‘I just thought that it was such an impossible thing’: A qualitative study of barriers and facilitators to discontinuing long‐term use of benzodiazepine receptor agonists using the Theoretical Domains Framework

Abstract Introduction Long-term use (>3 months) of benzodiazepine receptor agonists (BZRAs) persists in healthcare settings worldwide despite guidelines recommending short-term use (≤4 weeks). Potential harms of long-term BZRA use include dependence and withdrawal symptoms. A systematic review highlighted that brief interventions targeting long-term BZRA use lacked theoretical underpinning and were often poorly described (1). It is advocated that interventions should be systematically developed and reported, use an appropriate theory-base and involve key stakeholders in their development. Semi-structured interviews based on the Theoretical Domains Framework (TDF) can be used to identify patient-level barriers and facilitators that should be targeted by interventions (2). Aim The aim of this study was to explore the views and experiences of individuals who had previously used BZRAs on a long-term basis through semi-structured interviews and to identify key theoretical domains that acted as barriers and facilitators to discontinuing long-term BZRA use. Methods A multi-strand convenience sampling method was used to recruit participants through community pharmacies, general practices and social media (e.g. Twitter, Instagram). Individuals who had successfully discontinued long-term BZRA use were eligible to participate if they were ≥18 years of age, community dwelling and resident in the Republic of Ireland. Individuals with a: cognitive impairment, history of epilepsy, serious mental illness (e.g. prescribed anti-psychotics) or receiving opioid substitution treatment were excluded. Semi-structured interviews were conducted using a TDF-based topic guide (2). Questions covering each TDF domain were used to explore participants’ perceptions of barriers and facilitators to discontinuing long-term BZRA use. Data were recorded and transcribed verbatim. Transcripts were independently checked for accuracy. Data were analysed using the framework method. Interviews continued until data saturation was achieved. Ethical approval was granted by the RCSI Research Ethics Committee. Results Thirteen patients were interviewed (seven female; median age: 43 years; median duration of use: six years). Key barriers to discontinuing BZRA use were identified under the ‘Emotions’ and ‘Reinforcement’ domains. These included participants’ first-hand experience of withdrawal symptoms and resultant fear towards discontinuation of the medication. ‘Intentions’ and ‘Social influences’ were identified as key theoretical domains that facilitated participants in discontinuing BZRA use. For example, participants described having strong intentions to discontinue BZRA use and discussed the positive influence of healthcare professionals such as community pharmacists in supporting them. Conclusion The study findings indicate that individuals who have successfully discontinued long-term BZRA use often have strong intentions to do so, as well as the support of healthcare professionals. However, challenges to discontinuing BZRA use include withdrawal symptoms and negative emotions towards the discontinuation process. The main strength of this study is that it used the TDF to examine barriers and facilitators to discontinuing long-term BZRA use. A notable limitation was that none of the participants were aged ≥65 years which limits the transferability of the findings. Future work will look to examine the views and experiences of current long-term BZRA users, integrate the findings with this study and map key domains to behaviour change techniques to inform the development of an intervention to reduce long-term BZRA use. References 1. Lynch T, Ryan C, Hughes CM, Presseau J, van Allen ZM, Bradley CP, et al. Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis. Addiction. 2020;115(9):1618–39. 2. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science. 2012;7(1):37.

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Barriers and facilitators to orthopaedic surgeons’ uptake of decision aids for total knee arthroplasty: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2017-018614 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018614 ◽

Cited By ~ 10

Author(s):

Samantha Bunzli ◽

Elizabeth Nelson ◽

Anthony Scott ◽

Simon French ◽

Peter Choong ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Qualitative Study ◽

Knee Arthroplasty ◽

Decision Aid ◽

Decision Aids ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Meaningful Improvement ◽

Orthopaedic Surgeons ◽

Total Knee

ObjectivesThe demand for total knee arthroplasty (TKA) is increasing. Differentiating who will derive a clinically meaningful improvement from TKA from others is a key challenge for orthopaedic surgeons. Decision aids can help surgeons select appropriate candidates for surgery, but their uptake has been low. The aim of this study was to explore the barriers and facilitators to decision aid uptake among orthopaedic surgeons.DesignA qualitative study involving face-to-face interviews. Questions were constructed on the Theoretical Domains Framework to systematically explore barriers and facilitators.SettingOne tertiary hospital in Australia.ParticipantsTwenty orthopaedic surgeons performing TKA.Outcome measuresBeliefs underlying similar interview responses were identified and grouped together as themes describing relevant barriers and facilitators to uptake of decision aids.ResultsWhile prioritising their clinical acumen, surgeons believed a decision aid could enhance communication and patient informed consent. Barriers identified included the perception that one’s patient outcomes were already optimal; a perceived lack of non-operative alternatives for the management of end-stage osteoarthritis, concerns about mandatory cut-offs for patient-centred care and concerns about the medicolegal implications of using a decision aid.ConclusionsMultifaceted implementation interventions are required to ensure that orthopaedic surgeons are ready, willing and able to use a TKA decision aid. Audit/feedback to address current decision-making biases such as overconfidence may enhance readiness to uptake. Policy changes and/or incentives may enhance willingness to uptake. Finally, the design/implementation of effective non-operative treatments may enhance ability to uptake by ensuring that surgeons have the resources they need to carry out decisions.

