Taylor Natalie, Healey Emma, Morrow April, Greening Sian, Wakefield Claire E, Warwick Linda, Williams Rachel, Tucker Katherine M
Cancer Research Division, Cancer Council New South Wales, Sydney, New South Wales 2011 Australia.
Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2006 Australia.
Implement Sci Commun. 2020 Oct 14;1:90. doi: 10.1186/s43058-020-00054-0. eCollection 2020.
Despite considerable encouragement for healthcare professionals to use or be clear about the theory used in their improvement programmes, the uptake of these approaches to design interventions or report their content is lacking. Recommendations suggest healthcare practitioners work with social and/or behavioural scientists to gain expertise in programme theory, ideally before, but even during or after the work is done. We aim to demonstrate the extent to which intuitive intervention strategies designed by healthcare professionals to overcome patient barriers to communicating genetic cancer risk information to family members align with a theoretical framework of behaviour change.
As part of a pre-post intervention study, a team of genetic counsellors aimed to understand, and design interventions to overcome, the major barriers a group of familial cancer patients face around communicating hereditary cancer risk information to their relatives. A behavioural change specialist worked with the team to review and recode barriers and interventions according to the Theoretical Domains Framework (TDF) and 93 behaviour change techniques (BCTs). Resulting BCTs were cross-referenced against the Theory and Techniques Tool to examine whether evidence-based mechanistic links have been established to date.
Five themes emerged from the genetic counsellor coded barriers, which when recoded according to the TDF represented seven domains of behaviour change. Forty-five experiential and intuitive interventions were used to tackle key barriers. These were represented by 21 BCTs, which were found to be used on 131 occasions. The full mapping exercise is presented, resulting in a suite of intervention strategies explicitly linked to a theoretical framework. Structured, written reflections were provided retrospectively by the core clinical team.
Although the ideal is to use theory prospectively, or even whilst a project is underway, making links between theory and interventions explicit, even retrospectively, can contribute towards standardising intervention strategies, furthering understanding of intervention effects, and enhancing the opportunities for accurate replicability and generalisability across other settings. Demonstrating to healthcare professionals how their intuition aligns with theory may highlight the additional benefits that theory has to offer and serve to promote its use in improvement.
尽管大力鼓励医疗保健专业人员运用或明确其改进项目中所使用的理论，但在采用这些方法来设计干预措施或报告其内容方面仍存在不足。建议指出，医疗从业者应与社会和/或行为科学家合作，以获取项目理论方面的专业知识，理想情况下是在工作开展之前，但即使在工作进行期间或之后也可以。我们旨在证明医疗保健专业人员为克服患者向家庭成员传达遗传性癌症风险信息的障碍而设计的直观干预策略与行为改变理论框架的契合程度。
作为一项干预前后研究的一部分，一组遗传咨询师旨在了解并设计干预措施，以克服一群家族性癌症患者在向亲属传达遗传性癌症风险信息时面临的主要障碍。一名行为改变专家与该团队合作，根据理论领域框架（TDF）和93种行为改变技术（BCT）对障碍和干预措施进行审查和重新编码。将得出的BCT与理论和技术工具进行交叉参考，以检查迄今为止是否已建立基于证据的机制联系。
遗传咨询师编码的障碍中出现了五个主题，根据TDF重新编码后代表了行为改变的七个领域。使用了45种经验性和直观性干预措施来解决关键障碍。这些由21种BCT表示，共被使用了131次。展示了完整的映射练习，得出了一套与理论框架明确相关的干预策略。核心临床团队回顾性地提供了结构化的书面反思。
虽然理想情况是前瞻性地使用理论，甚至在项目进行过程中使用，但即使是回顾性地明确理论与干预措施之间的联系，也有助于使干预策略标准化，加深对干预效果的理解，并增加在其他环境中准确复制和推广的机会。向医疗保健专业人员展示他们的直觉与理论如何契合，可能会凸显理论所能带来的额外益处，并有助于促进其在改进工作中的应用。
