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Talkhan H, Stewart D, McIntosh T, Ziglam H, Abdulrouf PV, Al-Hail M, Diab M, Cunningham S. Exploring determinants of antimicrobial prescribing behaviour using the Theoretical Domains Framework. Res Social Adm Pharm 2024; 20:401-410. [PMID: 38320948 DOI: 10.1016/j.sapharm.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Few theoretically-based, qualitative studies have explored determinants of antimicrobial prescribing behaviour in hospitals. Understanding these can promote successful development and implementation of behaviour change interventions (BCIs). OBJECTIVE (s): To use the Theoretical Domains Framework (TDF) to explore determinants of clinicians' antimicrobial prescribing behaviour, identifying barriers (i.e., impediments) and facilitators to appropriate antimicrobial practice. METHODS Semi-structured interviews with purposively-sampled doctors and pharmacists with a wide range of specialties and expertise in Hamad Medical Corporation hospitals in Qatar. Interviews based on previous quantitative research and the TDF were audio-recorded, transcribed and independently analysed by two researchers using the TDF as an initial coding framework. RESULTS Data saturation was achieved after interviewing eight doctors and eight pharmacists. Inter-related determinants of antimicrobial prescribing behaviour linked to ten TDF domains were identified as barriers and facilitators that may contribute to inappropriate or appropriate antimicrobial prescribing. The main barriers identified were around hospital guidelines and electronic system deficiencies (environmental context and resources); knowledge gaps relating to guidelines and appropriate prescribing (knowledge); restricted roles/responsibilities of microbiologists and pharmacists (professional role and identity); challenging antimicrobial prescribing decisions (memory, attention and decision processes); and professional hierarchies and poor multidisciplinary teamworking (social influences). Key facilitators included guidelines compliance (goals and intentions), and participants' beliefs about the consequences of appropriate or inappropriate prescribing. Further education and training, and some changes to guidelines including their accessibility were also considered essential. CONCLUSIONS Antimicrobial prescribing behaviour in hospitals is a complex process influenced by a broad range of determinants including specific barriers and facilitators. The in-depth understanding of this complexity provided by this work may support the development of an effective BCI to promote appropriate antimicrobial stewardship.
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Affiliation(s)
- Hend Talkhan
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Trudi McIntosh
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
| | - Hisham Ziglam
- Infectious Diseases Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
| | | | - Moza Al-Hail
- Pharmacy Department, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
| | - Mohammad Diab
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Scott Cunningham
- School of Pharmacy and Life Sciences, Robert Gordon University, UK.
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2
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Carter EL, Hallen SAM, Welch GW, Gordon EN, Parker MG. Exploring attitudinal barriers to participation in inpatient fall risk assessment using the Theoretical Domains Framework: A survey of providers. Health Sci Rep 2024; 7:e2000. [PMID: 38605726 PMCID: PMC11006990 DOI: 10.1002/hsr2.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Background and Aims Lack of provider (physicians and advanced practice providers) participation in fall risk assessment was theorized to be contributing to rising rates of falls with injury at our institution. This project sought to identify if attitudinal barriers to inpatient provider participation in fall risk assessment were similar to those identified in other clinical settings. Methods Barriers to provider participation in fall risk assessment were identified in the literature. These were mapped to the Theoretical Domains Framework (TDF) domains to assist with interpretation of the data. A 10-item survey using a 5-point Likert scale (strongly agree to strongly disagree) with two open-ended questions was developed using these barriers. The survey was distributed via email to all providers on the Medical Staff in July 2021. Results The response rate was 9.1% (188/2062). 72.6% (95% confidence interval [CI]: 65.6, 78.5) of providers at our institution did agree that fall risk assessment was within their role and 72% (95% CI: 66.1, 78.5) agreed that assessment can prevent falls. Nearly half felt that they lacked formal training in fall risk assessment (48.1% [95% CI: 41.1, 55.1]) and 52.2% (95% CI: 44.6, 58.6) agreed that other aspects of patient care took priority over falls assessment. These barriers correlated best with the TDF domains of Beliefs about Capabilities and Beliefs about Consequences. Conclusions Survey results indicate that interventions focused on increasing provider motivation and capability regarding fall risk assessment and helping providers prioritize fall risk assessment are potential targets for future quality improvement projects.
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Affiliation(s)
- Emily L. Carter
- Division of Geriatric MedicineMaine Medical CenterPortlandMaineUSA
| | | | - Gavin W. Welch
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
| | - Erin N. Gordon
- Department of Family MedicineMaine Medical CenterPortlandMaineUSA
| | - Mark G. Parker
- Department of Quality and Patient SafetyMaineHealthPortlandMaineUSA
- Division of Nephrology and TransplantationMaine Medical CenterPortlandMaineUSA
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3
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Haseldine C, O'Donoghue G, Kearney PM, Riordan F, Cotterill S, McHugh S. Healthcare workers' perspectives on barriers and facilitators to referral and recruitment to diabetes prevention programmes: a systematic review protocol. HRB Open Res 2024; 6:23. [PMID: 38601792 PMCID: PMC11004599 DOI: 10.12688/hrbopenres.13702.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
Background Diabetes is a growing global health problem. International guidelines recommend identification, screening, and referral to behavioural programmes for those at high risk of developing type 2 diabetes. Diabetes prevention programmes (DPPs) can prevent type 2 diabetes in those at high risk, however many eligible participants are not referred to these programmes. Healthcare workers (HCWs) are pivotal to the referral and recruitment processes. This study aims to identify, appraise and synthesise the evidence on barriers and facilitators to referral and recruitment to DPPs from the perspective of HCWs. Methods A "best fit" framework synthesis method will synthesise qualitative, quantitative, and mixed methods evidence on factors that affect HCWs referral and recruitment to DPPs, with the Theoretical Domains Framework (TDF) as the a priori framework. MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science and Scopus will be searched for primary studies published in English. Year of publication will be restricted to the last 26 years (1997-2023). Quality will be assessed using the Mixed Methods Appraisal Tool. A mix of deductive coding using the TDF and inductive coding of data that does not fit the TDF will be synthesised into themes representing the whole dataset. The relationships between the final set of themes will be explored to create a new model to understand HCWs' perspectives on referral and recruitment to DPPs. Sensitivity analysis will be carried out on this conceptual model. Confidence in the synthesised findings will be assessed using the GRADE-CERQual approach. One author will screen, extract, appraise the literature while a second author will independently verify a 20% sample at each stage. Discussion Participation in DPPs is key for programme impact. HCWs typically identify those at risk and refer them to DPPs. Understanding HCWs' perspectives on the barriers and facilitators to referral and recruitment will inform future implementation of DPPs.
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Affiliation(s)
- Clair Haseldine
- School of Public Health, University College Cork, Cork, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork, Ireland
- Health Service Executive, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Sarah Cotterill
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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4
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Minian N, Wong M, Hafuth S, Rodak T, Rahimi A, Gjomema D, Rose J, Zawertailo L, Ratto M, Selby P. Identifying determinants of varenicline adherence using the Theoretical Domains framework: a rapid review. BMC Public Health 2024; 24:679. [PMID: 38438884 PMCID: PMC10910805 DOI: 10.1186/s12889-024-18139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Adhering to varenicline has been shown to significantly improve the chances of successfully quitting smoking, with studies indicating a twofold increase in 6-month quit rates. However, despite its potential benefits, many individuals struggle with maintaining good adherence to varenicline; thus there is a need to develop scalable strategies to help people adhere. As a first step to inform the development of an intervention to improve adherence to varenicline, we conducted a rapid literature review to identify: 1) modifiable barriers and facilitators to varenicline adherence, and 2) behaviour change techniques associated with increased adherence to varenicline. METHODS We searched MEDLINE, Embase, APA PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials for relevant studies published between 2006 and 2022. Search terms included "varenicline," "smoking cessation," and "adherence," and their respective subject headings and synonyms. We screened and included studies reporting modifiable determinants of adherence to varenicline and then assessed quality, extracted modifiable determinants and mapped them to the Theoretical Domains Framework version 2 and the Behaviour Change Technique Taxonomy version 1. RESULTS A total of 1,221 titles were identified through the database searches; 61 met the eligibility criteria. Most of the studies were randomized controlled trials and predominantly focused on barriers to varenicline. Only nine studies explicitly mentioned behaviour change techniques used to help varenicline adherence. Eight domains were identified as barriers to varenicline adherence (behavioural regulation, memory, goals, intentions, beliefs about capabilities, beliefs about consequences, optimism/pessimism, and environmental context) and five as facilitators (knowledge, behavioural regulation, beliefs about capabilities, social influences, and environmental context). CONCLUSIONS This study identifies barriers and facilitators that should be addressed when developing a complex adherence intervention tailored to patients' needs based on modifiable determinants of medication adherence, some of which are under- used by existing adherence interventions. The findings from this review will inform the design of a theory-based healthbot planned to improve varenicline adherence in people undergoing smoking cessation treatment. SYSTEMATIC REVIEW REGISTRATION This study was registered with PROSPERO (# CRD42022321838).
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Affiliation(s)
- Nadia Minian
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON , Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
| | - Melissa Wong
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Sowsan Hafuth
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Terri Rodak
- Department of Education, CAMH Library, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alma Rahimi
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
| | - Dea Gjomema
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
| | - Jonathan Rose
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
- Department of Electrical and Computer Engineering, The Edward S. Rogers Sr, University of Toronto, Toronto, ON, Canada
| | - Laurie Zawertailo
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Matt Ratto
- Faculty of Information Bell University Labs Chair in Human-Computer Interaction Faculty Affiliate, Schwartz-Reisman Institute for Technology and Society, University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab (Formerly Nicotine Dependence Service), Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6H 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON , Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Ahern L, Timmons S, Lamb SE, McCullagh R. A systematic review of Behaviour Change Interventions to improve exercise self-efficacy and adherence in people with Parkinson's disease using the Theoretical Domains Framework. J Frailty Sarcopenia Falls 2024; 9:66-68. [PMID: 38444546 PMCID: PMC10910257 DOI: 10.22540/jfsf-09-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 03/07/2024] Open
Abstract
Physical activity and exercise can limit the development of sarcopenia in Parkinson's Disease. This review aims to evaluate the potential effects of behavioural change (BC) interventions on exercise self-efficacy and adherence in people with Parkinson's. We searched nine databases and included randomised and non-randomised studies reporting exercise self-efficacy, quality of life (QoL), physical function and/or exercise adherence. Two reviewers independently screened, data extracted, and assessed risk of bias and certainty of evidence. The interventions were mapped to the Theoretical Domains Framework. Eleven studies (n=901) were included. Four were randomised trials and risk of bias was mixed. Most interventions were multi-component, including education, behavioural techniques, and support groups. The most effective domains appear to be Behavioural regulation, Belief about Capabilities, Social influences, Reinforcement and Goals. Future research should examine multi-component BC interventions encompassing the five most effective TDF domains.
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Affiliation(s)
- Leanne Ahern
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Sarah E. Lamb
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Ruth McCullagh
- Discipline of Physiotherapy, School of Clinical Therapies, University College Cork, Cork, Ireland
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6
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Knowles N, Elliott M, Cline A, Poole H. Factors influencing midwives' conversations about smoking and referral to specialist support: a qualitative study informed by the Theoretical Domains Framework. Perspect Public Health 2024:17579139241231213. [PMID: 38379125 DOI: 10.1177/17579139241231213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
AIMS The aim of this study was to identify factors influencing midwives' conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. METHODS Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. RESULTS Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women's decisions, limited appointment times, and competing priorities were identified as barriers. CONCLUSION Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.
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Affiliation(s)
- Nicky Knowles
- Public Health Wales Behavioural Science Unit, No. 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK
- School of Psychology, Liverpool John Moores University
| | | | - Alice Cline
- Public Health Wales Behavioural Science Unit, UK
| | - Helen Poole
- School of Psychology, Liverpool John Moores University, UK
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7
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Acampora M, Paleologo M, Graffigna G, Barello S. Uncovering influential factors in human antibiotic prescribing: a meta-synthesis study informed by the Theoretical Domains Framework. J Hosp Infect 2024; 144:28-55. [PMID: 38092303 DOI: 10.1016/j.jhin.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
This study aimed to identify modifiable determinants (facilitators and barriers) related to the choice of prescribing antibiotics in human medicine across clinical settings. Enhanced management of antibiotics can help slow the spread of resistant bacteria. A qualitative meta-synthesis approach was used, according to Sandelowski and Barroso's method. Included studies were evaluated using the Critical Appraisal Skills Programme. Findings were extracted and organized to form a qualitative meta-summary. The Theoretical Domains Framework, the Capabilities-Opportunities-Motivation (COM-B) model and the Behaviour Change Wheel were used as a coding matrix for data interpretation. The analysis of 63 included studies revealed barriers and facilitators in 12 of 14 domains specified by the Theoretical Domains Framework. Prescribers' capabilities, motivation and opportunities were found to be the main drivers of antibiotic prescribing behaviour. Knowledge, skills, beliefs, expectations, the influence of patients and colleagues, organizational culture and infrastructure characteristics have a significant impact on prescribing behaviours. A comprehensive inventory of factors related to antibiotic prescribing has been compiled. Interventions to promote appropriate antibiotic prescribing should take a systemic approach rather than focusing solely on individual-level variables. Furthermore, the adoption of co-design approaches for such interventions is desirable to ensure greater applicability and sustainability in the real-world context of organizations.
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Affiliation(s)
- M Acampora
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy
| | - M Paleologo
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy
| | - G Graffigna
- EngageMinds HUB - Consumer, Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore di Milano e Cremona, Milan and Cremona, Italy; Department of Psychology, Università Cattolica del Sacro Cuore di Milano, Milan, Italy; Faculty of Agricultural, Food and Environmental Sciences, Università Cattolica del Sacro Cuore di Cremona, Cremona, Italy
| | - S Barello
- Department of Brain and Behavioural Sciences, Università di Pavia, Pavia, Italy.
