Development of targeted, theory-informed interventions to improve bronchiolitis management

作者：Libby Haskell, Emma Tavender, Catherine Wilson, Sharon O’Brien, Franz E Babl, Meredith L Borland, Elizabeth Cotterell, Nicolette Sheridan, Ed Oakley, Stuart R. Dalziel · 发表于：BMC Health Services Research · 年份：2021 · DOI：10.1186/s12913-021-06724-6 · 被引用次数：27 · 研究领域：Respiratory viral infections research、Antibiotic Use and Resistance、Health Policy Implementation Science

BACKGROUND: Despite international guidelines providing evidence-based recommendations on appropriate management of infants with bronchiolitis, wide variation in practice occurs. This results in infants receiving care of no benefit, with associated cost and is potentially harmful. Theoretical frameworks are increasingly used to develop interventions, utilising behaviour change techniques specifically chosen to target factors contributing to practice variation, with de-implementation often viewed as harder than implementing. This paper describes the stepped process using the Theoretical Domains Framework (TDF) to develop targeted, theory-informed interventions which subsequently successfully improved management of infants with bronchiolitis by de-implementing ineffective therapies. Explicit description of the process and rationale used in developing de-implementation interventions is critical to dissemination of these practices into real world clinical practice. METHODS: A stepped approach was used: (1) Identify evidence-based recommendations and practice variation as targets for change, (2) Identify factors influencing practice change (barriers and enablers) to be addressed, and (3) Identification and development of interventions (behaviour change techniques and methods of delivery) addressing influencing factors, considering evidence of effectiveness, feasibility, local relevance and acceptability. The mode of delivery for the intervention components was informed by evidence ...