Webinar 5: Identifying barriers and enablers, and determinants, in practice
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This document discusses a webinar series focused on identifying barriers and enablers to implementing patient safety initiatives, particularly emphasizing physician hand hygiene compliance. It presents a structured approach using the Theoretical Domains Framework (TDF) and offers practical methods for gathering data through quantitative and qualitative research techniques. The overall aim is to improve patient safety by understanding and addressing the factors that influence behavioral change in healthcare professionals.
![EXAMPLES - CODING BY DOMAINS
Tie each statement to a domain
Does not practicing
hand hygiene
evoke worry or
concern in you?
‘No it wouldn’t.’
Emotion
“I think they [patients and their
families] have a reason to
expect it [hand hygiene] from
us, like I don’t do it to satisfy
them, their wishes.”](https://image.slidesharecdn.com/ktissession05-2018-05-30-180605205520/85/Webinar-5-Identifying-barriers-and-enablers-and-determinants-in-practice-55-320.jpg)
![Tie each statement to a domain
“I think they [patients and their
families] have a reason to
expect it [hand hygiene] from
us, like I don’t do it to satisfy
them, their wishes.”
Social
influences
EXAMPLES - CODING BY DOMAINS
Does not practicing
hand hygiene
evoke worry or
concern in you?
‘No it wouldn’t.’
Emotion](https://image.slidesharecdn.com/ktissession05-2018-05-30-180605205520/85/Webinar-5-Identifying-barriers-and-enablers-and-determinants-in-practice-56-320.jpg)
![EXAMPLES – GENERATING THEMES (ENABLERS)
“In fact, I like to make it [hand
hygiene] a very visible part of my
patient consultation…I try and make
sure that I’m actually still in the
process of putting alcohol-based
hand rub on my hands so that they
know I’m performing hand hygiene.”
Med Staff
“I think every healthcare professional
has to use it [hand hygiene].” Med
Res
Social
professional
role and
identity
Hand hygiene is a standard part
of my patient consultations.
(n = 40)](https://image.slidesharecdn.com/ktissession05-2018-05-30-180605205520/85/Webinar-5-Identifying-barriers-and-enablers-and-determinants-in-practice-59-320.jpg)
![EXAMPLE - DOMAIN SELECTION
When there is an emergency situation,
I am less likely to practice hand hygiene
(n = 14)
Life-threatening situations. I mean, I don’t see
myself, you know, looking for a sink when a patient
is having a cardiac arrest. Med staff
Hand hygiene is easy to practice
(n = 36)
Beliefs about capabilities
Hand hygiene is difficult to practice
(n = 8)
“It couldn’t be any easier.
The stuff [alcohol gel] is all
over the place.” Med staff
“…if you were in a situation where
you’re trying to do too much and you’re
carrying things in and out of rooms and
what have you, it’s not that you wouldn’t
be trying to practice hand hygiene but
that you might not be able to do it as
effectively, right.” Med Res](https://image.slidesharecdn.com/ktissession05-2018-05-30-180605205520/85/Webinar-5-Identifying-barriers-and-enablers-and-determinants-in-practice-63-320.jpg)
Webinar 5: Identifying barriers and enablers, and determinants, in practice
- 1. www.ohri.ca | Affiliated with • Affilié à CPSI National Webinar Series Knowledge Translation and Implementation Science Education Series Webinar 5: Identifying barriers and enablers, and determinants of implementation, in practice Justin Presseau Scientist, OHRI Assistant Professor, uOttawa @JPresseau jpresseau@ohri.ca Andrea Patey Senior Clinical Research Associate, OHRI Assistant Professor (Adjunct), Queen’s @andreapatey apatey@ohri.ca Centre for Implementation Research
- 2. Webinar 5 overview ▶ Situating our progress in the webinar series ▶ Refresher: Theoretical Domains Framework (TDF) ▶ Practical Approaches to Using the TDF to identify barriers and enablers of implementation • Quantitative approaches • Qualitative approaches
- 3. ▶ Brownson RC, Colditz GA and Proctor EK. (2012). Dissemination and Implementation Research in Health: Translating Science to Practice. Oxford University Press. ▶ Grol R, Wensing M, Eccles M. (2005). Improving Patient Care: The Implementation of Change in Clinical Practice. Elsevier. ▶ Straus S, Tetroe J, Graham ID. (2013). Knowledge Translation in Health Care: Moving from Evidence to Practice (2nd Edition). BMJ Books. KT / Implementation Science overviews: resources
