scholarly journals Barriers and enablers to access childhood cataract services across India. A qualitative study using the Theoretical Domains Framework (TDF) of behaviour change

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261308
Author(s):  
Sheeladevi Sethu ◽  
John G. Lawrenson ◽  
Ramesh Kekunnaya ◽  
Rahul Ali ◽  
Rishi R. Borah ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Analysis Data ◽  
Perceived Barriers ◽  
Early Presentation ◽  
Integrative Framework ◽  
Barriers And Enablers ◽  
Depth Interviews ◽  
Childhood Cataract

Early presentation for childhood cataract surgery is an important first step in preventing related visual impairment and blindness. In the absence of neonatal eye screening programmes in developing countries, the early identification of childhood cataract remains a major challenge. The primary aim of this study was to identify potential barriers to accessing childhood cataract services from the perspective of parents and carers, as a critical step towards increasing the timely uptake of cataract surgery. In-depth interviews were conducted using a pre-designed topic guide developed for this study to seek the views of parents and carers in nine geographic locations across eight states in India regarding their perceived barriers and enablers to accessing childhood cataract services. A total of 35 in-depth interviews were conducted including 30 at the hospital premises and 5 in the participants’ homes. All interviews were conducted in the local language and audio taped for further transcription and analysis. Data were organised using NVivo 11 and a thematic analysis was conducted utilising the Theoretical Domains Framework (TDF), an integrative framework of behavioural theories. The themes identified from interviews related to 11 out of 12 TDF domains. TDF domains associated with barriers included: ‘Environmental context and resources’, ‘Beliefs about consequences’ and ‘Social influences’. Reported enablers were identified in three theoretical domains: ‘Social influences’, ‘Beliefs about consequences’ and ‘Motivations and goals’. This comprehensive TDF approach enabled us to understand parents’ perceived barriers and enablers to accessing childhood cataract services, which could be targeted in future interventions to improve timely uptake.

scholarly journals Is Promotion of Mobility in Older Patients Hospitalized for Medical Illness a Physician’s Job?—An Interview Study with Physicians in Denmark

Geriatrics ◽  
2020 ◽  
Vol 5 (4) ◽  
pp. 74
Author(s):  
Mette Merete Pedersen ◽  
Rasmus Brødsgaard ◽  
Per Nilsen ◽  
Jeanette Wassar Kirk
Keyword(s):  
Older Patients ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Medical Illness ◽  
Medical Patients ◽  
Face To Face ◽  
Multiple Levels ◽  
Common Barriers

The aim of this study was to identify the most common barriers and facilitators physicians perceive regarding their role in the promotion of mobility in older adults hospitalized for medical illness as part of on an intervention to promote mobility. Twelve physicians at two medical departments were interviewed face-to-face using semi-structed interviews based on the Theoretical Domains Framework. The physicians’ perceived barriers to promoting mobility were: the patients being too ill, the department’s interior does not fit with mobility, a culture of bedrest, mobility not being part their job, lack of time and resources and unwillingness to accept an extra workload. The facilitators for encouraging mobility were enhanced cross-professional cooperation focusing on mobility, physician encouragement of mobility and patient independence in e.g., picking up beverages and clothes. The identified barriers and facilitators reflected both individual and social influences on physicians’ behaviors to achieve increased mobility in hospitalized older medical patients and suggest that targeting multiple levels is necessary to influence physicians’ propensity to promote mobility.

scholarly journals Using Theoretical Domains Framework to Identify Barriers and Enablers to Implementing a Virtual Tertiary-regional Telemedicine Rounding and Consultation (TRaC-K) Model for Kids: A Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Sumedh Bele ◽  
Christine Cassidy ◽  
Janet Curan ◽  
David W. Johnson ◽  
J A Michelle Bailey
Keyword(s):  
Rural Areas ◽  
Clinical Care ◽  
Healthcare Providers ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Successful Implementation ◽  
Access To Health Services ◽  
Barriers And Enablers ◽  
Pediatric Hospitals ◽  
Regional Hospitals

