Older adults living with frailty have increased healthcare needs, but require accurate identification for optimal care; nurses’ screening practice is unclear. This cross-sectional survey explored nurses’ frailty screening practices and barriers/facilitators in acute care. Descriptive statistics were generated from 5-point frequency and 101-point scales of frailty screening methods; practice areas were compared using linear regression. Means for barriers and facilitators were generated from a 43-item 6-point Likert-type Theoretical Domains Framework questionnaire. Respondents (n = 228) reported “usually” screening by clinical impression (median = 4, interquartile range = 4-5) and preferring it to formal frailty tools (M = 67.1, SD = 25.7). Practice area influenced general frailty screening (B = 0.81, r = .31, p < .001). The top barrier was belief conducting frailty screening was routine (M = 2.68, SD = 1.42, p > .05). Frailty screening tools supporting clinical judgement and embedded into routine have greater likelihood for uptake.

Yes / Understanding the factors that make it more or less likely that healthcare practitioners (HCPs) will perform certain patient safety behaviors is important in developing effective intervention strategies. A questionnaire to identify determinants of HCP patient safety behaviors does not currently exist. This study reports the development and initial validation of the Influences on Patient Safety Behaviors Questionnaire (IPSBQ) based on the Theoretical Domains Framework. Methods: Two hundred and thirty-three HCPs from three acute National Health Service Hospital Trusts in the United Kingdom completed the 34-item measure focusing on one specific patient safety behavior (using pH as the first line method for checking the position of a nasogastric tube). Confirmatory factor analysis (CFA) was undertaken to generate the model of best fit. Results: The final questionnaire consisted of 11 factors and 23 items, and CFA produced a reasonable fit: χ2 (175) = 345.7, p < 0.001; CMIN/DF = 1.98; GFI = 0.90 and RMSEA = 0.06, as well as adequate levels of discriminant validity, and internal consistency (r = 0.21 to 0.64). Conclusions: A reliable and valid theoretically underpinned measure of determinants of HCP patient safety behavior has been developed. The criterion validity of the measure is still unknown and further work is necessary to confirm the reliability and validity of this measure for other patient safety behaviors.

Yes / Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. Methods: A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. Results: A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. Conclusions: Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group. / Internal funding was received from the University of Bradford

Reducing medication wastage is a paramount objective in promoting appropriate utilisation of finite resources and preventing negative consequences. The aim of this research was to investigate aspects of medication wastage in Malta by applying mixed methods research and, by doing so, contribute original knowledge to this area. A systematic review was conducted to appraise critically, synthesize and present the available evidence on the possible causative factors associated with medication wastage and the effectiveness of any interventions focusing on wastage reduction as an outcome measure. Findings indicated that only one published paper reported a definition of medication wastage. The main factors contributing to wastage were ‘change in medication’, ‘patient's death’, ‘resolution of patient's condition’ and ‘passed expiry date’. Very few studies reported medication wastage as an outcome measure. The Delphi technique was applied to define ‘medication wastage’ and its contributory factors in the context of the Maltese population. A definition for medication wastage was generated with 86% of panellists agreeing/totally agreeing and sixty-one possible factors leading to wastage were identified by the panellists. The perspectives of the Maltese population, healthcare professionals and students on medication wastage were investigated through cross-sectional surveys. Results of questionnaires indicate lack of patient education and knowledge with the free healthcare system and the overstocking of medication by patients due to previous or potential out of stock situations as contributors to medication wastage. The beliefs and behaviours regarding medication wastage of the Maltese public and healthcare professionals were explored during focus groups. The theoretical domains framework was adopted to design the focus group guide and to interpret systematically the findings. Five key themes emerged which were proposed as solutions to minimise medication wastage: system effects, practitioner effects, patients effects, political effects and awareness and educational effects Research results and findings from all four phases will facilitate the systematic development of strategies and policies, with emphasis on prioritisation, with the aim of minimising medication wastage at all levels.

