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Turner RR, Hart J, Carr N, Bull E, Fraser J, Byrne-Davis L. Interview study exploring how global health partnership principles are enacted and recommendations for practice. BMJ Open 2024; 14:e076475. [PMID: 38862224 PMCID: PMC11168132 DOI: 10.1136/bmjopen-2023-076475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/04/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Effective global health partnerships can strengthen and improve health and healthcare systems across the world; however, establishing and maintaining effective partnerships can be challenging. Principles of Partnerships have been developed to improve the quality and effectiveness of health partnerships. It is unclear how principles are enacted in practice, and current research has not always included the voices of low-income and middle-income country partners. This study aimed to explore how The Tropical Health and Education Trust's nine Principles of Partnership are enacted in practice, from the points of view of partners from low-income, middle-income and high-income countries, to help improve partnerships' quality and sustainability. METHODS People who had been a part of previous and/or ongoing health partnerships were interviewed virtually. Participants were purposefully sampled and interviews were conducted using an appreciative inquiry approach. Audio recordings were transcribed and deductive framework analysis was conducted. RESULTS 13 participants from 8 partnerships were interviewed. Six participants were based in the low-income or middle-income countries and seven in the UK. Key findings identified strategies that enacted 'successful' and 'effective' partnerships within the Principles of Partnerships. These included practical techniques such as hiring a project manager, managing expectations and openly sharing information about the team's expertise and aspirations. Other strategies included the importance of consulting behavioural science to ensure the partnerships consider longevity and sustainability of the partnership. DISCUSSION Core principles to effective partnerships do not work in isolation of each other; they are intertwined and are complimentary to support equitable partnerships. Good communication and relationships built on trust which allow all partners to contribute equally throughout the project are core foundations for sustainable partnerships. Recommendations for established and future partnerships include embedding behavioural scientists/psychologists to support change to improve the quality and sustainability of health partnerships.
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Affiliation(s)
- Rebecca Rose Turner
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
| | - Jo Hart
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
| | - Natalie Carr
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
| | - Eleanor Bull
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
| | - Jessica Fraser
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
- Tropical Health and Education Trust (THET), London, UK
| | - Lucie Byrne-Davis
- Health Workforce Group, Division of Medical Education, The University of Manchester, Manchester, UK
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Fernandez R, tenHam-Baloyi W, Mathew E, Secginli S, Bahar Z, Jans C, Nahcivan N, Torun G, Lapkin S, Green H. Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries. J Clin Nurs 2023; 32:789-798. [PMID: 35475307 PMCID: PMC10083919 DOI: 10.1111/jocn.16330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To identify final-year undergraduate students and new graduate nurses' behavioural intentions towards medication safety across four countries. BACKGROUND Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society. DESIGN A multi-site cross-sectional study. METHODS A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines. RESULTS Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students. CONCLUSION Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates. RELEVANCE TO CLINICAL PRACTICE Understanding student and new graduate nurses' medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.
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Affiliation(s)
- Ritin Fernandez
- Centre for Research in Nursing and Health, St. George Hospital, Kogarah, New South Wales, Australia.,Centre for Evidence Based Initiatives in Health Care: A Joanna Briggs Centre of Excellence, Wollongong, New South Wales, Australia.,School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wilma tenHam-Baloyi
- Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Elsheba Mathew
- Community Medicine, Pushpagiri Medical College Hospital, Thiruvalla, India.,Pushpagiri Centre for Evidence Based Practice (PCEBP) - A JBI Affiliated Group, Tiruvalla, India
| | - Selda Secginli
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Zuhal Bahar
- Department of Nursing, Faculty of Health Sciences, Istanbul Aydin University, Istanbul, Turkey
| | - Carley Jans
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nursen Nahcivan
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Gizemnur Torun
- Department of Public Health Nursing, Kocaeli University, Kocaeli, Turkey
| | - Samuel Lapkin
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Heidi Green
- Centre for Research in Nursing and Health, St. George Hospital, Kogarah, New South Wales, Australia.,Centre for Evidence Based Initiatives in Health Care: A Joanna Briggs Centre of Excellence, Wollongong, New South Wales, Australia
