Abstract:BackgroundImproving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations.MethodsA … Show more
“…While there is substantial literature on determinants of behaviour of health staff [42], we found no articles that focus exclusively on staff behaviour to manage patient complaints. As for behaviour of patients, three key drivers of behaviour – opportunity, capability and motivation [43], can be targeted to improve patients’ willingness to complain, as we discuss next.…”
Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems.
Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research.
Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands.
Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context.
Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.
“…While there is substantial literature on determinants of behaviour of health staff [42], we found no articles that focus exclusively on staff behaviour to manage patient complaints. As for behaviour of patients, three key drivers of behaviour – opportunity, capability and motivation [43], can be targeted to improve patients’ willingness to complain, as we discuss next.…”
Background: Information from patient complaints – a widely accepted measure of patient satisfaction with services – can inform improvements in service quality, and contribute towards overall health systems performance. While analyses of data from patient complaints received much emphasis, there is limited published literature on key interventions to improve complaint management systems.
Objectives: The objectives are two-fold: first, to synthesise existing evidence and provide practical options to inform future policy and practice and, second, to identify key outstanding gaps in the existing literature to inform agenda for future research.
Methods: We report results of review of the existing literature. Peer-reviewed published literature was searched in OVID Medline, OVID Global Health and PubMed. In addition, relevant citations from the reviewed articles were followed up, and we also report grey literature from the UK and the Netherlands.
Results: Effective interventions can improve collection of complaints (e.g. establishing easy-to-use channels and raising patients’ awareness of these), analysis of complaint data (e.g. creating structures and spaces for analysis and learning from complaints data), and subsequent action (e.g. timely feedback to complainants and integrating learning from complaints into service quality improvement). No one single measure can be sufficient, and any intervention to improve patient complaint management system must include different components, which need to be feasible, effective, scalable, and sustainable within local context.
Conclusions: Effective interventions to strengthen patient complaints systems need to be: comprehensive, integrated within existing systems, context-specific and cognizant of the information asymmetry and the unequal power relations between the key actors. Four gaps in the published literature represent an agenda for future research: limited understanding of contexts of effective interventions, absence of system-wide approaches, lack of evidence from low- and middle-income countries and absence of focused empirical assessments of behaviour of staff who manage patient complaints.
“…This is not to say that motivation is external to the person, as it still works through the internal motivational system, but that it can be instigated by external sources. Drawing on the BCW framework (Michie et al, 2014b), the model also suggests potential mechanisms through which interventions might influence behavior change to help smokers progress towards cessation.Figure 1.A parsimonious model of the progression towards smoking cessation with potential intervention functions that could influence behavior change. Phases of progression towards cessation are in bold.…”
Section: Resultsmentioning
confidence: 99%
“…Solid line represents locus of motivation to stop smoking (solid background = extrinsic; dotted background = intrinsic). Dashed arrows represent intervention functions from the Behavior Change Wheel (BCW)(Michie et al, 2014b) that could influence progression towards smoking cessation. In this model, people may jump phases (e.g.…”
Section: Resultsmentioning
confidence: 99%
“…In the final stage of data synthesis, a ‘top-down’ (theory driven/deductive) data analysis approach was adopted to complement the ‘bottom-up’ (data driven/inductive) text analysis. For the deductive analysis, the BCW framework (Michie et al, 2014b) was used to explore how the proposed model fits within an existing comprehensive framework of intervention strategies; in particular, to identify relevant intervention functions that may be used to bring about behavior change.…”
Section: Methodsmentioning
confidence: 99%
“…It involves a thorough understanding of people’s smoking/quitting behavior, identifying potential intervention targets, utilizing intervention functions that are likely to bring about behavior change, and implementing relevant policies to enable these interventions (Michie, Atkins, & West, 2014b). The Behavior Change Wheel (BCW) (Michie et al, 2014b; Michie, Van Stralen & West, 2011) provides a systematic framework and a comprehensive list of intervention functions and policies to guide this strategy.…”
Background: Understanding how people transition between phases of not making a quit attempt to stopping smoking successfully is important in order to optimize interventions. This study aimed to explore differences in attitudes towards smoking and quitting among smokers and ex-smokers. Methods: Adult (age 18 and over) successful (n = 8), unsuccessful (n = 8) and never quitters (n = 7) were recruited through stop-smoking services in England. Semi-structured interviews were conducted and data were analysed using framework analysis. Results: Seven themes (starting to smoke, positive appraisal of smoking, responsibility for past/current smoking, negative effects of smoking, reasons to quit, process of quitting, and identity) were identified in all groups. Sub-group differences were explored and used to derive six typologies with descriptive characteristics: committed smokers, aware smokers, forced attempters, struggling attempters, pragmatic ex-smokers, and committed non-smokers. Using these typologies and the smallest number of differentiating factors between them (awareness of negative effects, motivation to stop and acceptance of responsibility), a parsimonious model of progression towards smoking cessation was developed. Conclusions: Awareness of negative effects, motivation and, crucially, a sense of commitment for taking responsibility to take actions towards behavior change may be important for whether smokers attempt to quit and progress to a successful quit attempt.
A nudge is an intervention designed to prompt people to "voluntarily" make the choice intended by those who altered the choice environment or situation, and therefore using nudges is thought to undermine selfdetermination. Evidence for this assumption is weak, however, and sets aside much of what we know about human conduct sociologically. This paper argues that the practical consciousness that people have about their own actions and reasons for executing those actions can inform our thinking about motivating compliance with treatments in clinical settings and the ethical issues involved. Case Mr H is a 58-year-old man with insulin-dependent diabetes, hypertension, and class II obesity (with a BMI of 35 kg/m 2). Mr H sees Dr K today after a 6-month trial of lifestyle changes to lose weight because he wasn't interested in taking anti-obesity medications. As Mr H has told Dr K in the past, "I am already on too many medications for my sugar and blood pressure." Evaluation reveals that Mr H's BMI has increased since the last visit, and Dr K is increasingly concerned, given Mr H's strong family history of coronary artery disease. Recalling that Mr H is afraid of bariatric surgery, Dr K considers reiterating the risk of death and a drawn-out recovery period as Mr H's most feared drawbacks of surgery in order to prompt Mr H to agree to taking anti-obesity medication. 1,2,3
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