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Demir B, Demir S, Wickens CM, Hoseinzadeh Nooshabadi M, Rodak T, Donmez B. Exploring the Behaviour Change Wheel and the Theoretical Domains Framework in interventions for mobile phone driver distraction: A scoping review. Accid Anal Prev 2024; 195:107369. [PMID: 38061292 DOI: 10.1016/j.aap.2023.107369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/30/2023]
Abstract
Mobile phone use while driving remains a significant traffic safety concern. Although numerous interventions have been developed to address it, there is a gap in the synthesis of relevant information through a comprehensive behaviour change lens. This scoping review uses the Behaviour Change Wheel (BCW) and the Theoretical Domains Framework (TDF) to examine the literature to (a) identify behavioural constructs targeted in interventions for mobile phone use while driving, (b) determine if the intervention success varied by sociodemographic group (e.g., age, gender, driving experience), and (c) map interventions to TDF domains to highlight areas for future research. Following the PRISMA extension for scoping reviews, we searched seven databases and identified 5,202 articles. After screening, 50 articles detailing 56 studies met the following inclusion criteria: (a) intervention studies, (b) providing details on methods and results, (c) written in English, and (d) targeting any driver behaviour related to mobile phone use while driving with a bottom-up approach, using not regulation or law enforcement, but individuals' psychological processes, such as cognitive, behavioural, and emotional. Findings show that most interventions targeted young drivers and were typically effective. Except for a few studies, the effectiveness of interventions targeting different sociodemographic groups either remained untested or revealed nonsignificant differences. This finding points to a gap in the literature, indicating a need for further investigation into the efficacy of interventions for different groups, and for tailoring and testing them accordingly. The interventions also often targeted multiple TDF domains, complicating the interpretation of the relative efficacy of specific domains. Most frequently targeted domains included beliefs and consequences, emotions, knowledge, social influence, social/professional role and identity, and behavioural regulation. Physical skills and optimism domains were not targeted in any intervention. Further, almost all interventions addressed deliberate engagement in mobile phone distractions, while the automatic and fast processes involved in such behaviours were often overlooked. Mobile phone distractions are in part habitual behaviours, yet the existing mitigation efforts mostly assumed intentional engagement. More focus on the habitual nature of mobile phone distractions is needed.
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Affiliation(s)
- Basar Demir
- University of Toronto, Department of Mechanical and Industrial Engineering, 5 King's College Road, Toronto, ON M5S 3G8, Canada; Faculty of Arts and Sciences, Final International University, Kyrenia via Mersin 10, Türkiye.
| | - Sila Demir
- Faculty of Arts and Sciences, Final International University, Kyrenia via Mersin 10, Türkiye; Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto ON M5S 2S1, Canada.
| | - Christine M Wickens
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto ON M5S 2S1, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Canada; Dalla Lana School of Public Health, University of Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Canada.
| | - Mehdi Hoseinzadeh Nooshabadi
- University of Toronto, Department of Mechanical and Industrial Engineering, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
| | - Terri Rodak
- CAMH Library, Department of Education, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Birsen Donmez
- University of Toronto, Department of Mechanical and Industrial Engineering, 5 King's College Road, Toronto, ON M5S 3G8, Canada.
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Damen MAW, Detaille SI, Engels JA, De Lange AH. Perceived Factors Influencing Blue-Collar Workers' Participation in Worksite Health Promotion Programs in Freight Transport: A Qualitative Investigation Using the TDF and COM-B. Int J Environ Res Public Health 2024; 21:116. [PMID: 38276810 PMCID: PMC10815228 DOI: 10.3390/ijerph21010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024]
Abstract
Blue-collar workers in the freight transport industry report a high risk of developing chronic diseases, partly due to an unhealthy lifestyle. Worksite health promotion programs (WHPPs) may be able to promote a healthier lifestyle, but participation among blue-collar workers in these programs is generally lower than among other workers. The current study aimed to further examine factors that can explain participation of blue-collar workers in these programs. A pragmatic, qualitative study was conducted, and semi-structured interviews were held with 32 blue-collar workers in freight transport in the Netherlands (94% men, 81% driver, mean age 48 (SD = 11)). The interview guide was based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model, and was used to assess perceived determinants that influence participation. A combination of framework analysis and thematic analysis was conducted, which yielded the following nine main themes: (i) not being aware of WHPPs on offer, (ii) no clear picture of what to expect, (iii) (not) giving priority to health, (iv) expecting feedback and practical support, (v) being open and ready to change, (vi) preferring to be self-dependent, (vii) being offered a practical, fun and joint WHPP, (viii) having an employer who cares, thinks along and facilitates participation, and (ix) working and living in an environment in which a healthy lifestyle is not the norm. With these insights we were able to formulate recommendations to enhance the participation of blue-collar workers in WHPPs.
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Affiliation(s)
- Marc A. W. Damen
- Faculty of Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Sarah I. Detaille
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Josephine A. Engels
- School of Organization and Development, Han University of Applied Sciences, P.O. Box 6960, 6503 GL Nijmegen, The Netherlands
| | - Annet H. De Lange
- Faculty of Psychology, Open Universiteit, P.O. Box 2960, 6401 DL Heerlen, The Netherlands
- Faculty of Social Sciences, Hotel School of Management, University of Stavanger, P.O. Box 8600, 4036 Stavanger, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Department of Psychology, Campus de A Coruña, Universidade da Coruña, 15701 A Coruña, Spain
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10
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Brady RE, Salwen-Deremer JK, Tunnell NC, Winter MW. Understanding Medication Nonadherence in Crohn's Disease Patients: A Qualitative Evaluation. Inflamm Bowel Dis 2023:izad296. [PMID: 38134389 DOI: 10.1093/ibd/izad296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Immune-modifying medications are widely available and recognized as valuable by most gastroenterologists. However, approximately 40% of patients with Crohn's disease (CD) do not comply with regimens using these medications, resulting in complications, hospitalization, and surgeries. We sought to identify factors that motivate adherence or nonadherence with medication recommendations for CD. METHODS We conducted qualitative interviews with patients living with CD who were identified as adherent or nonadherent to immune-modifying medication recommendations by their treating gastroenterologist. Semistructured interview guides were developed based on an established framework for understanding health behaviors. We conducted content analysis of the resulting qualitative data using an inductive-deductive approach to identify emergent themes that influence medication decision-making. RESULTS Twenty-five patients with CD completed interviews for this study. Interviews were independently coded and analyzed for thematic content. Two broad domains emerged comprising (1) themes reflected in the Theoretical Domains Framework and (2) novel themes specific to medication decision-making in CD. Adherent patients conveyed a sense of trust in science and healthcare provider expertise, while nonadherent patients were more likely to express beliefs in their ability to self-manage CD, concern about risks associated with medication, and a general ambivalence to treatment. CONCLUSIONS There are clear cognitive, behavioral, and relational factors that guide patients' medication-related decision-making. Several of the factors share features of other behavioral change and decision-making processes, while others are specific to the experience of patients with CD. A fuller understanding of these factors is essential to developing effective behavioral interventions to improve adherence to evidence-based treatment recommendations.
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Affiliation(s)
- Robert E Brady
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Natalie C Tunnell
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry and Behavioral Sciences, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael W Winter
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Wushouer H, Ko W, Du K, Zhang W, Hu L, Yu J, Zhang K, Shi L, Guan X. Exploring Facilitators and Barriers to Delayed Antibiotic Prescribing in Rural Northwest China: A Qualitative Study Using the Theoretical Domains Framework and Behavior Change Wheel. Antibiotics (Basel) 2023; 12:1741. [PMID: 38136775 PMCID: PMC10740748 DOI: 10.3390/antibiotics12121741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/28/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Antimicrobial resistance, exacerbated by antibiotic misuse, poses a global threat. Though delayed antibiotic prescribing (DAP) can mitigate antibiotic overuse, its adoption in developing nations, such as China, is limited. This study probed barriers and facilitators to DAP in Xinjiang, characterized by extensive rural landscapes and primary care institutions (PCIs). METHODS Adopting a qualitative methodology, we conducted key informant interviews with thirty participants across six county hospitals in Xinjiang using VooV Meeting. Employing a two-stage sampling method targeting economically diverse areas, our interviews spanned physicians, pharmacists, patients, and caregivers. We organized the data according to the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), spotlighting behavioral and policy elements impacting DAP. RESULTS Our research included thirty interviewees. Twelve physicians contemplated delayed prescriptions, while five adult patients and six caregivers encountered recommendations for delayed antibiotic prescriptions. Six patients sought pharmacists' advice on antibiotic necessity. Prominent TDF domains were memory, attention, and beliefs about consequences. Critical intervention functions included education and environmental restructuring, while vital policy categories encompassed communication/marketing and guidelines. CONCLUSIONS Countering antibiotic misuse and resistance in China necessitates overcoming barriers through strategic resource distribution, comprehensive education, rigorous training, and consistent monitoring, thereby promoting DAP adoption. The adoption of DAP in rural healthcare settings in China has the potential to significantly reduce antibiotic misuse, thereby mitigating the global threat of antimicrobial resistance.
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Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Weihsin Ko
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Wanmeng Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Junxuan Yu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Kairui Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China; (H.W.); (W.K.); (K.D.); (W.Z.); (L.H.); (J.Y.); (K.Z.)
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
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Benoit B, Cassidy C, Campbell-Yeo M, Gillis D, Kirk S, Sim SM, LeDrew M, Loring S, Tomblin Murphy G, Elliott Rose A, Betker C, MacKeen L, Arseneau L, Shebib K, Reid T, Daman R. Development of Interventions to Support Provincial Implementation of the Baby-Friendly Initiative: A Study Protocol. Nurs Rep 2023; 13:1731-1741. [PMID: 38133119 PMCID: PMC10745531 DOI: 10.3390/nursrep13040143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Breastfeeding is internationally recognized as the optimal form of infant nutrition. The Baby-Friendly Initiative (BFI) is an evidence-informed program that leads to improved breastfeeding outcomes. Despite the benefits of breastfeeding, Nova Scotia has one of the lowest breastfeeding rates in Canada. Additionally, only two birthing hospitals in the province have BFI designation. We aim to address this gap using a sequential qualitative descriptive design across three phases. In Phase 1, we will identify barriers and facilitators to BFI implementation through individual, semi-structured interviews with 40 health care professionals and 20 parents. An analysis of relevant policy and practice documents will complement these data. In Phase 2, we will develop implementation interventions aimed at addressing the barriers and facilitators identified in Phase 1. An advisory committee of 10-12 administrative, clinical, and parent partners will review these interventions. In Phase 3, the interventions will be reviewed by a panel of 10 experts in BFI implementation through an online survey. Feedback on the revised implementation interventions will then be sought from 20 health system and parent partners through interviews. This work will use implementation science methods to support integrated and sustained implementation of the BFI across hospital/community and rural/urban settings in Nova Scotia. This study was not registered.
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Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.C.); (M.C.-Y.)
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.C.); (M.C.-Y.)
| | - Doris Gillis
- Human Nutrition Department, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Sara Kirk
- School of Health & Human Performance, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - S. Meaghan Sim
- Research, Innovation, & Discovery, Nova Scotia Health, Halifax, NS B3S 0H6, Canada; (S.M.S.); (G.T.M.)
| | - Michelle LeDrew
- Breastfeeding Committee for Canada, Glen Margaret, NS B3Z 3H8, Canada; (M.L.); (S.L.)
| | - Sally Loring
- Breastfeeding Committee for Canada, Glen Margaret, NS B3Z 3H8, Canada; (M.L.); (S.L.)
| | - Gail Tomblin Murphy
- Research, Innovation, & Discovery, Nova Scotia Health, Halifax, NS B3S 0H6, Canada; (S.M.S.); (G.T.M.)
| | | | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Leanne MacKeen
- Reproductive Care Program of Nova Scotia, Halifax, NS B3H 1Y6, Canada;
| | - Lindsay Arseneau
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
| | - Kim Shebib
- Public Health, Nova Scotia Health, Halifax, NS B3S 1B8, Canada; (K.S.); (T.R.)
| | - Trudy Reid
- Public Health, Nova Scotia Health, Halifax, NS B3S 1B8, Canada; (K.S.); (T.R.)
| | - Ripu Daman
- Rankin School of Nursing, Faculty of Science, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada; (L.A.); (R.D.)
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Tierney-Hendricks C, Schliep ME, Vallila-Rohter S. Barriers and facilitators to outcome measurement and treatment practices in aphasia rehabilitation in the USA: a mixed methods approach using the Theoretical Domains Framework. Disabil Rehabil 2023:1-16. [PMID: 38053357 DOI: 10.1080/09638288.2023.2288221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. MATERIALS AND METHODS Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. RESULTS Factors related to the TDF domain of "environmental context and resources" (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of "memory, attention, decision-making" (decision-making processes), "knowledge" (awareness of evidence) and "social influences" (client and caregiver preferences). CONCLUSIONS Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators.
