Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Liver Unit, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Transl Behav Med. 2020 Oct 8;10(4):1016-1030. doi: 10.1093/tbm/ibz080.
Nonalcoholic fatty liver disease (NAFLD) is the most common liver condition worldwide and is steadily on the increase. In response, national and international guidance have been developed to standardize diagnosis and guide management of the condition. However, research has highlighted a discordance between published guidance and clinical practice. The purpose of this study is to identify barriers and enabling factors to implementation of guidance to inform the development of an intervention. We interviewed 21 health care professionals and 12 patients with NAFLD. Topic guides were developed with reference to national and international guidance. Data were content analyzed using the Theoretical Domains Framework. Beliefs about consequences and professional role and identity were the most prominent domains identified from health care professionals in the context of diagnosis and management of NAFLD. Environmental context and resources, memory, attention and decision processes, goals, behavioral regulation, knowledge, and skills emerged as important barriers/facilitators to implementation of guidance targeting management of NAFLD. Knowledge and beliefs about consequences were the most prominent domains from the perspective of patients. Social influences, environmental context and resources and behavioral regulation were most prominent in the context of NAFLD management. Guideline implementation can be improved by use of interventions that target standardized use of diagnostic criteria by health care professionals. Training of health care professionals was identified as important to improve care delivered to patients in order to effectively manage NAFLD. Interventions that target knowledge of patients, in particular, raising awareness that NAFLD can be progressive when not actively managed would facilitate implementation of guidance.
非酒精性脂肪性肝病 (NAFLD) 是全球最常见的肝脏疾病，且其发病率正在稳步上升。为此，各国制定了相应的指南以规范其诊断和管理。然而，研究表明，已发表的指南与临床实践之间存在差异。本研究旨在确定实施指南的障碍和促进因素，以为干预措施的制定提供信息。我们采访了 21 名医疗保健专业人员和 12 名 NAFLD 患者。主题指南的制定参考了国内外的指南。使用理论领域框架对数据进行内容分析。在诊断和管理 NAFLD 的背景下，医疗保健专业人员认为后果和专业角色与身份是最重要的领域。环境背景和资源、记忆、注意力和决策过程、目标、行为调节、知识和技能是针对 NAFLD 管理的指南实施的重要障碍/促进因素。从患者的角度来看，知识和对后果的信念是最重要的领域。在 NAFLD 管理方面，社会影响、环境背景和资源以及行为调节最为突出。通过针对医疗保健专业人员使用诊断标准的标准化的干预措施，可以改善指南的实施。医疗保健专业人员的培训被认为对改善患者护理以有效管理 NAFLD 至关重要。针对患者知识的干预措施，特别是提高人们对未积极管理的 NAFLD 可能会进展的认识，将有助于指南的实施。