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Dutra SVO, Kumar K, Clochesy JM. Instruction strategies for drug calculation skills: A systematic review of the literature. NURSE EDUCATION TODAY 2022; 111:105299. [PMID: 35228018 DOI: 10.1016/j.nedt.2022.105299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Medication errors and unsafe medication practices are a leading cause of injury and avoidable harm worldwide. OBJECTIVES The aim of this review was to (i) explore and identify evidence-based strategies to teach medication calculation skills by determining the most common errors and assess the quality, level, and role of the evidence, and (ii) describe instruction strategies for drug calculation skills development or improvement based on seven research-based principles for smart teaching. DESIGN Systematic review. DATA SOURCES CINAHL, PubMed, and PsycINFO. REVIEW METHODS The review followed Whittemore and Knafl's framework steps with an assessment of the studies reporting using PRISMA, STROBE, COREQ and categorizing their methods by evidence hierarchy and roles. Two authors independently assessed eligibility and extracted data. RESULTS From the total 1793 articles, 51 studies met the eligibility criteria. The studies included 9210 nursing students/nurses and mainly used a quantitative approach (67.5%), followed by qualitative (22.5%) and mixed methods (10.0%), with the students/nurses doing arithmetic and conceptual mistakes. The findings presented were low levels of evidence III (23.5%) and V (41.2%), quality Level B (82.4%), and 47.1% focused on choosing the appropriate teaching and intervention approaches (role of the evidence). The teaching strategies addressed multiple smart teaching principles, but mainly prior knowledge (principle 1, 39.2%). The least used strategies were those addressing the levers that influence motivation and behaviors such as value, expectations, and environment climate (principle 3, 13.7%). Two studies addressed five principles simultaneously. CONCLUSIONS Regarding teaching strategies, the most recurring strategies were early diagnostic assessments on knowledge, anxiety and/or self-confidence, considering knowledge organization with scaffolding complex tasks, being explicit about objectives and expectations, and usage of e-learning. However, e-learning was mainly used after 2018. Considering the low levels and quality of evidence, we recommend higher levels of research design for future research. Randomized Controlled Trials could be conducted when randomizing teaching methods per semester or questions embedded in software. Web-base software could be used to support teaching and research approaches.
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Affiliation(s)
| | - K Kumar
- Clemson University, School of Computing, Clemson, SC, USA; Medical University of South Carolina, Charleston, SC, USA
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O’Brien N, Shaw A, Flott K, Leatherman S, Durkin M. Safety in fragile, conflict-affected, and vulnerable settings: An evidence scanning approach for identifying patient safety interventions. J Glob Health 2022; 12:04018. [PMID: 35265329 PMCID: PMC8876158 DOI: 10.7189/jogh.12.04018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The number of people living in fragile, conflict-affected, and vulnerable (FCV) settings is growing rapidly and attention to achieving universal health coverage must be accompanied by sufficient focus on the safety of care for universal access to be meaningful. Healthcare workers in these settings are working under extreme conditions, often with insufficient contextualized evidence to support decision-making. Recognising the relative paucity of, and methodological issues in gathering evidence from these settings, the evidence scanning described in this paper considered which patient safety interventions might offer the 'better bet', eg, the most effective and appropriate intervention in FCV settings. Methods An evidence scanning approach was used to examine the literature. The search was limited to FCV settings and low-income settings as defined by the World Bank, but if a systematic review included a mix of evidence from FCV/low income settings, as well as low-middle income settings, it was included. The search was conducted in English and limited to studies published from 2003 onwards, utilising Google Scholar as a publicly accessible database and further review of the grey literature, with specific attention to the outputs of non-governmental organisations. The search and subsequent analysis were completed between April and June 2020. Results The majority of studies identified related to strengthening infection prevention and control which was also found to be the 'better bet' intervention that could generalise to other settings, be most feasible to implement, and most effective for improving patient care and associated outcomes. Other prioritized interventions include risk management, with contributing elements such as reporting, audits, and death review processes. Conclusions Infection prevention and control interventions dominate in the literature for multiple reasons including strength of evidence, acceptability, feasibility, and impact on patient and health worker well-being. However, there is an urgent need to further develop the evidence base, specialist knowledge, and field guidance on a range of other patient safety interventions such as education and training, patient identification, subject specific safety actions, and risk management.
