Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study

Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of ‘high-impact’ indicators based upon criteria including potential for significant pa...

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Vydané v:	Implementation science : IS Ročník 11; číslo 1; s. 113
Hlavní autori:	Lawton, Rebecca, Heyhoe, Jane, Louch, Gemma, Ingleson, Emma, Glidewell, Liz, Willis, Thomas A., McEachan, Rosemary R. C., Foy, Robbie
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	London BioMed Central 08.08.2016 BioMed Central Ltd
Predmet:	Adult Aged Analysis Atrial Fibrillation - drug therapy Diabetes Mellitus, Type 2 - drug therapy Evidence-based medicine Evidence-Based Medicine - methods Female General Practitioners - statistics & numerical data Guideline Adherence - statistics & numerical data Health Administration Health Informatics Health Policy Health Promotion and Disease Prevention Health Services Research Humans Hypertension - drug therapy Interviews as Topic Male Management Medicine Medicine & Public Health Methods Middle Aged Patient compliance Practice Patterns, Physicians' - statistics & numerical data Primary care nursing Primary Health Care - methods Public Health Qualitative Research United Kingdom Young Adult United Kingdom Hypertension Prescribing Guideline implementation Atrial fibrillation Theoretical Domains Framework Diabetes Qualitative Primary care Interviews
ISSN:	1748-5908, 1748-5908
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Abstract	Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of ‘high-impact’ indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals’ perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. Methods We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Results Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences , social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. Conclusions The TDF helped elicit a wide range of reported determinants of adherence to ‘high-impact’ indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations.
AbstractList	Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. Methods We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Results Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. Conclusions The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations. Keywords: Primary care, Diabetes, Hypertension, Prescribing, Atrial fibrillation, Theoretical Domains Framework, Guideline implementation, Qualitative, Interviews There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators.BACKGROUNDThere are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators.We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis.METHODSWe interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis.Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators.RESULTSProfessional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators.The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations.CONCLUSIONSThe TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations. Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of ‘high-impact’ indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals’ perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. Methods We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Results Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences , social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. Conclusions The TDF helped elicit a wide range of reported determinants of adherence to ‘high-impact’ indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations. There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations. There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened clinical guideline recommendations to derive a set of 'high-impact' indicators based upon criteria including potential for significant patient benefit, scope for improved practice and amenability to measurement using routinely collected data. Here, we explore health professionals' perceived determinants of adherence to these indicators, examining the degree to which determinants were indicator-specific or potentially generalisable across indicators. We interviewed 60 general practitioners, practice nurses and practice managers in West Yorkshire, the UK, about adherence to four indicators: avoidance of risky prescribing; treatment targets in type 2 diabetes; blood pressure targets in treated hypertension; and anticoagulation in atrial fibrillation. Interview questions drew upon the Theoretical Domains Framework (TDF). Data were analysed using framework analysis. Professional role and identity and environmental context and resources featured prominently across all indicators whilst the importance of other domains, for example, beliefs about consequences, social influences and knowledge varied across indicators. We identified five meta-themes representing more general organisational and contextual factors common to all indicators. The TDF helped elicit a wide range of reported determinants of adherence to 'high-impact' indicators in primary care. It was more difficult to pinpoint which determinants, if targeted by an implementation strategy, would maximise change. The meta-themes broadly underline the need to align the design of interventions targeting general practices with higher level supports and broader contextual considerations. However, our findings suggest that it is feasible to develop interventions to promote the uptake of different evidence-based indicators which share common features whilst also including content-specific adaptations.
ArticleNumber	113
Audience	Academic
Author	Foy, Robbie Glidewell, Liz Heyhoe, Jane Louch, Gemma Lawton, Rebecca Ingleson, Emma McEachan, Rosemary R. C. Willis, Thomas A.
Author_xml	– sequence: 1 givenname: Rebecca surname: Lawton fullname: Lawton, Rebecca email: r.j.lawton@leeds.ac.uk organization: School of Psychology, University of Leeds, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary – sequence: 2 givenname: Jane surname: Heyhoe fullname: Heyhoe, Jane organization: Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary – sequence: 3 givenname: Gemma surname: Louch fullname: Louch, Gemma organization: Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary – sequence: 4 givenname: Emma surname: Ingleson fullname: Ingleson, Emma organization: Leeds Institute of Health Sciences, University of Leeds – sequence: 5 givenname: Liz surname: Glidewell fullname: Glidewell, Liz organization: Leeds Institute of Health Sciences, University of Leeds – sequence: 6 givenname: Thomas A. surname: Willis fullname: Willis, Thomas A. organization: Leeds Institute of Health Sciences, University of Leeds – sequence: 7 givenname: Rosemary R. C. surname: McEachan fullname: McEachan, Rosemary R. C. organization: Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary – sequence: 8 givenname: Robbie surname: Foy fullname: Foy, Robbie organization: Leeds Institute of Health Sciences, University of Leeds
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/27502590$$D View this record in MEDLINE/PubMed
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Keywords	Hypertension Prescribing Guideline implementation Atrial fibrillation Theoretical Domains Framework Diabetes Qualitative Primary care Interviews
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Snippet	Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier... There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier screened... Background There are recognised gaps between evidence and practice in general practice, a setting posing particular implementation challenges. We earlier...
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SubjectTerms	Adult Aged Analysis Atrial Fibrillation - drug therapy Diabetes Mellitus, Type 2 - drug therapy Evidence-based medicine Evidence-Based Medicine - methods Female General Practitioners - statistics & numerical data Guideline Adherence - statistics & numerical data Health Administration Health Informatics Health Policy Health Promotion and Disease Prevention Health Services Research Humans Hypertension - drug therapy Interviews as Topic Male Management Medicine Medicine & Public Health Methods Middle Aged Patient compliance Practice Patterns, Physicians' - statistics & numerical data Primary care nursing Primary Health Care - methods Public Health Qualitative Research United Kingdom Young Adult
Title	Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study
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