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Affiliation(s)
| | - Megan E Schliep
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- MGH Institute of Health Professions, Boston, MA, USA
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Brummel B, van Heumen C, Smits A, van den Berg M, Ezendam NPM, Pijnenborg JMA, de van der Schueren MAE, Wilkinson SA, van der Meij BS. Barriers to and facilitators of a healthy lifestyle for patients with gynecological cancer: a systematic review of qualitative and quantitative research with healthcare providers and patients. Maturitas 2023; 177:107801. [PMID: 37541112 DOI: 10.1016/j.maturitas.2023.107801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
The prevalence of an unhealthy lifestyle among patients with gynecological cancer is high and associated with increased risk of all-cause mortality. Although lifestyle changes have the potential to improve outcomes, lifestyle counseling is not routinely integrated into standard care. This review explores research on the barriers to and facilitators of both the promotion of healthy lifestyles by healthcare providers (HCPs) and healthy lifestyle changes by patients with gynecological cancer. The Theoretical Domains Framework (TDF) was used to deductively code the identified factors for a comprehensive understanding of the barriers and facilitators. A search across five databases yielded a total of 12,687 unique studies, of which 43 were included in the review. Of these 43, 39 included gynecological cancer patients and only 6 included HCPs. Among the barriers identified for HCPs, most studies evaluated barriers regarding weight loss counseling. Limited knowledge, reluctance to address weight loss, skepticism about the benefits, and workload concerns were commonly reported barriers for HCPs. HCPs will benefit from education and training in lifestyle counseling, including effective communication skills like motivational interviewing. Gynecological cancer patients lacked tools, support, knowledge, and faced mental health issues, environmental constraints, and physical limitations. The review emphasizes the importance of addressing these barriers and utilizing identified facilitators, such as social support, to promote and support healthy lifestyle behaviors on the part of patients and their promotion by HCPs. Future research should focus not only on patients but also on supporting HCPs and implementing necessary changes in current practices.
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Affiliation(s)
- Bo Brummel
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands
| | - Cindy van Heumen
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands
| | - Anke Smits
- Department of Obstetrics & Gynecology, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Manon van den Berg
- Department of Gastroenterology and Hepatology- Dietetics, Radboudumc, 6525 GA Nijmegen, the Netherlands
| | - Nicole P M Ezendam
- Center of Research on Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, 5037 AB Tilburg, the Netherlands; Netherlands Comprehensive Cancer Organisation, 5612 HZ Eindhoven, the Netherlands
| | | | - Marian A E de van der Schueren
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands
| | - Shelley A Wilkinson
- Department of Obstetric Medicine, Mater Mothers Hospital, South Brisbane 4101, Australia; Lifestyle Maternity, Brisbane, QLD 4069, Australia
| | - Barbara S van der Meij
- Department of Human Nutrition and Health, Wageningen University & Research, 6708 WE Wageningen, the Netherlands; Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, the Netherlands; Bond University Nutrition and Dietetics Research Group, Bond University, Gold Coast, QLD 4226, Australia.
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15
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Testa V, Bennett A, Jutai J, Cantor Z, Burke P, McMahon J, Carleton RN, Colman I, Fikretoglu D, Heber A, Leduc S, Heisel MJ, Thavorn K, Corsi DJ, Hatcher S. Applying the Theoretical Domains Framework to identify police, fire, and paramedic preferences for accessing mental health care in a First Responder Operational Stress Injury Clinic: a qualitative study. Health Promot Chronic Dis Prev Can 2023; 43:431-449. [PMID: 37991887 PMCID: PMC10753900 DOI: 10.24095/hpcdp.43.10/11.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
INTRODUCTION First responders and other public safety personnel (PSP; e.g. correctional workers, firefighters, paramedics, police, public safety communicators) are often exposed to events that have the potential to be psychologically traumatizing. Such exposures may contribute to poor mental health outcomes and a greater need to seek mental health care. However, a theoretically driven, structured qualitative study of barriers and facilitators of help-seeking behaviours has not yet been undertaken in this population. This study used the Theoretical Domains Framework (TDF) to identify and better understand critical barriers and facilitators of help-seeking and accessing mental health care for a planned First Responder Operational Stress Injury (OSI) clinic. METHODS We conducted face-to-face, one-on-one semistructured interviews with 24 first responders (11 firefighters, five paramedics, and eight police officers), recruited using purposive and snowball sampling. Interviews were analyzed using deductive content analysis. The TDF guided study design, interview content, data collection, and analysis. RESULTS The most reported barriers included concerns regarding confidentiality, lack of trust, cultural competency of clinicians, lack of clarity about the availability and accessibility of services, and stigma within first responder organizations. Key themes influencing help-seeking were classified into six of the TDF's 14 theoretical domains: environmental context and resources; knowledge; social influences; social/professional role and identity; emotion; and beliefs about consequences. CONCLUSION The results identified key actions that can be utilized to tailor interventions to encourage attendance at a First Responder OSI Clinic. Such approaches include providing transparency around confidentiality, policies to ensure greater cultural competency in all clinic staff, and clear descriptions of how to access care; routinely involving families; and addressing stigma.
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Affiliation(s)
- Valerie Testa
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Alexandria Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeffrey Jutai
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- LIFE Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary Cantor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Paramedic Service, City of Ottawa, Ottawa, Ontario, Canada
| | - Peter Burke
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - James McMahon
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Canadian Institute for Public Safety Research and Treatment, Regina, Saskatchewan, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deniz Fikretoglu
- Operational Health and Performance Section, Defence Research and Development Canada, Toronto, Ontario, Canada
| | - Alexandra Heber
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Veterans Affairs Canada, Ottawa, Ontario, Canada
| | - Shannon Leduc
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Ottawa Paramedic Service, City of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Marnin J Heisel
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Better Outcomes Registry & Network Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Simon Hatcher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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16
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Heywood-Everett S, Henderson R, Webb C, Bland AR. Psychosocial factors impacting community-based pressure ulcer prevention: A systematic review. Int J Nurs Stud 2023; 146:104561. [PMID: 37542960 DOI: 10.1016/j.ijnurstu.2023.104561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Pressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership. OBJECTIVE To synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour. DESIGN Mixed methods systematic review and narrative synthesis. METHOD Systematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model. RESULTS Thirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport. CONCLUSIONS Several psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.
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Affiliation(s)
- Suzanne Heywood-Everett
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK.
| | - Rebecca Henderson
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
| | - Claire Webb
- Primary Care Wellbeing Service, Bradford District Care NHS Foundation Trust, Shipley BD18 3LD, UK
| | - Amy R Bland
- Department of Psychology, Manchester Metropolitan University, Manchester M15 6BH, UK
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González Casanova I, Martínez Rodriguez DL, Ortiz Brunel J, Rangel Gómez MG, de Groot M, Fernández A. Barriers and facilitators to mental health promotion for Mexican immigrants in the U.S. through the Ventanillas de Salud program. Front Public Health 2023; 11:1268253. [PMID: 37841719 PMCID: PMC10569420 DOI: 10.3389/fpubh.2023.1268253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Mental health promotion and screenings are recommended as part of standard preventive care. Mexican immigrants in the U.S. are at high risk for mental health illness especially after the COVID-19 pandemic, however access to mental health prevention for this population has been limited, which results in important implementation and equity gaps. The Ventanilla de Salud (VDS) program provides preventive services through Mexican consulates in the U.S. Objective The objective of this study was to assess capability, opportunity, and motivation for promotores to implement mental health programming through the VDS, leveraging early experiences of ongoing mental health prevention efforts. Methods This was a qualitative study using the Capability, Opportunity, and Motivation for Behavior Change model (COM-B). We conducted 9 focus groups with 40 VDS promotores and 6 semi-structured interviews with program stakeholders. Data were analyzed using inductive and deductive coding. Results We found high levels of interest from the leadership, partners, and promotores to provide mental health services through the VDS. Early implementation of a mental health strategy that included training sessions for promotores and mental health promotion, screenings and referrals for VDS users was ongoing. We identified facilitators and barriers that could affect capability, opportunity, and motivation to provide mental health services. Facilitators included promotores' extensive knowledge about the importance of mental health, promotores service mindset and commitment to provide services to VDS users, and general support from the VDS network and partners. Barriers included promotores' turnover, need for additional economic compensation, burnout, competing priorities, and lack of mental health professionals to provide clinical services or supervision. Additional investments are recommended to support promotores' well-being. Conclusion The main lesson learned from this study was that investing in VDS promotores' training, resources, and well-being is key to their capability, opportunity and motivation to provide mental health services for Mexican immigrants in the US. Results from this study can be applied to improve the ongoing VDS mental health strategy and increase its impact on the mental health of Mexican immigrants.
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Affiliation(s)
- Inés González Casanova
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, IN, United States
| | | | - Julissa Ortiz Brunel
- Department of Sciences of Human Movement, University Center for Health Sciences, Universidad de Guadalajara, Guadalajara, Guadalajara, Jalisco, Mexico
| | | | - Mary de Groot
- Division of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Alicia Fernández
- San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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Amirova A, Taylor L, Volkmer B, Ahmed N, Chater AM, Fteropoulli T. Informing behaviour change intervention design using systematic review with Bayesian meta-analysis: physical activity in heart failure. Health Psychol Rev 2023; 17:456-484. [PMID: 35701235 DOI: 10.1080/17437199.2022.2090411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 12/11/2022]
Abstract
Embracing the Bayesian approach, we aimed to synthesise evidence regarding barriers and enablers to physical activity in adults with heart failure (HF) to inform behaviour change intervention. This approach helps estimate and quantify the uncertainty in the evidence and facilitates the synthesis of qualitative and quantitative studies. Qualitative evidence was annotated using the Theoretical Domains Framework and represented as a prior distribution using an expert elicitation task. The maximum a posteriori probability (MAP) for the probability distribution for the log OR was used to estimate the relationship between physical activity and each determinant according to qualitative, quantitative, and qualitative and quantitative evidence combined. The probability distribution dispersion (SD) was used to evaluate uncertainty in the evidence. Three qualitative and 16 quantitative studies were included (N = 2739). High pro-b-type natriuretic peptide (MAP = -1.16; 95%CrI: [-1.21; -1.11]) and self-reported symptoms (MAP = - 0.48; 95%CrI: [ -0.40; -0.55]) were suggested as barriers to physical activity with low uncertainty (SD = 0.18 and 0.19, respectively). Modifiable barriers were symptom distress (MAP = -0.46; 95%CrI: [-0.68; -0.24], SD = 0.36), and negative attitude (MAP = -0.40; 95%CrI: [-0.49; -0.31], SD = 0.26). Modifiable enablers were social support (MAP = 0.56; 95%CrI: [0.48; 0.63], SD = 0.26), self-efficacy (MAP = 0.43; 95%CrI: [0.32; 0.54], SD = 0.37), positive physical activity attitude (MAP = 0.92; 95%CrI: [0.77; 1.06], SD = 0.36).
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Affiliation(s)
- Aliya Amirova
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lauren Taylor
- Department of Psychology, University of Surrey, Guildford, UK
| | - Brittannia Volkmer
- Psychology department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- Mental Health Policy Research Unit, UCL Division of Psychiatry, London, UK
| | - Angel M Chater
- Centre for Behaviour Change, Clinical, Educational & Health Psychology, Division of Psychology & Language Sciences, Faculty of Brain Sciences, UCL, London, UK
- Institute for Sport and Physical Activity Research (ISPAR), Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK
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Yap B, Rajaram N, Ho WK, Khor GL, Teo SH. Perceptions, attitudes and beliefs towards soya among healthy Asian women participating in a soya randomised controlled trial. J Nutr Sci 2023; 12:e69. [PMID: 37457681 PMCID: PMC10345781 DOI: 10.1017/jns.2023.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/17/2023] [Accepted: 05/25/2023] [Indexed: 07/18/2023] Open
Abstract
The soya-breast cancer risk relationship remains controversial in Asia due to limited and inconsistent research findings and is exacerbated by difficulties in recruiting and retaining participants in intervention trials. Understanding public perceptions towards soya is important for designing effective intervention trials. Here, we administered a close-ended, quantitative survey to healthy, peri- and post-menopausal Asian women in the Malaysian Soy and Mammographic Density (MiSo) Study to assess perception towards soya and explore motivators and barriers that affect study adherence using the Capability, Opportunity, Motivation and Belief (COM-B) Model and Theoretical Domains Framework (TDF). Of 118 participants, the majority reported the belief that soya promotes good health (Supplement = 85⋅7 %, Diet = 90⋅0 %, Control = 87⋅9 %). Most participants reported obtaining information about soya from the internet (Supplement = 61⋅0 %, Diet = 55⋅3 %, Control = 35⋅9 %), while health professionals were least reported (Supplement = 9⋅8 %, Diet = 7⋅9 %, Control = 5⋅1 %). Stratified analyses by study completion and adherence status yielded comparable findings. By the end of the study, dietary arm participants reported a strong belief that soya has no impact on their health (Supplement = 7⋅1 % v. Diet = 20⋅0 % v. Control = 0⋅0 %, P = 0⋅012). Motivation and opportunity strongly facilitated soya consumption, while psychological capability was the most common barrier to consumption though less evident among dietary arm participants. While most Asian women have a positive perception towards soya, theory-based intervention trials are warranted to understand the perception-study adherence relationship and to accurately inform the public of the health effects of soya.