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Affiliation(s)
- Niki O’Brien
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alexandra Shaw
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Kelsey Flott
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Sheila Leatherman
- UNC Gillings School of Global Public Health, University of North Carolina, North Carolina, USA
| | - Mike Durkin
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
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Whittenbury K, Kroll L, Dubicka B, Bull ER. Exploring barriers and facilitators for mental health professionals delivering behavioural activation to young people with depression: qualitative study using the Theoretical Domains Framework. BJPsych Open 2022; 8:e38. [PMID: 35118935 PMCID: PMC8867899 DOI: 10.1192/bjo.2022.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice. AIMS We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study. METHOD Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT). RESULTS Nine MHPs were interviewed. Thirteen of fourteen TDF domains were relevant, including perceived professional identity, beliefs about own capabilities and perceived positive or negative consequences of using manualised behavioural activation, social influences, memory and attention, and environmental resources. Fourteen theory-linked BCTs were identified as possible strategies to help clinicians overcome barriers (e.g. integrating behavioural practice/rehearsal, prompts and persuasive communications within training, and supervision). CONCLUSIONS Behavioural science approaches (TDF, TTT) helped conceptualise key barriers and facilitators for MHPs delivering manualised behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research-practice gap in clinical psychology.
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Affiliation(s)
- Kate Whittenbury
- Faculty of Health and Education, Manchester Metropolitan University, UK
| | - Leopold Kroll
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, UK
| | - Bernadka Dubicka
- Young People's Mental Health Research Unit, Pennine Care NHS Foundation Trust Headquarters, UK; and Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Eleanor R Bull
- Faculty of Health and Education, Manchester Metropolitan University, UK; and Department of Anaesthesia, Manchester University NHS Foundation Trust, UK
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Ernawati DK, Widhiartini IAA, Budiarti E. Knowledge and attitudes of healthcare professionals on prescribing errors. J Basic Clin Physiol Pharmacol 2021; 32:357-362. [PMID: 34214364 DOI: 10.1515/jbcpp-2020-0411] [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: 11/27/2020] [Accepted: 04/01/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to evaluate the knowledge and attitudes of healthcare professionals on prescribing errors. METHODS This was a cross-sectional study employing a questionnaire that consisted of 12 items on knowledge and 10 items on healthcare professionals' attitudes toward errors in prescribing process. The participants responded to the questionnaire with a 5-Likert scale of agreement. The domains assessed in the questionnaire were respondents' knowledge and attitudes on prescribing errors, professionals responsible for the errors, and professionals' competence on drug dose adjustment. Additionally, the questionnaire had two case scenarios to further assess the healthcare professionals' knowledge of prescribing errors. There were 300 questionnaires administered to physicians, nurses, and pharmacists who attended conferences in Denpasar from July to October 2019. RESULTS There were 30 physicians, 58 nurses, and 69 pharmacists who responded to the survey. A response rate of 52.3% (157/300) was obtained. All healthcare professionals agreed that errors may occur in prescribing, dispensing, and administration process. All healthcare professionals understood that physician is responsible for ensuring drug safety in prescribing process and also supported a standardized form on drugs which may need drug dose personalization. Concerning item on the importance of collaboration in drug dose adjustment, although the healthcare professionals agreed on the statement, they had significant differences on the level agreement on the statement (p=0.029). The healthcare professionals also supported having regular training on drug dose adjustment based on individual patients' regimentation. The healthcare professionals' responses showed that the significant differences found on the statement of healthcare professionals should have competency on personalized dose calculation (p<0.001). All healthcare professionals agreed that physicians should have competency on drug dose adjustment, yet physicians showed less agreement that other health professionals should have the competency. CONCLUSIONS All healthcare professionals understood that medication errors may occur during the prescribing process but showed different attitudes on professionals who had competence in drug dose calculation. They emphasize the need to have a standardized prescription format for medication with dose changes. The respondents also recommend having regular training on medication safety for healthcare professionals.
