Yes / Background: Interpreting evaluations of complex interventions can be difficult without sufficient description of key
intervention content. We aimed to develop an implementation package for primary care which could be delivered
using typically available resources and could be adapted to target determinants of behaviour for each of four
quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing.
We describe the development and prospective verification of behaviour change techniques (BCTs) embedded
within the adaptable implementation packages.
Methods: We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery
mechanisms—mainly audit and feedback, educational outreach and computerised prompts and reminders. We
drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely
determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from
stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation
packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the
packages and compared them across the delivery mechanisms and four quality indicators.
Results: Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of
16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to
feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. ‘graded tasks’
and ‘problem solving’ for educational outreach). BCTs addressing the determinants ‘environmental context’ and
‘social and professional roles’ (e.g. ‘restructuring the social and ‘physical environment’ and ‘adding objects to the
environment’) were indicator specific. We found it challenging to operationalise BCTs targeting ‘environmental
context’, ‘social influences’ and ‘social and professional roles’ within our chosen delivery mechanisms.
Conclusion: We have demonstrated a transparent process for selecting, operationalising and verifying the BCT
content in implementation packages adapted to target four quality indicators in primary care. There was
considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and
verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a
wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational
outreach can allow for flexibility and individual tailoring in delivery / UK National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (Grant Reference Number RP-PG-1209-10040).
| Identifer | oai:union.ndltd.org:BRADFORD/oai:bradscholars.brad.ac.uk:10454/17515 |
| Date | 12 November 2019 |
| Creators | Glidewell, L., Willis, T.A., Petty, Duncan R., Lawton, R., McEachan, Rosemary, Ingleson, E., Heudtlass, P., Davies, A., Jamieson, T., Hunter, C., Hartley, S., Gray-Burrows, K., Clamp, S., Carder, P., Alderson, S., Farrin, A.J., Foy, R. |
| Source Sets | Bradford Scholars |
| Language | English |
| Detected Language | English |
| Type | Article, Published version |
| Rights | © The Author(s). 2018 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
Page generated in 0.0027 seconds