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Affiliation(s)
- Beverley Yap
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
| | - Nadia Rajaram
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Weang Kee Ho
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- School of Mathematical Sciences, Faculty of Science and Engineering, University of Nottingham Malaysia, Semenyih, Selangor 43500, Malaysia
| | - Geok Lin Khor
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Soo Hwang Teo
- Cancer Research Malaysia, Subang Jaya, Selangor 47500, Malaysia
- Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur 50603, Malaysia
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Boyle K, Marsden DL, Waller A, Duff J. Barriers and enablers to providing evidence-based in-hospital urinary continence care: A cross-sectional survey informed by the Theoretical Domains Framework. J Clin Nurs 2023. [PMID: 37272209 DOI: 10.1111/jocn.16776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/07/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
AIMS To identify the barriers and enablers perceived by hospital-based clinicians to providing evidence-based continence care to inpatients. DESIGN This was a cross-sectional study of inpatient clinicians using a questionnaire. METHODS Acute care and rehabilitation clinicians from 15 wards that admit patients after stroke at 12 hospitals (NSW = 11, Queensland =1, metropolitan = 4, regional = 8) were invited to complete an online questionnaire. The 58 questions (answered on a 5-point Likert scale) were aligned to 13 of the 14 domains of the Theoretical Domains Framework. Results were dichotomized into 'strongly agree/agree' and 'unsure/disagree/strongly disagree' and proportions were calculated. Data collection occurred between January 2019 and March 2019. RESULTS The questionnaire was completed by 291 participants with 88% being nurses. Barriers were found in nine domains including knowledge; skills; memory attention and decision making; emotion; environmental context and resources; behavioural regulation; social professional role; intensions, social influences; and beliefs about capabilities. Enablers were found in seven domains including goals; social influences; knowledge; skills; social, professional role and identity; reinforcement and beliefs about consequences. CONCLUSION This multi-site, multi-professional study that included predominantly nurses highlights the barriers and enablers to inpatient continence care. Future implementation studies in inpatient continence management should address these identified barriers and enablers to improve effectiveness of implementation of evidence-based care. IMPLICATIONS FOR THE PROFESSION This study highlights that although there are many barriers to ward nurses providing evidence-based continence care, there are also several enablers. Both should be addressed to improve practice. REPORTING METHOD We adhered to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (Supplementary File 1). RELEVANCE TO CLINICAL PRACTICE Establishing barriers to practice gives a broader understanding of why practice does not occur and establishes areas where researchers and clinicians need to address in order to change behaviour.
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Affiliation(s)
- Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Heath District, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Heath District, New Lambton Heights, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing-University of Newcastle, Callaghan, New South Wales, Australia
| | - Amy Waller
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- College of Health, Medicine and Wellbeing-University of Newcastle, Callaghan, New South Wales, Australia
| | - Jed Duff
- College of Health, Medicine and Wellbeing-University of Newcastle, Callaghan, New South Wales, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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Kanzow P, Kanzow AF, Wiegand A, Schwendicke F. Implementation of repairs in dental practice: Randomized behavior simulation trial. J Am Dent Assoc 2023:S0002-8177(23)00210-6. [PMID: 37212760 DOI: 10.1016/j.adaj.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/07/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Despite increasing evidence, dentists have not widely adopted repairs. The authors aimed to develop and test potential interventions targeting dentists' behavior. METHODS Problem-centered interviews were performed. Emerging themes were linked to the Behavior Change Wheel to develop potential interventions. The efficacy of 2 interventions was then tested in a postally delivered behavioral change simulation trial among German dentists (n = 1,472 per intervention). Dentists' stated repair behavior regarding 2 case vignettes was assessed. Statistical analysis was performed using McNemar test, Fisher exact test, and a generalized estimating equation model (P < .05). RESULTS Two interventions (guideline, treatment fee item) were developed on the basis of identified barriers. A total of 504 dentists participated in the trial (17.1% response rate). Both interventions significantly changed dentists' behavior toward repairs of composite and amalgam restorations, respectively (guideline: difference [Δ] = +7.8% and Δ = +17.6%, treatment fee item: Δ = +6.4% and Δ = +31.5%; adjusted P < .001). Dentists were more likely to consider repairs if they already performed repairs frequently (odds ratio [OR], 1.23; 95% CI, 1.14 to 1.34) or sometimes (OR, 1.08; 95% CI, 1.01 to 1.16), if they regarded repairs as highly successful (OR, 1.24; 95% CI, 1.04 to 1.48), if their patients preferred repairs over total replacements (OR, 1.12; 95% CI, 1.03 to 1.23), for partially defective composite restorations (OR, 1.46; 95% CI, 1.39 to 1.53), and after receiving 1 of the 2 behavioral interventions (OR, 1.15; 95% CI, 1.13 to 1.19). CONCLUSIONS Systematically developed interventions targeting dentists' repair behaviors are likely efficacious to promote repairs. PRACTICAL IMPLICATIONS Most partially defective restorations are replaced completely. Effective implementation strategies are required to change dentists' behavior. This trial was registered at https://www. CLINICALTRIALS gov. The registration number is NCT03279874 for the qualitative phase and NCT05335616 for the quantitative phase.
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Olusanya OA, Tomar A, Thomas J, Alonge K, Wigfall LT. Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations. Vaccine 2023; 41:3564-3576. [PMID: 37164820 DOI: 10.1016/j.vaccine.2023.04.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/13/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Genital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15-25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low. METHODS Accordingly, our study utilized a comprehensive - Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18-26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes. RESULTS Overall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: 'knowledge' (82% of included studies), 'environmental context and resources' (53%), 'beliefs about consequences' (53%), 'unrealistic optimism' (50%) and 'pessimism' (6%), 'emotion' (50%), 'social influences' (50%), 'beliefs about capabilities' (41%), 'intention' (24%), 'reinforcement' (18%), 'social professional role and identity'(12%), and 'behavioral regulation' (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers' recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines. DISCUSSION Our study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.
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Affiliation(s)
- Olufunto A Olusanya
- University of Tennessee Health Science Center (UTHSC), UTHSC-Oak Ridge National Laboratory Center for Biomedical Informatics, Department of Pediatrics, Le Bonheur Research Center, 50 N Dunlap, Memphis, TN 38103, United States.
| | - Aditi Tomar
- Department of Health and Kinesiology, Texas A&M University, 107 Gilchrist Building (Reception Area), Mail Stop 4243, College Station, TX 77842-4243, United States.
| | - Jonathan Thomas
- Department of Public Health Studies, Texas A&M School of Public Health, 212 Adriance Lab Rd, College Station, TX 77843, United States.
| | - Kemi Alonge
- Marshfield Clinic Health System, Marshfield, WI 54449, United States.
| | - Lisa T Wigfall
- MD Anderson Cancer Center, Cancer Prevention Research Training Program, The University of Texas MD Anderson Cancer Center, 1150 Pressler Street, Cancer Prevention Research Building (CPB7.3556), Houston, TX 77030, United States.
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Umaefulam V, Wilson M, Boucher MC, Brent MH, Dogba MJ, Drescher O, Grimshaw JM, Ivers NM, Lawrenson JG, Lorencatto F, Maberley D, McCleary N, McHugh S, Sutakovic O, Thavorn K, Witteman HO, Yu C, Cheng H, Han W, Hong Y, Idrissa B, Leech T, Malette J, Mongeon I, Mugisho Z, Nguebou MM, Pabla S, Rahman S, Samandoulougou A, Visram H, You R, Zhao J, Presseau J. The co-development of a linguistic and culturally tailored tele-retinopathy screening intervention for immigrants living with diabetes from China and African-Caribbean countries in Ottawa, Canada. BMC Health Serv Res 2023; 23:302. [PMID: 36991464 PMCID: PMC10054218 DOI: 10.1186/s12913-023-09329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Diabetic retinopathy is a sight-threatening ocular complication of diabetes. Screening is an effective way to reduce severe complications, but screening attendance rates are often low, particularly for newcomers and immigrants to Canada and people from cultural and linguistic minority groups. Building on previous work, in partnership with patient and health system stakeholders, we co-developed a linguistically and culturally tailored tele-retinopathy screening intervention for people living with diabetes who recently immigrated to Canada from either China or African-Caribbean countries. METHODS Following an environmental scan of diabetes eye care pathways in Ottawa, we conducted co-development workshops using a nominal group technique to create and prioritize personas of individuals requiring screening and identify barriers to screening that each persona may face. Next, we used the Theoretical Domains Framework to categorize the barriers/enablers and then mapped these categories to potential evidence-informed behaviour change techniques. Finally with these techniques in mind, participants prioritized strategies and channels of delivery, developed intervention content, and clarified actions required by different actors to overcome anticipated intervention delivery barriers. RESULTS We carried out iterative co-development workshops with Mandarin and French-speaking individuals living with diabetes (i.e., patients in the community) who immigrated to Canada from China and African-Caribbean countries (n = 13), patient partners (n = 7), and health system partners (n = 6) recruited from community health centres in Ottawa. Patients in the community co-development workshops were conducted in Mandarin or French. Together, we prioritized five barriers to attending diabetic retinopathy screening: language (TDF Domains: skills, social influences), retinopathy familiarity (knowledge, beliefs about consequences), physician barriers regarding communication for screening (social influences), lack of publicity about screening (knowledge, environmental context and resources), and fitting screening around other activities (environmental context and resources). The resulting intervention included the following behaviour change techniques to address prioritized local barriers: information about health consequence, providing instructions on how to attend screening, prompts/cues, adding objects to the environment, social support, and restructuring the social environment. Operationalized delivery channels incorporated language support, pre-booking screening and sending reminders, social support via social media and community champions, and providing using flyers and videos as delivery channels. CONCLUSION Working with intervention users and stakeholders, we co-developed a culturally and linguistically relevant tele-retinopathy intervention to address barriers to attending diabetic retinopathy screening and increase uptake among two under-served groups.
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Affiliation(s)
- Valerie Umaefulam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mackenzie Wilson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie Carole Boucher
- Department of Ophthalmology, Maisonneuve-Rosemont Ophthalmology University Center, Université de Montréal, Montreal, QC, Canada
| | - Michael H Brent
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Maman Joyce Dogba
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
- Centre for Research On Sustainable Health, VITAM, Université Laval, Québec City, QC, Canada
| | - Olivia Drescher
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John G Lawrenson
- School of Health & Psychological Sciences, City, University of London, London, UK
| | | | - David Maberley
- Department of Ophthalmology, The Ottawa Hospital, Ottawa, Canada
| | - Nicola McCleary
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Olivera Sutakovic
- Donald K Johnson Eye Institute, University Health Network, Toronto, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Québec, Canada
| | - Catherine Yu
- Division of Endocrinology & Metabolism, Faculty of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Hao Cheng
- Patient Local Advisory Group, Ottawa, Canada
| | - Wei Han
- Patient Local Advisory Group, Ottawa, Canada
| | - Yu Hong
- Patient Local Advisory Group, Ottawa, Canada
| | | | - Tina Leech
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | | | - Sara Pabla
- Centretown Community Health Centre, Ottawa, Canada
| | | | | | | | - Richard You
- Patient Local Advisory Group, Ottawa, Canada
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- School of Psychology, University of Ottawa, Ottawa, Canada
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Fuster M, Santos MP, Dimond E, Huang TTK, Handley MA. Examining capabilities, opportunities, and motivations for healthy eating behaviors in Latin American restaurants: a quantitative application of the COM-B model to inform future interventions. BMC Nutr 2023; 9:57. [PMID: 36973765 PMCID: PMC10041691 DOI: 10.1186/s40795-023-00712-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Eating foods away from home has been associated with poor diet quality and adverse health outcomes. Research is needed to examine barriers and facilitators to making healthier eating choices in restaurant settings. We operationalized the Capability, Opportunity, and Motivation for Behavior Model (COM-B Model) to conduct a behavioral diagnosis for healthy eating behaviors at Latin American restaurants (LARs), an understudied yet increasingly important food environment with the potential to positively influence diets. METHODS We conducted an online survey with adults in the United States that reported eating food from LARs at least once a month (n = 509) recruited via an online market research panel to examine capabilities - physical (e.g., skills) and psychological (e.g., knowledge), opportunities - social (e.g., norms) and physical (e.g., environmental), and motivations - reflective (e.g., self-conscious intentions) and automatic (e.g., emotions) associated with healthier choices at LARs. In a survey focused on LAR-associated behaviors, each COM-B domain was scored between 1-5, with scores ≥ 4 denoted as having high capability, opportunity, and motivation to eat healthfully at LARs (potential range of total score = 6-35). Regression analysis was used to examine the association between COM-B scores (total and by domain) and select demographic characteristics (age, gender, race, Latin heritage, income, education, marital status, and Latin majority state of residency). RESULTS More than half of the participants (57.1%) were classified as having high physical capability, followed by psychological capability (43.9%) in the LAR environment. The proportions of participants with either high motivation or high opportunity were low, ranging from 37.3% (reflective motivation) to physical opportunity (15.6%). The overall mean COM-B total score was 19.8 ± 3.0. Higher total COM-B scores were associated with younger age, self-identifying as white, having Latin heritage, and having higher income (p < 0.05). CONCLUSIONS This study expands the application of the COM-B framework using quantitative inquiry to evaluate levels of capability, motivation, and opportunity for healthy eating in LAR settings and initial demographic associations with determinants for healthy eating in these settings. This work can aid in tailoring interventions and developing evaluation tools for LAR-related healthy eating interventions.
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Affiliation(s)
- Melissa Fuster
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
| | - Maria P Santos
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Emily Dimond
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Terry T K Huang
- Center for Systems and Community Design and NYU-CUNY Prevention Research Center, City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Margaret A Handley
- Partnership for Research in Implementation Science for Equity (PRIDE) Center and Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Bruneau J, Parsons K, Moralejo D, Donovan C. Development of the Cardiovascular Assessment Screening Program (CASP) using the qualitative findings of a mixed methods study and applying the TDF to address the barriers of and facilitators to comprehensive screening for cardiovascular disease. BMC Prim Care 2023; 24:65. [PMID: 36882713 PMCID: PMC9990229 DOI: 10.1186/s12875-023-02022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. This manuscript reports on the first phase of an exploratory sequential mixed methods study describing the integration of the qualitative study findings with the Theoretical Domains Framework (TDF) that led to the development of the Cardiovascular Assessment Screening Program (CASP). The main objective of the qualitative study was to inform the development of CASP. METHODS Focus groups (5) and interviews (10) were conducted in rural and urban settings in one Canadian province with target health professionals, managers in health care organizations, and the public to obtain different perspectives to inform the CASP intervention. Three focus groups were held with nurse practitioners and two with members of the public; individual interviews were conducted with target groups as well. Application of the TDF provided a comprehensive approach to determine the main factors influencing clinician behaviour, to assess the implementation process, and to support intervention design. Behaviour change techniques, modes of delivery, and intervention components were selected for the development of the CASP. RESULTS Themes identified such lack of knowledge about comprehensive screening, ambiguity around responsibility for screening, lack of time and commitment to screening were addressed in the components of the CASP intervention that were developed, including a website, education module, decision tools, and a toolkit. CONCLUSION CASP is a theory-informed intervention developed through the integration of the findings from the focus groups and interviews with selected TDF domains, behaviour change techniques, and modes of delivery available in the local context that may be a useful approach for knowledge translation of evidence into practice.
