Nursing Research Institute, St Vincent's Health Australia (Sydney) and Australian Catholic University, Executive Suite, Level 5 deLacy Building, St Vincent's Hospital, 390 Victoria Street, Darlinghurst 2010, New South Wales, Australia.
Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW 2011, Australia.
Implement Sci. 2017 Jul 17;12(1):88. doi: 10.1186/s13012-017-0616-6.
Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability.
A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt.
Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs).
The TDF was successfully applied in all steps of developing an implementation intervention for the T Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.
基于行为改变理论的理论框架和模型越来越多地应用于实施干预措施的开发。实施干预措施的制定通常基于现有证据基础和实际问题，即可行性和可接受性。本研究旨在描述 T 试验（急诊科脑卒中患者分诊、治疗和转院）实施干预措施的开发过程，该过程使用理论推荐行为改变技术（BCTs），并借鉴研究证据基础和可行性及可接受性方面的实际问题。
采用基于理论、证据和实际问题的复杂干预措施开发的分步方法，具体步骤如下：（1）谁需要做什么不同？（2）使用理论框架，需要解决哪些障碍和促进因素？（3）哪些干预措施（行为改变技术和交付模式）可以克服可改变的障碍并增强促进因素？召集一个研究人员小组审查建议使用的 BCT 清单，并确定最可行和可接受的技术。
参加研讨会的医院工作人员报告了 76 个障碍（步骤 1：研究人员确定了可能影响 T 试验临床干预实施的 13 个 TDF 领域；步骤 2：研究人员小组然后选择三分之一的 BCTs 推荐用于 ED 的临床环境，并使用促进因素研讨会数据，为每个选定的 BCT 设计促进策略；步骤 3：最终的实施干预措施包括 27 个 BCTs）。
TDF 成功应用于 T 试验临床干预实施干预措施的所有步骤。研究人员小组意见的使用是 BCT 选择过程的重要组成部分，既纳入了研究证据，又纳入了专家判断。建议使用这种分步骤的方法（理论、可行性和可接受性的证据和实际问题）来开发高度可报告的实施干预措施。使用公认的实施干预措施组件对 BCT 进行分类将促进在不同条件和临床环境下的推广和共享。
