard E, Archambault P, Lacombe G, St-Onge M. To call or not to call: behavioral determinants influencing the decision of intensivists to consult poison centers for calcium channel blocker poisoning. Clin Toxicol (Phila) 2019; 58:913-921. [PMID: 31888431 DOI: 10.1080/15563650.2019.1708376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: This study aimed to define the behavioral determinants influencing the decision of intensivists to consult a poison center (PC) when managing patients with calcium channel blocker (CCB) poisoning.Material and methods: Semi-structured interviews were conducted involving a convenience sample of 18 intensivists. Two independent reviewers analyzed the interview responses using the Theoretical Domains Framework. Based on the impact and frequency of the reported behaviors, we selected the most relevant domains likely to influence intensivists' decision to consult a PC for CCB poisoning.Results: Beliefs influencing physicians positively to consult a PC for CCB poisoning were identified in the following domains: knowledge (e.g., lower level of evidence), social or professional role and identity (e.g., high credibility attributed to the PC), reinforcement (e.g., multiple drug poisoning, infrequent or potentially lethal poisoning, medicolegal considerations), and behavioral regulation (e.g., facilitated access of PC to patient's hospital chart, direct communication with a toxicologist). Beliefs deterring physicians from consulting a PC for CCB poisoning were identified in the following domains: knowledge (e.g., better awareness of recommendations decreases tendency to call), goals (e.g., priority for patient stabilization), and memory, attention, and decision process (e.g., cognitive overload due to an unstable patient).Conclusion: This qualitative study identified potential behavioral targets that future implementation strategies should address to improve collaboration between PCs and intensivists. In light of our results, the Québec PC now asks clinicians if the poisoned patient is unstable prior to collecting any other information. When necessary, a teleconference with the toxicologist is proposed earlier than before.
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Affiliation(s)
- Eric Brassard
- Department of Anesthesiology and Critical Care, Université Laval, Québec, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care, Université Laval, Québec, Canada.,Centre de Recherche du Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
| | - Guillaume Lacombe
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada
| | - Maude St-Onge
- Department of Anesthesiology and Critical Care, Université Laval, Québec, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada.,Centre antipoison du Québec, CIUSSS Capitale Nationale, Québec, Canada.,CHU de Québec Research Center, Population Health and Optimal Health Practices, Université Laval, Québec, Canada
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Al Zoubi FM, French SD, Patey AM, Mayo NE, Bussières AE. Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors. Chiropr Man Therap 2019; 27:68. [PMID: 31857892 PMCID: PMC6909494 DOI: 10.1186/s12998-019-0286-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/01/2019] [Indexed: 12/28/2022] Open
Abstract
Background Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. Methods Individual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive sample of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Results Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise (Environmental Context and Resources); and consulting more experienced colleagues and chronic patients with important psychological overlay (Social Influences). Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives (Goals), and chiropractors: confidence in using stratified care approaches (Beliefs about Capabilities); intention to use stratified care approaches (Intentions); awareness and agreement with stratified care approaches (Knowledge); assessment of readiness for change and intentional planning behaviour (Behavioural Regulation); and improving the management of non-specific LBP patients and the uptake of evidence-based practice (Beliefs about Consequences). Conclusions Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice.
