Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
BMJ Open. 2022 Jun 14;12(6):e054739. doi: 10.1136/bmjopen-2021-054739.
The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project implemented an evidence-based intervention that offers a combination of pharmacotherapy and behavioural support to tobacco-dependent inpatients. Understanding key characteristics of CURE's implementation strategy, and identifying areas for improvement, is important to support the roll-out of nationwide tobacco dependence services. This study aimed to (1) specify key characteristics of CURE's exiting implementation strategy and (2) develop theoretical-informed and stakeholder-informed recommendations to optimise wider roll-out.
Data were collected via document review and secondary analysis of interviews with 10 healthcare professionals of a UK hospital. Intervention content was specified through behaviour change techniques (BCTs) and intervention functions within the Behaviour Change Wheel. A logic model was developed to specify CURE's implementation strategy and its mechanisms of impact. We explored the extent to which BCTs and intervention functions addressed the key theoretical domains influencing implementation using prespecified matrices. The development of recommendations was conducted over a two-round Delphi exercise.
We identified six key theoretical domains of influences: 'environmental context and resources', 'goals', 'social professional role and identity', 'social influences', 'reinforcement' and 'skills'. The behavioural analysis identified 26 BCTs, 4 intervention functions and 4 policy categories present within the implementation strategy. The implementation strategy included half the relevant intervention functions and BCTs to target theoretical domains influencing CURE implementation, with many BCTs focusing on shaping knowledge. Recommendations to optimise content were developed following stakeholder engagement.
CURE offers a strong foundation from which a tobacco dependence treatment model can be developed in England. The exiting strategy could be strengthened via the inclusion of more theoretically congruent BCTs, particularly relating to 'environmental context and resources'. The recommendations provide routes to optimisation that are both theoretically grounded and stakeholder informed. Future research should assess the feasibility/acceptability of these recommendations in the wider secondary-care context.
“对话、理解、替代、专家和循证治疗（CURE）”项目实施了一项循证干预措施，为住院烟草依赖患者提供药物治疗和行为支持相结合的服务。了解 CURE 实施策略的关键特征，并确定需要改进的领域，对于支持全国范围内的烟草依赖服务的推出至关重要。本研究旨在：（1）具体说明 CURE 现有实施策略的关键特征；（2）制定基于理论和利益相关者的建议，以优化更广泛的推广。
通过对英国一家医院的 10 名医疗保健专业人员的文件审查和二次访谈收集数据。通过行为改变技术（BCT）和行为改变轮中的干预功能来指定干预内容。制定了一个逻辑模型来具体说明 CURE 的实施策略及其影响机制。我们通过预定的矩阵探索了 BCT 和干预功能在多大程度上解决了影响实施的关键理论领域。建议的制定是通过两轮德尔菲法练习进行的。
我们确定了六个关键的理论影响领域：“环境背景和资源”、“目标”、“社会专业角色和身份”、“社会影响”、“强化”和“技能”。行为分析确定了实施策略中存在的 26 种 BCT、4 种干预功能和 4 种政策类别。实施策略包括针对影响 CURE 实施的理论领域的一半相关干预功能和 BCT，许多 BCT 侧重于塑造知识。在利益相关者参与的情况下制定了优化内容的建议。
CURE 为在英格兰开发烟草依赖治疗模型提供了坚实的基础。通过纳入更多与理论一致的 BCT，特别是与“环境背景和资源”相关的 BCT，可以加强现有的策略。这些建议提供了既基于理论又基于利益相关者的优化途径。未来的研究应评估这些建议在更广泛的二级保健环境中的可行性/可接受性。
