scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Majority Vote ◽  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Social Identities ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors and structures of power, offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. The modified Delphi involved two rounds of online voting followed by a final majority vote. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. By considering the role of intersecting social factors when selecting, tailoring, and implementing KT interventions, they may become more effective.

scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Majority Vote ◽  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Social Identities ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors and structures of power, offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. The modified Delphi involved two rounds of online voting followed by a final majority vote. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. By considering the role of intersecting social factors when selecting, tailoring, and implementing KT interventions, they may become more effective.

scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Interventions ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Interventions ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

scholarly journals Applying an intersectionality lens to the Theoretical Domains Framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

2020 ◽  
Author(s):  
Nicole Etherington ◽  
Isabel Braganca Rodrigues ◽  
Lora Giangregorio ◽  
Ian D. Graham ◽  
Alison M Hoens ◽  
...  
Keyword(s):  
Theoretical Domains Framework ◽  
Implementation Process ◽  
Barriers And Facilitators ◽  
Implementation Barriers ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Effective Interventions ◽  
Novel Approach ◽  
Interdisciplinary Framework ◽  
Context Shapes

Abstract Background: A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods: An interdisciplinary Framework Committee (n=17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the and its domains TDF. An iterative approach aimed at building consensus was used to finalize recommendations.Results: Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality-enhanced TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions: Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.

Important implementation constructs for federal agencies in health and human service settings that are selecting, monitoring, and supporting grantees

2020 ◽  
Vol 16 (3) ◽  
pp. 375-392
Author(s):  
Allison Dymnicki ◽  
Robin Bzura ◽  
David Osher ◽  
Abraham Wandersman ◽  
Dan Duplantier ◽  
...  
Keyword(s):  
Literature Review ◽  
Human Service ◽  
Implementation Process ◽  
Science Research ◽  
Federal Agencies ◽  
Routine Practice ◽  
Successful Implementation ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Areas Of Interest

Background:Federal agencies and other funders seeking to maximise their impact aim to understand factors associated with implementing evidence-based interventions (EBIs) to address health problems. Challenges exist, however, in synthesising information from different disciplines and reaching agreement about these factors due to different terminology, frameworks, and measures being used in different fields. Methods:A mixed-methods approach was used to identifying a set of implementation constructs helpful for selecting, monitoring, and supporting federal grantees in health and human service settings. Three phases of research were conducted: a literature review, structured expert interviews, and consensus building. Interviews with implementation experts were used to validate a set of implementation constructs identified in the literature review as strongly and consistently related to successful implementation of EBIs in international contexts. A modified Delphi approach was used with a technical working group (TWG) of federal staff to agree on the constructs most relevant for federally funded EBIs. Findings:This process yielded 11 constructs related to either the intervention, the intersection between the invention and context, or the implementation process. These constructs are areas of interest when integrating research evidence into routine practice. Expert interviewees recommended establishing clear, consistent construct definitions before developing valid, feasible measures of the constructs. In contrast to the numerous and specific constructs advanced by researchers, federal TWG members favoured fewer constructs with more generalisability. Discussion and conclusions:This article demonstrates the translation work required for policy contexts and highlights a successful approach to translate evidence from implementation science research for federal staff.

scholarly journals Consensus-based approach to managing opioids, including opioid misuse and opioid use disorder, in patients with serious illness: protocol for a modified Delphi process

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045402
Author(s):  
Caroline King ◽  
Robert Arnold ◽  
Emily Dao ◽  
Jennifer Kapo ◽  
Jane Liebschutz ◽  
...  
Keyword(s):  
Palliative Care ◽  
Opioid Therapy ◽  
Opioid Use Disorder ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Serious Illness ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Institutional Review ◽  
Management Guidance

IntroductionManagement of opioid misuse and opioid use disorder (OUD) among individuals with serious illness is an important yet understudied issue. Palliative care clinicians caring for individuals with serious illness, many of whom may live for months or years, describe a complex tension between weighing the benefits of opioids, which are considered a cornerstone of pain management in serious illness, and serious opioid-related harms like opioid misuse and OUD. And yet, little literature exists to inform the management of opioid misuse and OUDs among individuals with serious illness. Our objective is to provide evidence-based management guidance to clinicians caring for individuals with serious illness who develop opioid misuse or OUD.Methods and analysisWe chose a modified Delphi approach, which is appropriate when empirical evidence is lacking and expert input must be used to shape clinical guidance. We sought to recruit 60 clinicians with expertise in palliative care, addiction or both to participate in this study. We created seven patient cases that capture important management challenges in individuals with serious illness prescribed opioid therapy. We used ExpertLens, an online platform for conducting modified Delphi panels. Participants completed three rounds of data collection. In round 1, they rated and commented on the appropriateness of management choices for cases. In round 2, participants reviewed and discussed their own and other participants’ round 1 numerical responses and comments. In round 3 (currently ongoing), participants again reviewed rounds 1 and 2, and are allowed to change their final numerical responses. We used ExpertLens to automatically identify whether there is consensus, or disagreement, among responses in panels. Only round 3 responses will be used to assess final consensus and disagreement.Ethics and disseminationThis project received ethical approval from the University of Pittsburgh’s Institutional Review Board (study 19110301) and the RAND Institutional Research Board (study 2020-0142). Guidance from this work will be disseminated through national stakeholder networks to gain buy-in and endorsement. This study will also form the basis of an implementation toolkit for clinicians caring for individuals with serious illness who are at risk of opioid misuse or OUD.

