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Willis TA, Neal RD, Walter FM, Foy R. Priorities for implementation research on diagnosing cancer in primary care: a consensus process. BMC Health Serv Res 2023; 23:1308. [PMID: 38012602 PMCID: PMC10683096 DOI: 10.1186/s12913-023-10330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The early detection and diagnosis of cancer to reduce avoidable mortality and morbidity is a challenging task in primary health care. There is a growing evidence base on how to enable earlier cancer diagnosis, but well-recognised gaps and delays exist around the translation of new research findings into routine clinical practice. Implementation research aims to accelerate the uptake of evidence by health care systems and professionals. We aimed to identify priorities for implementation research in early cancer diagnosis in primary care. METHODS We used a RAND/UCLA modified Delphi consensus process to identify and rank research priorities. We asked primary care physicians, patients and researchers to complete an online survey suggesting priorities for implementation research in cancer detection and diagnosis. We summarised and presented these suggestions to an 11-member consensus panel comprising nine primary care physicians and two patients. Panellists independently rated the importance of suggestions on a 1-9 scale (9 = very high priority; 1 = very low priority) before and after a structured group discussion. We ranked suggestions using median ratings. RESULTS We received a total of 115 suggested priorities for implementation research from 32 survey respondents (including 16 primary care professionals, 11 researchers, and 4 patient and public representatives; 88% of respondents were UK-based). After removing duplicates and ineligible suggestions, we presented 37 suggestions grouped within 17 categories to the consensus panel. Following two rounds of rating, 27 suggestions were highly supported (median rating 7-9). The most highly rated suggestions concerned diagnostic support (e.g., access to imaging) interventions (e.g., professional or patient education), organisation of the delivery of care (e.g., communication within and between teams) and understanding variations in care and outcomes. CONCLUSIONS We have identified a set of priorities for implementation research on the early diagnosis of cancer, ranked in importance by primary care physicians and patients. We suggest that researchers and research funders consider these in directing further efforts and resources to improve population outcomes.
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Affiliation(s)
- Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom.
| | - Richard D Neal
- Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke's Campus Heavitree Road, Exeter, EX1 2LU, UK
| | - Fiona M Walter
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, United Kingdom
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Foy R, Ivers NM, Grimshaw JM, Wilson PM. What is the role of randomised trials in implementation science? Trials 2023; 24:537. [PMID: 37587521 PMCID: PMC10428627 DOI: 10.1186/s13063-023-07578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND There is a consistent demand for implementation science to inform global efforts to close the gap between evidence and practice. Key evaluation questions for any given implementation strategy concern the assessment and understanding of effects. Randomised trials are generally accepted as offering the most trustworthy design for establishing effectiveness but may be underused in implementation science. MAIN BODY There is a continuing debate about the primacy of the place of randomised trials in evaluating implementation strategies, especially given the evolution of more rigorous quasi-experimental designs. Further critiques of trials for implementation science highlight that they cannot provide 'real world' evidence, address urgent and important questions, explain complex interventions nor understand contextual influences. We respond to these critiques of trials and highlight opportunities to enhance their timeliness and relevance through innovative designs, embedding within large-scale improvement programmes and harnessing routine data. Our suggestions for optimising the conditions for randomised trials of implementation strategies include strengthening partnerships with policy-makers and clinical leaders to realise the long-term value of rigorous evaluation and accelerating ethical approvals and decluttering governance procedures for lower risk studies. CONCLUSION Policy-makers and researchers should avoid prematurely discarding trial designs when evaluating implementation strategies and work to enhance the conditions for their conduct.
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Affiliation(s)
- Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Noah M Ivers
- Women's College Hospital, Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Paul M Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Paukkunen M, Ala-Mursula L, Öberg B, Karppinen J, Sjögren T, Riska H, Nikander R, Abbott A. Measuring the determinants of implementation behavior in multiprofessional rehabilitation. Eur J Phys Rehabil Med 2023; 59:488-501. [PMID: 37486174 PMCID: PMC10548477 DOI: 10.23736/s1973-9087.23.07857-7] [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: 12/31/2022] [Revised: 05/04/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care. AIM To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language. DESIGN A two-round Delphi study. SETTING National-level online survey. POPULATION Purposively recruited experts in multiprofessional rehabilitation (N.=25). METHODS Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals' implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts' suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave). RESULTS After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93. CONCLUSIONS A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context. CLINICAL REHABILITATION IMPACT A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.
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Affiliation(s)
- Maija Paukkunen
- Institution for Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden -
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland -
| | - Leena Ala-Mursula
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Birgitta Öberg
- Institution for Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
| | - Jaro Karppinen
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland
| | - Tuulikki Sjögren
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Heidi Riska
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Riku Nikander
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Central Hospital of Central Finland, Jyväskylä, Finland
| | - Allan Abbott
- Institution for Health, Medicine and Caring Sciences, University of Linköping, Linköping, Sweden
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Sturgiss E, Lam T, Russell G, Ball L, Gunatillaka N, Barton C, Tam CWM, O'Donnell R, Chacko E, Skouteris H, Mazza D, Nielsen S. Patient and clinician perspectives of factors that influence the delivery of alcohol brief interventions in Australian primary care: a qualitative descriptive study. Fam Pract 2022; 39:275-281. [PMID: 34473282 DOI: 10.1093/fampra/cmab091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Brief interventions (BIs) delivered in primary care can reduce harmful alcohol consumption. Yet, clinicians do not routinely offer BIs to reduce harmful alcohol use. OBJECTIVE We explored the perspectives of clinicians and patients about the use of alcohol BIs during consultations in Australian primary care. METHODS Semi-structured interviews and focus groups (face-to-face and virtual) were undertaken with 34 general practitioners, eight practice nurses and 17 patients. Field notes were made from audio-recordings and themes were identified using a descriptive qualitative approach with the field notes as the point of data analysis. RESULTS Participants identified barriers within the consultation, practice setting and wider healthcare system plus across the community which reduce the delivery of BIs in primary care including: Australian drinking norms; inconsistent public health messaging around alcohol harm; primary care not recognized as a place to go for help; community stigma towards alcohol use; practice team culture towards preventive health, including systems for recording alcohol histories; limitations of clinical software and current patient resources. CONCLUSION Multiple layers of the healthcare system influence the use of BIs in primary care. Identified facilitators for embedding BIs in primary care included: (i) raising community and clinician awareness of the health harms of alcohol, (ii) reinforcing a primary care culture that promotes prevention and, (iii) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Alcohol BIs in primary care could be further supported by community public health messages about alcohol use.
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Affiliation(s)
- Elizabeth Sturgiss
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Grant Russell
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Nilakshi Gunatillaka
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Chris Barton
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, Australia.,Faculty of Medicine, School of Population Health, University of New South Wales (UNSW) Sydney, Australia
| | - Renee O'Donnell
- Health and Social Care Unit, NHMRC CRE in Health in Preconception and Pregnancy (CRE HiPP), School of Public Health and Preventive Medicine; Monash University, Clayton, Australia
| | - Elizabeth Chacko
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Helen Skouteris
- Health and Social Care Unit, NHMRC CRE in Health in Preconception and Pregnancy (CRE HiPP), School of Public Health and Preventive Medicine; Monash University, Clayton, Australia.,Warwick Business School, The University of Warwick, Coventry, UK
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Ball L, Somerville M, Crowley J, Calleja Z, Barnes K. Providing food to patients in primary care to induce weight loss: a systematic literature review. BMJ Nutr Prev Health 2021; 4:333-341. [PMID: 34308141 PMCID: PMC8258096 DOI: 10.1136/bmjnph-2020-000195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Primary care is the ideal setting to promote weight management, warranting innovative ways to support patients. This systematic review aimed to determine whether providing food to patients in primary care can help to reduce body weight. Methods Four databases were searched for studies that aimed to elicit weight loss by directly providing foodstuffs and/or supplements to patients in primary care settings. Interventions with adults of any gender or race were included. Interventions that involved other components such as exercise classes or education sessions were excluded. The methodological quality of each study was appraised using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results Four heterogeneous studies met the eligibility criteria, representing 476 adults. Two studies used meal-replacement products but differed in length and intensity, another study provided green tea and vitamin E supplementation, and the final study provided vouchers for use at a farmers’ market hosted at a primary care clinic. Interventions ranged in length from 4 to 13 weeks. Three of the four studies observed weight loss in some form and all studies observed at least one other improvement in a health outcome such as waist circumference, blood pressure or fasting insulin levels. Conclusions A small yet notable body of literature supports the concept of providing food to patients in primary care settings to support weight loss. Further, high-quality research is needed on the efficacy and cost-effectiveness of this approach to ultimately inform policy initiatives for primary care.
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Affiliation(s)
- Lauren Ball
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University-Gold Coast Campus, Southport, Queensland, Australia
| | - Mari Somerville
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University-Gold Coast Campus, Southport, Queensland, Australia
| | - Jennifer Crowley
- Discipline of Nutrition and Dietetics, The University of Auckland, Auckland, New Zealand
| | - Zoe Calleja
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University-Gold Coast Campus, Southport, Queensland, Australia
| | - Katelyn Barnes
- School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute, Griffith University-Gold Coast Campus, Southport, Queensland, Australia
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Rosen NO, Brotto LA. Introduction to the Special Section on Innovative Knowledge Translation in Sex Research. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:17-21. [PMID: 33398702 DOI: 10.1007/s10508-020-01894-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Natalie O Rosen
- Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
- Department of Obstetrics and Gynecology, IWK Health Centre, Halifax, NS, Canada.
| | - Lori A Brotto
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
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Morténius H, Baigi A. Promoting the creation of R&D intentions in primary healthcare measured by a validated instrument. Health Res Policy Syst 2019; 17:107. [PMID: 31888656 PMCID: PMC6937941 DOI: 10.1186/s12961-019-0513-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary healthcare has a long and successful patient care history in Sweden. Nevertheless, a research-oriented attitude has been more or less absent in this context. In society today, access to information has significantly influenced the nature of patients' demand for up-to-date healthcare. A prerequisite for this new demand is health professionals who are interested in novel ways of thinking and view a change of work practices as necessary. One way to achieve this goal is by means of strategic communication, which is a relatively new interdisciplinary field. The aim of this study was to analyse the role of strategic communication in the creation of intentions in Research and Development (R&D) among primary healthcare staff as measured by a validated instrument. METHODS An intervention study on staff was performed. A 15-item questionnaire was validated and implemented. All primary healthcare staff from the southwestern Swedish province of Halland were included. In total, 846 employees (70%) agreed to participate in the measurements. After 12 years, 352 individuals who had participated in the intervention and remained in the organisation were identified and followed up. The intervention comprised established communication channels. The measurements were performed after 7 and 12 years. A questionnaire was designed for this purpose. The questions were validated by a factor analysis, and the degree of reliability was measured with Cronbach's alpha coefficient. χ2 and Fisher's exact tests were used as statistical tests in comparisons. RESULTS Factor analysis identified five pure factors (most Cronbach's alpha > 0.70). Strategic communication contributed to a significant improvement in the staff members' interest in R&D and willingness to change in both the short (P < 0.05) and long (P < 0.05) term. The positive attitude was stable over time. CONCLUSIONS Strategic communication seems to be a significant tool for creating a stable positive attitude towards R&D in the primary healthcare context. The creation of a positive attitude towards a scientific approach is a relevant finding that deserves special attention in a context as complex as healthcare. Using a validated instrument seems to contribute to pure results in this case.