Non-medical prescribers make an increasing contribution to healthcare across the UK yet little is known about influences on their prescribing decision-making. The aim of this programme of research was to explore and describe prescribing decision-making by non-medical prescribers. A two stage programme of research was carried out. Stage 1 was a systematic review of the social and cognitive influences on prescribing decision-making by non-medical prescribers. Despite a paucity of research, various influences on prescribing decision-making were reported including evidence based guidelines, peer support and patient (or parental) relationships and expectations. While confidence and clinical experience as a practitioner were cited as influences, the lack of prescribing experience and aspects of pharmacological knowledge also impacted on prescribing decision-making, resulting in a cautious approach. Stage 2 of the research employed a phenomenological methodology underpinned by the Theoretical Domains Framework of behavioural determinants (TDF). It comprised three phases. In Phase 1, semi-structured interviews with five nurse prescribers and eight pharmacist prescribers in NHS Grampian explored their experiences and perceptions of influences on their prescribing decision-making, and the impact of these influences. Multiple and sometimes contradictory influences were uncovered. Twelve of the fourteen domains of the TDF were found to be influential along with multi-disciplinary working and experience; optimism and reinforcement did not feature. In Phase 2, these participants recorded reflections on prescribing decisions which they considered noteworthy in relation to their practice, and in Phase 3 participants were interviewed about their reflections. Complexity was a feature of many, in the patients’ clinical or social circumstances or in relation to wider concerns. The same 12 domains were found to be influential as were multi-disciplinary working, experience and complexity. This programme of research has produced original findings which it is hoped will impact on the education, training and practice of these increasingly important prescribers.

Hospital electronic prescribing and medicines administration (HEPMA) system implementation is advocated by national e-health strategies to produce patient safety benefits. No previous study has evaluated HEPMA implementation impacting discharge information communication or assessed discharge prescribing errors. The aims were to assess HEPMA system implementation impact on medicines related discharge communication and prescribing errors, and to gain the perspective of hospital staff involved in the communication process. Following a narrative literature review, a convergent parallel mixed methods was selected, consisting of interpretative phenomenology and experimental before and after study design. Face-to-face semi-structured interviews of a purposive sample of hospital staff involved in discharge information communication were undertaken using the Theoretical Domains Framework (TDF) as a theoretical lens. In addition a quasi experimental retrospective case notes review, both before and after implementation was completed. Pre-implementation, staff described patient safety concerns with traditional discharge communication processes. They cited frequent prescribing errors, and associated adverse events and hospital readmissions. HEPMA implementation was anticipated to improve patient safety and create more efficient discharge communication. Post-implementation staff articulated improved information quality highlighting fewer omitted medicines and improved patient safety. TDF findings of behaviour change highlighted behavioural alteration including adaption of processes to improve discharge quality. Quantitative data collection (n=159 before and after) confirmed qualitative findings; increased compliance with discharge documentation, for example staff grade recorded increased from 40% to 100% (p<0.001). Prescribing error quantity and severity were reduced; errors reduced from 99% to 23% of patients (p<0.001); only 22% of identified errors likely to cause harm. Omitted medicines decreased from 42% to 11% of patients (p<0.001). The findings contribute original knowledge concerning HEPMA implementation impacting discharge information communication and prescribing errors. The study demonstrated reduced prescribing errors and improved patient safety which potentially impacted health and wellbeing. Qualitative findings and quantitative results are transferable and applicable to other NHS organisations or similar healthcare settings.

Abstract: Family history (FH) is a risk factor for many conditions that can affect pediatric patients. While there is no evidence of the clinical utility of FH taking in pediatrics and there is no standard of care as to FH taking, many suggestions were made as to what conditions should be covered in a pediatric FH assessment. There is also no evidence of the current practice. In this study the Theoretical Domains Framework was applied to FH taking and used to conduct semi-structured interviews with pediatricians to explore their FH taking practice. The pediatricians reported similar FH taking habits. Their FH taking was reported to include a wide range of conditions and determinants of health, and they used this information for a broad range of clinical tasks. FH taking in pediatric practice was reported to be complex and embedded with other aspects of practice. Résumé: Les antécédents familiaux (AF) sont des facteurs de risque pour plusieurs maladies affectant les patients pédiatriques. Alors qu'il n'y a ni données probantes concernant l'utilité des AF en pédiatrie ni normes pour la prise d'AF, plusieurs ont fait des suggestions quant à ce qui devrait être couvert par la prise d'AF. Il n'y a pas de données probantes décrivant la pratique actuelle de prise d'AF en pédiatrie. Dans cette étude, le Theoretical Domains Framework a été appliqué à la prise d'AF et utilisé afin de diriger des entrevues semi-structurées avec des pédiatres, dans le but de décrire leur pratique actuelle. Les pédiatres ont dit avoir des habitudes semblables quant à la prise d'AF. Cette dernière inclut plusieurs maladies et déterminants de la santé, et ils utilisent cette information pour plusieurs tâches. La prise d'AF en pédiatrie a été décrite comme étant complexe et très intégrée à leur pratique entière.

