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 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 Protocol for assessing the determinants of preoperative test-ordering behaviour for low-risk surgical procedures using a theoretically driven, qualitative design

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036511
Author(s):  
Andrea Pike ◽  
Krista Mahoney ◽  
Andrea M Patey ◽  
Samantha Inwood ◽  
Sameh Mortazhejri ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Healthcare Providers ◽  
Theoretical Domains Framework ◽  
Low Risk ◽  
Current Evidence ◽  
X Rays ◽  
Plain Language ◽  
Preoperative Testing ◽  
Barriers And Enablers ◽  
Preoperative Test

IntroductionCurrent evidence suggests that preoperative tests such as chest X-rays, electrocardiograms and baseline laboratory studies may not be useful for healthy patients undergoing low-risk surgical procedures. Routine preoperative testing for healthy patients having low-risk surgery is not a scientifically sound practice. In this study, we will interview healthcare providers working at medical facilities where low-risk surgical procedures are carried out. This will allow us to gain insight into the determinants of preoperative testing behaviours for healthy patients undergoing low-risk surgeries and their barriers and enablers to guideline adherence.Methods and analysisWe will use semistructured interviews with anaesthesiologists, surgeons and preadmission clinic nurses to assess the determinants of preoperative testing behaviours. The interview guide was designed around the Theoretical Domains Framework (TDF), developed specifically to determine the barriers and enablers to implementing evidence-based guidelines. Interviews will be audio-recorded, transcribed verbatim and coded according to the TDF. Key themes will be generated for each of the identified domains.Ethics and disseminationWe have received ethics approval from the Health Research Ethics Board in Newfoundland and Labrador (HREB #2018.190) for this study. The results of this work will be disseminated through a peer-reviewed publication, presentation at a healthcare forum and plain-language infographic summaries. Additionally, deidentified data collected and analysed for this study will be available for review from the corresponding author on reasonable request.

scholarly journals Factors Influencing the Uptake of Canadian Research Findings into the Care of Children with Arthritis: A Healthcare Provider Perspective

2018 ◽  
Vol 46 (3) ◽  
pp. 294-300 ◽  
Author(s):  
Benjamin Rose-Davis ◽  
Janet Curran ◽  
Julia Wright ◽  
Tania Cellucci ◽  
Ciarån M. Duffy ◽  
...  
Keyword(s):  
Clinical Care ◽  
Healthcare Providers ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Primary Role ◽  
Comprehensive Overview ◽  
Allied Health Professionals ◽  
Translation Strategies ◽  
Telephone Interviews ◽  
Knowledge Translation Strategies

Objective.To determine barriers and facilitators to the uptake of findings from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) study into clinical care by pediatric rheumatologists (PR) and allied health professionals (AHP) caring for children with juvenile idiopathic arthritis (JIA) in Canada.Methods.PR and AHP participated in this qualitative study through telephone interviews. Interview guides were developed using the Theoretical Domains Framework and focused on the use of information from the ReACCh-Out study in the practice of counseling patients and families. A directed content analysis approach was used for coding.Results.Nineteen interviews (8 PR and 11 AHP) were completed. All PR had knowledge of the ReACCh-Out study. Three major themes were identified: (1) both groups are motivated to use information from research in clinical care; (2) volume and emotional effect of information on families are barriers; and (3) specific timepoints in care trigger providing this information. AHP had less knowledge of the ReACCh-Out study, did not feel it was their primary role to provide this information, and have a desire for more opportunity to participate in academic forums related to research.Conclusion.We have described a comprehensive overview of the barriers and facilitators perceived by healthcare providers in the translation of knowledge from JIA research into use in clinical practice. These findings provide a foundation for the development of knowledge translation strategies in the care of children with JIA and other rheumatic diseases.