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Affiliation(s)
- Helena Morténius
- Department of Health Care, Region Halland, Box 517, 301 80, Halmstad, Sweden. .,Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Amir Baigi
- Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Halland, Halmstad, Sweden
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Linden-Lahti C, Holmström AR, Pennanen P, Airaksinen M. Facilitators and barriers in implementing medication safety practices across hospitals within 11 European Union countries. Pharm Pract (Granada) 2019; 17:1583. [PMID: 31897250 PMCID: PMC6935546 DOI: 10.18549/pharmpract.2019.4.1583] [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: 05/31/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background: The study was carried out as part of the European Network for Patient Safety
(EUNetPas) project in 2008-2010. Objective: To investigate facilitators and barriers in implementation process of
selected medication safety practices across hospitals within European Union
countries. Methods: This was an implementation study of seven selected medication safety
practices in 55 volunteering hospitals of 11 European Union (EU) member
states. The selected practices were two different versions of medicine bed
dispensation; safety vest; discharge medication list for patients;
medication reconciliation at patient discharge; medication reconciliation at
patient admission and patient discharge, and sleep card. The participating
hospitals submitted an evaluation report describing the implementation
process of a chosen practice in their organisation. The reports were
analysed with inductive content analysis to identify general and
practice-specific facilitators and barriers to the practice
implementation. Results: Altogether 75 evaluation reports were submitted from 55 hospitals in 11 EU
member states. Implementation of the medication safety practices was
challenging and more time consuming than expected. The major reported
challenge was to change the work process because of the new practice.
General facilitators for successful implementation were existence of safety
culture, national guidelines and projects, expert support, sufficient
resources, electronic patient records, interdisciplinary cooperation and
clinical pharmacy services supporting the practice implementation. Conclusions: The key for the successful implementation of a medication safety practice is
to select the right practice for the right problem, in the right setting and
with sufficient resources in an organization with a safety culture.
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Affiliation(s)
- Carita Linden-Lahti
- MSc. Helsinki University Hospital, HUS Pharmacy; & Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki.Finland
| | - Anna-Riia Holmström
- PhD. Helsinki University Hospital, HUS Pharmacy; & Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki.Finland
| | - Pirjo Pennanen
- MD. City of Vantaa, Preventive Healthcare. Vantaa (Finland)
| | - Marja Airaksinen
- PhD. Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki.Finland
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Behera SK, Das S, Xavier AS, Selvarajan S, Anandabaskar N. Indian Council of Medical Research's National Ethical Guidelines for biomedical and health research involving human participants: The way forward from 2006 to 2017. Perspect Clin Res 2019; 10:108-114. [PMID: 31404208 PMCID: PMC6647898 DOI: 10.4103/picr.picr_10_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The Indian Council of Medical Research (ICMR) recently published the third revised guidelines "National Ethical Guidelines for Biomedical and Health-Related Research Involving Human Participants" in 2017. The changes to the guidelines were needed to acculturate the rapid advances in the research environment and advances in science and technology. The revised guidelines propose substantial changes/ modifications compared to the previous version. These include the introduction of broad consent, ethical issues related to deception, review of multi-centric research by a single ethics committee and ethical issues involved in implementation research and other issues related to public health research. The revised guidelines also incorporate modifications and minor changes to the previous version. Although most of the changes in the revised guidelines are in parallel to most of the international guidelines, we have also highlighted the minor differences compared to other international guidelines.
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Affiliation(s)
- Sapan Kumar Behera
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Alphienes Stanley Xavier
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
- IEC (Human Studies), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Nishanthi Anandabaskar
- Department of Pharmacology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Desveaux L, Saragosa M, Kithulegoda N, Ivers NM. Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study. BMC FAMILY PRACTICE 2019; 20:59. [PMID: 31077137 PMCID: PMC6511163 DOI: 10.1186/s12875-019-0947-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Longstanding variation in the views of family physicians (FPs) on the role of opioids seems to translate into widely varying prescribing rates. Improvement interventions are unlikely to achieve change if they do not understand and explicitly target the factors that determine physician prescribing behaviour. The aim of this work was to understand (1) the perspectives of FPs as it relates to opioid prescribing, and (2) the perceived barriers and enablers to guideline-adherent opioid prescribing and management of chronic non-cancer pain. METHODS A qualitative study involving one-on-one, semi-structured interviews with a sample of FPs in Ontario, Canada. Interviews were analyzed using a directed content analysis informed by the Theoretical Domains Framework. A framework approach was used to explore interaction across behavioural determinants (factors influencing behaviour) as well as demographic sources of variation. The behaviour of interest for the current study was the prescribing of opioid medications (including initiation, renewal, and dose reduction) for patients with chronic, non-cancer pain. Associated issues in the overall management of such patients were also explored. RESULTS Interviews were conducted with 22 FPs. Behavioural determinants interacted with one another to influence FPs prescribing behavior. The TDF domain Beliefs about Consequences played a central role in explaining physician prescribing behaviours as they related to the management of chronic non-cancer pain. Individual beliefs about prescribing consequences and patient behaviour interacted with prescriber beliefs about capabilities and perceptions of the FP's professional role to influence prescriber behaviour. Emotion and the environmental context influenced the impact of these determinants on opioid prescribing and the management of chronic non-cancer pain. CONCLUSIONS FPs face a wide range of complex (and often interacting) challenges when prescribing opioid therapy to their patients. Solution-based strategies should target these determinants directly using evidence-based strategies that move beyond guideline dissemination and general education. Shared decision-making strategies and patient-facing decision aids are likely to decrease the tension experienced in challenging conversations.
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Affiliation(s)
- L Desveaux
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada. .,Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, ON, Canada. .,Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada.
| | - M Saragosa
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada
| | - N Kithulegoda
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada
| | - N M Ivers
- Women's College Research Institute, Women's College Hospital, 76 Grenville Ave, Toronto, ON, M5S 1B2, Canada.,Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College Street Suite 425, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada
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12
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Tavender E, Babl FE, Middleton S. Review article: A primer for clinical researchers in the emergency department: Part VIII. Implementation science: An introduction. Emerg Med Australas 2019; 31:332-338. [DOI: 10.1111/1742-6723.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Emma Tavender
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute Melbourne Victoria Australia
- Paediatric Research in Emergency Departments International Collaborative (PREDICT) Melbourne, Victoria Australia
- Department of PaediatricsThe University of Melbourne Melbourne Victoria Australia
- Emergency DepartmentThe Royal Children's Hospital Melbourne Victoria Australia
| | - Sandy Middleton
- Nursing Research InstituteSt Vincent's Health Australia and Australian Catholic University Sydney New South Wales Australia
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13
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Khalaf AJ, Aljowder AI, Buhamaid MJ, Alansari MF, Jassim GA. Attitudes and barriers towards conducting research amongst primary care physicians in Bahrain: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:20. [PMID: 30684954 PMCID: PMC6347740 DOI: 10.1186/s12875-019-0911-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/18/2019] [Indexed: 11/12/2022]
Abstract
Background Research in primary care is essential for disease diagnosis, management and prevention in relation to the individuals, families and the community. This research aims to study the attitude of primary care physicians towards conducting research in Bahrain and to identify the main barriers encountered during research. Methods A cross-sectional study was conducted amongst 200 randomly selected primary care physicians registered in Ministry of Health affiliated primary healthcare centers in Bahrain. A self-administered validated questionnaire was adopted and used for data collection. Research data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Results Primary care physicians had a positive attitude towards conducting research with a total mean score (SD) of 4.47(0.65) (on a scale from 1 to 5 with higher scores indicating more positive attitudes). The total mean score (SD) for barriers encountered by physicians during research was 3.34 (0.80). Insufficient research allotted time (76.5%), insufficient financial support (63%), lack of financial incentives (51%) and lack of statistical support (50%) were major barriers. Physicians designation and board certificate were significantly associated with attitudes and barriers towards research (P-value < 0.05). Conclusion The majority or primary care physicians had positive attitudes towards conducting research. The major difficulties faced by physicians in conducting research are: Insufficient research allotted time, lack of financial incentives and inadequate statistical support. The study addressed a gap in building research capacity which should be embraced by many institutions through partnership and collaboration. Electronic supplementary material The online version of this article (10.1186/s12875-019-0911-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Abeer J Khalaf
- Family Practice Residency Program, Ministry of Health, PO Box 12, Juffair, Bahrain
| | - Aysha I Aljowder
- Family Practice Residency Program, Ministry of Health, PO Box 12, Juffair, Bahrain
| | - Meead J Buhamaid
- Family Practice Residency Program, Ministry of Health, PO Box 12, Juffair, Bahrain
| | - Mona F Alansari
- Family Practice Residency Program, Ministry of Health, PO Box 12, Juffair, Bahrain
| | - Ghufran A Jassim
- Family Medicine, Royal College of Surgeons in Ireland-Medical University in Bahrain, PO Box 15503, Adliya, Bahrain.
