Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, UK.
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.
Syst Rev. 2022 Aug 30;11(1):180. doi: 10.1186/s13643-022-02030-2.
Understanding the barriers and facilitators to behaviour change by primary care practitioners (PCPs) is vital to inform the design and implementation of successful Behaviour Change Interventions (BCIs), embed evidence-based medicine into routine clinical practice, and improve quality of care and population health outcomes.
A theory-led systematic review of reviews examining barriers and facilitators to clinical behaviour change by PCPs in high-income primary care contexts using PRISMA. Embase, MEDLINE, PsychInfo, HMIC and Cochrane Library were searched. Content and framework analysis was used to map reported barriers and facilitators to the Theoretical Domains Framework (TDF) and describe emergent themes. Intervention functions and policy categories to change behaviour associated with these domains were identified using the COM-B Model and Behaviour Change Wheel (BCW).
Four thousand three hundred eighty-eight reviews were identified. Nineteen were included. The average quality score was 7.5/11. Reviews infrequently used theory to structure their methods or interpret their findings. Barriers and facilitators most frequently identified as important were principally related to 'Knowledge', 'Environmental context and resources' and 'Social influences' TDF domains. These fall under the 'Capability' and 'Opportunity' domains of COM-B, and are linked with interventions related to education, training, restriction, environmental restructuring and enablement. From this, three key areas for policy change include guidelines, regulation and legislation. Factors least frequently identified as important were related to 'Motivation' and other psychological aspects of 'Capability' of COM-B. Based on this, BCW intervention functions of persuasion, incentivisation, coercion and modelling may be perceived as less relevant by PCPs to change behaviour.
PCPs commonly perceive barriers and facilitators to behaviour change related to the 'Capability' and 'Opportunity' domains of COM-B. PCPs may lack insight into the role that 'Motivation' and aspects of psychological 'Capability' have in behaviour change and/or that research methods have been inadequate to capture their function. Future research should apply theory-based frameworks and appropriate design methods to explore these factors. With no 'one size fits all' intervention, these findings provide general, transferable insights into how to approach changing clinical behaviour by PCPs, based on their own views on the barriers and facilitators to behaviour change.
A protocol was submitted to the London School of Hygiene and Tropical Medicine via the Ethics and CARE form submission on 16.4.2020, ref number 21478 (available on request). The project was not registered on PROSPERO.
了解初级保健医生（PCP）进行行为改变的障碍和促进因素对于告知成功的行为改变干预措施（BCI）的设计和实施、将循证医学纳入常规临床实践以及改善护理质量和人口健康结果至关重要。
使用 PRISMA 对高收入初级保健环境中 PCP 进行临床行为改变的障碍和促进因素进行理论指导的系统综述。对 Embase、MEDLINE、PsychInfo、HMIC 和 Cochrane 图书馆进行了检索。使用内容和框架分析将报告的障碍和促进因素映射到理论领域框架（TDF）并描述出现的主题。使用 COM-B 模型和行为改变轮（BCW）确定与这些领域相关的行为改变的干预功能和政策类别。
确定了 4388 篇评论。其中 19 篇被纳入。平均质量评分为 7.5/11。评论很少使用理论来构建其方法或解释其发现。被认为最重要的障碍和促进因素主要与 TDF 的“知识”、“环境背景和资源”和“社会影响”领域有关。这些属于 COM-B 的“能力”和“机会”领域，与与教育、培训、限制、环境重构和赋能相关的干预措施有关。由此，政策变革的三个关键领域包括准则、法规和立法。被认为不太重要的因素与 COM-B 的“能力”的“动机”和其他心理方面有关。基于此，BCW 干预功能的说服、激励、强制和示范可能被 PCP 认为与改变行为不太相关。
PCP 通常认为与 COM-B 的“能力”和“机会”领域相关的行为改变的障碍和促进因素。PCP 可能对“动机”和行为改变的“能力”的心理方面的作用缺乏洞察力，或者研究方法不足以捕捉他们的作用。未来的研究应该应用基于理论的框架和适当的设计方法来探索这些因素。由于没有“一刀切”的干预措施，这些发现根据 PCP 对行为改变的障碍和促进因素的看法，提供了一般性的、可转移的方法来改变他们的临床行为。
2020 年 4 月 16 日，通过伦敦卫生与热带医学学院的伦理和 CARE 表格提交向伦敦卫生与热带医学学院提交了一份方案，编号为 21478（可应要求提供）。该项目未在 PROSPERO 上注册。
