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

TY - JOUR

T1 - Using the Theoretical Domains Framework (TDF) to understand adherence to multiple evidence-based indicators in primary care

T2 - a qualitative study

AU - Lawton, Rebecca

AU - Heyhoe, Jane

AU - Louch, Gemma

AU - Ingleson, Emma

AU - Glidewell, Liz

AU - Willis, Thomas A

AU - McEachan, Rosemary R C

AU - Foy, Robbie

AU - ASPIRE programme

N1 - © 2016 Lawton et al

PY - 2016/8/8

Y1 - 2016/8/8

N2 - 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.

AB - 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.

KW - Adult

KW - Aged

KW - Atrial Fibrillation

KW - Diabetes Mellitus, Type 2

KW - Evidence-Based Medicine

KW - Female

KW - General Practitioners

KW - Guideline Adherence

KW - Humans

KW - Hypertension

KW - Interviews as Topic

KW - Male

KW - Middle Aged

KW - Practice Patterns, Physicians'

KW - Primary Health Care

KW - Qualitative Research

KW - United Kingdom

KW - Young Adult

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

UR - http://eprints.whiterose.ac.uk/103649/

U2 - 10.1186/s13012-016-0479-2

DO - 10.1186/s13012-016-0479-2

M3 - Article

C2 - 27502590

SN - 1748-5908

VL - 11

JO - Implementation science

JF - Implementation science

M1 - 113

ER -