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Hetrick SE, O'Connor DA, Stavely H, Hughes F, Pennell K, Killackey E, McGorry PD. Development of an implementation guide to facilitate the roll-out of early intervention services for psychosis. Early Interv Psychiatry 2018; 12:1100-1111. [PMID: 28177191 DOI: 10.1111/eip.12420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/06/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
AIM Our aim was to develop an implementation guide that was informed by an analysis of context-specific barriers and enablers, behaviour change theory, as well as evidence about the effects of implementation interventions, for the establishment and scaling up of an early intervention model for psychosis (called Early Psychosis Prevention and Intervention Centre (EPPIC)). METHODS We used a systematic approach involving four steps. First, the target behaviours of the EPPIC model for implementation were specified. Second, a consultation was undertaken to explore the barriers and enablers to undertaking these priority minimum standard clinical behaviours. Third, an implementation strategy that included a range of behaviour change techniques tailored to address the identified barriers was developed. Finally, a tool to assess whether those implementing the EPPIC model maintained fidelity to the implementation strategy was designed. RESULTS We identified a range of barriers that could act to dilute the core components of the EPPIC model and compromise its implementation. An implementation strategy using theory and evidence-based strategies for behaviour change was designed to address these barriers. CONCLUSIONS The process we used in the development of the implementation strategy provided a unique opportunity to consider the essential areas to cover, how to make information easily understandable and accessible while noting the complexity of issues involved in not only implementation, but also the scaling up of the EPPIC model for services.
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Affiliation(s)
- Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Denise A O'Connor
- Implementation Consultant, School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Frank Hughes
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre of Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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15
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Gray-Burrows KA, Willis TA, Foy R, Rathfelder M, Bland P, Chin A, Hodgson S, Ibegbuna G, Prestwich G, Samuel K, Wood L, Yaqoob F, McEachan RRC. Role of patient and public involvement in implementation research: a consensus study. BMJ Qual Saf 2018; 27:858-864. [PMID: 29666310 PMCID: PMC6166593 DOI: 10.1136/bmjqs-2017-006954] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 03/13/2018] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Background Patient and public involvement (PPI) is often an essential requirement for research funding. Distinctions can be drawn between clinical research, which generally focuses on patients, and implementation research, which generally focuses on health professional behaviour. There is uncertainty about the role of PPI in this latter field. We explored and defined the roles of PPI in implementation research to inform relevant good practice guidance. Methods We used a structured consensus process using a convenience sample panel of nine experienced PPI and two researcher members. We drew on available literature to identify 21 PPI research roles. The panel rated their agreement with roles independently online in relation to both implementation and clinical research. Disagreements were discussed at a face-to-face meeting prior to a second online rating of all roles. Median scores were calculated and a final meeting held to review findings and consider recommendations. Results Ten panellists completed the consensus process. For clinical research, there was strong support and consensus for the role of PPI throughout most of the research process. For implementation research, there were eight roles with consensus and strong support, seven roles with consensus but weaker support and six roles with no consensus. There were more disagreements relating to PPI roles in implementation research compared with clinical research. PPI was rated as contributing less to the design and management of implementation research than for clinical research. Conclusions The roles of PPI need to be tailored according to the nature of research to ensure authentic and appropriate involvement. We provide a framework to guide the planning, conduct and reporting of PPI in implementation research, and encourage further research to evaluate its use.
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Affiliation(s)
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Martin Rathfelder
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Pauline Bland
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Allison Chin
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Susan Hodgson
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Gus Ibegbuna
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Graham Prestwich
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Kirsty Samuel
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Laurence Wood
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Farhat Yaqoob
- ASPIRE PPI Panel, Leeds Institute for Health Sciences, University of Leeds, Leeds, UK
| | - Rosemary R C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, BD9 6RJ., Bradford, UK
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16
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Glidewell L, Willis TA, Petty D, Lawton R, McEachan RRC, Ingleson E, Heudtlass P, Davies A, Jamieson T, Hunter C, Hartley S, Gray-Burrows K, Clamp S, Carder P, Alderson S, Farrin AJ, Foy R. To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis. Implement Sci 2018; 13:32. [PMID: 29452582 PMCID: PMC5816358 DOI: 10.1186/s13012-017-0704-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages. METHODS We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms-mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators. RESULTS Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. 'graded tasks' and 'problem solving' for educational outreach). BCTs addressing the determinants 'environmental context' and 'social and professional roles' (e.g. 'restructuring the social and 'physical environment' and 'adding objects to the environment') were indicator specific. We found it challenging to operationalise BCTs targeting 'environmental context', 'social influences' and 'social and professional roles' within our chosen delivery mechanisms. CONCLUSION We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery.
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Affiliation(s)
- Liz Glidewell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Thomas A. Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Duncan Petty
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Emma Ingleson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Andrew Davies
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Tony Jamieson
- Yorkshire and Humber Academic Health Science Network, Wakefield, UK
| | - Cheryl Hunter
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Suzanne Hartley
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Susan Clamp
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Paul Carder
- West Yorkshire Research and Development, Bradford Districts Clinical Commissioning Group, Bradford, UK
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda J. Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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17
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Grandes G, Sanchez A, Cortada JM, Pombo H, Martinez C, Balagué L, Corrales MH, de la Peña E, Mugica J, Gorostiza E. Collaborative modeling of an implementation strategy: a case study to integrate health promotion in primary and community care. BMC Res Notes 2017; 10:699. [PMID: 29208052 PMCID: PMC5717849 DOI: 10.1186/s13104-017-3040-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/30/2017] [Indexed: 02/08/2023] Open
Abstract
Background Evidence-based interventions are more likely to be adopted if practitioners collaborate with researchers to develop an implementation strategy. This paper describes the steps to plan and execute a strategy, including the development of structure and supports needed for implementing proven health promotion interventions in primary and community care. Results Between 10 and 13 discussion and consensus sessions were performed in four highly-motivated primary health care centers involving 80% of the primary care staff and 21 community-based organizations. All four centers chose to address physical activity, diet, and smoking. They selected the 5 A’s evidence-based clinical intervention to be adapted to the context of the health centers. The planned implementation strategy worked at multiple levels: bottom-up primary care organizational change, top-down support from managers, community involvement, and the development of innovative e-health information and communication tools. Shared decision making and practice facilitation were perceived as the most positive aspects of the collaborative modeling process, which took more time than expected, especially the development of the new e-health tools integrated into electronic health records. Conclusions Collaborative modeling of an implementation strategy for the integration of health promotion in primary and community care was feasible in motivated centers. However, it was difficult, being hindered by the heavy workload in primary care and generating uncertainty inherent to a bottom-up decision making processes. Lessons from this experience could be useful in diverse settings and for other clinical interventions. Two companion papers report the evaluation of its feasibility and assess quantitatively and qualitatively the implementation process.
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Affiliation(s)
- Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain.
| | - Alvaro Sanchez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Josep M Cortada
- Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Haizea Pombo
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Catalina Martinez
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, BioCruces Health Research Institute, Luis Power 18, 48014, Bilbao, Spain
| | - Laura Balagué
- Iztieta Primary Care Center, Donostialdea Integrated Care Organization-Osakidetza, Avenida de Lezo, s/n, 20100, Renteria, Spain
| | - Mary Helen Corrales
- La Merced Primary Health Care Center, Bilbao-Basurto Integrated Care Organization-Osakidetza, Luis Iraurrizaga 1, 48003, Bilbao, Spain
| | - Enrique de la Peña
- Sondika Primary Health Care Center, Uribe Integrated Care Organization-Osakidetza, Lehendakari Agirre 41, 48160, Sondika, Spain
| | - Justo Mugica
- Beasain Primary Health Care Center, Goieri-Alto Urola Integrated Care Organization-Osakidetza, Bernedo s/n, 20200, Beasain, Spain
| | - Esther Gorostiza
- Matiena Primary Health Care Center, Barrualde-Galdakao Integrated Care Organization-Osakidetza, BioCruces Health Research Institute, Trañabarren 13-Bajo, 48220, Abadiño, Spain
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18
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Watkins K, Wood H, Schneider CR, Clifford R. Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review. Implement Sci 2015; 10:151. [PMID: 26514874 PMCID: PMC4627629 DOI: 10.1186/s13012-015-0337-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022] Open
Abstract
Background The clinical role of community pharmacists is expanding, as is the use of clinical guidelines in this setting. However, it is unclear which strategies are successful in implementing clinical guidelines and what outcomes can be achieved. The aim of this systematic review is to synthesise the literature on the implementation of clinical guidelines to community pharmacy. The objectives are to describe the implementation strategies used, describe the resulting outcomes and to assess the effectiveness of the strategies. Methods A systematic search was performed in six electronic databases (Medline, EMBASE, CINAHL, Web of Science, Informit, Cochrane Library) for relevant articles. Studies were included if they reported on clinical guidelines implementation strategies in the community pharmacy setting. Two researchers completed the full-search strategy, data abstraction and quality assessments, independently. A third researcher acted as a moderator. Quality assessments were completed with three validated tools. A narrative synthesis was performed to analyse results. Results A total of 1937 articles were retrieved and the titles and abstracts were screened. Full-text screening was completed for 36 articles resulting in 19 articles (reporting on 22 studies) included for review. Implementation strategies were categorised according to a modified version of the EPOC taxonomy. Educational interventions were the most commonly utilised strategy (n = 20), and computerised decision support systems demonstrated the greatest effect (n = 4). Most studies were multifaceted and used more than one implementation strategy (n = 18). Overall outcomes were moderately positive (n = 17) but focused on process (n = 22) rather than patient (n = 3) or economic outcomes (n = 3). Most studies (n = 20) were rated as being of low methodological quality and having low or very low quality of evidence for outcomes. Conclusions Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy. Most utilised educational strategies, but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems. Poor methodology, in the majority of the research, provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting. However, the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial. Improved methodological rigour in future research is required to strengthen the evidence for this hypothesis. Protocol registration PROSPERO 2012:CRD42012003019. Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0337-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim Watkins
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Helen Wood
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Carl R Schneider
- Faculty of Pharmacy, The University of Sydney, Sydney, Australia.
| | - Rhonda Clifford
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
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19
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Huijg JM, Gebhardt WA, Verheijden MW, van der Zouwe N, de Vries JD, Middelkoop BJC, Crone MR. Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review. Int J Behav Med 2015; 22:32-50. [PMID: 24788314 DOI: 10.1007/s12529-014-9398-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. PURPOSE To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices. METHOD Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors. RESULTS Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants. CONCLUSION This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.
