scholarly journals Improving case detection of tuberculosis in hospitalised Kenyan children– employing the Behaviour Change Wheel to aid intervention design and implementation

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Jacinta Nzinga ◽  
Enos Masini ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Audit And Feedback ◽  
Case Detection ◽  
Intervention Package ◽  
Stimulate Action ◽  
Behaviour Change Wheel ◽  
Tuberculosis In Children

Abstract Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.Methods We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included: i) what is the problem we are trying to solve; ii) what behaviours are we trying to change and in what way; iii) what will it take to bring about desired change; iv) what types of interventions are likely to bring about desired change; v) what should be the specific intervention content and how should this be implemented?Results The following behaviour change intervention functions were identified: i) training: imparting practical skills; ii) modelling: providing an example for people to aspire/imitate; iii) persuasion: using communication to induce positive or negative feelings or stimulate action; iv) environmental restructuring: changing the physical or social context; and v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and work flow restructuring with role specification.Conclusion The intervention components were selected for their effectiveness (from literature), affordability, acceptability and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.

scholarly journals Improving case detection of tuberculosis in hospitalised Kenyan children—employing the behaviour change wheel to aid intervention design and implementation

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Jacinta Nzinga ◽  
Enos Masini ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Audit And Feedback ◽  
Case Detection ◽  
Intervention Package ◽  
Stimulate Action ◽  
Behaviour Change Wheel ◽  
Tuberculosis In Children

Abstract Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya, and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 GeneXpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel. Methods We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included (i) what is the problem we are trying to solve; (ii) what behaviours are we trying to change and in what way; (iii) what will it take to bring about desired change; (iv) what types of interventions are likely to bring about desired change; (v) what should be the specific intervention content and how should this be implemented? Results The following behaviour change intervention functions were identified as follows: (i) training: imparting practical skills; (ii) modelling: providing an example for people to aspire/imitate; (iii) persuasion: using communication to induce positive or negative feelings or stimulate action; (iv) environmental restructuring: changing the physical or social context; and (v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and workflow restructuring with role specification. Conclusion The intervention components were selected for their effectiveness (from literature), affordability, acceptability, and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.

scholarly journals Improving case detection of tuberculosis in hospitalised Kenyan children– employing the Behaviour Change Wheel to aid intervention design and implementation

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Jacinta Nzinga ◽  
Enos Masini ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Audit And Feedback ◽  
Case Detection ◽  
Intervention Package ◽  
Stimulate Action ◽  
Behaviour Change Wheel ◽  
Tuberculosis In Children

Abstract Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 Xpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.Methods We used an iterative process, going back and forth from quantitative and qualitative empiric data to reviewing literature, and applying the Behaviour Change Wheel guide. The key questions reflected on included: i) what is the problem we are trying to solve; ii) what behaviours are we trying to change and in what way; iii) what will it take to bring about desired change; iv) what types of interventions are likely to bring about desired change; v) what should be the specific intervention content and how should this be implemented?Results The following behaviour change intervention functions were identified: i) training: imparting practical skills; ii) modelling: providing an example for people to aspire/imitate; iii) persuasion: using communication to induce positive or negative feelings or stimulate action; iv) environmental restructuring: changing the physical or social context; and v) education: increasing knowledge or understanding. The process resulted in a multi-faceted intervention package composed of redesigning of child tuberculosis training; careful selection of champions; use of audit and feedback linked to group problem solving; and work flow restructuring with role specification.Conclusion The intervention components were selected for their effectiveness (from literature), affordability, acceptability and practicability and designed so that TB programme officers and hospital managers can be supported to implement them with relative ease, alongside their daily duties. This work contributes to the field of implementation science by utilising clear definitions and descriptions of underlying mechanisms of interventions that will guide others to do likewise in their settings for similar problems.

scholarly journals Improving case detection of tuberculosis in hospitalised Kenyan children– employing the Behaviour Change Wheel to aid intervention design and implementation

2020 ◽  
Author(s):  
Jacquie Narotso Oliwa ◽  
Jacinta Nzinga ◽  
Enos Masini ◽  
Michaël Boele van Hensbroek ◽  
Caroline Jones ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Case Detection ◽  
Design And Implementation ◽  
Behaviour Change Wheel ◽  
National Tuberculosis ◽  
Tuberculosis Programme ◽  
Tuberculosis In Children

Abstract Background The true burden of tuberculosis in children remains unknown, but approximately 65% go undetected each year. Guidelines for tuberculosis clinical decision-making are in place in Kenya and the National Tuberculosis programme conducts several trainings on them yearly. By 2018, there were 183 Xpert® machines in Kenyan public hospitals. Despite these efforts, diagnostic tests are underused and there is observed under detection of tuberculosis in children. We describe the process of designing a contextually appropriate, theory-informed intervention to improve case detection of TB in children and implementation guided by the Behaviour Change Wheel.

