Nunes Ana Raquel, Atherton Helen, Dahlmann Frederik, Eccles Abi, Geddes Olivia, Gregg Michael, Karaba Florence, Spencer Rachel, Twohig Helen, Dale Jeremy
Warwick Medical School, Medical School Building, University of Warwick, Coventry, CV4 7AL, United Kingdom.
School of Primary Care, University of Southampton, University Road, Southampton, SO16 5ST, United Kingdom.
Fam Pract. 2025 Jun 4;42(4). doi: 10.1093/fampra/cmaf050.
Decarbonization in general practice is a critical step toward achieving a net zero healthcare system. Understanding the factors that facilitate or hinder the implementation of environmentally sustainable practices is essential for effective and equitable action. Hence, the overarching aim of this study is to advance understanding of the factors influencing decarbonization in general practice. This study's objective is to map and compare the application of the Normalization Process Theory (NPT) and Theoretical Domains Framework (TDF) in understanding the key factors and sub-factors related to decarbonization in general practice.
Factors derived from a systematic review and narrative synthesis were mapped to NPT constructs and TDF domains by a multidisciplinary team of 10 coders, including academic general practitioners (GPs), researchers, and patient representatives. The mapping was conducted independently, and coder agreement was evaluated for consistency and reliability in categorization.
The study identifies key NPT ('Coherence', 'Collective Action', and 'Cognitive Participation') and TDF domains ('Environmental Context and Resources', 'Knowledge', and 'Social/professional role and identity') associated with factors identified in previous research as being associated with achieving decarbonization in general practice. A high intercoder reliability rate (73% for NPT, 84% for TDF) supports the consistency of the analysis, particularly for structured drivers such as financial incentives and policy support.
The findings demonstrate that the NPT and TDF frameworks provide useful, though incomplete, insights into factors influencing decarbonization in general practice. Such factors require more attention when developing evidence-based strategies for promoting decarbonization, something that future research could evaluate.
全科医疗中的脱碳是实现医疗系统净零排放的关键一步。了解促进或阻碍环境可持续实践实施的因素对于有效且公平地采取行动至关重要。因此，本研究的总体目标是增进对影响全科医疗脱碳因素的理解。本研究的目的是绘制并比较规范化过程理论（NPT）和理论领域框架（TDF）在理解与全科医疗脱碳相关的关键因素和子因素方面的应用。
由10名编码员组成的多学科团队，包括学术全科医生（GPs）、研究人员和患者代表，将系统评价和叙述性综合得出的因素映射到NPT结构和TDF领域。映射工作独立进行，并评估编码员在分类方面的一致性和可靠性。
该研究确定了与先前研究中确定的与全科医疗实现脱碳相关的因素相关的关键NPT（“连贯性”、“集体行动”和“认知参与”）和TDF领域（“环境背景与资源”、“知识”以及“社会/专业角色与身份”）。较高的编码员间信度率（NPT为73%，TDF为84%）支持了分析的一致性，特别是对于财务激励和政策支持等结构化驱动因素。
研究结果表明，NPT和TDF框架为影响全科医疗脱碳的因素提供了有用但不完整的见解。在制定促进脱碳的循证策略时，这些因素需要更多关注，未来的研究可以对此进行评估。