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Affiliation(s)
- Johanna M Huijg
- Clinical, Health and Neuropsychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands,
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20
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Hange D, Björkelund C, Svenningsson I, Kivi M, Eriksson MC, Petersson EL. Experiences of staff members participating in primary care research activities: a qualitative study. Int J Gen Med 2015; 8:143-8. [PMID: 25926753 PMCID: PMC4403682 DOI: 10.2147/ijgm.s78847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this paper was to study primary care staff members’ experiences and perceptions of participating in a randomized controlled trial concerning Internet therapy. Methods Data were collected via five focus groups, each containing four to eight nurses or general practitioners. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases. Results The informants believed it was important to conduct research within the primary care setting, but it was difficult to combine clinical work and research. They stressed also that there was a need for continuous information and communication between primary care centers and researchers as well as internally at each primary care center. Conclusion Staff members’ experiences of participating in a research study were positive, although associated with various difficulties. It is important to include staff members when designing clinical studies; information should be given continuously during the study and communication facilitated between different occupational groups working at the primary care center.
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Affiliation(s)
- Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Irene Svenningsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Maria C Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, University of Gothenburg, Gothenburg, Sweden
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21
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Impact of the organisational culture on primary care staff members’ intention to engage in research and development. J Health Organ Manag 2015; 29:234-51. [DOI: 10.1108/jhom-03-2013-0067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to understand how organisational culture influences the intentions of primary care staff members (PCSM) to engage in research and development (R&D).
Design/methodology/approach
– The participants (n=30) were PCSM employed in a care centre in south-western Sweden. The study had an observational design with an ethnographic approach. The data were collected by means of observations, interviews and analysis of documents.
Findings
– The results revealed the perceptions of PCSM in two domains, research and clinical practice, both of which existed at three different cultural levels: visible (structures and policy), semi-visible (norms and values) and invisible (taken-for-granted attitudes).
Research limitations/implications
– It is difficult to conduct a purely objective ethnographic study because the investigation is controlled by its context. However, it is necessary to highlight and discuss the invisible level to improve understanding of negative attitudes and preconceptions related to the implementation of R&D in the clinical setting.
Practical implications
– By highlighting the invisible level of culture, the management of an organisation has the opportunity to initiate discussion of issues related to concealed norms and values as well as attitudes towards new thinking and change in the primary health context.
Originality/value
– This paper is one of the very few studies to investigate the influence of organisational culture on the intentions of PCSM to engage in R&D.
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Luctkar-Flude M, Aiken A, McColl MA, Tranmer J. A comprehensive framework and key guideline recommendations for the provision of evidence-based breast cancer survivorship care within the primary care setting. Fam Pract 2015; 32:129-40. [PMID: 25500746 DOI: 10.1093/fampra/cmu082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Breast cancer survivors continue to experience physical and psychosocial health care needs post-treatment. Primary care involvement is increasing as cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up. Research suggests primary care providers (PCPs) are willing to provide survivorship care but many lack knowledge and confidence to provide evidence-based care. Although clinical practice guidelines (CPGs) exist for follow-up surveillance and certain aspects of survivorship care, no single comprehensive guideline addresses all significant breast cancer survivorship issues encountered in primary care. PURPOSE The purpose of this research was to create a comprehensive clinical practice framework to guide the provision of breast cancer survivorship care in primary care settings. METHODS This study consisted of an extensive search, appraisal and synthesis of CPGs for post-treatment breast cancer care using a modified Delphi method. Breast cancer survivorship issues and relevant CPGs were mapped to four essential components of survivorship care to create a comprehensive clinical practice framework to guide provision of breast cancer survivorship care. RESULTS The completed framework consists of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations and a one-page list of guideline sources. The framework and key guideline recommendations were verified by a panel of experts for comprehensiveness, importance and relevance to primary care. CONCLUSIONS This framework may serve as a tool to remind PCPs about issues impacting breast cancer survivors, as well as the evidence-based recommendations and resources to provide the associated care.
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Affiliation(s)
| | - Alice Aiken
- Faculty of Health Sciences, School of Rehabilitation Therapy, Canadian Institute for Military and Veteran Health Research
| | - Mary Ann McColl
- Faculty of Health Sciences, School of Rehabilitation Therapy, Centre for Health Services and Policy Research and
| | - Joan Tranmer
- Faculty of Health Sciences, School of Nursing, Department of Public Health Sciences, Queen's University, Kingston, Canada
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Lowrie R, Lloyd SM, McConnachie A, Morrison J. A cluster randomised controlled trial of a pharmacist-led collaborative intervention to improve statin prescribing and attainment of cholesterol targets in primary care. PLoS One 2014; 9:e113370. [PMID: 25405478 PMCID: PMC4236200 DOI: 10.1371/journal.pone.0113370] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background Small trials with short term follow up suggest pharmacists’ interventions targeted at healthcare professionals can improve prescribing. In comparison with clinical guidance, contemporary statin prescribing is sub-optimal and achievement of cholesterol targets falls short of accepted standards, for patients with atherosclerotic vascular disease who are at highest absolute risk and who stand to obtain greatest benefit. We hypothesised that a pharmacist-led complex intervention delivered to doctors and nurses in primary care, would improve statin prescribing and achievement of cholesterol targets for incident and prevalent patients with vascular disease, beyond one year. Methods We allocated general practices to a 12-month Statin Outreach Support (SOS) intervention or usual care. SOS was delivered by one of 11 pharmacists who had received additional training. SOS comprised academic detailing and practical support to identify patients with vascular disease who were not prescribed a statin at optimal dose or did not have cholesterol at target, followed by individualised recommendations for changes to management. The primary outcome was the proportion of patients achieving cholesterol targets. Secondary outcomes were: the proportion of patients prescribed simvastatin 40 mg with target cholesterol achieved; cholesterol levels; prescribing of simvastatin 40 mg; prescribing of any statin and the proportion of patients with cholesterol tested. Outcomes were assessed after an average of 1.7 years (range 1.4–2.2 years), and practice level simvastatin 40 mg prescribing was assessed after 10 years. Findings We randomised 31 practices (72 General Practitioners (GPs), 40 nurses). Prior to randomisation a subset of eligible patients were identified to characterise practices; 40% had cholesterol levels below the target threshold. Improvements in data collection procedures allowed identification of all eligible patients (n = 7586) at follow up. Patients in practices allocated to SOS were significantly more likely to have cholesterol at target (69.5% vs 63.5%; OR 1.11, CI 1.00–1.23; p = 0.043) as a result of improved simvastatin prescribing. Subgroup analysis showed the primary outcome was achieved by prevalent but not incident patients. Statistically significant improvements occurred in all secondary outcomes for prevalent patients and all but one secondary outcome (the proportion of patients with cholesterol tested) for incident patients. SOS practices prescribed more simvastatin 40 mg than usual care practices, up to 10 years later. Interpretation Through a combination of educational and organisational support, a general practice based pharmacist led collaborative intervention can improve statin prescribing and achievement of cholesterol targets in a high-risk primary care based population. Trial Registration International Standard Randomised Controlled Trials Register ISRCTN61233866
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Affiliation(s)
- Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
- * E-mail:
| | - Suzanne M. Lloyd
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Alex McConnachie
- Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Jill Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, United Kingdom
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Morténius H. Creating an interest in research and development as a means of reducing the gap between theory and practice in primary care: an interventional study based on strategic communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8689-708. [PMID: 25162708 PMCID: PMC4198986 DOI: 10.3390/ijerph110908689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/06/2014] [Accepted: 08/20/2014] [Indexed: 12/23/2022]
Abstract
Today, healthcare professionals are faced with the challenge of implementing research results in an optimal way. It is therefore important to create a climate that is conducive to research and development (R&D). For this reason, new strategies are required to enhance healthcare professionals’ interest in innovative thinking and R&D. Strategic communication with roots in sociology, psychology and political science was employed as a means of achieving long-term behavioural change. The aim of this study was to describe, follow up and evaluate a primary care intervention based on strategic communication intended to increase healthcare professionals’ interest in R&D over time. An interventional cohort study comprising all staff members (N = 1276) in a Swedish primary care area was initiated in 1997 and continued for 12 years. The intention to engage in R&D was measured on two occasions; at 7 and 12 years. Both descriptive statistics and bivariate analyses were employed. The results demonstrated that the positive attitude to R&D increased over time, representing a first step towards new thinking and willingness to change work practices for the benefit of the patient. Strategic communication has not been previously employed as a scientific tool to create a long-term interest in R&D within primary care.
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Affiliation(s)
- Helena Morténius
- Department of Research and Development, Halland Hospital Halmstad, Region Halland, SE-301 80 Halmstad, Sweden.
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25
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Grandes G, Arce V, Arietaleanizbeaskoa MS. La investigación al alcance de los profesionales de Osakidetza: Programa de Investigación en Atención Primaria de Salud. Aten Primaria 2014; 46:188-97. [PMID: 24280036 PMCID: PMC6985641 DOI: 10.1016/j.aprim.2013.08.005] [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: 04/03/2013] [Revised: 07/23/2013] [Accepted: 08/16/2013] [Indexed: 11/04/2022] Open
Abstract
Objetivo Describir el proceso y resultados del Programa de Investigación en Atención Primaria de Salud 2010-2011, organizado por la Unidad de Investigación de Atención Primaria de Bizkaia. Diseño Estudio descriptivo. Emplazamiento Atención primaria del servicio público de salud Osakidetza. Participantes Un total de 107 profesionales que solicitaron participar entre los 4.338 médicos/as, enfermeros/as y personal administrativo a los que se difundió el programa. Mediciones principales Nivel de participación, clasificación de los temas de investigación, valoración del programa por los participantes, financiación de los proyectos generados y costes del programa. Resultados La proporción de profesionales que solicitaron participar en el programa fue de un 2,47%; IC 95% 2,41-2,88%. Se seleccionaron 28 de ellos y lo finalizaron 19. Los temas a investigar están mayoritariamente relacionados con los problemas de salud crónicos más frecuentes (32%) y la prevención y promoción de la salud (18%). Más del 90% de los participantes evaluó como buena o excelente la calidad del programa y la mitad lo consideró difícil o muy difícil. Se generaron 18 proyectos nuevos, de los que 12 obtuvieron financiación, con 16 ayudas, 10 del Departamento de Sanidad del Gobierno Vasco, 4 del Instituto de Salud Carlos III y 2 del Instituto Kronikgune, captando 500.000 € para dichos proyectos. Los costes totales del programa ascendieron a 198.327 €. Conclusiones Esta experiencia puede servir para otros interesados en el fomento de la investigación en atención primaria de salud (APS), ya que el programa ha logrado sus objetivos, es útil y productivo.