scholarly journals Building a neuroinfectious disease consensus curriculum

Neurology ◽  
2019 ◽  
Vol 93 (5) ◽  
pp. 208-216
Author(s):  
Arun Venkatesan ◽  
Felicia C. Chow ◽  
Allen Aksamit ◽  
Russell Bartt ◽  
Thomas P. Bleck ◽  
...  
Keyword(s):  
American Academy ◽  
Delphi Technique ◽  
Fellowship Training ◽  
Consensus Process ◽  
Diverse Range ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Modified Delphi Technique ◽  
Comprehensive Curriculum ◽  
American Academy Of Neurology

ObjectiveTo delineate a comprehensive curriculum for fellowship training in neuroinfectious diseases, we conducted a modified Delphi approach to reach consensus among 11 experts in the field.MethodsThe authors invited a diverse range of experts from the American Academy of Neurology Neuro-Infectious Diseases (AAN Neuro-ID) Section to participate in a consensus process using a modified Delphi technique.ResultsA comprehensive list of topics was generated with 101 initial items. Through 3 rounds of voting and discussion, a curriculum with 83 items reached consensus.ConclusionsThe modified Delphi technique provides an efficient and rigorous means to reach consensus on topics requiring expert opinion. The AAN Neuro-ID section provided the pool of diverse experts, the infrastructure, and the community through which to accomplish the consensus project successfully. This process could be applied to other subspecialties and sections at the AAN.

scholarly journals Data-driven approach for tailoring facilitation strategies to overcome implementation barriers in community pharmacy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Lydia Moussa ◽  
Shalom Benrimoj ◽  
Katarzyna Musial ◽  
Simon Kocbek ◽  
Victoria Garcia-Cardenas
Keyword(s):  
Random Forest ◽  
Community Pharmacy ◽  
Implementation Research ◽  
Theoretical Domains Framework ◽  
Professional Services ◽  
Data Driven ◽  
Machine Learning Techniques ◽  
Community Pharmacies ◽  
Continuous Change ◽  
Implementation Barriers

Abstract Background Implementation research has delved into barriers to implementing change and interventions for the implementation of innovation in practice. There remains a gap, however, that fails to connect implementation barriers to the most effective implementation strategies and provide a more tailored approach during implementation. This study aimed to explore barriers for the implementation of professional services in community pharmacies and to predict the effectiveness of facilitation strategies to overcome implementation barriers using machine learning techniques. Methods Six change facilitators facilitated a 2-year change programme aimed at implementing professional services across community pharmacies in Australia. A mixed methods approach was used where barriers were identified by change facilitators during the implementation study. Change facilitators trialled and recorded tailored facilitation strategies delivered to overcome identified barriers. Barriers were coded according to implementation factors derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Tailored facilitation strategies were coded into 16 facilitation categories. To predict the effectiveness of these strategies, data mining with random forest was used to provide the highest level of accuracy. A predictive resolution percentage was established for each implementation strategy in relation to the barriers that were resolved by that particular strategy. Results During the 2-year programme, 1131 barriers and facilitation strategies were recorded by change facilitators. The most frequently identified barriers were a ‘lack of ability to plan for change’, ‘lack of internal supporters for the change’, ‘lack of knowledge and experience’, ‘lack of monitoring and feedback’, ‘lack of individual alignment with the change’, ‘undefined change objectives’, ‘lack of objective feedback’ and ‘lack of time’. The random forest algorithm used was able to provide 96.9% prediction accuracy. The strategy category with the highest predicted resolution rate across the most number of implementation barriers was ‘to empower stakeholders to develop objectives and solve problems’. Conclusions Results from this study have provided a better understanding of implementation barriers in community pharmacy and how data-driven approaches can be used to predict the effectiveness of facilitation strategies to overcome implementation barriers. Tailored facilitation strategies such as these can increase the rate of real-time implementation of innovations in healthcare, leading to an industry that can confidently and efficiently adapt to continuous change.

scholarly journals Selecting contextually appropriate performance indicators in a circumpolar context: a modified Delphi approach

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rebecca Rich ◽  
Thomsen D’Hont ◽  
Kellie E. Murphy ◽  
Jeremy Veillard ◽  
Susan Chatwood
Keyword(s):  
Child Health ◽  
Performance Measurement ◽  
Performance Indicators ◽  
Maternity Care ◽  
Cultural Safety ◽  
Determinants Of Health ◽  
Maternal Child Health ◽  
Modified Delphi ◽  
Delphi Approach ◽  
Maternal Child

Abstract Background Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions. Methods Fourteen maternity care and health systems experts participated in a modified Delphi consensus process. The list of proposed indicators was derived from a previously published scoping review. Fourteen participants rated each proposed indicator according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration. Results Consensus was achieved after two rounds, as measured by a Cronbach’s alpha of 0.87. Eleven indicators, many of which represented physical health outcomes, were ranked highly on all four criteria. Twenty-nine additional indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Travel for care, cultural safety and upstream structural determinants of health were identified as important themes. Conclusions This study identified the important gaps between current performance measurement strategies and the context and values that permeate maternal-child health in circumpolar regions. The indicators identified in this study provide an important foundation for ongoing work. We recommend that future work encompass an appreciation for the intersectoral nature of social, structural, and colonial determinants of maternal-child health in circumpolar regions.

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