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Affiliation(s)
- Jill Bruneau
- Faculty of Nursing, Memorial University of Newfoundland, 323 Prince Philip Drive, St. John's, NL, A1B 3X8, Canada.
| | - Karen Parsons
- Faculty of Nursing, Memorial University of Newfoundland, 323 Prince Philip Drive, St. John's, NL, A1B 3X8, Canada
| | - Donna Moralejo
- Faculty of Nursing, Memorial University of Newfoundland, 323 Prince Philip Drive, St. John's, NL, A1B 3X8, Canada
| | - Catherine Donovan
- Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada
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Jasaui Y, Mortazhejri S, Dowling S, Duquette D, L’Heureux G, Linklater S, Mrklas KJ, Wilkinson G, Beesoon S, Patey AM, Ruzycki SM, Grimshaw JM. Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing. Perioper Med (Lond) 2023; 12:3. [PMID: 36864470 PMCID: PMC9979452 DOI: 10.1186/s13741-023-00292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/12/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery ('low-value preoperative testing') among anesthesiologists, internal medicine specialists, nurses, and surgeons. METHODS Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. RESULTS Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). CONCLUSIONS We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels.
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Affiliation(s)
- Yamile Jasaui
- grid.22072.350000 0004 1936 7697Continuing Medical Education, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sameh Mortazhejri
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON Canada
| | - Shawn Dowling
- grid.22072.350000 0004 1936 7697Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - D’Arcy Duquette
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Geralyn L’Heureux
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Stefanie Linklater
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Kelly J. Mrklas
- grid.413574.00000 0001 0693 8815Strategic Clinical Networks, Provincial Clinical Excellence, Alberta Health Services, Edmonton, AB Canada
| | - Gloria Wilkinson
- Patient Partner, De-Implementing Wisely Research Group, Edmonton, Canada
| | - Sanjay Beesoon
- grid.413574.00000 0001 0693 8815Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB Canada
| | - Andrea M. Patey
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Shannon M. Ruzycki
- grid.17089.370000 0001 2190 316XFaculty of Medicine and Dentistry, University of Alberta, Edmonton, AB Canada ,grid.22072.350000 0004 1936 7697Department of Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jeremy M. Grimshaw
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255Department of Medicine, University of Ottawa, Ottawa, ON Canada
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Ataiyero Y, Dyson J, Graham M. The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless.". Am J Infect Control 2023; 51:295-303. [PMID: 36804099 DOI: 10.1016/j.ajic.2022.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 02/18/2023]
Abstract
BACKGROUND Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. METHODS A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. RESULTS There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. CONCLUSIONS Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.
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Affiliation(s)
- Yetunde Ataiyero
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom.
| | - Judith Dyson
- Centre for Social Care, Health and Related Research, Birmingham City University, Birmingham, United Kingdom
| | - Moira Graham
- School of Nursing and Midwifery, University of Hull, Hull, United Kingdom
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Haines KJ, Sawyer A, McKinnon C, Donovan A, Michael C, Cimoli C, Gregory M, Berney S, Berlowitz DJ. Barriers and enablers to telehealth use by physiotherapists during the COVID-19 pandemic. Physiotherapy 2023; 118:12-19. [PMID: 36308980 PMCID: PMC9450484 DOI: 10.1016/j.physio.2022.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/07/2022] [Accepted: 09/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the perceived barriers and enablers experienced by physiotherapists whilst delivering community and outpatient services during the COVID-19 pandemic. METHODS Qualitative study undertaken at a University-affiliated hospital in Melbourne, Australia. Physiotherapists working in the outpatient setting participated in a semi-structured interview. Interviews were analysed using Framework Analysis, with themes mapped to the Theoretical Domains Framework (TDF). RESULTS From 19 interviews, we identified major themes and mapped these to the TDF domains: 1. The pandemic rapidly closed the knowledge-practice gap; 2. Adaptation of existing skills and integration of new skills were required; 3. Supportive senior leadership helped the transition; 4. Capabilities and confidence improved with time; 5. Environmental factors were crucial to success or failure of telehealth; 6. Access to and delivery of care improved for some; 7. Identification of appropriate patients and future hybrid models of care; 8. Changes in work practices, role certainty and identity; 9. Development of educational resources consolidated knowledge; 10. Socialisation of telehealth and optimism for the future. Within each domain, key barriers and enablers were also identified. CONCLUSIONS The findings of this study suggest that the delivery of community and outpatient physiotherapy via telehealth during the COVID-19 pandemic was an initial challenge. Growing knowledge, confidence and ability to problem solve barriers enabled physiotherapists to move along the continuum of 'fear' to 'triumph' as the pandemic progressed. These results can be used by clinicians, managers, and academics to guide future workforce planning, hospital environmental design, and service delivery. CLINICAL MESSAGE.
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Affiliation(s)
- Kimberley J. Haines
- Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia,Department of Critical Care, School of Medicine, The University of Melbourne, Victoria, Australia,Corresponding author at: Department of Physiotherapy, Western Health, Melbourne, Victoria, Australia
| | - Abbey Sawyer
- Melbourne School of Health Sciences, The University of Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Victoria, Australia
| | - Clare McKinnon
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Ashleigh Donovan
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Michael
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Chris Cimoli
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Mel Gregory
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - Sue Berney
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia
| | - David J. Berlowitz
- Department of Physiotherapy, Division of Allied Health, Austin Health, Melbourne, Victoria, Australia,Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia,Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Lohiniva AL, Hussein I, Lehtinen JM, Sivelä J, Hyökki S, Nohynek H, Nuorti P, Lyytikäinen O. Qualitative Insights into Vaccine Uptake of Nursing Staff in Long-Term Care Facilities in Finland. Vaccines (Basel) 2023; 11:530. [PMID: 36992113 PMCID: PMC10056830 DOI: 10.3390/vaccines11030530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
Vaccine hesitancy and refusal have undermined COVID-19 vaccination efforts of nursing staff. This study aimed to identify behavioral factors associated with COVID-19 vaccine uptake among unvaccinated nursing staff in long-term care facilities (LTCF) in Finland. Methodology: The study was based on the Theoretical Domains Framework. Data were collected through qualitative in-depth interviews among nursing staff and managers of LTCFs. The analysis was based on thematic analysis. We identified seven behavioral domains, with several themes, that reduced the staff's intention to get vaccinated: knowledge (information overload, inability to identify trustworthy information sources, lack of vaccine-specific and understandable scientific information), beliefs about consequences (incorrect perceptions about the vaccine effectiveness, and lack of trust in the safety of the vaccine), social influences (influence of family and friends), reinforcement (limited abilities of the management to encourage vaccination), beliefs about capabilities (pregnancy or desire to get pregnant), psychological factors (coping with changing opinion), and emotions (confusion, suspicion, disappointment, and fatigue). We also identified three behavioral domains that encouraged vaccine uptake: social influences (trust in health authorities), environmental context and resources (vaccination logistics), and work and professional role (professional pride). The study findings can help authorities to develop tailored vaccine promotion strategies for healthcare workers in LTCFs.
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Affiliation(s)
- Anna-Leena Lohiniva
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Idil Hussein
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Jaana-Marija Lehtinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Jonas Sivelä
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Suvi Hyökki
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Hanna Nohynek
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
| | - Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Kalevankatu 4, 33520 Tampere, Finland
| | - Outi Lyytikäinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270 Helsinki, Finland
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To D, De Carvalho D, Pike A, Lawrence R, Etchegary H, Patey AM, Toomey E, Hall A. A qualitative study exploring perceived barriers and enablers to fidelity of training and delivery for an intervention to reduce non-indicated imaging for low back pain. Chiropr Man Therap 2023; 31:6. [PMID: 36721165 PMCID: PMC9890790 DOI: 10.1186/s12998-023-00480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Non-specific low back pain (LBP) commonly presents to primary care, where inappropriate use of imaging remains common despite guideline recommendations against its routine use. Little is known about strategies to enhance intervention fidelity (i.e., whether interventions were implemented as intended) for interventions developed to reduce non-indicated imaging for LBP. OBJECTIVES We aim to inform the development of an intervention to reduce non-indicated imaging among general practitioners (GPs) and chiropractors in Newfoundland and Labrador (NL), Canada. The study objectives are: [1] To explore perceived barriers and enablers to enhancing fidelity of training of GPs and chiropractors to deliver a proposed intervention to reduce non-indicated imaging for LBP and [2] To explore perceived barriers and enablers to enhancing fidelity of delivery of the proposed intervention. METHODS An exploratory, qualitative study was conducted with GPs and chiropractors in NL. The interview guide was informed by the National Institutes of Health Behavior Change Consortium fidelity checklist; data analysis was guided by the Theoretical Domains Framework (TDF). Participant quotes were coded into TDF domains, belief statements were generated at each domain, and domains relevant to enhancing fidelity of provider training or intervention delivery were identified. RESULTS The study included five GPs and five chiropractors from urban and rural settings. Barriers and enablers to enhancing fidelity to provider training related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Reinforcement, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Emotion, and [7] Behavioural regulation. Barriers and enablers to enhancing fidelity to intervention delivery related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Goals, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Social influences, and [7] Behavioural regulation. CONCLUSION The largest perceived barrier to attending training was time; perceived enablers were incentives and flexible training. Patient pressure, time, and established habits were perceived barriers to delivering the intervention as intended. Participants suggested enhancement strategies to improve their ability to deliver the intervention as intended, including reminders and check-ins with researchers. Most participants perceived intervention fidelity as important. These results may aid in the development of a more feasible and pragmatic intervention to reduce non-indicated imaging for GPs and chiropractors in NL.
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Affiliation(s)
- Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, NL, A1B 3V6, Canada.
| | - Diana De Carvalho
- grid.25055.370000 0000 9130 6822Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL A1B 3V6 Canada
| | - Andrea Pike
- grid.25055.370000 0000 9130 6822Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL Canada
| | - Rebecca Lawrence
- grid.25055.370000 0000 9130 6822Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL Canada
| | - Holly Etchegary
- grid.25055.370000 0000 9130 6822Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL A1B 3V6 Canada
| | - Andrea M. Patey
- grid.412687.e0000 0000 9606 5108Centre for Implementation Research, Ottawa Hospital Research Institute – General Campus, Ottawa, ON Canada
| | - Elaine Toomey
- grid.10049.3c0000 0004 1936 9692School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Amanda Hall
- grid.25055.370000 0000 9130 6822Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL Canada
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Bar L, Marks D, Brandis S. Developing a Suite of Resources to Improve Patient Adherence to Compression Stockings: Application of Behavior Change Theory. Patient Prefer Adherence 2023; 17:51-66. [PMID: 36636284 PMCID: PMC9831124 DOI: 10.2147/ppa.s390123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings. METHODS Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts. RESULTS Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie's Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers. CONCLUSION Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians. PRACTICE IMPLICATIONS These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.
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Affiliation(s)
- Laila Bar
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
- Department of Occupational Therapy, Gold Coast University Hospital, Southport, Queensland, Australia
- Correspondence: Laila Bar, Department of Occupational Therapy, Level 4, Bond Institute of Health and Sport, 2 Promethean Way, Robina, Queensland, 4226, Australia, Tel +61 413 855 090, Email
| | - Darryn Marks
- Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
| | - Susan Brandis
- Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia
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Tan E, Haskell L, Beck S, MacLean A, Rogan A, Than M, Venning B, White C, Yates K, McKinlay CJD, Dalziel SR. Use of the Theoretical Domains Framework to explore factors influencing paediatric fever management practices and antipyretic use in New Zealand emergency departments. J Paediatr Child Health 2022; 58:1847-1854. [PMID: 35869746 PMCID: PMC9796887 DOI: 10.1111/jpc.16127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Abstract
AIM To explore factors influencing fever management practices and antipyretic use among New Zealand Emergency Department (ED) doctors and nurses using the Theoretical Domains Framework (TDF). METHODS Cross-sectional survey of doctors and nurses across 11 New Zealand EDs. The questionnaire examined eight of 12 TDF domains, based on a generic questionnaire validated to assess TDF-based determinants of health-care professional behaviour. Relevant domains were identified by the frequency of beliefs; the presence of conflicting beliefs within a domain; and the likely strength of impact of a belief on paediatric fever management in the ED. RESULTS About 602 participants (243 doctors, 353 nurses and 6 unknown) completed the survey (response rate 47.5%). Over half (351/591, 59.6%, 95% confidence interval (CI) 55.5-63.5%) knew the content of clinical practice guidelines regarding antipyretic use in febrile children (TDF Domain Knowledge), or had been trained to ensure antipyretics are given to febrile children only if they appear distressed (347/592, 58.6%, 95% CI 54.5-62.6%) (Skills). Over 40% (246/590, 95% CI 37.7-45.8%) aim to reduce the fever before discharge (Goals). Most (444/591, 75.1%, 95% CI 71.4-78.6%) participants felt capable of explaining appropriate antipyretic use to parents/care givers (Beliefs about Capabilities). Only a minority (155/584, 26.5%, 95% CI 23.0-30.3%) thought that they can ensure antipyretics are given to febrile children only if they appear distressed when the ED is busy (Environmental Context and Resources). CONCLUSIONS Using the TDF, we identified factors influencing fever management practices and antipyretic use in the ED. These factors can guide the design of targeted, theory-informed knowledge translation strategies.