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Huijg JM, Gebhardt WA, Dusseldorp E, Verheijden MW, van der Zouwe N, Middelkoop BJC, Crone MR. Measuring determinants of implementation behavior: psychometric properties of a questionnaire based on the theoretical domains framework. Implement Sci 2014; 9:33. [PMID: 24641907 PMCID: PMC4000005 DOI: 10.1186/1748-5908-9-33] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To be able to design effective strategies to improve healthcare professionals' implementation behaviors, a valid and reliable questionnaire is needed to assess potential implementation determinants. The present study describes the development of the Determinants of Implementation Behavior Questionnaire (DIBQ) and investigates the reliability and validity of this Theoretical Domains Framework (TDF)-based questionnaire. METHODS The DIBQ was developed to measure the potential behavioral determinants of the 12-domain version of the TDF (Michie et al., 2005). We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Confirmatory factor analysis was used to examine whether the predefined structure of the TDF-based questionnaire was supported by the data. Cronbach's alpha was calculated to assess internal consistency reliability of the questionnaire, and domains' discriminant validity was investigated. RESULTS We developed an initial questionnaire containing 100 items assessing 12 domains. Results obtained from confirmatory factor analysis and Cronbach's alpha resulted in the final questionnaire consisting of 93 items assessing 18 domains, explaining 63.3% of the variance, and internal consistency reliability values ranging from .68 to .93. Domains demonstrated good discriminant validity, although the domains 'Knowledge' and 'Skills' and the domains 'Skills' and 'Social/professional role and identity' were highly correlated. CONCLUSIONS We have developed a valid and reliable questionnaire that can be used to assess potential determinants of healthcare professional implementation behavior following the theoretical domains of the TDF. The DIBQ can be used by researchers and practitioners who are interested in identifying determinants of implementation behaviors in order to be able to develop effective strategies to improve healthcare professionals' implementation behaviors. Furthermore, the findings provide a novel validation of the TDF and indicate that the domain 'Environmental context and resources' might be divided into several environment-related domains.
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Affiliation(s)
- Johanna M Huijg
- Clinical, Health and Neuropsychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
| | - Winifred A Gebhardt
- Clinical, Health and Neuropsychology, Leiden University, Wassenaarseweg 52, Leiden, The Netherlands
| | - Elise Dusseldorp
- Netherlands Organization for Applied Scientific Research (TNO), Leiden, Wassenaarseweg 56, Leiden, The Netherlands
| | - Marieke W Verheijden
- Netherlands Organization for Applied Scientific Research (TNO), Leiden, Wassenaarseweg 56, Leiden, The Netherlands
| | | | - Barend JC Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, The Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, The Netherlands
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Huijg JM, Gebhardt WA, Crone MR, Dusseldorp E, Presseau J. Discriminant content validity of a theoretical domains framework questionnaire for use in implementation research. Implement Sci 2014; 9:11. [PMID: 24423394 PMCID: PMC3896680 DOI: 10.1186/1748-5908-9-11] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/11/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To improve the implementation of innovations in healthcare settings, it is important to understand factors influencing healthcare professionals' behaviors. We aimed to develop a generic questionnaire in English and in Dutch assessing the 14 domains of behavioral determinants from the revised TDF (Cane et al., 2012) that can be tailored to suit different targets, actions, contexts, and times of interest, and to investigate questionnaire items' discriminant content validity. METHODS We identified existing questionnaires including items assessing constructs within TDF domains and developed new items where needed. Nineteen judges allocated 79 items to one or more TDF domains. One-sample t-tests were used to examine the discriminant content validity of each item, i.e., whether items measured intended domains or whether items measured a combination of domains. RESULTS We identified items judged to discriminately measure 11 out of 14 domains. Items measuring the domains Reinforcement, Goals, and Behavioral regulation were judged to measure a combination of domains. CONCLUSIONS We have developed a questionnaire in English and in Dutch able to discriminately assess the majority of TDF domains. The results partly support Cane et al.'s (2012) 14-domain validation of the TDF and suggest that Michie et al.'s (2005) 12-domain original version might be more applicable in developing a TDF-based questionnaire. The identified items provide a robust basis for developing a questionnaire to measure TDF-based determinants of healthcare professionals' implementation behaviors to suit different targets, actions, contexts, and times. Future research should investigate the concurrent and predictive validity and reliability of such a questionnaire in practice.
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Affiliation(s)
- Johanna M Huijg
- Clinical, Health, and Neuropsychology, Leiden University, Leiden, Wassenaarseweg 52, the Netherlands
| | - Winifred A Gebhardt
- Clinical, Health, and Neuropsychology, Leiden University, Leiden, Wassenaarseweg 52, the Netherlands
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, the Netherlands
| | - Elise Dusseldorp
- Netherlands Organization for Applied Scientific Research (TNO), Wassenaarseweg 56, Leiden, the Netherlands
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, UK
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Century J, Cassata A, Rudnick M, Freeman C. Measuring enactment of innovations and the factors that affect implementation and sustainability: moving toward common language and shared conceptual understanding. J Behav Health Serv Res 2013; 39:343-61. [PMID: 22948708 DOI: 10.1007/s11414-012-9287-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article describes research that focuses on the concern that researchers are unable to fully realize the potential value of their collective efforts because they do not have shared conceptual or operational tools for communicating assumptions, ideas, research strategies, or findings with others outside, or even within their disciplines. This research, through the lens of measuring implementation of educational programs, has taken steps toward bringing researchers' varied pictures of understanding into a coherent landscape. This article describes a conceptual framework for describing aspects of implementation, a conceptual framework for describing the factors that affect implementation, and tools for measuring each. It describes the challenges addressed in the development of these approaches, and the application of these approaches to current studies in education and other fields in the social sciences. In doing so, it demonstrates that meaningful communication between researchers and accumulation of knowledge across fields is possible, and necessary.
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Affiliation(s)
- Jeanne Century
- Center for Elementary Mathematics and Science Education (CEMSE), University of Chicago, 1225 E. 60th Street, Chicago, IL 60637, USA.
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Hirsch O, Keller H, Krones T, Donner-Banzhoff N. Arriba-lib: evaluation of an electronic library of decision aids in primary care physicians. BMC Med Inform Decis Mak 2012; 12:48. [PMID: 22672414 PMCID: PMC3461416 DOI: 10.1186/1472-6947-12-48] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 05/21/2012] [Indexed: 11/29/2022] Open
Abstract
Background The successful implementation of decision aids in clinical practice initially depends on how clinicians perceive them. Relatively little is known about the acceptance of decision aids by physicians and factors influencing the implementation of decision aids from their point of view. Our electronic library of decision aids (arriba-lib) is to be used within the encounter and has a modular structure containing evidence-based decision aids for the following topics: cardiovascular prevention, atrial fibrillation, coronary heart disease, oral antidiabetics, conventional and intensified insulin therapy, and unipolar depression. The aim of our study was to evaluate the acceptance of arriba-lib in primary care physicians. Methods We conducted an evaluation study in which 29 primary care physicians included 192 patients. The physician questionnaire contained information on which module was used, how extensive steps of the shared decision making process were discussed, who made the decision, and a subjective appraisal of consultation length. We used generalised estimation equations to measure associations within patient variables and traditional crosstab analyses. Results Only a minority of consultations (8.9%) was considered to be unacceptably extended. In 90.6% of consultations, physicians said that a decision could be made. A shared decision was perceived by physicians in 57.1% of consultations. Physicians said that a decision was more likely to be made when therapeutic options were discussed “detailed”. Prior experience with decision aids was not a critical variable for implementation within our sample of primary care physicians. Conclusions Our study showed that it might be feasible to apply our electronic library of decision aids (arriba-lib) in the primary care context. Evidence-based decision aids offer support for physicians in the management of medical information. Future studies should monitor the long-term adoption of arriba-lib in primary care physicians.
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Affiliation(s)
- Oliver Hirsch
- Department of General Practice/Family Medicine, University of Marburg, Marburg, Germany.
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Simms AM, Li LC, Geddes EL, Brooks D, Hoens AM, Reid WD. Impact of a behavioral-based intervention on inspiratory muscle training prescription by a multidisciplinary team. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:116-125. [PMID: 22733639 DOI: 10.1002/chp.21134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Our goal was to compare behavioral- and information-based interventions aimed at increasing prescription of inspiratory muscle training (IMT) for people with chronic obstructive pulmonary disease (COPD) by interdisciplinary teams during pulmonary rehabilitation (PR). METHODS Six hospital PR programs were randomly assigned to a behavioral- or information-based intervention. Both interventions provided evidence supporting IMT and its prescription details. However, the behavioral-based intervention focused on barriers and challenges to IMT prescription informed by a nationwide survey and the theory of planned behavior (TPB). It included hands-on practice and content, in part, was driven by learners' questions. In contrast, the information-based intervention delivered information in a typical didactic education session followed by a demonstration and question period. It was supplemented with evidence-based research articles. The primary outcome was the change in prescription rate of IMT for COPD patients by determining the difference during the 6 months preceding compared to the 6 months during the interventions. RESULTS Sixty-one health professionals and 488 COPD outpatients within 6 PR programs participated. No COPD patients were prescribed IMT at any of the sites during the 6-month preintervention phase. The behavioral-based intervention resulted in an IMT prescription rate of 10.2% to people with COPD, whereas the information-based intervention resulted in no IMT prescriptions. DISCUSSION A behavioral-based intervention that is based on TPB and addresses challenges identified by health professionals is more effective than a traditional lecture approach to increase health professionals' prescription of IMT for patients with COPD.