BACKGROUND Inequities in access to health services is a global concern and a concern for Canadian populations living in rural areas. Rural children hospitalized at tertiary children’s hospitals have higher rates of medical complexity and experience more expensive hospitalizations and more frequent readmissions. The two tertiary pediatric hospitals in Alberta, Canada have already been operating over capacity, but the pediatric beds at regional hospitals are underutilized. Such imbalance could lead to poor patient safety, and increased readmission risk at tertiary pediatric hospitals and diminish the clinical exposure of regional pediatric healthcare providers, erode their confidence, and compel health systems to further reduce the capacity in regional sites. A “Telemedicine Rounding and Consultation for Kids” (TRaC-K) model was proposed to enable healthcare providers at the Alberta Children’s Hospital to partner with their counterparts in Medicine Hat Regional Hospital to provide inpatient clinical care for pediatric patients who would otherwise have to travel or be transferred to the tertiary site. OBJECTIVE The current study is aimed at identifying perceived barriers and enablers to implementing the TRaC-K model. METHODS This study was guided by the Theoretical Domain Framework (TDF) and utilized qualitative methods. We collected qualitative data from 42 participants from tertiary and regional hospitals through 31 semi-structured interviews and two focus groups. This data was thematically analysed to identify major sub-themes within each TDF domain. These sub-themes were further aggregated themes and categorized into as barriers or enablers to the TRaC-K model and were tabulated separately. RESULTS Our study identified 31 sub-themes in 14 TDF domains ranging from administrative issues to specific clinical conditions. We were able to merge these sub-themes into larger themes and categorize them into 4 barriers and 4 enablers. Our findings showed that barriers were lack of awareness of telemedicine, skills to provide virtual clinical care, and unclear processes and resources to support TRaC-K and concerns about clear roles and responsibilities. To the contrary, enablers were of healthcare providers’ motivation to provide care closer to home, supporting system resource stewardship, site and practice compatibility, and motivation to strengthen tertiary-regional relationships. CONCLUSIONS Systematic enquiry of perceived barriers and enablers to implementation of TRaC-K helped us gain insights from various healthcare providers and family member’s perspectives. We will use these findings to design interventions to overcome the identified barriers and harness the enablers to encourage successful implementation of TRaC-K. These findings will inform the implementation of telemedicine-based interventions in pediatric settings in other parts of Canada and beyond. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s12913-018-3859-2

scholarly journals Investigating primary health care practitioners’ barriers and enablers to referral of COPD patients to Pulmonary Rehabilitation: an exploratory sequential mixed methods study using the Theoretical Domains Framework

2020 ◽  
Author(s):  
Jane Suzanne Watson ◽  
Rachel Elizabeth Jordan ◽  
Peymane Adab ◽  
Ivo Vlaev ◽  
Alexandra Enocson ◽  
...  
Keyword(s):  
Health Care ◽  
Pulmonary Rehabilitation ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Mixed Methods Study ◽  
Barriers And Enablers ◽  
Primary Health ◽  
Health Care Practitioners ◽  
Sequential Mixed Methods ◽  
Copd Patients

Abstract BackgroundPulmonary rehabilitation is a highly effective, globally recommended intervention for patients with Chronic Obstructive Pulmonary Disease (COPD). Understanding why referral rates remain persistently low is important and enables the development of targeted interventions in order to improve future uptake. MethodsWe undertook an exploratory sequential mixed methods study to investigate the referral practices of Primary Health Care Practitioners (PHCPs) in the United Kingdom (UK). In phase 1 semi structured interviews were undertaken. Content analysis was used to map arising themes to the Theoretical Domains Framework (TDF) and the development of a 54-item TDF based questionnaire.In Phase 2 we distributed the questionnaire through relevant conferences and organisation memberships, to obtain views from a larger, more generalisable PHCP population. We used descriptive analyses to identify the most important barriers and enablers, and key TDF domains. Mixing of data occurred at 2 time points; instrument design and interpretation. Results19 PHCP took part in interviews and 233 responded to the survey. Integrated results revealed that PHCPs with a post qualifying respiratory qualification (154/241; 63.9%) referred more frequently (91/154; 59.1%) than those without (28/87; 32.2%).There were more barriers than enablers for referral in all 13 mapped TDF domains. Key barriers included: infrequent engagement from PR provider to referrer, concern around patient’s physical ability and access to PR (particularly for those in work), assumed poor patient motivation, no clear practice referrer and few referral opportunities. These mapped to the following domains: belief about capabilities, social influences, environment, optimism, skills and social and professional role.Enablers to referral were observed within the knowledge, social influences memory and environment domains. Many PHCPs believed in the physical and psychological value of PR, and helpful enablers were out-of-practice support from respiratory interested colleagues, dedicated referral time (annual review) and on-screen referral prompts. ConclusionsReferral to PR is a complex process. Barriers outweighed enablers. Aligning these findings to behaviour change techniques will identify practice-based interventions to overcome current barriers and strengthen enablers, thereby increasing referral of COPD patients to PR as recommended by international COPD guidelines

scholarly journals Exploring perceived barriers and enablers to fidelity of training and delivery of an intervention to reduce imaging for low back pain: a qualitative interview study protocol

2021 ◽  
Vol 4 ◽  
pp. 49
Author(s):  
Daphne To ◽  
Diana De Carvalho ◽  
Andrea Pike ◽  
Holly Etchegary ◽  
Andrea Patey ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Controlled Trial ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Intervention Fidelity ◽  
Low Back ◽  
Barriers And Enablers ◽  
Qualitative Interview Study ◽  
The Impact