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Affiliation(s)
- Eunicia Tan
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Emergency DepartmentMiddlemore HospitalAucklandNew Zealand
| | - Libby Haskell
- Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Sierra Beck
- Emergency DepartmentDunedin HospitalDunedinNew Zealand,Department of MedicineUniversity of OtagoDunedinNew Zealand
| | | | - Alice Rogan
- Emergency DepartmentWellington Regional HospitalWellingtonNew Zealand,Department of Surgery and AnaesthesiaUniversity of OtagoWellingtonNew Zealand
| | - Martin Than
- Emergency DepartmentChristchurch HospitalChristchurchNew Zealand
| | - Bridget Venning
- Emergency DepartmentMiddlemore HospitalAucklandNew Zealand,School of Nursing, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | | | - Kim Yates
- Emergency DepartmentsNorth Shore and Waitakere HospitalsAucklandNew Zealand,Centre for Medical and Health Science Education, Faculty of Medical & Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Christopher JD McKinlay
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Kidz First Neonatal CareCounties Manukau HealthAucklandNew Zealand
| | - Stuart R Dalziel
- Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Children's Emergency DepartmentStarship Children's HospitalAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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Kwak L, Toropova A, Powell BJ, Lengnick-Hall R, Jensen I, Bergström G, Elinder LS, Stigmar K, Wåhlin C, Björklund C. A randomized controlled trial in schools aimed at exploring mechanisms of change of a multifaceted implementation strategy for promoting mental health at the workplace. Implement Sci 2022; 17:59. [PMID: 36050743 PMCID: PMC9438275 DOI: 10.1186/s13012-022-01230-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study will explore implementation mechanisms through which a single implementation strategy and a multifaceted implementation strategy operate to affect the implementation outcome, which is fidelity to the Guideline For The Prevention of Mental Ill Health within schools. The guideline gives recommendations on how workplaces can prevent mental ill health among their personnel by managing social and organizational risks factors in the work environment. Schools are chosen as the setting for the study due to the high prevalence of mental ill health among teachers and other personnel working in schools. The study builds on our previous research, in which we compared the effectiveness of the two strategies on fidelity to the guideline. Small improvements in guideline adherence were observed for the majority of the indicators in the multifaceted strategy group. This study will focus on exploring the underlying mechanisms of change through which the implementation strategies may operate to affect the implementation outcome. Methods We will conduct a cluster-randomized-controlled trial among public schools (n=55 schools) in Sweden. Schools are randomized (1:1 ratio) to receive a multifaceted strategy (implementation teams, educational meeting, ongoing training, Plan-Do-Study-Act cycles) or a single strategy (implementation teams, educational meeting). The implementation outcome is fidelity to the guideline. Hypothesized mediators originate from the COM-B model. A mixed-method design will be employed, entailing a qualitative study of implementation process embedded within the cluster-randomized controlled trail examining implementation mechanisms. The methods will be used in a complementary manner to get a full understanding of the implementation mechanisms. Discussion This implementation study will provide valuable knowledge on how implementation strategies work (or fail) to affect implementation outcomes. The knowledge gained will aid the selection of effective implementation strategies that fit specific determinants, which is a priority for the field. Despite recent initiatives to advance the understanding of implementation mechanisms, studies testing these mechanisms are still uncommon. Trial registration ClinicalTrials.org dr.nr 2020-01214. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01230-7.
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Affiliation(s)
- Lydia Kwak
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Toropova
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rebecca Lengnick-Hall
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm, Stockholm Region, Sweden
| | | | - Charlotte Wåhlin
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Christina Björklund
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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MacLennan S, Duncan E, Skolarus TA, Roobol MJ, Kasivisvanathan V, Gallagher K, Gandaglia G, Sakalis V, Smith EJ, Plass K, Ribal MJ, N'Dow J, Briganti A. Improving Guideline Adherence in Urology. Eur Urol Focus 2022; 8:1545-1552. [PMID: 34702647 DOI: 10.1016/j.euf.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023]
Abstract
CONTEXT Clinical practice guidelines (CPGs) distil an evidence base into recommendations. CPG adherence is associated with better patient outcomes. However, preparation and dissemination of CPGs are a costly task involving multiple skilled personnel. Furthermore, dissemination alone does not ensure CPG adherence. Reasons for nonadherence are often complex, but understanding practice variations and reasons for nonadherence is key to improving CPG adherence and harmonising clinically appropriate and cost-effective care. OBJECTIVE To overview approaches to improving guideline adherence, to provide urology-specific examples of knowledge-practice gaps, and to highlight potential solutions informed by implementation science. EVIDENCE ACQUISITION Three common approaches to implementation science (the Knowledge-To-Action framework, the Consolidated Framework for Implementation Research, and the Behaviour Change Wheel), are summarised. EVIDENCE SYNTHESIS Three implementation problems in urology are illustrated: underuse of single instillation of intravesical chemotherapy in non-muscle-invasive bladder cancer, overuse of androgen deprivation therapy in localised prostate cancer, and guideline-discordant imaging in prostate cancer. Research using implementation science approaches to address these implementation problems is discussed. CONCLUSIONS Urologists, patients, health care providers, funders, and other key stakeholders must commit to reliably capturing and reporting data on patient outcomes, practice variations, guideline adherence, and the impact of adherence on outcomes. Leverage of implementation science frameworks is a sound next step towards improving guideline adherence and the associated benefits of evidence-based care. PATIENT SUMMARY Clinical practice guideline documents are created by expert panels. These documents provide overviews of the evidence for the tests and treatments used in patient care. They also provide recommendations and it is expected that in most circumstances clinicians will follow these recommendations. Sometimes, health care professionals cannot or do not follow these recommendations and it is not always clear why. In this review article we look at some examples of research approaches to addressing this problem of nonadherence and we provide some examples specific to urology.
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Affiliation(s)
- Steven MacLennan
- Academic Urology Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK; European Association of Urology Guidelines Office and Methodology Committee, Arnhem, The Netherlands.
| | - Eilidh Duncan
- Health Services Research Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA; Veterans Affairs Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Veeru Kasivisvanathan
- Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Kevin Gallagher
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Giorgio Gandaglia
- Department of Urology, University Vita e Salute-San Raffaele, Milan, Italy
| | - Vasileios Sakalis
- Department of Urology, General Hospital Agios Pavlos, Thessaloniki, Greece
| | - Emma Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands; Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - James N'Dow
- Academic Urology Unit, Institute of Applied Health Sciences, The University of Aberdeen, Aberdeen, UK; European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Alberto Briganti
- Department of Urology, University Vita e Salute-San Raffaele, Milan, Italy; European Association of Urology Guidelines Office, Arnhem, The Netherlands
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Crawshaw J, Konnyu K, Castillo G, van Allen Z, Grimshaw JM, Presseau J. Behavioural determinants of COVID-19 vaccination acceptance among healthcare workers: a rapid review. Public Health 2022; 210:123-133. [PMID: 35985082 PMCID: PMC9192793 DOI: 10.1016/j.puhe.2022.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Vaccinating healthcare workers (HCWs) against COVID-19 has been a public health priority since rollout began in late 2020. Promoting COVID-19 vaccination among HCWs would benefit from identifying modifiable behavioural determinants. We sought to identify and categorize studies looking at COVID-19 vaccination acceptance to identify modifiable factors to increase uptake in HCWs. STUDY DESIGN Rapid evidence review. METHODS We searched MEDLINE and Cochrane databases until May 2021 and conducted a grey literature search to identify cross-sectional, cohort, and qualitative studies. Key barriers to, and enablers of, vaccine acceptance were categorized using the Theoretical Domains Framework (TDF), a comprehensive theoretical framework comprising 14 behavioural domains. RESULTS From 19,591 records, 74 studies were included. Almost two-thirds of responding HCWs were willing to accept a COVID-19 vaccine (median = 64%, interquartile range = 50-78%). Twenty key barriers and enablers were identified and categorized into eight TDF domains. The most frequently identified barriers to COVID-19 vaccination were as follows: concerns about vaccine safety, efficacy, and speed of development (TDF domain: Beliefs about consequences); individuals in certain HCW roles (Social/professional role and identity); and mistrust in state/public health response to COVID-19 (Social influences). Routinely being vaccinated for seasonal influenza (Reinforcement), concerns about contracting COVID-19 (Beliefs about consequences) and working directly with COVID-19 patients (Social/professional role and identity) were key enablers of COVID-19 vaccination among HCWs. DISCUSSION Our review identified eight (of a possible 14) behavioural determinants of COVID-19 vaccine acceptance among HCWs that, if targeted, could help design tailored vaccination messaging, policy, campaigns, and programs to support HCWs vaccination uptake.
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Affiliation(s)
- J Crawshaw
- Centre for Evidence-Based Implementation, Hamilton Health Sciences, ON, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, ON, Canada
| | - K Konnyu
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, RI, USA
| | - G Castillo
- Centre for Implementation Research, Ottawa Hospital Research Institute, ON, Canada
| | - Z van Allen
- Centre for Implementation Research, Ottawa Hospital Research Institute, ON, Canada
| | - J M Grimshaw
- Centre for Implementation Research, Ottawa Hospital Research Institute, ON, Canada; Department of Medicine, University of Ottawa, ON, Canada
| | - J Presseau
- Centre for Implementation Research, Ottawa Hospital Research Institute, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, ON, Canada.
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Bondaronek P, Dicken SJ, Singh Jennings S, Mallion V, Stefanidou C. Barriers to and Facilitators of the Use of Digital Tools in Primary Care to Deliver Physical Activity Advice: Semistructured Interviews and Thematic Analysis. JMIR Hum Factors 2022; 9:e35070. [PMID: 36040764 PMCID: PMC9472053 DOI: 10.2196/35070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/11/2022] [Accepted: 04/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes, and cancer; therefore, increasing physical activity (PA) is a public health priority. Health care professionals (HCPs) in primary care are pivotal in addressing physical inactivity; however, few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including lack of time, confidence, or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital tools are used to deliver PA advice in primary care consultations and what factors influence their use. Objective We aimed to understand the use of digital tools to support primary care consultations and to identify the barriers to and facilitators of using these systems. Methods Overall, 25 semistructured interviews were conducted with primary care HCPs. Professionals were sampled based on profession (general practitioners, practice nurses, and health care assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. The data were analyzed thematically to identify the influences on the use of digital tools. Themes were categorized using the COM-B (capability, opportunity, and motivation—behavior) model and the Theoretical Domains Framework to identify the barriers to and facilitators of using digital tools to support the delivery of PA advice in primary care consultations. Results The identified themes fell within 8 domains of the Theoretical Domains Framework. The most prominent influence (barrier or facilitator) within psychological capability was having the skills to use digital tools. Training in the use of digital tools was also mentioned several times. The most notable influences within physical opportunity were limited digital tools to prompt/support the provision of PA advice, time constraints, efficiency of digital tools, simplicity and ease of use of digital tools, and integration with existing systems. Other physical opportunity influences included lack of access to digital tools and technical support in the use of digital tools. Within social opportunity, a notable barrier was that digital tools reduce interpersonal communication with patients. Patient preference was also identified. Several important influences were within reflective motivation, including confidence to use digital tools, beliefs about the usefulness of digital tools, the belief that digital tools “are the way forward,” beliefs related to data privacy and security concerns, and perceptions about patient capabilities. About automatic motivation, influences included familiarity and availability regarding digital tools and the fact that digital tools prompt behavior. Conclusions A variety of influences were identified on the use of digital tools to support primary care consultations. These findings provide a foundation for designing a digital tool addressing barriers and leverages the facilitators to support PA advice provision within primary care to elicit patient behavior change and increase PA.
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Affiliation(s)
- Paulina Bondaronek
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom.,Institute of Health Informatics, University College London, London, United Kingdom
| | - Samuel J Dicken
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom.,Centre for Obesity Research, University College London, London, United Kingdom
| | - Seth Singh Jennings
- Research, Translation & Innovation, Public Health England, London, United Kingdom
| | - Verity Mallion
- Research, Translation & Innovation, Public Health England, London, United Kingdom
| | - Chryssa Stefanidou
- Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom.,Research, Translation & Innovation, Public Health England, London, United Kingdom
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Wittek M, Voß H, Kiefer A, Wiloth S, Schmitt E. Community support for caring relatives of people with dementia: qualitative analysis using the Theoretical Domains Framework. Z Gesundh Wiss 2022; 31:1-11. [PMID: 35975189 PMCID: PMC9371957 DOI: 10.1007/s10389-022-01744-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
Aim Although caring relatives of people with dementia are a mainstay of many care systems, the availability of support services for them within the municipal community shows deficiencies. Adopting the Theoretical Domains Framework (TDF) this study aims to investigate 1) which of the TDF domains adapted to gerontology show up in public dialogue, and 2) the results that public dialogues produce in terms of support services for caring relatives. Subject and methods The data consists of town hall meetings and focus groups from 14 municipal communities in Germany. Participants were caring relatives and stakeholders of the communities. A qualitative content analysis was conducted, focusing on the assessment of three TDF domains, namely knowledge, goals, and sociopolitical context as well as outcomes of care optimisation. Results With regard to domain knowledge, it was evident that in every community there were actors aware of the situation and relevance of carers and their relatives. Only some actors mentioned goals for optimising the care of the target group. The sociopolitical context is often addressed through statements about incomplete requirements. Conclusion Overall, a relation between the discussion about the domains in public dialogues and changes in supporting carers of people with dementia can be assumed. The results indicate that an increased discussion about the domains within town hall meetings influences the actors and their statements with regard to the improvement of support services for caring relatives of people with dementia. Since the domains were not developed exclusively for the outlined context, this approach can also be applied to other areas of care. Supplementary information The online version contains supplementary material available at 10.1007/s10389-022-01744-w.
