运用行为洞察来设计公共心理健康环境中的实施策略：一项关于临床决策的定性研究
Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making.
作者信息
Last Briana S, Schriger Simone H, Timon Carter E, Frank Hannah E, Buttenheim Alison M, Rudd Brittany N, Fernandez-Marcote Sara, Comeau Carrie, Shoyinka Sosunmolu, Beidas Rinad S
机构信息
Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Implement Sci Commun. 2021 Jan 11;2(1):6. doi: 10.1186/s43058-020-00105-6.
BACKGROUND
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians' use of TNs. The behavioral insights literature-an interdisciplinary field studying judgment and decision-making-offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants.
METHODS
Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N = 17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the "Easy Attractive Social Timely" framework, a behavioral insights design approach.
RESULTS
We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation.
CONCLUSIONS
Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.
背景
创伤聚焦认知行为疗法（TF-CBT）是一种针对患有创伤后应激障碍的青少年的循证干预方法。TF-CBT的一个重要组成部分是创伤叙事（TN），这是干预过程中的一个阶段，在此阶段中，青少年会被引导去处理与他们的创伤经历相关的记忆、想法和感受。先前的研究表明，TF-CBT临床医生仅与一半的客户完成了创伤叙事，然而对于决定TF-CBT临床医生使用创伤叙事的因素却知之甚少。行为洞察文献——一个研究判断和决策的跨学科领域——提供了理论和实证工具，以概念化驱动复杂人类行为和决策的因素。借鉴行为洞察文献，本研究旨在了解决定临床医生使用创伤叙事的因素，并制定针对这些决定因素的策略。
方法
通过半结构化定性访谈，我们寻求在费城全市公共心理健康机构工作的受过训练的TF-CBT临床医生（N = 17）的观点，以了解他们与客户使用创伤叙事的决定因素。我们使用一种受行为洞察文献启发的编码方法来分析定性数据。我们采用结构化假设生成的迭代过程，借助行为洞察指南，并通过行为洞察进行快速验证，以揭示使用创伤叙事的决定因素。然后，我们使用“简单、有吸引力、社交化、及时”框架（一种行为洞察设计方法）制定针对这些决定因素的实施策略。
结果
我们生成并验证了关于决定临床医生实施创伤叙事的三个广泛主题：决策复杂性、临床医生情感体验和机构规范。我们假设了这些实施决定因素背后的行为洞察，并设计了一份包含九条相应行为洞察策略的清单，这些策略可能有助于创伤叙事的实施。
结论
我们的研究调查了为什么循证干预的一个有效组成部分难以实施。我们利用行为洞察文献中强大的科学理论和实证规律来理解临床医生对创伤叙事实施的观点。这些因素在理论上与实施策略相关联。我们的工作揭示了在诊断循证干预决定因素和设计实施策略中使用行为洞察方法的潜力。
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