了解基层医疗从业者如何看待用于高血压管理的在线干预措施。
Understanding how primary care practitioners perceive an online intervention for the management of hypertension.
作者信息
Bradbury Katherine, Morton Katherine, Band Rebecca, May Carl, McManus Richard, Little Paul, Yardley Lucy
机构信息
Academic unit of psychology, University of Southampton, Southampton, UK.
Faculty of Health Sciences, University of Southampton, Southampton, UK.
出版信息
BMC Med Inform Decis Mak. 2017 Jan 9;17(1):5. doi: 10.1186/s12911-016-0397-x.
BACKGROUND
In order to achieve successful implementation an intervention needs to be acceptable and feasible to its users and must overcome barriers to behaviour change. The Person-Based Approach can help intervention developers to improve their interventions to ensure more successful implementation. This study provides an example of using the Person-Based Approach to refine a digital intervention for hypertension (HOME BP).
METHODS
Our Person-Based Approach involved conducting qualitative focus groups with practice staff to explore their perceptions of HOME BP and to identify any potential barriers to implementation of the HOME BP procedures. We took an iterative approach moving between data collection, analysis and modifications to the HOME BP intervention, followed by further data collection. The data was analysed using thematic analysis.
RESULTS
Many aspects of HOME BP appeared to be acceptable, persuasive and feasible to implement. Practitioners perceived benefits in using HOME BP, including that it could empower patients to self-manage their health, potentially overcome clinical inertia around prescribing medication and save both the patient and practitioner time. However, practitioners also had some concerns. Some practitioners were concerned about the accuracy of patients' home blood pressure readings, or the potential for home monitoring to cause patients anxiety and therefore increase consultations. Some GPs lacked confidence in choosing multiple medication changes, or had concerns about unanticipated drug interactions. A few nurses were concerned that the model of patient support they were asked to provide was not consistent with their perceived role. Modifications were made to the intervention based on this feedback, which appeared to help overcome practitioners' concerns and improve the acceptability and feasibility of the intervention.
CONCLUSIONS
This paper provides a detailed example of using the Person-Based Approach to refine HOME BP, demonstrating how we improved the acceptability and feasibility of HOME BP based on feedback from practice staff. This demonstration may be useful to others developing digital interventions.
背景
为了实现成功实施，一项干预措施需要对其使用者来说是可接受且可行的，并且必须克服行为改变的障碍。基于人的方法可以帮助干预措施开发者改进他们的干预措施，以确保更成功地实施。本研究提供了一个使用基于人的方法来完善高血压数字干预措施（家庭血压监测，HOME BP）的例子。
方法
我们基于人的方法包括与实践人员进行定性焦点小组讨论，以探讨他们对HOME BP的看法，并确定实施HOME BP程序的任何潜在障碍。我们采用迭代方法，在数据收集、分析和对HOME BP干预措施的修改之间循环，随后进行进一步的数据收集。使用主题分析法对数据进行分析。
结果
HOME BP的许多方面似乎是可接受、有说服力且可行的。从业者认为使用HOME BP有诸多益处，包括它可以使患者能够自我管理健康，有可能克服围绕开药的临床惰性，并节省患者和从业者的时间。然而，从业者也有一些担忧。一些从业者担心患者家庭血压读数的准确性，或者家庭监测可能导致患者焦虑从而增加会诊次数。一些全科医生在选择多种药物变更时缺乏信心，或者担心意外的药物相互作用。一些护士担心他们被要求提供的患者支持模式与他们所认知的角色不一致。根据这些反馈对干预措施进行了修改，这似乎有助于克服从业者的担忧并提高干预措施的可接受性和可行性。
结论
本文提供了一个使用基于人的方法来完善HOME BP的详细例子，展示了我们如何根据实践人员的反馈提高HOME BP的可接受性和可行性。这一示范可能对其他开发数字干预措施的人有用。
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