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Affiliation(s)
- Maren Wittek
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Henrike Voß
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Anna Kiefer
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Stefanie Wiloth
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
| | - Eric Schmitt
- Institute of Gerontology, Ruprecht-Karls-University of Heidelberg, Bergheimer Straße 20, 69115 Heidelberg, Germany
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Chater AM, Hannah Family, Abraao LM, Burnett E, Castro-Sanchez E, Du Toit B, Gallagher R, Gotterson F, Manias E, Mcewen J, Moralez de Figueiredo R, Nathan M, Ness V, Olans R, Padoveze MC, Courtenay M. Influences on nurses' engagement in antimicrobial stewardship behaviours: A multi-country survey using the Theoretical Domains Framework. J Hosp Infect 2022; 129:171-180. [PMID: 35843415 DOI: 10.1016/j.jhin.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/20/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is significantly affected by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible antimicrobial use, and is essential for limiting AMR. Nurses have an important role to play in this context. AIM This study investigated the determinants of nurse AMS behaviours and the impact of past training. METHOD A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses (223 female; mean age = 44.45; SD = 10.77 years) from ten nationalities, with individual survey links sent via professional networks in 5 countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were quantitatively assessed using the Theoretical Domains Framework (TDF), and mapped to the COM-B (Capability, Opportunity, Motivation - Behaviour) model. Analysis identified differences between nurses with and without AMS training. The influence of COVID-19 on AMS behaviour was qualitatively investigated using free text data. FINDINGS Nurses performed all nine AMS behaviours, which were significantly higher (t(238) = -4.14, p < .001), by those who had training (M = 53.15; SD = 7.40) compared to those who had not (M = 48.30; SD = 10.75). Those with AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with 'Skills' and 'Behavioural Regulation' (e.g. ability to self-monitor and plan), shown to be the most predictive of AMS actions. Both of these domains are situated in the Capability construct of COM-B, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since COVID-19, regardless of previous training. Six core themes were linked to AMS: 1) Infection prevention and control, 2) Antimicrobials and antimicrobial resistance, 3) The diagnosis of infection and the use of antibiotics, 4) Antimicrobial prescribing practice, 5) Person-centred care, and 6) Interprofessional collaborative practice. CONCLUSION This research, has identified the significant benefit of nurse training on AMS behaviour, and its determinants. Those who had training, scored higher in all TDF determinants of behaviour, compared to those who had had no training, resulting in higher Capability, Opportunity and Motivation to perform AMS behaviours. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimise AMS behaviour, with a focus on developing skills and behavioural regulation.
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Affiliation(s)
- Angel Marie Chater
- Centre for Health, Wellbeing and Behaviour Change, University of Bedfordshire, Bedford, UK; Centre for Behaviour Change, University College London, UK.
| | - Hannah Family
- Bristol Medical School, Bristol University, Bristol, UK.
| | - Ligia Maria Abraao
- Americas Medical Serviçes, United Health Group, Sao Paulo State, Brazil.
| | - Emma Burnett
- Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.
| | | | - Briëtte Du Toit
- Infection Control Africa Network, Cape Town, Western Cape, South Africa.
| | | | - Fiona Gotterson
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, Dept of Medicine, The University of Melbourne, Melbourne, Australia.
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Melbourne, Australia.
| | | | - Rosely Moralez de Figueiredo
- Departamento de Enfermagem, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos - UFSCar.
| | - Martina Nathan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
| | - Val Ness
- Department of Nursing & Community Health/ School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK.
| | - Rita Olans
- School of Nursing, MGH Institute of Health Professions, Boston, USA;.
| | | | - Molly Courtenay
- School of Healthcare Sciences, Cardiff University, Cardiff, UK.
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Hughes CM. One size fits all? How to optimize the prescribing of appropriate polypharmacy in chronic diseases, using a behavioral approach - a United Kingdom perspective. Expert Rev Clin Pharmacol 2022; 15:497-499. [PMID: 35762041 DOI: 10.1080/17512433.2022.2094767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Carmel M Hughes
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland
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To D, Hall A, Bussières A, French SD, Lawrence R, Pike A, Patey AM, Brake-Patten D, O'Keefe L, Elliott B, De Carvalho D. Exploring factors influencing chiropractors' adherence to radiographic guidelines for low back pain using the Theoretical Domains Framework. Chiropr Man Therap 2022; 30:23. [PMID: 35534902 PMCID: PMC9082849 DOI: 10.1186/s12998-022-00433-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada. Methods We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors’ statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours. Results Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on “gut feeling” (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients’ previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation). Conclusion We identified potential influences, in six theoretical domains, on participating chiropractors’ LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL. Supplementary Information The online version contains supplementary material available at 10.1186/s12998-022-00433-5.
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Affiliation(s)
- Daphne To
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada
| | - Amanda Hall
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Simon D French
- Department of Chiropractic, Macquarie University, Sydney, NSW, Australia
| | - Rebecca Lawrence
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea Pike
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Andrea M Patey
- Centre for Implementation Research, Ottawa Hospital Research Institute - General Campus, Ottawa, ON, Canada
| | | | | | - Barbara Elliott
- Patient Engagement Partner, North Bay, ON, Canada.,Faculty of Education and Professional Studies - School of Nursing, Nipissing University, North Bay, ON, Canada
| | - Diana De Carvalho
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, A1B 3V6, Canada.
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Judah G, Dilib F, Darzi A, Huf S. A population survey on beliefs around cervical cancer screening: determining the barriers and facilitators associated with attendance. BMC Cancer 2022; 22:522. [PMID: 35534802 PMCID: PMC9082843 DOI: 10.1186/s12885-022-09529-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background Cervical screening saves approximately 5000 lives annually in England. However, screening rates have been falling continuously, and coverage in London is particularly low (64.7%). While demographic predictors of uptake have been well researched, there has been less thorough investigation of the individual barriers and facilitators which predict cervical screening attendance. Understanding modifiable factors influencing attendance can guide the design of effective interventions to increase cervical screening uptake. The aim of this study was to understand the demographic, and individual factors associated with self-reported attendance at cervical screening in London. Methods The study used an online survey of 500 women in London (June-July 2017). The survey included self-reported measures of past attendance, demographic variables (including age, household income, ethnicity), past experience variables, and individual variables (list of potential barriers and facilitators developed based on the Theoretical Domains Framework and existing literature, which included: environmental context and resources, perceived risk, anticipated pain/embarrassment). Participants were categorised into regular attenders and non-regular attenders. Backwards stepwise logistic regression investigated the barriers and facilitators predicting past attendance. Demographic variables with significant differences between regular and non-regular attenders were added to the final regression model. Results Of women who had previously been invited (n = 461, age range: 25–65), 34.5% (n = 159) were classified as non-regular attenders, and 65.5% (n = 302) as regular attenders. The individual barriers and facilitators predicting attendance were: cervical screening priority, memory, environmental context and resources, and intention. The only demographic variables related to regular attendance were relationship status (married/civil partnership having higher rates than single) and higher household income. Relationship status was not significant when adjusting for barriers and facilitators. Those who have ever been sexually active or who have had an STI in the past were significantly more likely to be regular attenders. Conclusions The study shows the importance of individual barriers and facilitators in predicting self-reported cervical screening attendance. Household income was the only significant demographic variable when combined with the individual variables. Interventions targeting priority, memory, and practical barriers affecting environmental context may be expected to be effective an increasing attendance. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09529-w.
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Affiliation(s)
- Gaby Judah
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK.
| | - Faisal Dilib
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
| | - Sarah Huf
- Department of Surgery and Cancer, Imperial College London, St Mary's Campus, Praed Street, London, W2 1NY, UK
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Leather JZ, Keyworth C, Epton T, Goldthorpe J, Ulph F, Armitage CJ. "We want to live a little longer and our family want[s] us around": A summative content analysis of adherence to COVID-19-related guidelines using the Theoretical Domains Framework. Br J Health Psychol 2022; 27:1119-1152. [PMID: 35319141 PMCID: PMC9111475 DOI: 10.1111/bjhp.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Public adherence to COVID‐19‐related government guidance varied during the initial lockdown in the UK, but the determinants of public adherence to such guidance are unclear. We capture spontaneous reflections on adherence to UK government guidance from a representative UK sample, and use the TDF to identify key determinants of COVID‐related behaviours. Design The design was cross‐sectional. Methods Qualitative data were collected from a large sample of UK adults (N = 2,252) via an online questionnaire as part of a wider survey about the UK public’s responses to the government’s COVID‐19‐related guidance. Summative content analysis was used to identify key guideline terms in the data, followed by latent analysis to interpret the underlying meanings behind the terms using the TDF as an analytical framework. Results Six TDF domains were identified in the data: Environmental Context and Resources; Beliefs about Consequences; Social Influences; Memory, Attention and Decision Processes; Emotion; and Knowledge. Although the samples were motivated and capable of adhering, limitations in their environments, resources, and social support mechanisms restricted behaviour. Self‐reported adherence was sensitive to positive and negative beliefs about the effectiveness of the measures, in addition to interpretations of the terms ‘essential’ and ‘necessary’ in the guidance. Conclusions Despite extensive structural obstacles to adherence, the majority of the British public were able to follow government COVID‐19‐related instructions, provided they had sufficient resources, social support, and positive perceptions about the effectiveness of the measures. Ambiguities surrounding key terminology in the guidance left room for interpretation, which may have contributed to non‐adherence.
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Affiliation(s)
- Jessica Z Leather
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Tracy Epton
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Joanna Goldthorpe
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Fiona Ulph
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK
| | - Christopher J Armitage
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester Academic Health Science Centre, UK.,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Gullick J, Wu J, Chew D, Gale C, Yan AT, Goodman SG, Waters D, Hyun K, Brieger D. Objective risk assessment vs standard care for acute coronary syndromes-The Australian GRACE Risk tool Implementation Study (AGRIS): a process evaluation. BMC Health Serv Res 2022; 22:380. [PMID: 35317816 PMCID: PMC8941820 DOI: 10.1186/s12913-022-07750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Structured risk-stratification to guide clinician assessment and engagement with evidence-based therapies may reduce care variance and improve patient outcomes for Acute Coronary Syndrome (ACS). The Australian Grace Risk score Intervention Study (AGRIS) explored the impact of the GRACE Risk Tool for stratification of ischaemic and bleeding risk in ACS. While hospitals in the active arm had a higher overall rate of invasive ACS management, there was neutral impact on important secondary prevention prescriptions/referrals, hospital performance measures, myocardial infarction and 12-month mortality leading to early trial cessation. Given the Grace Risk Tool is under investigation internationally, this process evaluation study provides important insights into the possible contribution of implementation fidelity on the AGRIS study findings. Methods Using maximum variation sampling, five hospitals were selected from the 12 centres enrolled in the active arm of AGRIS. From these facilities, 16 local implementation stakeholders (Cardiology advanced practice nurses, junior and senior doctors, study coordinators) consented to a semi-structured interview guided by the Theoretical Domains Framework. Directed Content Analysis of qualitative data was structured using the Capability/Opportunity/Motivation-Behaviour (COM-B) model. Results Physical capability was enhanced by tool usability. While local stakeholders supported educating frontline clinicians, non-cardiology clinicians struggled with specialist terminology. Physical opportunity was enhanced by the paper-based format but was hampered when busy clinicians viewed risk-stratification as one more thing to do, or when form visibility was neglected. Social opportunity was supported by a culture of research/evidence yet challenged by clinical workflow and rotating medical officers. Automatic motivation was strengthened by positive reinforcement. Reflective motivation revealed the GRACE Risk Tool as supporting but potentially overriding clinical judgment. Divergent professional roles and identity were a major barrier to integration of risk-stratification into routine Emergency Department practice. The cumulative result revealed poor form completion behaviors and a failure to embed risk-stratification into routine patient assessment, communication, documentation, and clinical practice behaviors. Conclusions Numerous factors negatively influenced AGRIS implementation fidelity. Given the prominence of risk assessment recommendations in United States, European and Australian guidelines, strategies that strengthen collaboration with Emergency Departments and integrate automated processes for risk-stratification may improve future translation internationally.
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Affiliation(s)
- Janice Gullick
- Susan Wakil School of Nursing & Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - John Wu
- Susan Wakil School of Nursing & Midwifery, and Site Services, University of Sydney Library, University of Sydney, Sydney, NSW, Australia
| | - Derek Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Chris Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, England
| | - Andrew T Yan
- Department of Medicine, University of Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Shaun G Goodman
- Canadian VIGOUR Centre, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Donna Waters
- Susan Wakil School of Nursing & Midwifery, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, ANZAC Research Institute, Concord West, Australia
| | - David Brieger
- Concord Clinical School, Concord Repatriation General Hospital, ANZAC Research Institute, Concord West, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, +61 2 9767 5000, Australia
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Gibson R, Oliver N, McGowan B, Vetter C, Palla L, D'Annibale M, Linley J, Lorencatto F, Guess N. Towards targeted dietary support for shift workers with type 2 diabetes (Shift-Diabetes study): A mixed-methods case study protocol. Diabet Med 2022; 39:e14714. [PMID: 34611942 DOI: 10.1111/dme.14714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Blood glucose is higher in people working night shifts compared to day workers. Changes to eating behaviour, activity and sleep patterns in addition to circadian disruption are likely to impact glucose management in night-shift workers with type 2 diabetes. AIM To investigate current dietary intake and glucose variability during night work, including barriers and facilitators to dietary behaviour in this context. METHODS A mixed-methods case study will be conducted. Shift workers with type 2 diabetes working in a hospital setting will be recruited to this two-part study. Part 1: 70 participants will complete a 10-day observational study collecting data on continuous glucose, diet (self-report diary), sleep and physical activity during a period covering night work, rest days and non-night workdays. Mean glucose concentration and variability, and the mean healthy diet index score, will be compared between days of night work, non-night work and rest, after adjusting for other individual factors (sleep/physical activity/demographics). Part 2: A sample (n~13) will complete semi-structured interviews based on behavioural science frameworks to explore barriers/enablers to dietary behaviour when working night shifts. This will inform a quantitative survey to explore the generalisability of interview findings. DISCUSSION Findings from Part 1 and 2 will be triangulated to identify potential intervention strategies to address key barriers and enablers to healthier eating, and in turn improved glucose control, in shift workers with type 2 diabetes. This will be facilitated through stakeholder consultation and application of behavioural science frameworks. Shift-Diabetes study registration: ISRCTN11764942.