No description available.

The consequences of sleep disordered breathing (SDB) in women are fatigue, morning headaches, insomnia, depression, low functional status, daytime sleepiness, mood disturbances, and poor neuro-behavioural performance. Women appear to be more symptomatic at lower disease severity than men. When CPAP is prescribed, women use it less than men, they reduce their usage within the first week of treatment, and they discontinue it more than men. There is a need to understand the factors influencing CPAP therapy uptake and usage in women to meaningfully address their needs. The purpose of this qualitative evidence synthesis was to identify and synthesize the factors influencing the uptake and use of CPAP in women by conducting a qualitative evidence synthesis guided by the Bargaining and Balancing Life with CPAP theory for content, and the Theoretical Domains Framework for data analysis. Twenty-one studies were included. Barrier domains were Skills, Emotions, Social/Professional Role and Identity, and Beliefs about Capabilities, while facilitator domains were Reinforcement, Social Influences, Goals, and Optimism. Seven themes emerged : 1) Expectations about CPAP, 2) Learning to use my CPAP machine, 3) The burden of the technology, 4) Improvement of SDB symptoms, 5) Not feeling (or looking) like myself, 6) Receiving support, and 7) Choosing my attitude. To ensure appropriate and meaningful SDB care for women, practices must be based on knowledge relevant to women with SDB. Findings from this thesis can inform the design and development of interventions to support women with CPAP therapy uptake and usage. Research on this topic is urgently needed because there was no study eligible with a sample comprised of women only.

Multidisciplinary cancer conferences (MCCs) are prospective meetings to discuss diagnoses and treatment plans for patients with cancer. MCCs are typically attended by surgeons, medical and radiation oncologists, pathologists and radiologists. To date, the quality of MCCs, specifically MCC decision making, has not been formally evaluated in a Canadian context. We utilized progressive knowledge translation methodology, specifically the use of theory, models and an integrated knowledge translation approach, to design, implement and evaluate an intervention, titled the KT-MCC Strategy (KT-MCC). The purpose of the KT-MCC is to improve the quality of MCC decision making. This thesis is comprised of four parts. In Part 1, we completed a generalizability study to evaluate the reliability of an MCC assessment tool (MTB-MODe) in an Ontario context. In Part 2, we conducted key informant interviews using the Theoretical Domains Framework (TDF) to identify barriers and facilitators to optimal MCC decision making. In Part 3, we mapped identified TDF barriers and facilitators to the COM-B Behavioural Change Wheel to develop the KT-MCC, an intervention aimed at improving the quality of MCC decision making. In this study, we examined the validity of the key informant findings using focus groups and surveys completed by individual MCC participants. In Part 4, we conducted a before-and-after pilot study to evaluate the feasibility and impact of the KT-MCC on MCC decision making in preparation for a possible randomized controlled trial testing the efficacy of the KT-MCC. There are few examples in the KT literature that provide a complete and detailed description of the design, implementation and evaluation of a complex KT strategy using progressive KT methods such as TDF interviews to identify barriers and facilitators to practice change; the COM-B model to identify potential interventions; and use of integrated KT with front-line workers. We describe in detail our methods to design, implement and evaluate the KT-MCC. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario. / Thesis / Doctor of Philosophy (PhD) / Multidisciplinary cancer conferences (MCCs) are regular meetings held by health professionals to prospectively discuss diagnoses and treatment plans for patients with cancer. The purpose of MCCs is to facilitate input from numerous experts to ensure that each patient receives an optimal treatment recommendation. To date, the quality of MCCs, specifically MCC decision making, in Ontario has not been formally evaluated. We aimed to identify gaps in Ontario MCC decision making and design an intervention to mitigate these gaps. The intervention was designed using an integrated knowledge translation approach, meaning MCC participants were involved in the design, implementation and evaluation of the intervention. The resulting intervention, called the KT-MCC Strategy, was evaluated at four Ontario MCC sites. This thesis provides a significant contribution to the knowledge translation literature and provides recommendations to improve the quality of MCCs in Ontario.