Department of General Practice, School of Primary Health Care, Monash University, Building 3, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia.
Implement Sci. 2014 May 23;9:60. doi: 10.1186/1748-5908-9-60.
More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice.
Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis.
Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners' confidence and motivation to perform HKCs.
Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners' training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.
超过五分之一的澳大利亚儿童在入学时发育脆弱。为了应对这一问题，2008 年澳大利亚普通科医生开始引入一次性健康评估——健康儿童检查（Healthy Kids Check，HKC），以针对学龄前儿童。然而，该服务的提供仍然很低。理论领域框架（Theoretical Domains Framework）为理解行为提供了一种理论方法，可以浓缩为三个核心组件：能力、机会和动机，以及 COM-B 模型。利用这个系统，本研究旨在确定提供 HKC 的障碍和促进因素，为在澳大利亚普通科医生中推广 HKC 服务的干预措施的设计提供信息。
对来自维多利亚州墨尔本社会文化多样化地区的 40 名普通科医生的 6 次焦点小组讨论的数据进行了主题分析。
许多医生对自己提供 HKC 的能力和实际操作存在不确定性，但在某些情况下，HKC 已成为专业发展的催化剂。免疫服务和 HKC 提供之间的关键联系促使实践采取召回和提醒系统。发育评估方法的标准化和简化的转诊途径影响了医生执行 HKC 的信心和动力。
系统框架的应用有效地展示了如何针对多种行为进行干预以增加 HKC 的提供。干预措施需要针对实践系统、办公室工作人员的支持和转诊选择以及医生的培训。许多行为改变可以通过单一的干预计划来实现，该计划由负责当地医疗需求的基层医疗组织（Medicare Locals）实施，为普通科医生、社区和幼儿健康之间提供了重要联系。
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