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Affiliation(s)
- Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Nick Oliver
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Barbara McGowan
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Céline Vetter
- Circadian and Sleep Epidemiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado, USA
| | - Luigi Palla
- Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Rome, Italy
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
- Department of Global Health, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Maria D'Annibale
- Department of Nutritional Sciences, King's College London, London, UK
| | - Jayne Linley
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Nicola Guess
- Department of Nutritional Sciences, King's College London, London, UK
- Research Centre for Optimal Health, University of Westminster, London, UK
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46
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Wong E, Mavondo F, Horvat L, McKinlay L, Fisher J. Healthcare professionals' perspective on delivering personalised and holistic care: using the Theoretical Domains Framework. BMC Health Serv Res 2022; 22:281. [PMID: 35232432 PMCID: PMC8887936 DOI: 10.1186/s12913-022-07630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Interventions to improve personalised and holistic care delivery by healthcare professionals are more likely to be effective if they target the factors influencing specific behaviours. This study reports on the development and testing of a questionnaire to identify perspectives of healthcare professionals’ personalised and holistic care behaviours based on the Theoretical Domains Framework. Methods The study was conducted in public health services in Victoria, Australia. The questionnaire was developed and pilot-tested with behaviour change researchers and healthcare professionals. Doctors, nurses and midwives were recruited via notices and email invitations from Safer Care Victoria's website and mailing lists of healthcare professionals and invited to completed the questionnaire online (hosted on Qualtrics). Health services administrators and allied health professionals were excluded from the study. Confirmatory factor analysis was undertaken to generate the model of best fit and group differences were tested using univariate tests. Results One hundred and four healthcare professionals from public health services in Victoria, Australia, completed the 39-item questionnaire focusing on specific personalised and holistic care behaviours. The final model consisted of 13 factors and 39 items, and CFA produced an acceptable fit, as well as adequate levels of discriminant validity and internal consistency (α = 0.60 to 0.84). Seven domains, “social influence”, “motivation & goals”, “environmental context and resources’, “skills”, ‘beliefs about consequences”, “behaviour regulation” and “nature of behaviour” were identified. Significant differences in the factors influencing these behaviours were found in groups with different years of experience and role seniority. These findings suggest that future interventions need to be targeted to specific groups. Conclusion This study identified the specific behaviours and the factors associated with performance of personalised and holistic care among healthcare professionals. The findings suggest several interventions and policy functions may be taken to improve personalised and holistic care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07630-1.
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Affiliation(s)
- Eunice Wong
- Monash Sustainable Development Institute, BehaviourWorks Australia, Monash University, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Felix Mavondo
- Department of Marketing, Monash University, Melbourne, Australia
| | - Lidia Horvat
- Safer Care Victoria, Department of Health Victoria, Melbourne, Australia
| | - Louise McKinlay
- Safer Care Victoria, Department of Health Victoria, Melbourne, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Abboud J, Rahman AA, Shaikh N, Dempster M, Adair P. Physicians' perceptions and preferences for implementing venous thromboembolism (VTE) clinical practice guidelines: a qualitative study using the Theoretical Domains Framework (TDF). Arch Public Health 2022; 80:52. [PMID: 35168681 PMCID: PMC8845331 DOI: 10.1186/s13690-022-00820-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous thromboembolism is a primary cause of morbidity and mortality in hospitalised patients. Clinical practice guidelines were developed to prevent venous thromboembolism events. This study adopted the Theoretical Domains Framework to explore the beliefs and perceptions of physicians adoption of clinical practice guidelines for the uptake of venous thromboembolism prevention guidelines. METHODS Semi-structured interviews were conducted with a stratified purposive sample of internal medicine physicians in an acute hospital. The interview topic guide was developed using the Theoretical Domains Framework to identify the factors perceived to influence the practice. Two researchers coded the interview transcripts using thematic content analysis. Emerging relevant themes were mapped to TDF domains. RESULTS A total of sixteen medical physicians were interviewed over a six-month period. Nine theoretical domains derived from thirty-three belief statements were identified as relevant to the target behaviour; knowledge (education about the importance of VTE guidelines); beliefs about capabilities (with practice VTE tool easier to implement); beliefs about consequences (positive consequences in reducing the development of VTE, length of stay, financial burden and support physician decision) and (negative consequence risk of bleeding); reinforcement (recognition and continuous reminders); goals (patient safety goal); environmental context and resources (workload and availability of medications were barriers, VTE coordinator and electronic medical record were enablers); social influences (senior physicians and patient/family influence the VTE practice); behavioural regulation (monitoring and mandatory hospital policy); and nature of the behaviour. CONCLUSIONS Using the Theoretical Domains Framework, factors thought to influence the implementation of VTE clinical practice guidelines were identified which can be used to design theoretically based interventions by targeting specific psychological constructs and linking them to behaviour change techniques to change the clinical practice of physicians.
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Affiliation(s)
- Juliana Abboud
- Centre for Improving Health Related Quality of Life, School of Psychology, Queens University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, United Kingdom. .,Rashid Hospital, Dubai Health Authority, Umm Hurair II 315, PO Box 4545, Dubai, United Arab Emirates.
| | - Abir Abdel Rahman
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Balamand, Youssef Sursok Street, PO Box 166378, Ashrafieh, Beirut, Lebanon
| | - Niaz Shaikh
- Rashid Hospital, Dubai Health Authority, Umm Hurair II 315, PO Box 4545, Dubai, United Arab Emirates
| | - Martin Dempster
- Centre for Improving Health Related Quality of Life, School of Psychology, Queens University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, United Kingdom
| | - Pauline Adair
- Centre for Improving Health Related Quality of Life, School of Psychology, Queens University Belfast, David Keir Building, 18-30 Malone Road, BT9 5BN, Belfast, United Kingdom
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Haskell L, Tavender EJ, O'Brien S, Wilson CL, Borland ML, Cotterell E, Babl FE, Zannino D, Sheridan N, Oakley E, Dalziel SR. Can targeted interventions change the factors influencing variation in management of infants with bronchiolitis? A survey of Australian and New Zealand clinicians: A paediatric research in emergency departments international collaborative (PREDICT) study. J Paediatr Child Health 2022; 58:302-311. [PMID: 34498782 DOI: 10.1111/jpc.15710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/29/2022]
Abstract
AIM This study aimed to determine whether targeted interventions, proven to be effective at improving evidence-based bronchiolitis management, changed factors previously found to influence variation in bronchiolitis management. METHODS This survey assessed change in factors influencing clinicians' (nurses and doctors) bronchiolitis management at baseline and post-intervention in a cluster randomised controlled trial of targeted, theory-informed interventions aiming to de-implement non-evidence-based bronchiolitis management (no use of chest X-ray, salbutamol, antibiotics, glucocorticoids and adrenaline). Survey questions addressed previously identified factors influencing bronchiolitis management from six Theoretical Domains Framework domains (knowledge; skills; beliefs about consequences; social/professional role and identity; environmental context and resources; social influences). Data analysis was descriptive. RESULTS A total of 1958 surveys (baseline = 996; post-intervention = 962) were completed by clinicians from the emergency department and paediatric inpatient units from 26 hospitals (intervention = 13; control = 13). Targeted bronchiolitis interventions significantly increased knowledge of the Australasian Bronchiolitis Guideline (intervention clinicians = 74%, control = 39%, difference = 34.7%, 95% confidence interval (CI) = 25.6-43.8%), improved skills in diagnosing (intervention doctors = 89%, control = 76%, difference = 12.6%, 95% CI = 6.2-19%) and managing bronchiolitis (intervention doctors = 87%, control = 76%, difference = 9.9%, 95% CI = 3.7-16.1%), positively influenced both beliefs about consequences regarding salbutamol use (intervention clinicians = 49%, control = 29%, difference = 20.3%, 95% CI = 13.2-27.4%) and nurses questioning non-evidence-based bronchiolitis management (chest X-ray: intervention = 71%, control = 51%, difference = 20.8%, 95% CI = 11.4-30.2%; glucocorticoids: intervention = 64%, control = 40%, difference = 21.9%, 95% CI = 10.4-33.5%) (social/professional role and identity). A 14% improvement in evidence-based bronchiolitis management favouring intervention hospitals was demonstrated in the cluster randomised controlled trial. CONCLUSION Targeted interventions positively changed factors influencing bronchiolitis management resulting in improved evidence-based bronchiolitis care. This study has important implications for improving bronchiolitis management and future development of interventions to de-implement low-value care.
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Affiliation(s)
- Libby Haskell
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Emma J Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Sharon O'Brien
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Nursing, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Catherine L Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Cotterell
- Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.,School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Franz E Babl
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Diana Zannino
- Clinical Epidemiology and Biostatistics, Melbourne Children's Trials Centre, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Ed Oakley
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics and Critical Care, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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49
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Haig Y, Feiring E. Stakeholder views of the development of a clinical quality registry for interventional radiology: a qualitative study. BMC Health Serv Res 2022; 22:44. [PMID: 34998395 PMCID: PMC8742914 DOI: 10.1186/s12913-021-07423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Clinical quality registries (CQRs) can likely improve quality in healthcare and research. However, studies indicate that effective use of CQRs is hindered by lack of engagement and interest among stakeholders, as well as factors related to organisational context, registry design and data quality. To fulfil the potential of CQRs, more knowledge on stakeholders’ perceptions of the factors that will facilitate or hamper the development of CQRs is essential to the more appropriate targeting of registry implementation and the subsequent use of the data. The primary aim of this study was to examine factors that can potentially affect the development of a national CQR for interventional radiology in Norway from the perspective of stakeholders. Furthermore, we wanted to identify the intervention functions likely to enable CQR development. Only one such registry, located in Sweden, has been established. To provide a broader context for the Norwegian study, we also sought to investigate experiences with the development of this registry. Methods A qualitative study of ten Norwegian radiologists and radiographers using focus groups was conducted, and an in-depth interview with the initiator of the Swedish registry was carried out. Questions were based on the Capability, Opportunity and Motivation for Behaviour Model and the Theoretical Domains Framework. The participants’ responses were categorised into predefined themes using a deductive process of thematic analysis. Results Knowledge of the rationale used in establishing a CQR, beliefs about the beneficial consequences of a registry for quality improvement and research and an opportunity to learn from a well-developed registry were perceived by the participants as factors facilitating CQR development. The study further identified a range of development barriers related to environmental and resource factors (e.g., a lack of organisational support, time) and individuallevel factors (e.g., role boundaries, resistance to change), as well as several intervention functions likely to be appropriate in targeting these barriers. Conclusion This study provides a deeper understanding of factors that may be involved in the behaviour of stakeholders regarding the development of a CQR. The findings may assist in designing, implementing and evaluating a methodologically rigorous CQR intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07423-y.
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Affiliation(s)
- Ylva Haig
- Department of Radiology, Oslo University Hospital- Ullevål, PO Box 4950 Nydalen, 0424, Oslo, Norway.
| | - Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, PO Box 1089 Blindern, 0317, Oslo, Norway
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Skibdal KM, Emme C, Hansen H. Listen to Me! - A Mixed-Methods Study of Thoughts and Attitudes Towards Participation in Pulmonary Telerehabilitation Among People with Severe and Very Severe COPD Who Declined Participation in Pulmonary Rehabilitation. Patient Prefer Adherence 2022; 16:2781-2798. [PMID: 36281352 PMCID: PMC9587731 DOI: 10.2147/ppa.s380832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pulmonary rehabilitation (PR) is a key standard treatment for people with chronic obstructive pulmonary disease (COPD) with documented effect on symptom relief, improved physical function, and quality of life. However, referral, uptake and adherence rates remain low. Pulmonary telerehabilitation (PTR) is a safe and effective alternative to conventional PR. This study explores associations, thoughts and attitudes towards PTR in patients with COPD who decline referral to outpatient hospital-based routine PR. METHODS A mixed-methods study with integration of survey data (n=84) and semi-structured interviews (n=9). RESULTS We found a significant association between belief of effect of PTR and willingness to participate. Increasing age was significantly associated with reduced odds of daily use of central processing unit (CPU) or tablet. One-third of the participants were undecided about potential participation in PTR. Qualitative findings highlight that participants perceived participating in PTR as more convenient and had preferences for individualized, supervised, and monitored rehabilitation. CONCLUSION Those willing to participate in a PTR program believed in the benefits, were comfortable with technological devices, had preferences for exercising at home, and saw opportunities in the social setting. Future PTR programs should include monitoring, preferably managed by a familiar health care professional (HCP).
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Affiliation(s)
- Kira Marie Skibdal
- Department of Physical and Occupational Therapy, University Hospital Amager-Hvidovre Hospital, Hvidovre, Denmark
| | - Christina Emme
- Department of Quality and Education, University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Henrik Hansen
- Respiratory Research Unit and Department of Respiratory Medicine, University Hospital Amager Hvidovre Hospital, Hvidovre, Denmark
- Correspondence: Henrik Hansen, Email
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