职业医师对改善心理健康问题指南依从性的认知障碍及建议解决方案：同伴小组培训分析
Occupational physicians' perceived barriers and suggested solutions to improve adherence to a guideline on mental health problems: analysis of a peer group training.
作者信息
Lugtenberg Marjolein, van Beurden Karlijn M, Brouwers Evelien P M, Terluin Berend, van Weeghel Jaap, van der Klink Jac J L, Joosen Margot C W
机构信息
Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
出版信息
BMC Health Serv Res. 2016 Jul 16;16:271. doi: 10.1186/s12913-016-1530-3.
BACKGROUND
Despite the impact of mental health problems on sickness absence, only few occupational health guidelines addressing these problems are available. Moreover, adherence has found to be suboptimal. To improve adherence to the Dutch guideline on mental health problems a training was developed for Dutch occupational physicians (OPs) focusing on identifying barriers and addressing them. The aim of this study was to provide an overview of the barriers that OPs perceived in adhering to the Dutch guideline on mental health problems as well as their solutions to overcome them.
METHODS
A qualitative study was conducted using data from the peer group training. Thirty-two (6 groups of 4 to 6) OPs received a multiple-session interactive training over the course of a year, focusing on identifying and addressing barriers, using a Plan-Do-Check-Act approach. Sessions were audio-taped and transcribed verbatim. Thematic content analysis was performed by two researchers with a selection of 50 % (21 out of 42) of the transcripts to identify the perceived barriers and the suggested solutions, using AtlasTi 7.0.
RESULTS
Knowledge-related barriers were perceived regarding the content of all parts of the guideline. Commonly perceived attitude-related barriers were a lack of self-efficacy to perform certain guideline recommendations and difficulties with changing habits and routines. External barriers that were commonly perceived were work-contextual barriers, such as a lack of time/work pressure, tight contracts between occupational health services (OHSs) and employers, and conflicting policy of and a lack of collaboration with other parties (e.g. employer, other healthcare providers). The most often tested solutions by OPs during the training were sharing information, experiences, tips and tricks and referring to existing tools, or developing new tools to facilitate guideline usage.
CONCLUSIONS
Dutch OPs perceive a range of knowledge-related, attitude-related and external barriers in adhering to the guideline on mental health problems. The tested solutions during the training particularly seemed to focus on knowledge and attitude-related barriers. To optimally implement this or similar mental health guidelines, it may be important to complement guideline training and education of individual or groups of OPs, with interventions that address external barriers such as changing tight contracts, or improving communication and collaboration with other parties.
背景
尽管心理健康问题对病假有影响，但针对这些问题的职业健康指南却寥寥无几。此外，指南的依从性也不尽人意。为提高对荷兰心理健康问题指南的依从性，针对荷兰职业医师（OPs）开发了一项培训，重点是识别障碍并加以解决。本研究的目的是概述职业医师在遵循荷兰心理健康问题指南时所感知到的障碍以及他们克服这些障碍的解决方案。
方法
采用来自同伴小组培训的数据进行定性研究。32名（6组，每组4至6人）职业医师在一年的时间里接受了多阶段互动培训，重点是使用计划-执行-检查-行动方法识别和解决障碍。培训课程进行了录音并逐字转录。两名研究人员对50%（42份中的21份）的转录本进行了主题内容分析，以使用AtlasTi 7.0识别感知到的障碍和建议的解决方案。
结果
在指南所有部分的内容方面都存在与知识相关的障碍。常见的与态度相关的障碍是缺乏执行某些指南建议的自我效能感以及改变习惯和日常工作的困难。常见的外部障碍是工作环境方面的障碍，例如时间/工作压力不足、职业健康服务机构（OHSs）与雇主之间的合同紧张，以及与其他各方（如雇主、其他医疗服务提供者）的政策冲突和缺乏合作。职业医师在培训期间最常尝试的解决方案是分享信息、经验、提示和技巧，参考现有工具，或开发新工具以促进指南的使用。
结论
荷兰职业医师在遵循心理健康问题指南时感知到一系列与知识、态度和外部相关的障碍。培训期间尝试的解决方案似乎特别侧重于与知识和态度相关的障碍。为了最佳地实施该指南或类似的心理健康指南，除了对个体或职业医师群体进行指南培训和教育外，采取干预措施解决外部障碍（如改变紧张的合同，或改善与其他各方的沟通与合作）可能也很重要。
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