英国饮食失调早期干预服务实施情况的临床医生观点：一项混合方法研究
Clinician perspectives of the implementation of an early intervention service for eating disorders in England: a mixed method study.
作者信息
Richards Katie L, Phillips Matthew, Grycuk Luiza, Hyam Lucy, Allen Karina, Schmidt Ulrike
机构信息
Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AB, UK.
Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
出版信息
J Eat Disord. 2024 Apr 5;12(1):45. doi: 10.1186/s40337-024-01000-4.
BACKGROUND
The First Episode Rapid Early Intervention for Eating Disorders (FREED) service has been shown to reduce the wait for care and improve clinical outcomes in initial evaluations. These findings led to the national scaling of FREED in England. To support this scaling, we conducted a mixed method evaluation of the perceptions and experiences of clinicians in the early phases of scaling. The Normalisation Process Theory (NPT) was used as a conceptual lens to understand if and how FREED becomes embedded in routine practice.
METHODS
The convergent mixed method evaluation included 21 semi-structured interviews with clinicians from early adopter sites and 211 surveys administered to clinicians before, immediately after and 3 months after the FREED training. The interview guide and survey included questions evaluating attitudes towards early intervention for eating disorders (EDs) and NPT mechanisms. Interview data were analysed using an inductive thematic analysis. The NPT was applied to the inductively derived themes to evaluate if and how NPT domains impacted the implementation. Survey data were analysed using multilevel growth models.
RESULTS
Six themes and 15 subthemes captured barriers and facilitators to implementation at the patient, clinician, service, intervention, implementation and wider system levels. These interacted with the NPT mechanisms to facilitate or hinder the embedding of FREED. Overall, clinicians were enthusiastic and positive towards early intervention for EDs and FREED, largely because of the expectation of improved patient outcomes. This was a considerable driver in the uptake and implementation of FREED. Clinicians also had reservations about capacity and the potential impact on other patients, which, at times, was a barrier for its use. The FREED training led to significant improvements in positive attitudes and NPT mechanisms that were largely maintained at the 3-month follow-up. However, negative attitudes did not significantly improve following training.
CONCLUSIONS
Positive attitudes towards early intervention for EDs increased enthusiasm and engagement with the model. Features of the model and its implementation were effective at developing adopter commitment and capabilities. However, there were aspects of the model and its implementation which require attention in the future (e.g., capacity and the potential impact on the wider service).
背景
饮食失调首次发作快速早期干预（FREED）服务已被证明可减少等待护理的时间，并改善初始评估中的临床结果。这些发现促使FREED在英国全国范围内推广。为支持这一推广，我们对推广早期阶段临床医生的看法和经历进行了混合方法评估。正常化过程理论（NPT）被用作一个概念框架，以了解FREED是否以及如何融入常规实践。
方法
这项收敛性混合方法评估包括对来自早期采用地点的临床医生进行21次半结构化访谈，以及在FREED培训前、培训后立即和培训后3个月对临床医生进行211次调查。访谈指南和调查问卷包括评估对饮食失调早期干预（EDs）态度和NPT机制的问题。访谈数据采用归纳主题分析法进行分析。将NPT应用于归纳得出的主题，以评估NPT领域是否以及如何影响实施。调查数据采用多层次增长模型进行分析。
结果
六个主题和15个子主题涵盖了在患者、临床医生、服务、干预措施、实施过程和更广泛系统层面上实施的障碍和促进因素。这些因素与NPT机制相互作用，促进或阻碍了FREED的融入。总体而言，临床医生对EDs的早期干预和FREED充满热情且持积极态度，主要是因为期望改善患者预后。这是FREED被采用和实施的一个重要推动因素。临床医生也对能力以及对其他患者的潜在影响有所保留，这有时成为使用FREED的障碍。FREED培训使积极态度和NPT机制有了显著改善，且在3个月的随访中基本保持。然而，培训后消极态度并未显著改善。
结论
对EDs早期干预的积极态度提高了对该模式的热情和参与度。该模式及其实施的特点有效地培养了采用者的承诺和能力。然而，该模式及其实施的某些方面在未来需要关注（例如，能力以及对更广泛服务的潜在影响）。
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