The views of health care professionals about selective decontamination of the digestive tract: An international, theoretically informed interview study
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Materials and MethodsParticipants were health professionals with 'decisional authority' for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery and further SDD research were explored. Directed content analysis of interview data identified sub-themes which informed item development for … Show more
“…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
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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.
“…Credibility of intrapersonal channels (eg, peer to peer or opinion leader to professional) makes these channels more influential on adoption decisions [ 13 , 15 , 18 , 21 , 22 ]. Current social networks in health care organizations are generally homophilous with strong professional boundaries [ 23 , 24 ], which tend to control clinical practice [ 25 ].…”
BackgroundPrevailing health care structures and cultures restrict intraprofessional communication, inhibiting knowledge dissemination and impacting the translation of research into practice. Virtual communities may facilitate professional networking and knowledge sharing in and between health care disciplines.ObjectivesThis study aimed to review the literature on the use of social media by health care professionals in developing virtual communities that facilitate professional networking, knowledge sharing, and evidence-informed practice.MethodsAn integrative literature review was conducted to identify research published between 1990 and 2015. Search strategies sourced electronic databases (PubMed, CINAHL), snowball references, and tables of contents of 3 journals. Papers that evaluated social media use by health care professionals (unless within an education framework) using any research design (except for research protocols or narrative reviews) were included. Standardized data extraction and quality assessment tools were used.ResultsOverall, 72 studies were included: 44 qualitative (including 2 ethnographies, 26 qualitative descriptive, and 1 Q-sort) and 20 mixed-methods studies, and 8 literature reviews. The most common methods of data collection were Web-based observation (n=39), surveys (n=23), interviews (n=11), focus groups (n=2), and diaries (n=1). Study quality was mixed. Social media studied included Listservs (n=22), Twitter (n=18), general social media (n=17), discussion forums (n=7), Web 2.0 (n=3), virtual community of practice (n=3), wiki (n=1), and Facebook (n=1). A range of health care professionals were sampled in the studies, including physicians (n=24), nurses (n=15), allied health professionals (n=14), followed by health care professionals in general (n=8), a multidisciplinary clinical specialty area (n=9), and midwives (n=2). Of 36 virtual communities, 31 were monodiscipline for a discrete clinical specialty. Population uptake by the target group ranged from 1.6% to 29% (n=4). Evaluation using related theories of “planned behavior” and the “technology acceptance model” (n=3) suggests that social media use is mediated by an individual’s positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions.ConclusionsThere is emerging evidence that hea...
“…The failure of HCPs and organisations to cease using or investing in outdated, unsafe or non‐evidence‐based practices, which potentially contribute to poorer patient outcomes (Hollingsworth et al, ) is of significant concern in health care (Braithwaite & Donaldson, ). This issue was illustrated by the theme “corporate memory loss”; if clinicians do not have communication channels beyond local social networks, they may be under the illusion that local practices reflect the majority view (Duncan et al, ) and fail to evolve practices. These practices may continue to linger when key individuals leave, further reinforcing clinical practice silos created by ineffective social networks where units are not connected to the broader professional organisation and HCPs do not engage with their professional community.…”
Aims and objectives
To explore the nature of knowledge exchange on a multi‐disciplinary Australasian intensive care virtual community of practice, “ICUConnect.”
Background
Current organisational structures and cultures constrain the social networks of healthcare professionals, limiting access to contemporary best practice knowledge. While virtual communities can facilitate knowledge and clinical expertise exchange in professional networks, their effectiveness has not been established.
Design
A sequential mixed‐methods design with a quantitative core and qualitative supplementary component was used to explore the content of discussions from an intensive care virtual community. SRQR has been used to report this study.
Methods
Email archives of an intensive care listserv (2003–2013) were mined using a two‐stage sampling technique to identify discussion threads (with >2 posts) concerning ventilator or airway practices (cluster) and two sets of 20 threads (stratified across years). Summative content analysis was used to examine both manifest and latent content.
Results
Forty threads containing 326 emails posted by 133 individuals from 80 organisations were analysed. Nurses contributed 68% (55% were in clinical leadership roles) and physicians 27%. Three subject areas were identified: clinical practices (71%); equipment (23%); and clinical governance (6%). “Knowledge‐requested” and “knowledge‐supplied” posts were categorised as follows: experiential and explicit (33% and 16%, respectively); experiential (27% and 35%); or explicit (40% and 17%). Knowledge supplied was also categorised as “know‐how” (20%); “know‐why” (5%) or “no knowledge” exchanged (6%). The central construct of virtual community work was identified with six elements that facilitated participation and knowledge exchange including: (a) the discussion thread; (b) sharing of artefacts; (c) community; (d) cordiality; (e) maven work; and (f) promotion of the VC. Members asked questions to benchmark their practice, while those who answered were focused on ensuring that best practices were delivered.
Conclusions
ICUConnect reflected characteristics of a virtual community of practice, enabling key benefits for members and the broader Australasian intensive care community, especially access to best practice knowledge from clinical experts.
Relevance to clinical practice
This study demonstrated that a practice‐based VC can function effectively as a VCoP to establish an effective professional network where members have access to up‐to‐date best practice knowledge. Healthcare organisations could leverage VCs to support the professional development of HCPs and ensure that local clinical practices are based on contemporaneous knowledge. Participation by nurses in these communities facilitates individual professional development and access to important clinical knowledge and expertise, and ultimately reinforcing the unique position of nursing in delivering effective, consistent high‐quality patient care.
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