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Affiliation(s)
- Fadi M Al Zoubi
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada
| | - Simon D French
- 3Department of Chiropractic, Macquarie University, Sydney, NSW Australia.,4School of Rehabilitation Therapy, Queen's University, Kingston, ON Canada
| | - Andrea M Patey
- 5Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Nancy E Mayo
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada
| | - André E Bussières
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC Canada.,6Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC Canada
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Presseau J, McCleary N, Lorencatto F, Patey AM, Grimshaw JM, Francis JJ. Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implement Sci 2019; 14:102. [PMID: 31806037 PMCID: PMC6896730 DOI: 10.1186/s13012-019-0951-x] [Citation(s) in RCA: 148] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. METHODS AND RESULTS We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. CONCLUSIONS Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Nicola McCleary
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Andrea M Patey
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jill J Francis
- School of Health Sciences, City University of London, London, UK
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Eilayyan O, Thomas A, Hallé MC, Ahmed S, Tibbles AC, Jacobs C, Mior S, Davis C, Evans R, Schneider MJ, Owens H, Zoubi FA, Barnsley J, Long CR, Bussières A. Promoting the use of self-management in patients with spine pain managed by chiropractors and chiropractic interns: barriers and design of a theory-based knowledge translation intervention. Chiropr Man Therap 2019; 27:44. [PMID: 31636895 PMCID: PMC6794734 DOI: 10.1186/s12998-019-0267-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/05/2019] [Indexed: 12/29/2022] Open
Abstract
Background The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify patients’ barriers and enablers to using SMS, and 3) map behaviour change techniques (BCTs) to key barriers to inform the design of a knowledge translation (KT) intervention aimed to increase the use of SMS. Methods In summer 2016, we invited 250 patients with spine pain seeking care at the Canadian Memorial Chiropractic College in Ontario, Canada to complete the Patient Activation Measure (PAM) survey to assess the level of participation in self-care. We subsequently conducted individual interviews, in summer 2017, based on the Theoretical Domains Framework (TDF) in a subset of patients to identify potential challenges to using SMS. The interview guide included 20 open-ended questions and accompanying probes. Findings were deductively analysed guided by the TDF. A panel of 7 experts mapped key barriers to BCTs, designed a KT intervention, and selected the modes of delivery. Results Two hundred and twenty-three patients completed the PAM. Approximately 24% of respondents were not actively involved in their care. Interview findings from 13 spine pain patients suggested that the potential barriers to using SMS corresponded to four TDF domains: Environmental Context and Resources; Emotion; Memory, Attention & Decision-Making; and Behavioural Regulation. The proposed theory-based KT intervention includes paper-based educational materials, webinars and videos, summarising and demonstrating the therapeutic recommendations including exercises and other lifestyle changes. In addition, the KT intervention includes Brief Action Planning, a SMS strategy based on motivational interviewing, along with a SMART plan and reminders. Conclusions Almost one quarter of study participants were not actively engaged in their spine care. Key barriers likely to influence uptake of SMS among patients were identified and used to inform the design of a theory-based KT intervention to increase their participation level. The proposed multi-component KT intervention may be an effective strategy to optimize the quality of spine pain care and improve patients’ health-outcomes. Electronic supplementary material The online version of this article (10.1186/s12998-019-0267-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Owis Eilayyan
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Aliki Thomas
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Marie-Christine Hallé
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Sara Ahmed
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Anthony C Tibbles
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Craig Jacobs
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Silvano Mior
- 3Canadian Memorial Chiropractic College, 6100 Leslie St, North York, ON M2H 3J1 Canada
| | - Connie Davis
- 4University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada.,Centre for Collaboration, Motivation and Innovation, PO Box 1343, Vernon, BC V1T 6N6 Canada
| | - Roni Evans
- 6University of Minnesota, Minneapolis, MN 55455 USA
| | | | - Heather Owens
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada
| | - Fadi Al Zoubi
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
| | - Jan Barnsley
- 8University of Toronto, 27 King's College Cir, Toronto, ON M5S Canada
| | - Cynthia R Long
- 9Palmer College, Davenport, 1000 Brady St, Davenport, IA 52803 USA
| | - Andre Bussières
- 1School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, Quebec H3G 1Y5 Canada.,2Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 6363, Hudson Road, office 061, Lindsay Pavilion of the IURDPM, Montreal, QC H3S 1M9 Canada
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Gray TA, Wilson P, Dumville JC, Cullum NA. What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework. BMJ Open 2019; 9:e024859. [PMID: 31371284 PMCID: PMC6678001 DOI: 10.1136/bmjopen-2018-024859] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice. DESIGN Qualitative focus group study using the Theoretical Domains Framework (TDF) to structure the questions, prompts and analyses. SETTING Community healthcare settings in the North of England, UK. PARTICIPANTS Forty-six clinical professionals who cared for patients with complex wounds and eight non-clinical professionals who were responsible for procuring wound care products participated across six focus group interviews. RESULTS We found the TDF domains: environmental context and resources, knowledge, skills, social influences and behaviour regulation to best explain the variation in wound care and the underuse of research evidence. Factors such as financial pressures were perceived as having a negative effect on the continuity of care, the availability of wound care services and workloads. We found practice to be mainly based on experiential knowledge and personal preference and highly influenced by colleagues, patients and the pharmaceutical industry, although not by research evidence. CONCLUSIONS Our study provides new insight into the role that experiential learning and social influences play in determining wound care and on the limited influence of research. Workforce pressures and limited resources are perceived to impede care by reducing patient access to services and the ability to provide holistic care. Participative collaboration between university and healthcare organisations may offer a supportive route to addressing issues, implementing sustainable changes to practice and service delivery and a resolute commitment to research use among clinical professionals.