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Affiliation(s)
- Alanna M Simms
- Department of Physical Therapy, University of British Columbia, Canada
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Spatz ES, Phipps MS, Wang OJ, Lagarde S, Lucas GI, Curry LA, Rosenthal MS. Expanding the safety net of specialty care for the uninsured: a case study. Health Serv Res 2011; 47:344-62. [PMID: 22092239 DOI: 10.1111/j.1475-6773.2011.01330.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe core principles and processes in the implementation of a navigated care program to improve specialty care access for the uninsured. STUDY SETTING Academic researchers, safety-net providers, and specialty physicians, partnered with hospitals and advocates for the underserved to establish Project Access-New Haven (PA-NH). PA-NH expands access to specialty care for the uninsured and coordinates care through patient navigation. STUDY DESIGN Case study to describe elements of implementation that may be relevant for other communities seeking to improve access for vulnerable populations. PRINCIPAL FINDINGS Implementation relied on the application of core principles from community-based participatory research (CBPR). Effective partnerships were achieved by involving all stakeholders and by addressing barriers in each phase of development, including (1) assessment of the problem; (2) development of goals; (3) engagement of key stakeholders; (4) establishment of the research agenda; and (5) dissemination of research findings. CONCLUSIONS Including safety-net providers, specialty physicians, hospitals, and community stakeholders in all steps of development allowed us to respond to potential barriers and implement a navigated care model for the uninsured. This process, whereby we integrated principles from CBPR, may be relevant for future capacity-building efforts to accommodate the specialty care needs of other vulnerable populations.
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Affiliation(s)
- Erica S Spatz
- Robert Wood Johnson Foundation Clinical Scholars Program, Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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Spyridonidis D, Calnan M. Opening the black box: a study of the process of NICE guidelines implementation. Health Policy 2011; 102:117-25. [PMID: 21767891 DOI: 10.1016/j.healthpol.2011.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 06/01/2011] [Accepted: 06/22/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study informs 'evidence-based' implementation by using an innovative methodology to provide further understanding of the implementation process in the English NHS using two distinctly different NICE clinical guidelines as exemplars. METHODS The implementation process was tracked retrospectively and prospectively using a comparative case-study and longitudinal design. 74 unstructured interviews were carried out with 48 key informants (managers and clinicians) between 2007 and 2009. RESULTS This study has shown that the NICE guidelines implementation process has both planned and emergent components, which was well illustrated by the use of the prospective longitudinal design in this study. The implementation process might be characterised as strategic and planned to begin with but became uncontrolled and subject to negotiation as it moved from the planning phase to adoption in everyday practice. The variations in the implementation process could be best accounted for in terms of differences in the structure and nature of the local organisational context. The latter pointed to the importance of managers as well as clinicians in decision-making about implementation. CONCLUSION While national priorities determine the context for implementation the shape of the process is influenced by the interactions between doctors and managers, which influence the way they respond to external policy initiatives such as NICE guidelines. NICE and other national health policy-makers need to recognise that the introduction of planned change 'initiatives' in clinical practice are subject to social and political influences at the micro level as well as the macro level.
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Affiliation(s)
- Dimitrios Spyridonidis
- Health Management Group, Imperial College, Business School London, Tanaka Building, South Kensington Campus, London SW7 2AZ, United Kingdom.
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Gandjour A. Prioritizing comparative effectiveness research: are drug and implementation trials equally worth funding? PHARMACOECONOMICS 2011; 29:555-561. [PMID: 21534639 DOI: 10.2165/11588330-000000000-00000] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Comparative effectiveness research (CER) is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of this article is to compare--within the scope of CER--the value of implementation and drug trials. Implementation trials have limitations similar to drug trials in terms of generalizability of results outside the trial setting and ability to identify best practice. However, in contrast to drug trials, implementation trials do not provide value in terms of ruling out harm, as implementation strategies are unlikely to cause harm in the first place. Still, implementation trials may provide good value when there is a high error probability in deciding whether implementation will be cost effective or if costs associated with making an erroneous decision are high. Yet the low risk of implementation programmes to cause harm may also allow for alternative approaches to identify best implementation practice, perhaps outside the scope of rigorous trials and testing. One such approach that requires further investigation is a competitive market for quality of care, where implementation programmes may be introduced without prior evaluation.
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Affiliation(s)
- Afschin Gandjour
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana 70808, USA.
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Watson MC, Bond CM, Walker A, Grimshaw J. Why educational interventions are not always effective: a theory-based process evaluation of a randomised controlled trial to improve non-prescription medicine supply from community pharmacies†. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/ijpp.14.4.0004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Objective
The Theory of Planned Behaviour (TPB) has been used to explore health professionals' intentions to behave in a particular way. This study measured community pharmacists' behavioural intention and actual behaviour as part of an evaluation of a randomised controlled trial (RCT) of two educational interventions to promote the appropriate treatment of vaginal candidiasis in community pharmacies. This study aimed to explore reasons for the success or failure of educational interventions by conducting a theory-based process evaluation alongside the RCT.
Method
The RCT was conducted in 60 community pharmacies in Grampian, Scotland, and compared educational outreach visits and continuing education workshops. A postal questionnaire was conducted, comprising five measures derived from TPB: behaviour; behavioural intention, attitudes, subjective norms, and perceived behavioural control; together with a measure of clinical knowledge of candidiasis and its treatment; and a measure of guideline compliance. Guideline compliance was assessed using four scenarios. Simulated patient visits were made to participating pharmacies to derive objective measures of actual behaviour.
Results
Completed questionnaires were returned from 50 pharmacists (response rate: 83%). Forty (80%) respondents were fully guideline compliant (correct response with all four scenarios). Pharmacists' knowledge was high and they had positive attitudes towards the supply of antifungals, as well as strong intentions to sell them appropriately. No statistically significant differences were shown in questionnaire responses or actual behaviour across the four trial groups.
Conclusion
This evaluation demonstrates that the interventions may have failed because of psychological ceiling effects, i.e. existing attitudes and intentions were already strong. Further studies are needed to identify factors that prevent strong intentions from being put into practice, in order to develop effective interventions.
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Affiliation(s)
- Margaret C Watson
- Department of General Practice and Primary Care, University of Aberdeen, Scotland, UK
| | - Christine M Bond
- Department of General Practice and Primary Care, University of Aberdeen, Scotland, UK
| | - Anne Walker
- Health Services Research Unit, University of Aberdeen, Scotland, UK
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Información, conocimiento y práctica sanitaria: la participación de los profesionales como pieza clave del engranaje. Med Clin (Barc) 2010; 134 Suppl 1:10-5. [DOI: 10.1016/s0025-7753(10)70003-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Heselmans A, Van de Velde S, Donceel P, Aertgeerts B, Ramaekers D. Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review. Implement Sci 2009; 4:82. [PMID: 20042070 PMCID: PMC2806389 DOI: 10.1186/1748-5908-4-82] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 12/30/2009] [Indexed: 11/21/2022] Open
Abstract
Background Electronic guideline-based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines. A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services. Methods A systematic literature search (1990 to December 2008) of the English literature indexed in the Medline database, Embase, the Cochrane Central Register of Controlled Trials, and CRD (DARE, HTA and NHS EED databases) was conducted to identify evaluation studies of electronic multi-step guideline implementation systems in ambulatory care settings. Important inclusion criterions were the multidimensionality of the guideline (the guideline needed to consist of several aspects or steps) and real-time interaction with the system during consultation. Clinical decision support systems such as one-time reminders for preventive care for which positive findings were shown in earlier reviews were excluded. Two comparisons were considered: electronic multidimensional guidelines versus usual care (comparison one) and electronic multidimensional guidelines versus other guideline implementation methods (comparison two). Results Twenty-seven publications were selected for analysis in this systematic review. Most designs were cluster randomized controlled trials investigating process outcomes more than patient outcomes. With success defined as at least 50% of the outcome variables being significant, none of the studies were successful in improving patient outcomes. Only seven of seventeen studies that investigated process outcomes showed improvements in process of care variables compared with the usual care group (comparison one). No incremental effect of the electronic implementation over the distribution of paper versions of the guideline was found, neither for the patient outcomes nor for the process outcomes (comparison two). Conclusions There is little evidence at the moment for the effectiveness of an increasingly used and commercialised instrument such as electronic multidimensional guidelines. After more than a decade of development of numerous electronic systems, research on the most effective implementation strategy for this kind of guideline-based decision support systems is still lacking. This conclusion implies a considerable risk towards inappropriate investments in ineffective implementation interventions and in suboptimal care.
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Affiliation(s)
- Annemie Heselmans
- School of Public Health, Katholieke Universiteit Leuven, Kapucijnenvoer 35 blok d, 3000 Leuven, Belgium.
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Taljaard M, Weijer C, Grimshaw JM, Belle Brown J, Binik A, Boruch R, Brehaut JC, Chaudhry SH, Eccles MP, McRae A, Saginur R, Zwarenstein M, Donner A. Ethical and policy issues in cluster randomized trials: rationale and design of a mixed methods research study. Trials 2009; 10:61. [PMID: 19638233 PMCID: PMC2725043 DOI: 10.1186/1745-6215-10-61] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 07/28/2009] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cluster randomized trials are an increasingly important methodological tool in health research. In cluster randomized trials, intact social units or groups of individuals, such as medical practices, schools, or entire communities--rather than individual themselves--are randomly allocated to intervention or control conditions, while outcomes are then observed on individual cluster members. The substantial methodological differences between cluster randomized trials and conventional randomized trials pose serious challenges to the current conceptual framework for research ethics. The ethical implications of randomizing groups rather than individuals are not addressed in current research ethics guidelines, nor have they even been thoroughly explored. The main objectives of this research are to: (1) identify ethical issues arising in cluster trials and learn how they are currently being addressed; (2) understand how ethics reviews of cluster trials are carried out in different countries (Canada, the USA and the UK); (3) elicit the views and experiences of trial participants and cluster representatives; (4) develop well-grounded guidelines for the ethical conduct and review of cluster trials by conducting an extensive ethical analysis and organizing a consensus process; (5) disseminate the guidelines to researchers, research ethics boards (REBs), journal editors, and research funders. METHODS We will use a mixed-methods (qualitative and quantitative) approach incorporating both empirical and conceptual work. Empirical work will include a systematic review of a random sample of published trials, a survey and in-depth interviews with trialists, a survey of REBs, and in-depth interviews and focus group discussions with trial participants and gatekeepers. The empirical work will inform the concurrent ethical analysis which will lead to a guidance document laying out principles, policy options, and rationale for proposed guidelines. An Expert Panel of researchers, ethicists, health lawyers, consumer advocates, REB members, and representatives from low-middle income countries will be appointed. A consensus conference will be convened and draft guidelines will be generated by the Panel; an e-consultation phase will then be launched to invite comments from the broader community of researchers, policy-makers, and the public before a final set of guidelines is generated by the Panel and widely disseminated by the research team.
