ORCID Profile
0000-0002-8770-4494
Current Organisations
Ottawa Hospital Research Institute
,
Queen's University
,
University of Ottawa
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Publisher: Springer Science and Business Media LLC
Date: 25-09-2017
Publisher: Springer Science and Business Media LLC
Date: 31-08-2012
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12998-019-0286-3
Abstract: Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. In idual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive s le of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise ( Environmental Context and Resources ) and consulting more experienced colleagues and chronic patients with important psychological overlay ( Social Influences ) . Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives ( Goals ), and chiropractors: confidence in using stratified care approaches ( Beliefs about Capabilities ) intention to use stratified care approaches ( Intentions ) awareness and agreement with stratified care approaches ( Knowledge ) assessment of readiness for change and intentional planning behaviour ( Behavioural Regulation ) and improving the management of non-specific LBP patients and the uptake of evidence-based practice ( Beliefs about Consequences ). Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice.
Publisher: Springer Science and Business Media LLC
Date: 09-06-2012
Publisher: Elsevier BV
Date: 07-2023
Publisher: Informa UK Limited
Date: 15-07-2023
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.IJNURSTU.2019.103503
Abstract: Venous leg ulcers represent the most common chronic wound problem managed in Australian primary care. Despite the prevalence of the condition, there is an evidence-practice gap in both diagnosis and management of venous leg ulcers. We used the Theoretical Domains Framework to identify barriers and enablers perceived by primary care practitioners in implementing venous leg ulcer guidelines in clinical practice. We collected data to explore the experiences of practice nurses and general practitioners related to their use of clinical practice guidelines in management of venous leg ulcers. We recruited participants from primary care settings located in metropolitan and rural areas across Victoria, Australia. We recruited general practitioners (15) and practice nurses (20). We conducted 35 semi-structured face-to-face and telephone interviews. Content analysis of health practitioners' statements was performed and barriers to implementing clinical practice guidelines were mapped across the Theoretical Domains Framework theoretical domains. Six main domains from the Theoretical Domains Framework (Environmental context and resources, Knowledge, Skills, Social influences, Social/Professional Role and Identity and Belief about Capabilities) best explained these barriers and enablers. Many participants were not aware of venous leg ulcer clinical practice guidelines. Those that were aware, stated that finding and accessing guidelines was challenging and most participants relied on other sources of information. Venous leg ulcer management was greatly influenced by professional experience and suggestions from colleagues. Other barriers included busy clinical practice, absence of handheld Doppler ultrasonography, insufficient skills and a lack of confidence related to the use of technology to rule out arterial involvement prior to compression application, a particular skill related to venous leg ulcer management that will impact on healing outcomes. We identified a number of barriers and the lack of enablers that influence the uptake of venous leg ulcer clinical practice guidelines in primary care. This paper adds a theoretically sound, systematic approach for understanding and addressing the behaviour change required to improve translation of venous leg ulcer clinical practice guidelines in clinical practice. Tweetable abstract: The need to optimise venous leg ulcer clinical practice guidelines (CPG) has never been greater as the current estimate of health cost is AUD3billion and increasing due to rising epidemics of diabetes and obesity. We found most primary care health practitioners are unaware of CPG and this will impact on health and healing outcomes in Australian primary care.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2017
Publisher: Springer Science and Business Media LLC
Date: 25-02-2021
DOI: 10.1186/S13012-021-01089-0
Abstract: Decreasing ineffective or harmful healthcare practices (de-implementation) may require different approaches than those used to promote uptake of effective practices (implementation). Few psychological theories differentiate between processes involved in decreasing, versus increasing, behaviour. However, it is unknown whether implementation and de-implementation interventions already use different approaches. We used the behaviour change technique (BCT) taxonomy (version 1) (which includes 93 BCTs organised into 12 groupings) to investigate whether implementation and de-implementation interventions for clinician behaviour change use different BCTs. Intervention descriptions in 181 articles from three systematic reviews in the Cochrane Library were coded for (a) implementation versus de-implementation and (b) intervention content (BCTs) using the BCT taxonomy (v1). BCT frequencies were calculated and compared using Pearson’s chi-squared ( χ 2 ), Yates’ continuity correction and Fisher’s exact test, where appropriate. Identified BCTs were ranked according to frequency and rankings for de-implementation versus implementation interventions were compared and described. Twenty-nine and 25 BCTs were identified in implementation and de-implementation interventions respectively. Feedback on behaviour was identified more frequently in implementation than de-implementation ( Χ 2 (2, n =178) = 15.693, p = .000057). Three BCTs were identified more frequently in de-implementation than implementation: Behaviour substitution ( Χ 2 (2, n =178) = 14.561, p = .0001 Yates’ continuity correction) Monitoring of behaviour by others without feedback ( Χ 2 (2, n =178) = 16.187, p = .000057 Yates’ continuity correction) and Restructuring social environment ( p = .000273 Fisher’s 2-sided exact test). There were some significant differences between BCTs reported in implementation and de-implementation interventions suggesting that researchers may have implicit theories about different BCTs required for de-implementation and implementation. These findings do not imply that the BCTs identified as targeting implementation or de-implementation are effective, rather simply that they were more frequently used. These findings require replication for a wider range of clinical behaviours. The continued accumulation of additional knowledge and evidence into whether implementation and de-implementation is different will serve to better inform researchers and, subsequently, improve methods for intervention design.
Publisher: Springer Science and Business Media LLC
Date: 29-10-2018
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Andrea Patey.