Tavender Emma J, Bosch Marije, Gruen Russell L, Green Sally E, Michie Susan, Brennan Sue E, Francis Jill J, Ponsford Jennie L, Knott Jonathan C, Meares Sue, Smyth Tracy, O'Connor Denise A
National Trauma Research Institute, The Alfred, Monash University, Melbourne, Australia.
Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
Implement Sci. 2015 May 25;10:74. doi: 10.1186/s13012-015-0264-7.
Despite the availability of evidence-based guidelines for the management of mild traumatic brain injury in the emergency department (ED), variations in practice exist. Interventions designed to implement recommended behaviours can reduce this variation. Using theory to inform intervention development is advocated; however, there is no consensus on how to select or apply theory. Integrative theoretical frameworks, based on syntheses of theories and theoretical constructs relevant to implementation, have the potential to assist in the intervention development process. This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention.
A stepped approach was followed: (i) identification of locally applicable and actionable evidence-based recommendations as targets for change, (ii) selection and use of two theoretical frameworks for identifying barriers to and enablers of change (Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations) and (iii) identification and operationalisation of intervention components (behaviour change techniques and modes of delivery) to address the barriers and enhance the enablers, informed by theory, evidence and feasibility/acceptability considerations. We illustrate this process in relation to one recommendation, prospective assessment of post-traumatic amnesia (PTA) by ED staff using a validated tool.
Four recommendations for managing mild traumatic brain injury were targeted with the intervention. The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains. The mode of delivery was informed by six Cochrane reviews. It was delivered via five intervention components : (i) local stakeholder meetings, (ii) identification of local opinion leader teams, (iii) a train-the-trainer workshop for appointed local opinion leaders, (iv) local training workshops for delivery by trained local opinion leaders and (v) provision of tools and materials to prompt recommended behaviours.
Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED. The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster randomised trial, part of the Neurotrauma Evidence Translation (NET) program.
尽管急诊科（ED）有基于证据的轻度创伤性脑损伤管理指南，但实际操作仍存在差异。旨在实施推荐行为的干预措施可以减少这种差异。提倡运用理论指导干预措施的制定；然而，对于如何选择或应用理论尚无共识。基于与实施相关的理论和理论构建的综合理论框架，有可能协助干预措施的制定过程。本文描述了应用两个理论框架来调查影响推荐行为的因素以及实施干预措施的行为改变技术和传播方式选择的过程。
采用逐步推进的方法：（i）确定适用于当地且可操作的基于证据的推荐意见作为变革目标，（ii）选择并使用两个理论框架来识别变革的障碍和促进因素（理论领域框架和服务组织中的创新扩散模型），以及（iii）根据理论、证据和可行性/可接受性考虑，确定并实施干预措施的组成部分（行为改变技术和传播方式），以解决障碍并增强促进因素。我们以一项推荐意见为例说明这一过程，即急诊科工作人员使用经过验证的工具对创伤后遗忘（PTA）进行前瞻性评估。
该干预措施针对四项轻度创伤性脑损伤管理推荐意见。针对PTA推荐意见的干预措施包括14种行为改变技术，涉及6个理论领域和5个组织领域。传播方式参考了六项Cochrane系统评价。它通过五个干预组成部分实施：（i）当地利益相关者会议，（ii）确定当地意见领袖团队，（iii）为指定的当地意见领袖举办培训师培训工作坊，（iv）由经过培训的当地意见领袖举办当地培训工作坊，以及（v）提供工具和材料以促使采取推荐行为。
两个理论框架以互补方式用于指导急诊科轻度创伤性脑损伤管理干预措施的制定。所制定干预措施的有效性和成本效益正在一项整群随机试验中进行评估，该试验是神经创伤证据转化（NET）项目的一部分。
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