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Affiliation(s)
- Monica Taljaard
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Hospital, 1053 Carling Avenue, Civic Campus, C409, Ottawa, ON K1Y 4E9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Charles Weijer
- Departments of Philosophy and Medicine, Joseph L. Rotman Institute of Science and Values, University of Western Ontario, London, Ontario, N6A 3K7, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1053 Carling Avenue, Civic Campus, ASB 2-018, Ottawa, Ontario K1Y 4E9, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Judith Belle Brown
- Center for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, 245-100 Collip Circle, London, Ontario, N6G 4X8, Canada
| | - Ariella Binik
- Joseph L. Rotman Institute of Science and Values, Department of Philosophy, University of Western Ontario, London, Ontario, N6A 3K7, Canada
| | - Robert Boruch
- Graduate School of Education and Statistics Department, Wharton School, University of Pennsylvania, 3700 Walnut Street; Philadelphia; Pennsylvania 19104, USA
| | - Jamie C Brehaut
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa Hospital, 1053 Carling Avenue, ASB 2-004, Ottawa, Ontario K1Y 4E9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Shazia H Chaudhry
- Ottawa Hospital Research Institute, Clinical Epidemiology Program; Ottawa Hospital, 1053 Carling Avenue, F663a; Ottawa, ON K1Y 4E9, Canada
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Canada
| | - Martin P Eccles
- Institute of Health & Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK
| | - Andrew McRae
- Joseph L. Rotman Institute of Science and Values, Department of Philosophy, University of Western Ontario, London, Ontario, N6A 3K7, Canada
- Joseph L. Rotman Institute of Science and Values, Department of Epidemiology and Biostatistics, Ontario, N6A 3K7, Canada
- Department of Emergency Medicine, London Health Sciences Centre, 800 Commissioners Rd East, London, ON, N6A 5W9, Canada
- Department of Epidemiology and Biostatistics, University of Western Ontario, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada
| | - Raphael Saginur
- Department of Medicine, University of Ottawa and Ottawa Hospital; Ottawa Hospital Research Institute, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
| | - Merrick Zwarenstein
- Centre for Health Services Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5, Canada
| | - Allan Donner
- Department of Epidemiology and Biostatistics, University of Western Ontario, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada
- Robarts Clinical Trials, Robarts Research Institute, London, ON, N6A 5K8, Canada
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Hawe P, Potvin L. What is population health intervention research? Canadian Journal of Public Health 2009. [PMID: 19263977 DOI: 10.1007/bf03405503] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Population-level health interventions are policies or programs that shift the distribution of health risk by addressing the underlying social, economic and environmental conditions. These interventions might be programs or policies designed and developed in the health sector, but they are more likely to be in sectors elsewhere, such as education, housing or employment. Population health intervention research attempts to capture the value and differential effect of these interventions, the processes by which they bring about change and the contexts within which they work best. In health research, unhelpful distinctions maintained in the past between research and evaluation have retarded the development of knowledge and led to patchy evidence about policies and programs. Myths about what can and cannot be achieved within community-level intervention research have similarly held the field back. The pathway forward integrates systematic inquiry approaches from a variety of disciplines.
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Affiliation(s)
- Penelope Hawe
- Population Health Intervention Research Centre, University of Calgary, G012, 3330 Hospital Drive NW, Calgary, AB T2N 4N1.
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Hutton JL, Eccles MP, Grimshaw JM. Ethical issues in implementation research: a discussion of the problems in achieving informed consent. Implement Sci 2008; 3:52. [PMID: 19091100 PMCID: PMC2639614 DOI: 10.1186/1748-5908-3-52] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Accepted: 12/17/2008] [Indexed: 11/25/2022] Open
Abstract
Background Improved quality of care is a policy objective of health care systems around the world. Implementation research is the scientific study of methods to promote the systematic uptake of clinical research findings into routine clinical practice, and hence to reduce inappropriate care. It includes the study of influences on healthcare professionals' behaviour and methods to enable them to use research findings more effectively. Cluster randomized trials represent the optimal design for evaluating the effectiveness of implementation strategies. Various codes of medical ethics, such as the Nuremberg Code and the Declaration of Helsinki inform medical research, but their relevance to cluster randomised trials in implementation research is unclear. This paper discusses the applicability of various ethical codes to obtaining consent in cluster trials in implementation research. Discussion The appropriate application of biomedical codes to implementation research is not obvious. Discussion of the nature and practice of informed consent in implementation research cluster trials must consider the levels at which consent can be sought, and for what purpose it can be sought. The level at which an intervention is delivered can render the idea of patient level consent meaningless. Careful consideration of the ownership of information, and rights of access to and exploitation of data is required. For health care professionals and organizations, there is a balance between clinical freedom and responsibility to participate in research. Summary While ethical justification for clinical trials relies heavily on individual consent, for implementation research aspects of distributive justice, economics, and political philosophy underlie the debate. Societies may need to trade off decisions on the choice between individualized consent and valid implementation research. We suggest that social sciences codes could usefully inform the consideration of implementation research by members of Research Ethics Committees.
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Affiliation(s)
- Jane L Hutton
- Department of Statistics, University of Warwick, Coventry, CV4 7AL, UK.
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Page M, Wallace I, McFarlane W, Law J. Emergent Change and its Implications for Professional Autonomy and Managerial Control: A Case Study from Midwifery. JOURNAL OF CHANGE MANAGEMENT 2008. [DOI: 10.1080/14697010802396950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Brazil K, Cloutier MM, Tennen H, Bailit H, Higgins PS. A qualitative study of the relationship between clinician attributes, organization, and patient characteristics on implementation of a disease management program. ACTA ACUST UNITED AC 2008; 11:129-37. [PMID: 18426379 DOI: 10.1089/dis.2008.1120008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The purpose of this study was to examine the challenges of integrating an asthma disease management (DM) program into a primary care setting from the perspective of primary care practitioners. A second goal was to examine whether barriers differed between urban-based and nonurban-based practices. Using a qualitative design, data were gathered using focus groups in primary care pediatric practices. A purposeful sample included an equal number of urban and nonurban practices. Participants represented all levels in the practice setting. Important themes that emerged from the data were coded and categorized. A total of 151 individuals, including physicians, advanced practice clinicians, registered nurses, other medical staff, and nonmedical staff participated in 16 focus groups that included 8 urban and 8 nonurban practices. Content analyses identified 4 primary factors influencing the implementation of a DM program in a primary care setting. They were related to providers, the organization, patients, and characteristics of the DM program. This study illustrates the complexity of the primary care environment and the challenge of changing practice in these settings. The results of this study identified areas in a primary care setting that influence the adoption of a DM program. These findings can assist in identifying effective strategies to change clinical behavior in primary care practices.
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Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Ontario, Canada.
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Shcherbatykh I, Holbrook A, Thabane L, Dolovich L. Methodologic issues in health informatics trials: the complexities of complex interventions. J Am Med Inform Assoc 2008; 15:575-80. [PMID: 18579839 DOI: 10.1197/jamia.m2518] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE All electronic health (e-health) interventions require validation as health information technologies, ideally in randomized controlled trial settings. However, as with other types of complex interventions involving various active components and multiple targets, health informatics trials often experience problems of design, methodology, or analysis that can influence the results and acceptance of the research. Our objective was to review selected key methodologic issues in conducting and reporting randomized controlled trials in health informatics, provide examples from a recent study, and present practical recommendations. DESIGN For illustration, we use the COMPETE III study, a large randomized controlled clinical trial investigating the impact of a shared decision-support system on the quality of vascular disease management in Ontario, Canada. RESULTS We describe a set of methodologic, logistic, and statistical issues that should be considered when planning and implementing trials of complex e-health interventions, and provide practical recommendations for health informatics trialists. CONCLUSIONS Our recommendations emphasize validity and pragmatic considerations and would be useful for health informaticians conducting or evaluating e-health studies.
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Affiliation(s)
- Ivan Shcherbatykh
- Centre for Evaluation of Medicines, St Joseph's Healthcare Hamilton, Hamilton, Ontario L8N1G6, Canada.
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Barwick MA, Boydell KM, Stasiulis E, Ferguson HB, Blase K, Fixsen D. Research utilization among children's mental health providers. Implement Sci 2008; 3:19. [PMID: 18400090 PMCID: PMC2323017 DOI: 10.1186/1748-5908-3-19] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 04/09/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. METHODS A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. RESULTS There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. CONCLUSION These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.
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Affiliation(s)
- Melanie A Barwick
- Community Health Systems Resource Group, The Hospital for Sick Children, Toronto ON, Canada.
