Shin Hwayeon Danielle, Cassidy Christine, Weeks Lori E, Campbell Leslie Anne, Drake Emily K, Wong Helen, Donnelly Lauren, Dorey Rachel, Kang Hyelee, Curran Janet A
School of Nursing, Dalhousie University, Halifax, NS, Canada.
Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada.
JBI Evid Synth. 2022 Mar 1;20(3):788-846. doi: 10.11124/JBIES-21-00149.
The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework.
An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine the functional mechanisms of interventions and how these characteristics can influence emergency department clinicians' behaviors related to suicide prevention care.
This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude.
This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behaviour Change Wheel's intervention functions. Reported outcome measures were categorized. Findings were tabulated and synthesized narratively.
This review included a total of 70 sources, describing 66 different interventions. Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivization (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches.
Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and organization-level barriers for a given context. The ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors; however, current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
本综述性研究的目的是，以行为改变轮作为指导理论框架，探索、描述和梳理关于为改变急诊科临床医生自杀预防相关行为而实施的干预措施及干预组成部分的文献。
急诊科是自杀预防的关键场所，但患者常常在未经过适当自杀风险评估或转诊的情况下就被放走。因此，我们必须支持急诊科临床医生改变行为，以遵循循证自杀预防策略。然而，迄今为止的综述尚未系统地从理论上审视干预措施的作用机制，以及这些特征如何影响急诊科临床医生与自杀预防护理相关的行为。
本综述纳入了旨在改变急诊科临床医生自杀预防相关行为的干预措施。行为改变既指可观察到的实践变化，也指行为改变的替代指标，包括知识和态度的变化。
本综述遵循循证卫生保健国际协作网（JBI）的综述性研究方法。检索数据库包括PubMed、PsycINFO、护理学与健康领域数据库（CINAHL）、Embase以及灰色文献，包括针对性的谷歌搜索相关组织/网站、ProQuest全球博硕士论文数据库以及Scopus会议论文（使用特定筛选条件）。本综述未设置任何日期限制，但检索仅限于英文文献。使用专门为本综述目的开发的图表进行数据提取。使用行为改变轮的干预功能对干预措施的叙述性描述进行编码。对报告的结局指标进行分类。将结果制成表格并进行叙述性综合分析。
本综述共纳入70篇文献，描述了66种不同的干预措施。数据库检索纳入41项研究，包括实验性研究（n = 2）、半实验性研究（n = 24）、非实验性研究（n = 12）、定性研究（n = 1）和混合方法研究（n = 2）。灰色文献检索又纳入29篇文献。其中1篇是试点混合方法研究，其余均为干预措施。确定的干预措施包括行为改变轮中一系列改变临床医生行为的干预功能：教育（n = 48）、培训（n = 40）、赋能（n = 36）、劝说（n = 21）、环境重构（n = 18）、示范（n = 7）和激励（n = 2）。基于行为改变轮分析，许多干预措施针对行为改变的多个决定因素，通常同时采用教育和培训来提高临床医生的知识和技能。在报告了结局指标的42项研究中，在临床医生层面（n = 38）、患者层面（n = 4）或组织层面（n = 6）测量了有效性。很少有研究报告实施结果，如覆盖范围（n = 4）、采用情况（n = 5）或保真度（n = 1）的测量指标。通过谷歌搜索确定的干预措施没有报告评估数据。
本综述纳入的干预措施多种多样，并利用了一系列机制来改变急诊科临床医生的行为。然而，大多数干预措施仅依靠教育和/或培训来提高临床医生的知识和/或技能。未来的研究应考虑采用多种干预功能，针对特定背景下的个人和组织层面障碍。改变急诊科临床医生行为的最终目标是改善与自杀相关想法和行为的患者健康结局；然而，目前的研究最常孤立地评估临床医生的行为，而未考虑患者结局。未来的研究应考虑同时报告患者层面和临床医生层面的结局。