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Affiliation(s)
- Desak Ketut Ernawati
- Department of Pharmacology and Therapy, Universitas Udayana, Denpasar, Indonesia
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Mrayyan MT, Al-Atiyyat N, Al-Rawashdeh S, Sawalha M, Awwad M. Comparing rates and causes of, and views on reporting of medication errors among nurses working in different-sized hospitals. Nurs Forum 2021; 56:560-570. [PMID: 33884638 DOI: 10.1111/nuf.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medication errors are detrimental to patient safety and the quality of hospital services. PURPOSE The purpose of the study was to compare registered nurses working in the small-, medium-, and large-sized Jordanian hospitals' responses in terms of reported rate and cause of medication errors and their views on medication error reporting. METHODS This was a cross-sectional comparative design, with a total sample of 229 nurses working in different-sized hospitals. RESULTS The rates of reported medication errors were significantly different across hospitals representing 53.5% in small-sized, 41.8% in medium-sized, and 32.8% in large-sized hospitals. No significant differences between hospitals regarding the nurses' reported causes of medication errors. Nurses' views were significantly different in all aspects of their reporting except in their failure to report (drug) error. CONCLUSIONS The hospital's size may associate with nurses' reporting rate and nurses' views on reporting such errors. There is an urgent need for more diligent systematic efforts to prevent, detect, and report medication errors. Collaboration with other health team members, including information technology members, will enhance the outcomes associated with medication administration. The findings of this study warranted further investigations.
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Affiliation(s)
- Majd T Mrayyan
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Nijmeh Al-Atiyyat
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Sami Al-Rawashdeh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
| | - Murad Sawalha
- Department of Maternal, Child, and Family Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Azad A, Min JG, Syed S, Anderson S. Continued nursing education in low-income and middle-income countries: a narrative synthesis. BMJ Glob Health 2020; 5:e001981. [PMID: 32181001 PMCID: PMC7042573 DOI: 10.1136/bmjgh-2019-001981] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/30/2019] [Accepted: 01/13/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction Continued nursing education and development can reduce mortality and morbidity of patients and can alleviate the shortage of healthcare workers by training of nurses for high-demand skill sets. We reviewed patterns of educational interventions and strategies in initiating behaviour change, improving patient outcomes or knowledge for nurses in low- and middle-income countries (LMICs). Methods The study searched the MEDLINE (PubMed), Embase, CINAHL, Google Scholar and Web of Science databases. The study included interventional studies on continued nursing education from 2007 to 2017. Of the 6216 publications retrieved, 98 articles were included and analysed by three independent reviewers. Results Of the 98 studies that met inclusion criteria, five were randomised controlled trials, two were qualitative in design and the remaining 91 were quasi-experimental, before-and-after studies. Of these studies, the median sample size of participants was 64, and the majority were conducted in Asia (53.1%). During the 10-year study period, 20.4% was conducted in 2015, the highest proportion, with a general increase in number of studies over time from 2007 to 2017. Main themes that arose from the review included train-the-trainer models, low-dose/high-frequency models, use of multiple media for training, and emphasis on nurse empowerment, strong international partnerships, and the integration of cultural context. Overall, the studies were limited in quality and lacked rigorous study design. Conclusion Continued nursing education in LMICs is essential and effective in improving nurses’ knowledge base, and thus patient outcomes and quality of care. Long-term, randomised studies are needed to understand how training strategies compare in impact on nurses and patients.
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Affiliation(s)
- Amee Azad
- Stanford University School of Medicine, Stanford, California, USA
| | - Jung-Gi Min
- Stanford University School of Medicine, Stanford, California, USA
| | - Sharjeel Syed
- Stanford University School of Medicine, Stanford, California, USA
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Pearson E, Byrne-Davis L, Bull E, Hart J. Behavior change techniques in health professional training: developing a coding tool. Transl Behav Med 2020; 10:96-102. [PMID: 30535181 DOI: 10.1093/tbm/iby125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Health professional Continuing Professional Development (CPD) courses often aim to change practice; understanding which training techniques drive behavior change can help educators facilitate this. The 93-item Behaviour Change Technique Taxonomy (BCTT) describes behavior change techniques (BCTs) used in behavior change interventions but was not designed for understanding CPD; it is necessary to explore how best to use the BCTT in this context. This study aimed to explore the BCTs used by CPD course educators to change healthcare practice and to develop and pilot an e-tool, based on the BCTT, to enable course designers and educators to understand which BCTs are in their training. This understanding could lead to enhanced CPD and an experimental approach to assessing the benefits of including a variety of BCTs in CPD. Two psychologists, trained in using the BCTT, observed three postgraduate medical CPD courses. In Phase 1, the BCTT was used to code 26 hours of observations. An e-tool including observed BCTs was developed and used to code 35 hours of observations in Phase 2. Feedback was collected through short discussions with educators from each course. The tool was further refined in Phase 3. Thirty-seven BCTs were identified in Phase 1, a further four in Phase 2, and a further two in Phase 3. The final e-tool comprised 43 BCTs with examples of their use based on course observations to aid identification, since educators fed back that they would value an uncomplicated tool with practice-related examples. A coding tool to understand the active ingredients in health professional CPD could enable educators to maximize the impact of CPD on practice. Further work should explore whether educators themselves are able to use the tool to code their training interventions.