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Barriers and facilitators to hospital pharmacists’ engagement in medication safety activities: a qualitative study using the theoretical domains framework

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-018-0129-y ◽

2018 ◽

Vol 11 (1) ◽

Cited By ~ 7

Author(s):

Alemayehu B. Mekonnen ◽

Andrew J. McLachlan ◽

Jo-anne E. Brien ◽

Desalew Mekonnen ◽

Zenahebezu Abay

Keyword(s):

Qualitative Study ◽

Medication Safety ◽

Theoretical Domains Framework ◽

Barriers And Facilitators ◽

Hospital Pharmacists

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Barriers and facilitators for the usage of a personal health record for medication reconciliation: a qualitative study among patients (Preprint)

10.2196/preprints.33674 ◽

2021 ◽

Author(s):

Denise van der Nat ◽

Victor J B Huiskes ◽

Margot Taks ◽

Bart J F van den Bemt ◽

Hein A W van Onzenoort

Keyword(s):

Qualitative Study ◽

Medication Reconciliation ◽

Data Exchange ◽

Personal Health Record ◽

Healthcare Providers ◽

Theoretical Domains Framework ◽

Information Provision ◽

Perceived Usefulness ◽

Barriers And Facilitators ◽

Personal Health

BACKGROUND Transitions in care are a risk factor for medication discrepancies, which can be identified and solved with medication reconciliation (MR). However, MR is a time consuming process, its effect on clinical outcomes is limited and a central role for patients is missing. As multiple organizations stimulate a more central role for patients in healthcare, personal health records (PHRs) are more often applied in medical care. However, patients’ adoption rate of using a PHR for MR is low. OBJECTIVE Therefore, the aim of this study was to provide insight into patients’ barriers and facilitators for the usage of a PHR for MR prior to an in- or outpatient visit. METHODS A qualitative study was conducted among PHR users and non-users who had a planned visit at the in- or outpatient clinic. About one week after the visit, patients were interviewed about barriers and facilitators for the use of a PHR for MR using a semi-structured interview guide based on the theoretical domains framework. Afterwards, data were analysed following thematic content analysis. RESULTS In total, 10 PHR users and 10 PHR non-users were interviewed. The barriers and facilitators were classified in four domains: 1) patient, consisting of the barriers: limited (health) literacy and/or computer skills, limited perceived usefulness and/or motivation, concerns about data safety, no computer/smartphone, and poor memory, and the facilitators: perceived importance/usefulness and place and time independent; 2) application, consisting of the barriers: practical and technical issues, poor usability and missing functionalities, and the facilitators: improve usability and add functionalities; 3) process, consisting of the barrier: ambiguity about who is responsible, the patient or the healthcare provider, and the facilitators: check by healthcare providers, more frequent update of medication list by healthcare providers and target patients who benefit most and/or have sufficient skills; 4) context, consisting of the barriers: lack of data exchange and connectivity between ICT applications, privacy concerns, healthcare professional do not use the requested data, insufficient information provision and bad (timing) of invitations and reminders, and the facilitators: integration of different applications, information provision by healthcare providers and support of professionals and/or family. CONCLUSIONS Patients reported barriers and facilitators for using a PHR to perform MR are identified at the patient, application, process and context level. Furthermore, patients indicated that they become more engagement in their own healthcare when they use a PHR. To improve the implementation of MR by using PHRs, the barriers and facilitators need to be addressed to effectively develop and implement PHRs in the MR process.

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THU0457 Long Term Barriers and Facilitators to Exercise and Physical Activity in Older Adults with Knee Pain: The Beep Longitudinal Qualitative Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.1426 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 365.3-366 ◽

Cited By ~ 1

Author(s):

C. Jinks ◽

A. Moore ◽

M.A. Holden ◽

N.E. Foster

Keyword(s):

Physical Activity ◽

Older Adults ◽

Qualitative Study ◽

Knee Pain ◽

Barriers And Facilitators

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Barriers and facilitators to implementing the CURE stop smoking project: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-06504-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Angela Wearn ◽

Anna Haste ◽

Catherine Haighton ◽

Verity Mallion ◽

Angela M. Rodrigues

Keyword(s):

Qualitative Study ◽

Intervention Development ◽

Theoretical Domains Framework ◽

Tobacco Dependence ◽

Preliminary Evidence ◽

Environmental Context ◽

Barriers And Facilitators ◽

Theoretical Frameworks ◽

Targeted Interventions ◽

Treatment Services

Abstract Background The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals’ implementation behaviour within the pilot site. Methods Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development. Results Eight TDF domains were identified as important areas influencing CURE implementation; ‘environmental context and resources’ (physical opportunity), ‘social influence’ (social opportunity), ‘goals’, ‘professional role and identity’ and ‘beliefs about consequences’ (reflective motivation), ‘reinforcement’ (automatic motivation), ‘skills’ and ‘knowledge’ (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of ‘beliefs about consequences’ and ‘knowledge’, which were highlighted as facilitators of CURE. Participants suggested that ‘environmental context and resources’ was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context. Conclusions This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts.

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Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study

Journal of Occupational Rehabilitation ◽

10.1007/s10926-021-10004-9 ◽

2021 ◽

Author(s):

Margot C. W. Joosen ◽

Marjolein Lugtenberg ◽

Iris Arends ◽

Hanneke J. A. W. M. van Gestel ◽

Benedikte Schaapveld ◽

...

Keyword(s):

Mental Disorders ◽

Qualitative Study ◽

Return To Work ◽

Sickness Absence ◽

Common Mental Disorders ◽

Coping Behavior ◽

Work Conditions ◽

Barriers And Facilitators ◽

Structured Interviews

AbstractPurpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers’ perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers’ perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective coping behaviors. According to workers, RTW was facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance. Workers with short-term leave more often reported favorable work conditions, and proactive coping behavior. In contrast, the long-term group reported reactive coping behavior and dissatisfaction with their work. Conclusion Supporting workers with CMDs in gaining self-awareness and regaining control, discussing the value of their work, and creating work conditions that enable workers to do valuable work, seem central for successful RTW and might prevent sickness absence. Supervisors play a key role in enabling workers to do valuable work and further research should focus on how supervisors can be supported in this task.

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