Hubeishy Maja Husted, Rossen Camilla Blach, Dannapfel Petra, Thomas Kristin, Jensen Tue Secher, Maribo Thomas, Rolving Nanna
Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Hospital in Central Denmark Region, Falkevej 1-3, 8600, Silkeborg, Denmark.
Department of Public Health, Aarhus University, Aarhus, Denmark.
Implement Sci Commun. 2024 Apr 3;5(1):33. doi: 10.1186/s43058-024-00568-x.
Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care.
A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme.
The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks.
A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project's next phase.
Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.
腰痛仍是导致残疾和社会负担的主要原因，2020年全球有6.19亿例流行病例。大多数国家制定了临床指南，以支持医疗保健专业人员对腰痛进行循证护理。然而，多项研究发现指南的采用率相对较低。有人认为，制定针对性的策略以促进指南的实施可以提高采用率。本研究旨在制定一个因地制宜的实施计划，以加强丹麦初级保健中的物理治疗师和脊医对循证腰痛护理的应用。
采用行为改变轮开展了一项理论驱动的实施计划开发研究，医疗保健专业人员高度参与。数据收集包括与来自初级保健诊所的7名物理治疗师和6名脊医举办的4次研讨会。开发过程包括：[1]建立理论框架，[2]让参与者参与，[3]了解行为，[4]设计实施计划，以及[5]最终实施计划。
为实施计划选定的目标行为（指南建议）为：（i）筛查心理社会风险因素和（ii）提供患者教育。描述了所选行为的障碍和促进因素，并将其与干预功能和行为技巧联系起来。最后，实施计划包括五项策略：网络研讨会、电子学习视频、沟通练习、同伴学习和小组对话会议。此外，该计划还包括实施支持：倡导者、实体资料夹、每周电子邮件提醒、专门设计的网站以及实施顾问的访问。总体计划的一个关键要素是，它被设计为一个逐步实施的过程，包括在16周内进行16小时的教育和培训。
基于行为改变理论以及涉及医疗保健专业人员的4次联合设计研讨会，制定了一项实施腰痛指南建议的计划，以克服因地制宜确定的障碍。让医疗保健专业人员参与的理论驱动方法有助于确定相关目标行为，并使计划能够因地制宜，考虑到实施的障碍和促进因素。最终实施计划的有效性将在项目的下一阶段进行评估。
丹麦中部地区，2021年11月11日注册，编号1-16-02-93-19。
