Lawton, Rebecca, Heyhoe, Jane, Louch, Gemma et al. (5 more authors) (2016) Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care:a qualitative study. Implementation science. 113. ISSN 1748-5908
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.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 Lawton et al |
Keywords: | Adult,Aged,Atrial Fibrillation,Diabetes Mellitus, Type 2,Evidence-Based Medicine,Female,General Practitioners,Guideline Adherence,Humans,Hypertension,Interviews as Topic,Male,Middle Aged,Practice Patterns, Physicians',Primary Health Care,Qualitative Research,United Kingdom,Young Adult,Journal Article,Research Support, Non-U.S. Gov't |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Hull York Medical School (York) |
Depositing User: | Pure (York) |
Date Deposited: | 28 Jun 2018 11:40 |
Last Modified: | 26 Nov 2024 00:39 |
Published Version: | https://doi.org/10.1186/s13012-016-0479-2 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1186/s13012-016-0479-2 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:132761 |
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Description: Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study
Licence: CC-BY 2.5