Bull Eleanor R, Hart Joanne K, Swift Juliette, Baxter Kirstie, McLauchlan Neil, Joseph Sophia, Byrne-Davis Lucie M T
Division of Medical Education, University of Manchester, Oxford Road, Manchester, M139PT, UK.
Department of Psychology, Manchester Metropolitan University, Manchester, M156GX, UK.
BMC Health Serv Res. 2019 Feb 4;19(1):97. doi: 10.1186/s12913-019-3885-8.
Health and social care organisations globally are moving towards prevention-focussed community-based, integrated care. The success of this depends on professionals changing practice behaviours. This study explored the feasibility of applying a behavioural science approach to help staff teams from health organisations overcome psychological barriers to change and implement new models of care.
An Organisational Participatory Research study was conducted with health organisations from North West England, health psychologists and health workforce education commissioners. The Behaviour Change Wheel (BCW) was applied with teams of professionals seeking help to overcome barriers to practice change. A mixed-methods data collection strategy was planned, including qualitative stakeholder interview and focus groups to explore feasibility factors and quantitative pre-post questionnaires and audits measuring team practice and psychological change barriers. Qualitative data were analysed with thematic analysis; pre-post quantitative data were limited and thus analysed descriptively.
Four clinical teams from paediatrics, midwifery, heart failure and older adult mental health specialties in four organisations enrolled, seeking help to move care to the community, deliver preventative healthcare tasks, or become more integrated. Eighty-one managers, medical doctors, nurses, physiotherapists, midwives and other professionals contributed data. Three teams successfully designed a BCW intervention; two implemented and evaluated this. Five feasibility themes emerged from the thematic analysis of qualitative data. Optimising the BCW in an organisational change context meant 1) qualitative over quantitative data collection, 2) making behavioural science attractive, 3) co-development and a behavioural focus, 4) effective ongoing communication and 5) support from engaged leaders. Pre-post quantitative data collected suggested some positive changes in staff practice behaviours and psychological determinants following the intervention.
Behavioural science approaches such as the BCW can be optimised to support teams within health and social care organisations implementing complex new models of care. The efficacy of this approach should now be trialled.
全球范围内的卫生和社会护理组织正朝着以预防为重点的社区综合护理方向发展。其成功与否取决于专业人员改变实践行为。本研究探讨了应用行为科学方法帮助卫生组织的工作人员团队克服变革心理障碍并实施新护理模式的可行性。
对英格兰西北部的卫生组织、健康心理学家和卫生人力教育专员开展了一项组织参与式研究。行为改变轮（BCW）应用于寻求帮助以克服实践变革障碍的专业人员团队。计划采用混合方法数据收集策略，包括定性的利益相关者访谈和焦点小组，以探索可行性因素，以及定量的前后问卷调查和审计，以衡量团队实践和心理变革障碍。定性数据采用主题分析法进行分析；前后定量数据有限，因此进行描述性分析。
四个组织中来自儿科、助产、心力衰竭和老年心理健康专科的四个临床团队参与其中，寻求帮助将护理转移到社区、开展预防性医疗保健任务或实现更高程度的整合。81名管理人员、医生、护士、物理治疗师、助产士和其他专业人员提供了数据。三个团队成功设计了BCW干预措施；两个团队实施并评估了该措施。定性数据的主题分析产生了五个可行性主题。在组织变革背景下优化BCW意味着：1）定性数据收集多于定量数据收集；2）使行为科学具有吸引力；3）共同开发和关注行为；4）有效的持续沟通；5）来自积极参与的领导者的支持。收集的前后定量数据表明，干预后工作人员的实践行为和心理决定因素出现了一些积极变化。
诸如BCW之类的行为科学方法可以进行优化，以支持卫生和社会护理组织内实施复杂新护理模式的团队。现在应该对这种方法的有效性进行试验。