Background: Diagnostic imaging has limited utility in the assessment and management of non-specific low back pain (LBP), but remains commonly used in clinical practice. Interventions have been designed to reduce non-indicated imaging for LBP; however, evidence of effectiveness has been variable. It is unclear whether intervention fidelity was adequately assessed in these interventions, which may have an impact on the interpretation of trial results. Within implementation research, intervention fidelity refers to the degree to which an intervention was delivered as intended and to the strategies used to monitor and enhance this process. Intervention fidelity covers five domains: design, training, delivery, receipt, and enactment. Objectives: The objectives of this study are to explore perceived barriers and enablers to fidelity of training and delivery of a proposed theory-informed intervention aimed at reducing non-indicated imaging for LBP by general practitioners (GPs) and chiropractors in Newfoundland and Labrador (NL), Canada. Methods: Semi-structured interviews will be conducted with GPs and chiropractors in NL to explore their views on barriers and enablers towards enhancing and/or assessing fidelity of training and delivery. Interviews will be audio-recorded, transcribed verbatim, and analysed with the Theoretical Domains Framework. Relevant domains related to perceived barriers and enablers will be identified by: the frequency of beliefs; the presence of conflicting beliefs; and the perceived strength of the impact a belief may have on the target behaviours. Discussion: Results of this study will aid in the development of a fidelity protocol for an upcoming cluster randomised controlled trial of a theory-informed intervention aimed at reducing non-indicated imaging for LBP. Our results may help to ensure that the proposed intervention will be delivered with good fidelity and that fidelity can be appropriately assessed.

Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework

2020 ◽  
pp. bmjqs-2020-011793
Author(s):  
Ashika D Maharaj ◽  
Sue M Evans ◽  
John R Zalcberg ◽  
Liane J Ioannou ◽  
Marnie Graco ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Care ◽  
Multidisciplinary Team ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Environmental Context ◽  
Evidence Based ◽  
Common Belief ◽  
Barriers And Enablers ◽  
Belief Statements

BackgroundEvidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.Objectives(1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).MethodsSemistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.ResultsIn total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).ConclusionsThe internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.

scholarly journals “It’s the Attraction of Winning That Draws You In”—A Qualitative Investigation of Reasons and Facilitators for Videogame Loot Box Engagement in UK Gamers

2021 ◽  
Vol 10 (10) ◽  
pp. 2103
Author(s):  
Laura Nicklin ◽  
Stuart Gordon Spicer ◽  
James Close Close ◽  
Jonathan Parke ◽  
Oliver Smith ◽  
...  
Keyword(s):  
Thematic Analysis ◽  
Social Influences ◽  
Disordered Gambling ◽  
Qualitative Investigation ◽  
Contributing Factors ◽  
Research Priority ◽  
Potential Risks ◽  
Problematic Gambling ◽  
The Uk ◽  
Depth Interviews

Excessive engagement with (increasingly prevalent) loot boxes within games has consistently been linked with disordered gambling and/or gaming. The importance of recognising and managing potential risks associated with loot box involvement means understanding contributing factors is a pressing research priority. Given that motivations for gaming and gambling have been informative in understanding risky engagement with those behaviours, this qualitative study investigated motivations for buying loot boxes, through in-depth interviews with 28 gamers from across the UK. A reflexive thematic analysis categorised reasons for buying into seven “themes”; opening experience; value of box contents; game-related elements; social influences; emotive/impulsive influences; fear of missing out; triggers/facilitators. These themes are described in detail and discussed in relation to the existing literature and motivation theories. This study contributes to understanding ways in which digital items within loot boxes can be highly valued by purchasers, informing the debate around parallels with gambling. Findings that certain motivations were disproportionately endorsed by participants with symptoms of problematic gambling has potential implications for policy and warrants further study.

scholarly journals Perceived Barriers and Facilitators for Bedtime Routines in Families with Young Children

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 50
Author(s):  
George Kitsaras ◽  
Michaela Goodwin ◽  
Michael Kelly ◽  
Iain Pretty ◽  
Julia Allan
Keyword(s):  
Young Children ◽  
Social Role ◽  
Theoretical Domains Framework ◽  
Structured Interview ◽  
Perceived Barriers ◽  
Sources Of Information ◽  
Important Health ◽  
Motivation For Change ◽  
Past Experiences ◽  
Bedtime Routine

Objectives: Bedtime routines are a highly recurrent family activity with important health, social and behavioural implications. This study examined perceived barriers to, and facilitators of, formulating, establishing, and maintaining optimal bedtime routines in families with young children. Design: Participants completed a semi-structured interview based on the Theoretical Domains Framework (TDF). Analysis followed a deductive approach. Participants: A total of 32 parents participated in the study. Most participants (N = 30) were females, were white (N = 25) and stay at home parents (N = 12). Results: Key barriers included lack of appropriate knowledge and sources of information, problematic skills development, social influences, cognitive overload, and lack of motivation for change. Facilitators included social role, access to resources, positive intentions, beliefs about consequences and reinforcement. In particular, optimal bedtime routines were less likely to be enacted when parents were tired/fatigued and there was a strong effect of habit, with suboptimal routines maintained over time due to past experiences and a lack of awareness about the importance of a good bedtime routine. Conclusions: Several theory-based, and potentially modifiable, determinants of optimal bedtime routines were identified in this study, providing important information for future interventions. Several of the key determinants identified were transient (tiredness) and/or non-conscious (habit), suggesting that future interventions may need to be deployed in real time, and should extend beyond conventional techniques.

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