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Affiliation(s)
- Emma Pearson
- Department of Applied Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lucie Byrne-Davis
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Eleanor Bull
- Division of Medical Education, University of Manchester, Manchester, UK
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, UK
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Bull ER, Hart JK, Swift J, Baxter K, McLauchlan N, Joseph S, Byrne-Davis LMT. An organisational participatory research study of the feasibility of the behaviour change wheel to support clinical teams implementing new models of care. BMC Health Serv Res 2019; 19:97. [PMID: 30717764 PMCID: PMC6360652 DOI: 10.1186/s12913-019-3885-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/07/2019] [Indexed: 11/28/2022] Open
Abstract
Background Health and social care organisations globally are moving towards prevention-focussed community-based, integrated care. The success of this depends on professionals changing practice behaviours. This study explored the feasibility of applying a behavioural science approach to help staff teams from health organisations overcome psychological barriers to change and implement new models of care. Methods An Organisational Participatory Research study was conducted with health organisations from North West England, health psychologists and health workforce education commissioners. The Behaviour Change Wheel (BCW) was applied with teams of professionals seeking help to overcome barriers to practice change. A mixed-methods data collection strategy was planned, including qualitative stakeholder interview and focus groups to explore feasibility factors and quantitative pre-post questionnaires and audits measuring team practice and psychological change barriers. Qualitative data were analysed with thematic analysis; pre-post quantitative data were limited and thus analysed descriptively. Results Four clinical teams from paediatrics, midwifery, heart failure and older adult mental health specialties in four organisations enrolled, seeking help to move care to the community, deliver preventative healthcare tasks, or become more integrated. Eighty-one managers, medical doctors, nurses, physiotherapists, midwives and other professionals contributed data. Three teams successfully designed a BCW intervention; two implemented and evaluated this. Five feasibility themes emerged from the thematic analysis of qualitative data. Optimising the BCW in an organisational change context meant 1) qualitative over quantitative data collection, 2) making behavioural science attractive, 3) co-development and a behavioural focus, 4) effective ongoing communication and 5) support from engaged leaders. Pre-post quantitative data collected suggested some positive changes in staff practice behaviours and psychological determinants following the intervention. Conclusions Behavioural science approaches such as the BCW can be optimised to support teams within health and social care organisations implementing complex new models of care. The efficacy of this approach should now be trialled. Electronic supplementary material The online version of this article (10.1186/s12913-019-3885-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleanor R Bull
- Division of Medical Education, University of Manchester, Oxford Road, Manchester, M139PT, UK. .,Department of Psychology, Manchester Metropolitan University, Manchester, M156GX, UK.
| | - Joanne K Hart
- Division of Medical Education, University of Manchester, Oxford Road, Manchester, M139PT, UK
| | - Juliette Swift
- Health Education England working across the North West, 3rd Floor, 3 Piccadilly Place, Manchester, M1 3BN, UK
| | - Kirstie Baxter
- Health Education England working across the North West, 3rd Floor, 3 Piccadilly Place, Manchester, M1 3BN, UK
| | - Neil McLauchlan
- Health Education England working across the North West, 3rd Floor, 3 Piccadilly Place, Manchester, M1 3BN, UK
| | - Sophia Joseph
- Division of Medical Education, University of Manchester, Oxford Road, Manchester, M139PT, UK
| | - Lucie M T Byrne-Davis
- Division of Medical Education, University of Manchester, Oxford Road, Manchester, M139PT, UK.
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Davies KM, Coombes ID, Keogh S, Whitfield KM. Medication administration evaluation tool design: An expert panel review. Collegian 2019. [DOI: 10.1016/j.colegn.2018.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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