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Affiliation(s)
- Trish A Gray
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Paul Wilson
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Nicky A Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
- Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
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Dhopte P, French SD, Quon JA, Owens H, Bussières A. Guideline implementation in the Canadian chiropractic setting: a pilot cluster randomized controlled trial and parallel study. Chiropr Man Therap 2019; 27:31. [PMID: 31346409 PMCID: PMC6636122 DOI: 10.1186/s12998-019-0253-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
Background Feasibility and pilot studies are recommended prior to embarking on large-scale costly confirmatory trials. The objectives were to determine the feasibility of conducting a cluster randomized controlled trial (C-RCT) to evaluate a complex knowledge translation (KT) intervention to improve the management of people with neck pain, and to identify challenges and potential solutions to conducting a fully powered C-RCT in the chiropractic setting. Methods Pilot C-RCT involving a nationally representative sample of chiropractors and patients. We invited 400 chiropractors and 150 patients to participate. Clinicians were randomized to receive either an online theory-based KT educational and brief action plan (BAP) intervention (intervention group) or a copy of a clinical practice guideline (control group). Study-related challenges were ascertained via mid-study phone interviews and end-of-study feedback questionnaires. Analyses focused on descriptive estimates of likely recruitment, retention, and adherence rates, and documentation of potential barriers. Results In total, 47 chiropractors (12%) agreed to participate and were randomized after resampling. Fifteen withdrew from the study, leaving a total of 32 (8%) participants. Eleven chiropractors in the intervention group completed the webinars and e-learning modules, two partially completed them and three did not register. Participating chiropractors recruited a total of 29 patients. Sixty-three percent (n = 7) of intervention and 56% (n = 10) of control group patients completed all outcome measures at both baseline and 3-months follow-up, attended follow-up visits and performed home exercises. Patients in the intervention group reported significant reductions in pain (mean 1.6, 95% CI 0.26–2.94, P = 0.027) and disability scores (9.8, 95% CI 3.68–15.91, P = 0.033) from baseline to 3-month follow-up. Key barriers to participation reported by chiropractors included lack of time, difficulties in recruiting patients, problems with the administration of study questionnaires, concern that the clinician-patient relationship might be jeopardized, and lack of assistance from office staff. Over half (55%) of the respondents in the intervention group encountered some difficulty registering or completing the educational modules. Conclusion Recruitment of clinicians and patients for a trial of a complex intervention can be challenging, and retention of participants after enrolment may be low. Future trials of this nature likely require multiple recruitment strategies to achieve desired sample sizes. Moreover, time-constraint issues are perceived particularly by clinicians as a major barrier to both study enrolment before, and protocol adherence during, their actual participation in a trial. Trial registration The study was registered at, NCT02483091, on 17th June 2015. Electronic supplementary material The online version of this article (10.1186/s12998-019-0253-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prakash Dhopte
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada
| | - Simon D French
- 3Department of Chiropractic, Macquarie University, 24/1 Lakeside Rd, Eastwood NSW, 2122 Australia
| | - Jeffrey A Quon
- 4School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada.,5International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, 818 West 10th Avenue, Vancouver, BC Canada.,6Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, 11th Floor - 2775 Laurel Street, Vancouver, BC V5Z 1M9 Canada.,The Cambie Chiropractic Centre, 2786 W 16th Ave suite 101, Vancouver, BC V6K 4M1 Canada
| | - Heather Owens
- 8CISSS Laval-Jewish Rehabilitation Hospital, CRIR-Feil Oberfeld Research Centre, 3205 Place Alton Goldbloom, Laval, Qc H7V 1R2 Canada
| | - André Bussières
- 1School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, Hosmer House, Montreal, Quebec H3G 1Y5 Canada.,2Centre de recherche interdisciplinaire en réadaptation (CRIR), 6363 chemin Hudson, bureau 061,Pavillon Lindsay de l'IURDPM, Montréal, QC H3S 1M9 Canada.,9Département chiropratique, Université du Québec à Trois-Rivières, 3351 Boul. des Forges, Trois-Rivières, Qc G8Z 4M3 Canada
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Fingleton N, Duncan E, Watson M, Matheson C. Specialist Clinicians' Management of Dependence on Non-Prescription Medicines and Barriers to Treatment Provision: An Exploratory Mixed Methods Study Using Behavioural Theory. PHARMACY 2019; 7:E25. [PMID: 30841493 PMCID: PMC6473901 DOI: 10.3390/pharmacy7010025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/15/2019] [Accepted: 02/28/2019] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to establish how non-prescription medicine (NPM) dependence is treated by doctors in specialist substance misuse treatment services and to identify perceived barriers to providing treatment. An online survey was conducted to establish current practice and whether changes to service provision are needed to facilitate treatment (n = 83). Semi-structured interviews, based on the Theoretical Domains Framework, were conducted to derive a detailed exploration of suggested changes (n = 11). Most survey respondents had encountered cases of NPM dependence. Analgesics containing codeine were the most frequently NPMs of dependence mentioned by respondents. Most respondents were unaware of specific guidelines for the treatment of NPM dependence. The most frequently identified barriers to providing treatment identified by interviewees were limited resources or capacity and the challenges presented by this client group. There was a perception that this client group could be difficult to treat due to comorbidities, and these this client group perceived themselves to be different from people dependent on alcohol or illicit drugs. This study identified a clear need for specific clinical guidelines for the treatment of NPM dependence. Such guidance should be appropriate for specialist and generalist clinicians as the current pressure on resources may force more treatment into general practice. Appropriate care pathways need to be established and defined, and sufficient resources allocated to accommodate this client group.
