Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia.
BMC Prim Care. 2024 Apr 6;25(1):108. doi: 10.1186/s12875-024-02321-8.
Non-drug interventions are recommended for chronic condition prevention and management yet are underused in clinical practice. Understanding barriers and enablers to using non-drug interventions may help implement non-drug interventions in primary care. We aimed to conduct an overview of reviews to identify and summarise common barriers and enablers for using non-drug interventions for common chronic conditions in primary care.
We included qualitative and quantitative reviews that used systematic process or methods to examine barriers and enablers to using non-drug interventions for chronic condition prevention and management in primary care settings. We searched 5 electronic databases (PubMed, Cochrane Database of Systematic Reviews, EMBASE, PsycInfo and CINAHL) from inception to September 2022. Two authors independently screened reviews. One author extracted and deductively coded data to Consolidated Framework of Implementation Research (CFIR) (and where relevant, Theoretical Domains Framework [TDF]). A second author validated 10% of extracted data and coding. Data was synthesised thematically using CFIR and TDF. One author assessed the methodological quality of included reviews using a modified AMSTAR 2 tool, with 10% validated by a second author. We assessed overlap between primary studies in included reviews.
From 5324 records, we included 25 reviews, with data predominately from patients. Overall, 130 subthemes (71 barrier and 59 enabler) were identified across 4 CFIR domains (Innovation, Outer Setting, Inner Setting, and Individuals), and all TDF domains. Common barrier and enabler subthemes were identified for CFIR constructs of Innovation Adaptability, Innovation Cost, Innovation Relative Advantage, Local Attitudes, External Pressure, Local Conditions, Relational Connections, Available Resources, and Access to Knowledge and Information. For TDF domains, important barrier and enabler subthemes were identified for Knowledge, Skills, Environmental Context and Resources, Beliefs about Consequences, Reinforcement, and Emotion.
We synthesised reviews to provide new insight into common barriers and enablers for using non-drug interventions to prevent and manage chronic conditions in primary care. The factors identified can inform the development of generalisable implementation interventions to enhance uptake of multiple non-drug interventions simultaneously.
This study was registered in PROSPERO (CRD42022357583).
非药物干预措施被推荐用于慢性病的预防和管理，但在临床实践中未得到充分利用。了解使用非药物干预措施的障碍和促进因素可能有助于在初级保健中实施非药物干预措施。我们旨在进行综述，以确定和总结在初级保健中使用非药物干预措施预防和管理常见慢性病的常见障碍和促进因素。
我们纳入了使用系统过程或方法来检查在初级保健环境中使用非药物干预措施预防和管理慢性病的障碍和促进因素的定性和定量综述。我们从开始到 2022 年 9 月在 5 个电子数据库（PubMed、Cochrane 系统评价数据库、EMBASE、PsycInfo 和 CINAHL）中进行了搜索。两名作者独立筛选了综述。一名作者提取并演绎编码数据到实施研究综合框架（CFIR）（以及相关的理论领域框架 [TDF]）。第二名作者验证了 10%的提取数据和编码。使用 CFIR 和 TDF 对数据进行主题综合。一名作者使用改良的 AMSTAR 2 工具评估纳入综述的方法学质量，第二名作者验证了 10%的综述。我们评估了纳入综述中主要研究之间的重叠。
从 5324 条记录中，我们纳入了 25 篇综述，数据主要来自患者。总体而言，在 4 个 CFIR 领域（创新、外部环境、内部环境和个体）和所有 TDF 领域中，确定了 130 个子主题（71 个障碍和 59 个促进因素）。在 CFIR 结构的创新适应性、创新成本、创新相对优势、局部态度、外部压力、局部条件、关系联系、可用资源以及知识和信息获取方面，确定了常见的障碍和促进因素子主题。对于 TDF 领域，在知识、技能、环境背景和资源、对后果的信念、强化和情绪方面，确定了重要的障碍和促进因素子主题。
我们综合了综述，为在初级保健中使用非药物干预措施预防和管理慢性病提供了新的见解。确定的因素可以为开发通用的实施干预措施提供信息，以同时增强对多种非药物干预措施的采用。
本研究在 PROSPERO（CRD42022357583）中注册。
