Arar Nedal, Seo Joann, Abboud Hanna E, Parchman Michael, Noel Polly
Division of Nephrology/Department of Medicine, University of Texas Health Science Center at San Antonio, Audie L Murphy Memorial Veterans Hospital, 7703 Floyd Curl Drive, San Antonio, TX, USA.
Per Med. 2010 Sep;7(5):485-494. doi: 10.2217/pme.10.47.
To examine providers' behavioral intention toward the utilization of genomic services at the Veterans Health Administration (VHA; Washington, DC, USA) through the lens of the 'Theory of Planned Behavior'. The theory of planned behavior posits that individuals' behaviors (using genomic services) are driven by their behavioral intentions. Behavioral intentions is a function of: first, behavioral beliefs; second, normative beliefs, and third; control beliefs.
MATERIALS & METHODS: Semi-structured interviews were conducted with 20 providers working in different units at the South Texas Veterans Health Care System (STVHCS; TX USA). The interviews focused on assessing providers' behavioral beliefs, normative beliefs and control beliefs regarding the delivery of genomic medicine at the STVHCS. Interview materials were tape recorded, transcribed and the content was analyzed using qualitative methods.
All participating providers perceived genomic medicine to be an important area in medicine (behavioral beliefs). They agreed that the VHA has the necessary infrastructure to foster the delivery of genomic services. The majority of participants (n = 18; 90%) agreed that primary care providers will play a major role in delivering genomic services. Providers indicated that referents' (other providers) opinions about genomic services may affect their decisions about whether to utilize genomic services (normative beliefs). However, most providers (n = 17; 85%) raised concerns about the impact of using genomic services on the process of care (control beliefs). Participants indicated that additional training for providers and patients, and decision support will facilitate the delivery of genomic services (control beliefs). Providers also identified three external barriers: first, uncertainty about genomic findings; second, coordination of care between primary care, specialists and genetic services (system level barriers); and third ethical issues associated with genomic information and services.
Our findings highlight several opportunities and challenges related to the delivery of genomic medicine at the VHA. The results suggest that strategies to address providers' concerns in the control beliefs domain may be necessary to enhance providers' utilization of genomic services in clinical practice.
通过“计划行为理论”的视角，研究美国退伍军人健康管理局（VHA；华盛顿特区）的医疗服务提供者对利用基因组服务的行为意图。计划行为理论认为，个体的行为（使用基因组服务）是由其行为意图驱动的。行为意图是以下因素的函数：第一，行为信念；第二，规范信念；第三，控制信念。
对在美国德克萨斯州南部退伍军人医疗保健系统（STVHCS；美国德克萨斯州）不同科室工作的20名医疗服务提供者进行了半结构化访谈。访谈重点评估了医疗服务提供者对STVHCS提供基因组医学服务的行为信念、规范信念和控制信念。访谈材料进行了录音、转录，并采用定性方法对内容进行了分析。
所有参与的医疗服务提供者都认为基因组医学是医学中的一个重要领域（行为信念）。他们一致认为VHA拥有促进基因组服务提供的必要基础设施。大多数参与者（n = 18；90%）同意初级保健提供者将在提供基因组服务中发挥主要作用。医疗服务提供者表示，参照对象（其他医疗服务提供者）对基因组服务的意见可能会影响他们是否使用基因组服务的决定（规范信念）。然而，大多数医疗服务提供者（n = 17；85%）对使用基因组服务对医疗过程的影响表示担忧（控制信念）。参与者表示，为医疗服务提供者和患者提供额外培训以及决策支持将有助于基因组服务的提供（控制信念）。医疗服务提供者还确定了三个外部障碍：第一，基因组研究结果的不确定性；第二，初级保健、专科医生和基因服务之间的医疗协调（系统层面障碍）；第三，与基因组信息和服务相关的伦理问题。
我们的研究结果突出了与VHA提供基因组医学相关的几个机遇和挑战。结果表明，可能有必要采取策略来解决医疗服务提供者在控制信念领域的担忧，以提高他们在临床实践中对基因组服务的利用。