Cross-cultural Application of Behaviour Therapy

1991 ◽  
Vol 8 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Nick Higginbotham ◽  
Juriko Tanaka-Matsumi
Keyword(s):  
Decision Making ◽  
Behaviour Change ◽  
Potential Application ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cross Cultural ◽  
Cultural Norms ◽  
Behaviour Therapy ◽  
Norms And Values ◽  
Functional Analyses

The potential application of behaviour therapy to cross-cultural situations is explored as societies move to recognise their bicultural or multicultural composition. First reviewed are the moral and epistemological underpinnings of behaviour therapy and questions involving the universality of behaviour principles and technologies. Expected competencies of cross-cultural therapists are next raised. The basic message, told through examples from Australia, North American, and elsewhere, is that cultural norms and values penetrate every facet of client–therapist interaction and clinical decision-making. Competently performed functional analyses can produce culturally accommodating interventions that respond to culture-specific definitions of deviancy, accepted norms of role behaviour, expectations of change techniques, and approved behaviour change practitioners.

scholarly journals 35. Acceptability of Proposed Stewardship Interventions to Reduce Preoperative Screening and Treatment of Asymptomatic Bacteriuria

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
Kimberly Dukes ◽  
Julia Walhof ◽  
Madisen Brown ◽  
Kalpana Gupta ◽  
Judith Strymish ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Asymptomatic Bacteriuria ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Structured Interviews ◽  
Research Support ◽  
Independent Contractor ◽  
Urine Screening ◽  
Urine Testing

Abstract Background In 2019, the IDSA Clinical Practice guidelines on asymptomatic bacteriuria (ASB) recommended that clinicians no longer screen or treat patients for ASB before non-urological surgeries. However, it remains to be seen whether these guideline recommendations alone will produce changes in practice. Understanding clinical decision-making about preoperative urine screening and treatment can help design effective interventions to facilitate guideline concordance and support antibiotic stewardship. Our project objective was to qualitatively assess barriers and facilitators to reducing preoperative urine testing and treatment. Methods We conducted semi-structured interviews with 24 participants (surgeons, advance practice providers, pharmacists, infectious disease physicians, epidemiologists) at 4 Veterans Administration hospitals. We solicited feedback on 4 proposed interventions (substitution, lab restrictions, audit and feedback, interactive workshop), and invited suggestions on other interventions. Three researchers separately coded 20% of interview notes to sort responses to each intervention into acceptable, possibly acceptable, and not acceptable. The team then compared coding, resolved differences by consensus, and refined the code dictionary to ensure intercoder agreement; then each member coded one third of remaining notes. Results Participants expressed concerns about de-implementing routine urine testing and treatment for specific procedures and specialties (e.g., cardiothoracic). Some actively sought to identify and treat ASB. Participants found audit and feedback and substitution of different infection-control practices most acceptable. Participants suggested changes to make interventions more acceptable or feasible (e.g., tailoring to procedure, educational tailoring). Participants also identified new potential interventions (e.g. order set changes, collaborative decision making, education on potential harms, identification of testing costs). Table 1. Acceptability of Proposed Interventions by Percentage of Participants. Percentages Do Not Add up to 100% Because Some Interviewees Did Not Answer Every Question. Conclusion Interventions to optimize urine screening and treatment for patients undergoing surgeries may require tailoring for surgical specialties, and should address clinical concerns about intervention feasibility. Disclosures Kalpana Gupta, MD, MPH, Abbott (Shareholder)DBC Pri-Med (Consultant)Glaxo Smith Kline (Consultant)Moderna (Shareholder)Nabriva Therapeutics (Consultant)Pfizer (Other Financial or Material Support, Grant to the institution)Qiagen (Consultant)Rebiotix (Consultant)Spero Therapeutics (Consultant)Utility Therapeutics (Consultant) Daniel Suh, MS MPH, General Electric (Shareholder)Merck (Shareholder)Moderna (Shareholder)Smile Direct Club (Shareholder) Bruce Alexander, PharmD, Bruce Alexander Consulting (Independent Contractor) Marin Schweizer, PhD, 3M (Grant/Research Support)PDI (Grant/Research Support)

scholarly journals Implementation of evidence-based practice: The experience of nurses and midwives

