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

2018 ◽  
Vol 11 (1) ◽  
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

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

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018614 ◽  
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.

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

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.

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

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.

A qualitative study of school leader experiences adopting and implementing a whole of school physical activity and sedentary behaviour programme: Transform-Us!

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Samuel Cassar ◽  
Jo Salmon ◽  
Anna Timperio ◽  
Sofie Koch ◽  
Harriet Koorts
Keyword(s):  
Physical Activity ◽  
Qualitative Study ◽  
Knowledge Sharing ◽  
Sedentary Behaviour ◽  
Primary Schools ◽  
School Leaders ◽  
Theoretical Domains Framework ◽  
Theory And Practice ◽  
Barriers And Facilitators ◽  
Content Type

PurposeLittle is known about the experiences of school leaders adopting and implementing real-world, scaled-up physical activity interventions in the Australian educational system. Transform-Us! is a novel physical activity and sedentary behaviour intervention available to all primary schools in Victoria, Australia, since September 2018. This study explored barriers and facilitators experienced by school leaders during the adoption and early implementation phases of Transform-Us!.Design/methodology/approachQualitative study involving seven semi-structured telephone interviews with school leaders implementing Transform-Us! in primary schools in Victoria, Australia. Interview schedules were developed based on the theoretical domains framework (TDF). Interviews were coded using a framework analysis approach.FindingsFour key themes emerged relating to ten of the 14 TDF domains. Themes included: knowledge, goals, implementation factors and leadership. School leaders play a central role in creating a positive implementation environment including the delivery setting (classroom) and a supportive culture (knowledge sharing) in the school. The application of the TDF to the study bridges the gap between theory and practice and identifies potential future implementation strategies which may be further tested in professional practice future studies. Recommendations for increased adoption and sustained implementation related to seven core areas: presence of a school/programme champion(s); collaborative knowledge sharing; online training; school-based workshops; promotion of behavioural and mental health outcomes; teacher autonomy in delivery; and a supportive implementation environment.Originality/valueSchool leaders have a unique scope to influence the adoption and implementation of physical activity and sedentary behaviour interventions. This study outlines specific barriers and facilitators for implementation of a physical activity programme in the Australian educational setting and offers recommendations for programme optimisation.

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