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Affiliation(s)
- Niamh Fingleton
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, UK.
| | - Margaret Watson
- Department of Pharmacy and Pharmacology, University of Bath, Bath BA2 7AY, UK.
| | - Catriona Matheson
- Faculty of Social Sciences, University of Stirling, Stirling FK9 4LA, UK.
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47
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Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, Straker L, Maher CG, O'Sullivan PPB. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med 2019; 54:79-86. [PMID: 30826805 DOI: 10.1136/bjsports-2018-099878] [Citation(s) in RCA: 436] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To identify common recommendations for high-quality care for the most common musculoskeletal (MSK) pain sites encountered by clinicians in emergency and primary care (spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis [OA] and shoulder) from contemporary, high-quality clinical practice guidelines (CPGs). DESIGN Systematic review, critical appraisal and narrative synthesis of MSK pain CPG recommendations. ELIGIBILITY CRITERIA Included MSK pain CPGs were written in English, rated as high quality, published from 2011, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment. DATA SOURCES Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. RESULTS 6232 records were identified, 44 CPGs were appraised and 11 were rated as high quality (low back pain: 4, OA: 4, neck: 2 and shoulder: 1). We identified 11 recommendations for MSK pain care: ensure care is patient centred, screen for red flag conditions, assess psychosocial factors, use imaging selectively, undertake a physical examination, monitor patient progress, provide education/information, address physical activity/exercise, use manual therapy only as an adjunct to other treatments, offer high-quality non-surgical care prior to surgery and try to keep patients at work. CONCLUSION These 11 recommendations guide healthcare consumers, clinicians, researchers and policy makers to manage MSK pain. This should improve the quality of care of MSK pain.
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Affiliation(s)
- Ivan Lin
- WA Centre for Rural Health, University of Western Australia, Geraldton, Western Australia, Australia
| | - Louise Wiles
- Centre for Population Health Research, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Rob Waller
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Roger Goucke
- Pain Management Centre, Sir Charles Gardner Hospital, Perth, Western Australia, Australia
| | - Yusuf Nagree
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia.,Emergency Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Michael Gibberd
- Emergency Department, Geraldton Hospital, Geraldton, Western Australia, Australia
| | - Leon Straker
- School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Chris G Maher
- School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter P B O'Sullivan
- Department of Physiotherapy, Curtin University, Perth, Western Australia, Australia
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48
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Ayub A, Osama M, Ahmad S. Effects of active versus passive upper extremity neural mobilization combined with mechanical traction and joint mobilization in females with cervical radiculopathy: A randomized controlled trial. J Back Musculoskelet Rehabil 2019; 32:725-730. [PMID: 30664500 DOI: 10.3233/bmr-170887] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neural mobilization is an effective technique in the management of cervical radiculopathy (CR). However, the difference between active versus passive upper extremity (UE) neural mobilization techniques in the management of cervical radiculopathy is not well established. OBJECTIVE To determine the role of active versus passive UE neural mobilization in females with cervical radiculopathy. METHODS A double blind randomized controlled trial was conducted at Shifa International Hospital from Sep 2016 to Feb 2017, and 44 females were included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A received active whereas Group B received passive UE neural mobilization, along with cervical traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome measurement tools. Non-parametric tests of significance were used for inter group and intra group comparison (Mann-Whitney U test and Wilcoxon test). RESULTS A statistically significant difference was observed between pre and post NPRS, NDI and ROM scores after 4 weeks of treatment for both groups (p< 0.05). However, no significant differences were observed in post treatment scores of active and passive neural mobilization groups (p> 0.05). CONCLUSION Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the interventions is not superior to the other.