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256600
Author(s):  
Asrat Hailu Dagne ◽  
Mekonnen Haile Beshah
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Evidence Based ◽  
Limited Support ◽  
Research Findings ◽  
Nurses And Midwives ◽  
And Training

Background Implementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore the implementation of evidence-based practice of nurses and midwives working in public hospitals. Methods A qualitative descriptive study was conducted to explore the experience of implementing evidence-based practice among nurses and midwives working in public hospitals. A total of 86 participants, of which, 25 in-depth interviews, 5 FGDs having 47 participants and 14 participants were involved during observations, were considered in Amhara Region public hospitals from November 17, 2019 to April 25, 2020. The observational data, interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. Results Nurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives. The lack of knowledge and skill to use evidence like research findings, time mismanagement, the lack of motivation, the lack of resources and training were the perceived barriers to the implementation of evidence-based practice. Stick to the traditional practice due to lack of incentive and unclear job description between diploma and BSc nurses and midwives were the perceived causes of the lack of motivation. Conclusions The experience of evidence-based practice of nurses and midwives indicated that there was limited support for the implementation of evidence-based practice. However, research findings were rarely used in clinical decision-making practice The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation were the barriers to the implementation of evidence-based practice. Therefore, the promotion of adopting the implementation of evidence-based practice and training on the identified barriers are mandatory.

scholarly journals Research utilisation in clinical practice: the experience of nurses and midwives working in public hospitals

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Asrat Hailu Dagne ◽  
H. /Mariam Demewozu Tebeje
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Public Hospitals ◽  
Perceived Barriers ◽  
Research Utilisation ◽  
Limited Support ◽  
Research Findings ◽  
Nurses And Midwives

Abstract Background Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, limited support for research utilisation and barriers of research utilisation hamper to utilise up-to-date research findings in clinical practice. Therefore, this study aimed to explore nurses’ and midwives’ experience of research utilisation in public hospitals. Methods A qualitative descriptive approach was conducted to explore nurses’ and midwives’ experience of research utilisation in clinical practice within South Gondar Zone public hospitals from January 3 to June 28, 2020. A total of 20 interviewees, 40 participants of FGDs, and 8 observations were considered in the study. Data from the interview, FGD, and observation were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis. Results Nurses’ and midwives’ experience of using research findings in clinical decision-making emerged as “the non-intentional research utilisation” the main theme. Data analysis produced as “the belief towards research utilisation”, “the limited support for nurses and midwives”, and, “the perceived barriers of research utilisation” as the three themes. Participants believed that the non-use of the primary research was recommended due to fear of accountability for client harm. The limited support for nurses’ and midwives’ experience of research utilisation decrease nurses’ and midwives’ confidence to utilise research in clinical practice. Knowledge, attitude, time mismanagement, and the lack of motivation were perceived barriers to research utilisation. The lack of training and access to systematic review and meta-analysis research findings limited the research utilisation in clinical practice. Conclusions The experience of research utilisation indicated that there was limited support for nurses and midwives to utilise research. Nurses and midwives did not utilise research in their clinical practice intentionally. This study identified that knowledge, negative attitude towards research utilisation, lack of training; time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory. Plain English summary Nurses and midwives play a vital role to utilise research in clinical decision-making practice. However, the limited support for research utilisation and barriers of research utilisation hamper the utilisation of up-to-date research in clinical practice. Therefore, this study aimed to explore nurses’ and midwives’ experience of using the knowledge obtained from research findings in clinical and healthcare decision-making practice within public hospitals. The experience of research utilisation among nurses and midwives working in public hospitals was studied. There was limited support for nurses’ and midwives’ experience of research utilisation. Nurses and midwives did not utilise research in their clinical practice intentionally. The knowledge, negative attitude towards research utilisation, lack of training, time mismanagement, and lack of motivation were the perceived barriers to research utilisation. Therefore, the promotion of adopting the research utilisation and training on the identified barriers are mandatory.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

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