Process evaluation of a behaviour change approach to improving clinical practice for detecting hereditary cancer View Full Text


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Article Info

DATE

2019-12

AUTHORS

Janet C. Long, Teresa Winata, Deborah Debono, Kim-Chi Phan-Thien, Christine Zhu, Natalie Taylor

ABSTRACT

BACKGROUND: This retrospective process evaluation reports on the application of a 1-year implementation program to increase identification and management of patients at high risk of a hereditary cancer syndrome. The project used the Theoretical Domains Framework Implementation (TDFI) approach, a promising implementation methodology, used successfully in the United Kingdom to address patient safety issues. This Australian project run at two large public hospitals aimed to increase referrals of patients flagged as being at risk of Lynch syndrome on the basis of a screening test to genetic services. At the end of the project, the pathologists' processes had changed, but the referral rate remained inconsistent and low. METHODS: Semi-structured interviews explored participants' perceptions of the TDFI approach and Health services researchers wrote structured reflections. Interview transcripts and reflections were coded initially against implementation outcomes for the various TDFI approach activities: acceptability, appropriateness, feasibility, value for time cost, and adoption. On a second pass, themes were coded around challenges to the approach. RESULTS: Interviews were held with nine key project participants including pathologists, oncologists, surgeons, genetic counsellors and an administrative officer. Two health services researchers wrote structured reflections. The first of two major themes was 'Theory-related challenges', with subthemes of accessibility of theory underpinning the TDFI, commitment to that theory-based approach, and the problem of complexity. The second theme was 'Practical challenges' with subthemes of stakeholder management, navigating the system, and perceptions of the problem. Health services researchers reflected on the benefits of bridging professional divides and facilitating collective learning and problem solving, but noted frustrations around clinicians' time constraints that led to sparse interactions with the team, and lack of authority to effect change themselves. CONCLUSIONS: Mixed success of adoption as an outcome was attributed to the complexity and highly nuanced nature of the setting. This made identifying the target behaviour, a key step in the TDFI approach, challenging. Introduced changes in the screening process led to new, unexpected issues yet to be addressed. Strategies to address challenges are presented, including using an internal facilitator with a focus on applying a theory-based implementation approach. More... »

PAGES

180

References to SciGraph publications

  • 2013-12. Development and initial validation of the Influences on Patient Safety Behaviours Questionnaire in IMPLEMENTATION SCIENCE
  • 2011-12. The behaviour change wheel: A new method for characterising and designing behaviour change interventions in IMPLEMENTATION SCIENCE
  • 2016-12. Achieving behaviour change for detection of Lynch syndrome using the Theoretical Domains Framework Implementation (TDFI) approach: a study protocol in BMC HEALTH SERVICES RESEARCH
  • 2009-12. Specifying and reporting complex behaviour change interventions: the need for a scientific method in IMPLEMENTATION SCIENCE
  • 2013-08. The Behavior Change Technique Taxonomy (v1) of 93 Hierarchically Clustered Techniques: Building an International Consensus for the Reporting of Behavior Change Interventions in ANNALS OF BEHAVIORAL MEDICINE
  • 2017-12. Service provider perceptions of transitioning from audio to video capability in a telehealth system: a qualitative evaluation in BMC HEALTH SERVICES RESEARCH
  • 2014-12. Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi in BMC HEALTH SERVICES RESEARCH
  • 2018-12. When complexity science meets implementation science: a theoretical and empirical analysis of systems change in BMC MEDICINE
  • 2009-01. Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges in ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
  • 2013-12. The demonstration of a theory-based approach to the design of localized patient safety interventions in IMPLEMENTATION SCIENCE
  • 2014-12. Towards a common terminology: a simplified framework of interventions to promote and integrate evidence into health practices, systems, and policies in IMPLEMENTATION SCIENCE
  • 2013-12. Bridges, brokers and boundary spanners in collaborative networks: a systematic review in BMC HEALTH SERVICES RESEARCH
  • 2015-12. Do complexity-informed health interventions work? A scoping review in IMPLEMENTATION SCIENCE
  • 2017-12. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework in BMC HEALTH SERVICES RESEARCH
  • 2017-12. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems in IMPLEMENTATION SCIENCE
  • 2018-12. Using behaviour change and implementation science to address low referral rates in oncology in BMC HEALTH SERVICES RESEARCH
  • 2011-03. Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda in ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1186/s12913-019-3985-5

    DOI

    http://dx.doi.org/10.1186/s12913-019-3985-5

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1112901897

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/30894169


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