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Taljaard M, Donner A, Villar J, Wojdyla D, Velazco A, Bataglia V, Faundes A, Langer A, Narváez A, Valladares E, Carroli G, Zavaleta N, Shah A, Campodónico L, Romero M, Reynoso S, de Pádua KS, Giordano D, Kublickas M, Acosta A. Intracluster correlation coefficients from the 2005 WHO Global Survey on Maternal and Perinatal Health: implications for implementation research. Paediatr Perinat Epidemiol 2008; 22:117-25. [PMID: 18298685 DOI: 10.1111/j.1365-3016.2007.00901.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cluster-based studies involving aggregate units such as hospitals or medical practices are increasingly being used in healthcare evaluation. An important characteristic of such studies is the presence of intracluster correlation, typically quantified by the intracluster correlation coefficient (ICC). Sample size calculations for cluster-based studies need to account for the ICC, or risk underestimating the sample size required to yield the desired levels of power and significance. In this article, we present values for ICCs that were obtained from data on 97,095 pregnancies and 98,072 births taking place in a representative sample of 120 hospitals in eight Latin American countries. We present ICCs for 86 variables measured on mothers and newborns from pregnancy to the time of hospital discharge, including 'process variables' representing actual medical care received for each mother and newborn. Process variables are of primary interest in the field of implementation research. We found that overall, ICCs ranged from a minimum of 0.0003 to a maximum of 0.563 (median 0.067). For maternal and newborn outcome variables, the median ICCs were 0.011 (interquartile range 0.007-0.037) and 0.054 (interquartile range 0.013-0.075) respectively; however, for process variables, the median was 0.161 (interquartile range 0.072-0.328). Thus, we confirm previous findings that process variables tend to have higher ICCs than outcome variables. We demonstrate that ICCs generally tend to increase with higher prevalences (close to 0.5). These results can help researchers calculate the required sample size for future research studies in maternal and perinatal health.
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Affiliation(s)
- Monica Taljaard
- Ottawa Health Research Institute and University of Ottawa, Ottawa, Ontario, Canada.
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Akl EA, Treweek S, Foy R, Francis J, Oxman AD. NorthStar, a support tool for the design and evaluation of quality improvement interventions in healthcare. Implement Sci 2007; 2:19. [PMID: 17594495 PMCID: PMC1913538 DOI: 10.1186/1748-5908-2-19] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 06/26/2007] [Indexed: 11/10/2022] Open
Abstract
Background The Research-Based Education and Quality Improvement (ReBEQI) European partnership aims to establish a framework and provide practical tools for the selection, implementation, and evaluation of quality improvement (QI) interventions. We describe the development and preliminary evaluation of the software tool NorthStar, a major product of the ReBEQI project. Methods We focused the content of NorthStar on the design and evaluation of QI interventions. A lead individual from the ReBEQI group drafted each section, and at least two other group members reviewed it. The content is based on published literature, as well as material developed by the ReBEQI group. We developed the software in both a Microsoft Windows HTML help system version and a web-based version. In a preliminary evaluation, we surveyed 33 potential users about the acceptability and perceived utility of NorthStar. Results NorthStar consists of 18 sections covering the design and evaluation of QI interventions. The major focus of the intervention design sections is on how to identify determinants of practice (factors affecting practice patterns), while the major focus of the intervention evaluation sections is on how to design a cluster randomised trial. The two versions of the software can be transferred by email or CD, and are available for download from the internet. The software offers easy navigation and various functions to access the content. Potential users (55% response rate) reported above-moderate levels of confidence in carrying out QI research related tasks if using NorthStar, particularly when developing a protocol for a cluster randomised trial Conclusion NorthStar is an integrated, accessible, practical, and acceptable tool to assist developers and evaluators of QI interventions.
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Affiliation(s)
- Elie A Akl
- Department of Medicine, State University of New York at Buffalo, USA
| | - Shaun Treweek
- Tayside Centre for General Practice, Community Health Sciences Division, University of Dundee, UK
| | - Robbie Foy
- Centre for Health Services Research, Newcastle University, UK
| | - Jill Francis
- Health Services Research Unit, University of Aberdeen, UK
| | - Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - the ReBEQI group
- Research-Based Education and Quality Improvement, European partnership
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Segaar D, Willemsen MC, Bolman C, De Vries H. Nurse adherence to a minimal-contact smoking cessation intervention on cardiac wards. Res Nurs Health 2007; 30:429-44. [PMID: 17654478 DOI: 10.1002/nur.20204] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Health promotion interventions are often underused by care practitioners and, therefore, are not effective. In this study, we assessed nurses' use of a smoking cessation intervention in Dutch cardiac wards and factors associated with their adherence. Ninety-four of 206 nurses did not fully apply the intervention in daily practice; they did not always provide patients with self-help guides, discuss smoking cessation aids, or provide follow-up care. The significant factors in our integrated change model accounted for 52% of the variance in adherence. Adherence was most likely if nurses consistently used an intervention card, perceived advantages of the intervention, had other nurses around them who used it, and had been involved in decision-making.
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Affiliation(s)
- Dewi Segaar
- Department of Health Promotion and Health Education, University of Maastricht, Maastricht, The Netherlands
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Ramos Martín A, Domínguez Bidagor J, Cuenca Ruiz-Pérez R, De Lucas Gómez F, Ayala Luna S, Méndez-Bonito González E. [Organisational issues in implementing clinical trials in primary care]. Aten Primaria 2006; 38:375-9. [PMID: 17173810 PMCID: PMC7677050 DOI: 10.1016/s0212-6567(06)70527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify health professionals concerns on the organisational issues of a randomised clinical trial. DESIGN A qualitative cross-sectional, descriptive study. SETTING Primary Care Area 11, Madrid, Spain. PARTICIPANTS Twenty-four doctors and nurses from 4 primary care teams. METHOD Three planning meetings with researchers. Design of an anonymous self-administered questionnaire to collect researchers' perceptions on design, method, and organisation during the implementation of a clinical trial. RESULTS The prestige of being involved in a multi-centre nationwide project, the training sessions offered, a primary care research topic, a working team model of doctor and nurse, and the support provided by team from the 11th Area, were the main organisational incentives. Lack of time, increased clinic workload, and methodological difficulties are discouraging issues. 79.2% (19/24) of the researchers returned the questionnaire. 94.7% (18/19) considered themselves highly motivated. 84.2% (16/19) of researchers, the time required to complete recruitment was reasonable. The 57.9% (13/19) spent 20-25 minutes collecting data at the interview. Cooperation between doctors and nurses had been effective for 68.4% (13/19) of researchers. 89.4% (17/18) considered that support from the Area 11 organisers was useful. CONCLUSIONS Organisational barriers for implementation are: complexity of data collection at the recruitment interview, design and methodological issues too unrealistic for a primary care setting, and lack of time and extra workload at consultations. The factors that make organisation easier are: having a high level of motivation, sharing workload with other professionals, and support provided by organisers of the trial.
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Affiliation(s)
- Alicia Ramos Martín
- Unidad de Formación e Investigación, Gerencia, Area 11 de Atención Primaria, Madrid, España.
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Segaar D, Bolman C, Willemsen MC, Vries HD. Determinants of adoption of cognitive behavioral interventions in a hospital setting: example of a minimal-contact smoking cessation intervention for cardiology wards. PATIENT EDUCATION AND COUNSELING 2006; 61:262-71. [PMID: 15967623 DOI: 10.1016/j.pec.2005.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2004] [Revised: 03/30/2005] [Accepted: 04/09/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The aim of our study was to identify the psychological and organizational determinants of adopting a smoking cessation intervention in cardiology wards, using the Integrated Change Model (I-Change Model) as the theoretical basis. METHODS A cross-sectional survey by means of questionnaires was conducted among the heads of all 121 cardiology wards in Dutch hospitals, of whom 77 (64%) responded. RESULTS Adopters had a significantly lower level of formalization and more nurses working on the ward. Adopters also had a significantly more positive attitude towards working with the intervention, perceived more positive social influences from their direct environment and had higher self-efficacy. Psychological determinants explained adoption to a greater extent than organizational determinants did. CONCLUSION It is very important to take psychological factors into account when studying the adoption of preventive innovations and developing diffusion strategies. PRACTICE IMPLICATIONS Programs for dissemination of preventive innovations in a hospital setting should primarily focus on psychological characteristics like social influence and self-efficacy.
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Affiliation(s)
- Dewi Segaar
- University of Maastricht, Department of Health Promotion and Health Education, Maastricht, P.O. Box 16070, 2500 BB The Hague, The Netherlands.
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Gregory S, Bostock Y, Backett-Milburn K. Recovering from a heart attack: a qualitative study into lay experiences and the struggle to make lifestyle changes. Fam Pract 2006; 23:220-5. [PMID: 16243955 DOI: 10.1093/fampra/cmi089] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The adoption of healthy living advice by people with heart disease is known to be poor even in targeted interventions. Reasons for this can range from confusion about the seriousness of the condition to ineffectiveness in the form of advice and how it is conveyed. However, the social setting can be an important influence on lifestyle change. OBJECTIVES To identify views and experiences of people recovering from myocardial infarction, specifically barriers to, and facilitators of, following advice about lifestyle change and maintenance. METHODS Focus groups and interviews were undertaken with men and women discharged from hospital two/three years previously. A total of 53 people (35 men and 18 women) took part, recruited via a coronary care unit and patients' GPs. RESULTS A major finding was participants' desires for long-term monitoring and support. While reported sources, form and content of coronary heart disease advice varied, most participants agreed that long-term follow up or back-up would be helpful, although what this should include and how it should be undertaken was not the same for all participants. This would fulfil needs such as: help in following lifestyle advice; sharing with people with similar experiences; regular contact with medical/health professionals (for confirmation of good heath and to ask questions); providing reassurance to other members of the patients' families. CONCLUSIONS A long-term programme is needed incorporating mutual support and sharing with regular (not necessarily frequent) input from practitioners of information, advice and reassurance, as a support strategy for lifestyle change.
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Affiliation(s)
- Susan Gregory
- Research Unit in Health Behaviour and Change, School of Clinical Sciences and Community Health, University of Edinburgh Medical School, UK.
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Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N. Lost in knowledge translation: time for a map? THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2006; 26:13-24. [PMID: 16557505 DOI: 10.1002/chp.47] [Citation(s) in RCA: 2394] [Impact Index Per Article: 133.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
There is confusion and misunderstanding about the concepts of knowledge translation, knowledge transfer, knowledge exchange, research utilization, implementation, diffusion, and dissemination. We review the terms and definitions used to describe the concept of moving knowledge into action. We also offer a conceptual framework for thinking about the process and integrate the roles of knowledge creation and knowledge application. The implications of knowledge translation for continuing education in the health professions include the need to base continuing education on the best available knowledge, the use of educational and other transfer strategies that are known to be effective, and the value of learning about planned-action theories to be better able to understand and influence change in practice settings.
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Affiliation(s)
- Ian D Graham
- School of Nursing and Department of Epidemiology and Community Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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