Action, actor, context, target, time (AACTT): a framework for specifying behaviour

Presseau, Justin; McCleary, Nicola; Lorencatto, Fabiana; Patey, Andrea M.; Grimshaw, Jeremy; Francis, Jill J

doi:10.1186/s13012-019-0951-x

Cited by 208 publications

(268 citation statements)

References 56 publications

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“…The worksheet is based on the Action, Actor, Context, Target, Time (i.e. AACTT) framework, which helps to specify what behaviour needs to change and how to define this particular behaviour [ 23 ]. The worksheet contains the following steps: (1) specify the eHealth application, (2) define the problem, (3) specify the desired implementation behaviour, i.e.…”

Section: Implementation Strategiesmentioning

confidence: 99%

“…The worksheet contains the following steps: (1) specify the eHealth application, (2) define the problem, (3) specify the desired implementation behaviour, i.e. describe ‘who does what; to, for or with whom; when; where?’ [ 23 ], (4) choose the implementation strategy from the overview provided by Powell et al. [ 22 ], and (5) evaluate the implementation strategy.…”

Section: Implementation Strategiesmentioning

confidence: 99%

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SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

Versluis

Luenen

Meijer

et al. 2020

European Journal of General Practice

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Background The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. Objectives We consider how evidence-based implementation strategies can be built to support eHealth implementation. Discussion What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Conclusion Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.

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Section: Implementation Strategiesmentioning

confidence: 99%

Section: Implementation Strategiesmentioning

confidence: 99%

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

Versluis

Luenen

Meijer

et al. 2020

European Journal of General Practice

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show abstract

“…Consensus discussions resolved any coding disagreements. After nalisation of coding, one author (AD) organised the data by "actor" category as suggested by the AACTT framework and then identi ed the most common barriers mentioned by participants in each category [13]. After allocating participants to actor categories, we devised the action they contributed to the PAST-P.…”

Section: Resultsmentioning

confidence: 99%

“…It can be used at multiple phases of implementation and facilitates multi-level analysis (including individual, organisational, environment and process) [12]. The AACTT is designed to assist with mapping each person involved in the delivery of an intervention, specifying the action they are required to perform, the context in which it needs to be undertaken, to whom the action is targeted at, and the time frame required to carry it out [13]. The AACTT framework is used in this study to conceptualise actor categories and de ned actions they need to perform when using the PAST-P [13].…”

Section: Belowmentioning

confidence: 99%

Preoperative anaemia screening and treatment: Barrier identification and implementation strategy mapping

Delaforce

Duff²,

Munday

et al. 2020

Preprint

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Background: Patients undergoing major surgery are at risk of significant blood loss and subsequent transfusion, which increases substantially if the patient has pre-existing anaemia. Preoperative anaemia screening and treatment pathways (PAST-P) outline recommended blood tests and treatment to ensure patient optimisation before surgery. Although documented success in using PAST-P to reduce transfusions and improve patient outcomes exists, the reporting quality of such studies is suboptimal, and it remains unclear what implementation strategies best support the implementation of PAST-P. This study uses qualitative methods to identify local barriers and maps them to recommended implementation strategies.Method: Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients. Qualitative data was collected using semi-structured interviews. Data analysis utilised a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. The Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection.Results: The analysis revealed ten barriers: external policy and incentives, patient needs and resources, structural characteristics, networks and communications, relative priority, available resources, access to knowledge and information, knowledge and beliefs about the intervention, self-efficacy and executing. ERIC strategies recommended to mitigate barriers are: conduct educational meetings, develop educational materials, distribute educational materials, access new funding, promote network weaving, organise clinician implementation team meetings, obtain and use patients/consumers/family feedback, involve patients/consumers/family members and conduct a local needs assessment.Conclusion: Five of ten identified barriers had strong recommendations, and nine implementation strategies were identified as being suitable to address them. Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAST-P, once it is launched at the study hospital.

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“…12 16 For this study, behaviours of interest were defined using the Action, Actor, Context, Target, Time (AACTT) framework to ensure study of specific behaviours (table 1). [17][18][19] Details of the interview guide can be found in online supplementary methods I-III.…”

Section: Interview Topic Guidementioning

confidence: 99%

What are potential barriers and enablers to patient and physician participation in Canadian cell therapy trials for stroke? A stakeholder interview study

et al. 2020

Self Cite

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ObjectivesEarly phase cell therapy trials face many barriers to successful, timely completion. To optimise the conduct of a planned clinical trial of mesenchymal stem cell (MSC) therapy for chronic stroke, we sought patient and physician views on possible barriers and enablers that may influence their participation.DesignSemistructured interview study.SettingPatients were recruited from three rehabilitation centres in Ontario, Canada; physicians were recruited from across Canada through snowball sampling.ParticipantsThirteen chronic stroke patients (patients who had experienced a stroke at least 3 months prior; 10 male, 3 female) and 15 physicians (stroke physiatrists; 9 male, 6 female) participated in our interview study. Data adequacy was reached after 13 patient interviews and 13 physician interviews.MethodsInterview guides and directed content analysis were based on the Theoretical Domains Framework (TDF). Interviews were coded, and relevant themes were identified.ResultsMost patients were optimistic about participating in an MSC therapy clinical trial, and many expressed interest in participating, even if it was a randomised controlled trial with the possibility of being allocated to a placebo group. However, the method of administration of cells (intravascular preferred to intracerebral) and goal of the trial (efficacy preferred to safety) may influence their intention to participate. All physicians expressed interest in screening for the trial, though many stated they were less motivated to contribute to a safety trial. Physicians also identified several time-related barriers and the need for resources to ensure feasibility.ConclusionsThis novel application of the TDF helped identify key potential barriers and enablers prior to conducting a clinical trial of MSC therapy for stroke. This will be used to refine the design and conduct of our trial. A similar approach may be adopted by other investigators considering early phase cell therapy trials.

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Action, actor, context, target, time (AACTT): a framework for specifying behaviour

Cited by 208 publications

References 56 publications

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation

Preoperative anaemia screening and treatment: Barrier identification and implementation strategy mapping

What are potential barriers and enablers to patient and physician participation in Canadian cell therapy trials for stroke? A stakeholder interview study

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