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.

scholarly journals Exploring Barriers and Enablers to Dietitians Completing Body Composition Assessments as Part of Routine Clinical Care 

2020 ◽  
Author(s):  
Chloe Jobber ◽  
Shelley Wilkinson ◽  
Elyssa Hughes ◽  
Fiona Nave ◽  
Barbara van der Meij
Keyword(s):  
Body Composition ◽  
Clinical Care ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Implementation Process ◽  
Routine Practice ◽  
Muscle Loss ◽  
Body Composition Assessment ◽  
Knowledge To Action ◽  
Barriers And Enablers

Abstract Background: Malnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). However, limited literature exists regarding integration of BCA into routine practice. This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.Methods:Applying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians in our department. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel. Results:Twenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement. Conclusions:This study showed that hospital dietitians experience numerous individual, team, and organisational barriers to adopt BCAs in clinical practice. Information on barriers and enablers and implementation strategies have been suggested to overcome these barriers to assist BCA adoption into routine practice.

scholarly journals Perceived Barriers to COVID-19 Testing

2021 ◽  
Vol 18 (5) ◽  
pp. 2278
Author(s):  
Pearl A. McElfish ◽  
Rachel Purvis ◽  
Laura P. James ◽  
Don E. Willis ◽  
Jennifer A. Andersen
Keyword(s):  
Analytical Approach ◽  
Nasal Swab ◽  
Healthcare Providers ◽  
Research Participant ◽  
Perceived Barriers ◽  
Lower Income ◽  
The Us ◽  
Qualitative Descriptive ◽  
Descriptive Method ◽  
Background Prior

(1) Background: Prior studies have documented that access to testing has not been equitable across all communities in the US, with less testing availability and lower testing rates documented in rural counties and lower income communities. However, there is limited understanding of the perceived barriers to coronavirus disease 2019 (COVID-19) testing. The purpose of this study was to document the perceived barriers to COVID-19 testing. (2) Methods: Arkansas residents were recruited using a volunteer research participant registry. Participants were asked an open-ended question regarding their perceived barriers to testing. A qualitative descriptive analytical approach was used. (3) Results: Overall, 1221 people responded to the open-ended question. The primary barriers to testing described by participants were confusion and uncertainty regarding testing guidelines and where to go for testing, lack of accessible testing locations, perceptions that the nasal swab method was too painful, and long wait times for testing results. (4) Conclusions: This study documents participant reported barriers to COVID-19 testing. Through the use of a qualitative descriptive method, participants were able to discuss their concerns in their own words. This work provides important insights that can help public health leaders and healthcare providers with understanding and mitigating barriers to COVID-19 testing.

scholarly journals The failure of community-based health insurance schemes in Tanzania: opening the black box of the implementation process

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ramadhani Kigume ◽  
Stephen Maluka
Keyword(s):  
Health Insurance ◽  
Community Health ◽  
Rural Areas ◽  
Health Coverage ◽  
Access To Health Services ◽  
Community Based ◽  
Community Based Health Insurance ◽  
Urban Districts ◽  
Health Fund ◽  
The Government

Abstract Background Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study investigated the implementation of TIKA scheme in urban districts of Tanzania. Methods A descriptive qualitative case study was conducted in four urban districts in Tanzania in 2019. Data were collected using semi-structured interviews, focus group discussions and review of documents. A thematic approach was used to analyse the data. Results While TIKA scheme was important in increasing access to health services for the poor and other disadvantaged groups, it faced many challenges which hindered its performance. The challenges included frequent stock-out of drugs and medical supplies, which frustrated TIKA members and hence contributed to non-renewal of membership. In addition, the scheme was affected by poor collections and management of the revenue collected from TIKA members, limited benefit packages and low awareness of the community. Conclusions Similar to rural-based Community Health Fund, the TIKA scheme faced structural and operational challenges which subsequently resulted into low uptake of the schemes. In order to achieve universal health coverage, the government should consider integrating or merging Community-Based Health Insurance schemes into a single national pool with decentralised arms to win national support while also maintaining local accountability.

scholarly journals What is stopping us? An implementation science study of kangaroo care in British Columbia’s neonatal intensive care units

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Coutts ◽  
Alix Woldring ◽  
Ann Pederson ◽  
Julie De Salaberry ◽  
Horacio Osiovich ◽  
...  
Keyword(s):  
Intensive Care ◽  
Healthcare Provider ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Healthcare Providers ◽  
Neurodevelopmental Outcomes ◽  
Kangaroo Care ◽  
Optimal Care ◽  
Barriers And Enablers ◽  
Provider Beliefs

Abstract Background The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers’ perspectives on the barriers and enablers of implementing KC. Methods This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. Results Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. Conclusions A ‘one size fits all’ approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.

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