“…Beliefs about Consequences was the most populous domain. “SDD increases antibiotic resistance”, “SDD reduces Ventilator Associated Pneumonia” and “SDD benefits the patients to whom it is delivered” were the most frequently mentioned beliefs, illustrating the problematic balance between potential harms and benefits.Study outputs Cuthbertson et al [75, 76]; Dombrowski et al [77]; Francis et al [78]; Duncan et al [79]; Marshall et al [80]Fig. 1Flow chart illustrating steps to analyse interview transcripts to select a theoretical basis for designing a questionnaire study
…”
BackgroundImplementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations.MethodsResearchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the authors’ collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide.ResultsWe explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis.ConclusionsWe offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0605-9) contains supplementary material, which is available to authorized users.
“…Beliefs about Consequences was the most populous domain. “SDD increases antibiotic resistance”, “SDD reduces Ventilator Associated Pneumonia” and “SDD benefits the patients to whom it is delivered” were the most frequently mentioned beliefs, illustrating the problematic balance between potential harms and benefits.Study outputs Cuthbertson et al [75, 76]; Dombrowski et al [77]; Francis et al [78]; Duncan et al [79]; Marshall et al [80]Fig. 1Flow chart illustrating steps to analyse interview transcripts to select a theoretical basis for designing a questionnaire study
…”
BackgroundImplementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations.MethodsResearchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the authors’ collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide.ResultsWe explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis.ConclusionsWe offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0605-9) contains supplementary material, which is available to authorized users.
“…36 Although patients' discomfort during oral procedures has been examined in other populations of patients, [37][38][39] this issue in ICU patients has received limited attention. 13,40 Our findings suggest this gap in procedural knowledge may have serious implications for the effective application of oral chlorhexidine and selective oral decontamination with antibiotic pastes to prevent VAP.…”
“…VAP is the most frequent infection after MHS, with incidence rates ranging from 5.7% to 21.6%, 2 although incidence can reach 46% in high-risk patients, who must remain under MV for more than 48 hours. 19 The effect of SDD with topical antibiotics (with or without parenteral antibiotics) remains open to debate [25][26][27] ; however, this measure was associated with a reduction in mortality in a recent meta-analysis. 13,28 Most data on the efficacy of SDD are obtained from general ICUs, as opposed to MHS-ICUs.…”
Our study shows that SDD without parenteral antibiotics can reduce the incidence of VAP in high-risk patients after major heart surgery, with no significant ecologic influence.
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