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Affiliation(s)
- Afsah Ayub
- Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Osama
- Institute of Rehabilitation Sciences, Foundation University, Islamabad, Pakistan
| | - Shakeel Ahmad
- Riphah College of Rehabilitation Sciences, Islamabad, Pakistan
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49
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Backman R, Foy R, Diggle PJ, Kneen R, Easton A, Defres S, McGill F, Michael BD, Solomon T. A pragmatic cluster randomised controlled trial of a tailored intervention to improve the initial management of suspected encephalitis. PLoS One 2018; 13:e0202257. [PMID: 30521521 PMCID: PMC6283633 DOI: 10.1371/journal.pone.0202257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/04/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether a tailored multifaceted implementation strategy improves the initial management of patients with suspected encephalitis. DESIGN Pragmatic two arm cluster randomised controlled trial. SETTING Hospitals within the United Kingdom. PARTICIPANTS Twenty-four hospitals nested within 12 postgraduate deaneries. Patients were identified retrospectively by searching discharge, microbiology, radiology and pharmacy records and included if they met clinical criteria or had a recorded suspicion of encephalitis. INTERVENTION An implementation strategy designed to overcome barriers to change, comprising local action planning, education and training, feedback on performance, a lumbar puncture pack and a range of optional components. OUTCOMES The primary outcome was the proportion of patients with suspected encephalitis undergoing diagnostic lumbar puncture within 12 hours of admission and starting aciclovir treatment within six hours. Secondary outcomes included the proportions of adults and children who had a lumbar puncture, who had appropriate cerebrospinal fluid investigations, and who had appropriate radiological imaging within 24 hours of admission. Data were collected from patient records for 12 months before and 12 months during the intervention period, and analysed blind to allocation. RESULTS 13 hospitals were randomised to intervention and 11 to control (no intervention), with 266 and 223 patients with suspected encephalitis identified respectively. There was no significant difference in primary outcome between intervention and control hospitals (13.5% and 14.8% respectively, p = 0.619; treatment effect -0.188, 95% confidence interval -0.927 to 0.552), but both had improved compared to pre-intervention (8.5%). CONCLUSION The improvement in both intervention and control arms may reflect overall progress in management of encephalitis through wider awareness and education. TRIAL REGISTRATION Controlled Trials: ISRCTN06886935.
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Affiliation(s)
- Ruth Backman
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Peter J. Diggle
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Department Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Rachel Kneen
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Department of Neurology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Ava Easton
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- The Encephalitis Society, Malton, North Yorkshire, United Kingdom
| | - Sylviane Defres
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Fiona McGill
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
| | - Benedict Daniel Michael
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Tom Solomon
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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50
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Barker C, Dunn S, Moore GP, Reszel J, Lemyre B, Daboval T. Shared decision making during antenatal counselling for anticipated extremely preterm birth. Paediatr Child Health 2018; 24:240-249. [PMID: 31239813 DOI: 10.1093/pch/pxy158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Objectives To explore health care providers' (HCPs) perceptions of using shared decision making (SDM) and to identify facilitators of and barriers to its use with families facing the anticipated birth of an extremely preterm infant at 22+0 to 25+6 weeks gestational age. Study Design Qualitative descriptive study design: we conducted interviews with 25 HCPs involved in five cases at a tertiary care centre and completed qualitative content analysis of their responses. Results Nine facilitators and 16 barriers were identified. Facilitators included: a correct understanding of this process and how to apply it, a belief that parents should be the decision makers in these situations, and a positive outlook toward using SDM during antenatal counselling. Barriers included: HCPs' misunderstandings of how and when to apply SDM during antenatal counselling, challenges using the process for cases at the lower end of the gestational age range, fear of the negative emotions and stress parents face when making decisions, and HCPs' uncertainty about their ability to properly apply SDM. Conclusions This study identified facilitators and barriers to use of SDM during antenatal counselling for anticipated birth of extremely preterm infants that can be used to inform development of tailored strategies to facilitate future implementation of shared decision making in this area.
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Affiliation(s)
- Conor Barker
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Sandra Dunn
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute (CHEORI)
| | - Gregory P Moore
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute (CHEORI).,Department of Obstetrics Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario
| | - Jessica Reszel
- Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Better Outcomes Registry & Network (BORN) Ontario, Ottawa, Ontario
| | - Brigitte Lemyre
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute (CHEORI).,Department of Obstetrics Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario
| | - Thierry Daboval
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario.,Department of Paediatrics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute (CHEORI).,Department of Obstetrics Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario.,The Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario
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