Leather, JZ, Keyworth, C orcid.org/0000-0002-7815-6174, Kapur, N et al. (2 more authors) (2022) Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework. British Journal of Health Psychology, 27 (4). pp. 1275-1295. ISSN 1359-107X
Abstract
Objectives
This study aimed to (1) examine barriers and enablers to General Practitioners’ (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. Design: Qualitative interview study.
Methods
Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified.
Results
GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities).
Conclusions
Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | evidence-based guidelines, general practice, self-harm |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Psychology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 07 Apr 2022 14:19 |
Last Modified: | 30 May 2023 22:36 |
Status: | Published |
Publisher: | Wiley |
Identification Number: | 10.1111/bjhp.12598 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:185530 |