- 4. A behavioural perspective to KT and IS ▶ Successful implementation of patient safety programs needs key actors (patients, healthcare providers, managers and policy makers) to change their behaviours and/or decisions whilst working in the complex (ordered chaos) of health care environments ▶ There is a substantial evidence base in behavioural sciences that can support the development of patient safety programs and increase the likelihood of success
- 5. The webinar series – overview ▶ Webinar 1: Introduction to KT and Implementation Science ▶ Webinar 2: Knowledge creation and synthesis ▶ Webinar 3: Who needs to do what, differently, to promote implementation? ▶ Webinar 4: Identifying barriers and enablers, and determinants, in theory ▶ Webinar 5: Identifying barriers and enablers, and determinants, in practice ▶ Webinar 6: Selecting and evaluating strategies to address barriers and enablers Aim: build capacity in the basic principles and practice of Knowledge Translation and Implementation Science to inform your own patient safety initiatives
- 6. Situating ourselves in the webinar series Knowledge to Action Framework Graham et al (2006) Webinar 2: Focus on the Knowledge Creation funnel Knowledge creation funnel produces: - Systematic reviews (e.g. Cochrane) - Clinical practice guidelines - Decision Aids - Policy briefs but… producing and disseminating these products does not guarantee change
- 7. Situating ourselves in the webinar series Knowledge to Action Framework Graham et al (2006) Webinar 3: Focus on identifying the problem • Identified gaps between what evidence suggests and current performance • Specified: who needs to do what, differently • Used TACT-A to specify each actors’ behaviour ... but selecting and tailoring interventions depends on knowing what to tailor on so that solutions designed are fit for purpose
- 8. Knowledge to Action Framework Graham et al (2006) Webinar 4: What helps and hinders implementation? • Theoretical frameworks provide a strong, replicable basis for identifying barriers and enablers to implementing a patient safety-related behaviour • Gives leg-up on factors to consider • Prevents “re-inventing the wheel” • Helps to generalize across settings Situating ourselves in the webinar series
- 9. Today’s webinar Knowledge to Action Framework Graham et al (2006) Webinar 5: What helps and hinders implementation? A practical approach
- 10. ▶Healthcare-associated infections are one of the top 10 causes of hospital deaths worldwide • Affects 10% of all patients in acute-care hospitals ▶Physician hand hygiene compliance is an international problem • Average reported compliance rate: 49-57% ▶Reasons for poor compliance not well understood ▶Our case study: assume we want to develop a patient safety initiative to improve physician hand hygiene Our Case Study to inform our overview: Physician hand hygiene
- 11. TACT-A: Atool for specifying behaviours Use alcohol-based hand gel Staff physicians, nurses and residents Patients receiving care at the hospital Patient rooms and hallways Before and after touching a patient Example 1: a ‘do more’ behavior Hand hygiene Now what?
- 12. Step 1: Who needs to do what, differently? Whose behaviour need to change, and which behaviours? What is the evidence supporting this? Step 2: What factors determine whether or not they do it? What are the barriers and enablers? Step 3: Which strategies can be effectively used to target those factors? Which behaviour change techniques are best suited to specifically target the identified barriers and enablers Step 4: How can we robustly measure the outcome? 1 2 3 4 12 (French et al., 2012) Key Process model: The French Model
- 13. Step 1: Who needs to do what, differently? Whose behaviour need to change, and which behaviours? What is the evidence supporting this? Step 2: What factors determine whether or not they do it? What are the barriers and enablers? Step 3: Which strategies can be effectively used to target those factors? Which behaviour change techniques are best suited to specifically target the identified barriers and enablers Step 4: How can we robustly measure the outcome? 1 2 3 4 13 (French et al., 2012) Key Process model: The French Model
- 14. Approaches: ▶ Interviews or focus groups with healthcare professionals to understand their views about what helps and hinders their performance of a specific behaviour ▶ Questionnaires: understanding which domains correlate with behaviour ▶ Observations: infer from watching what happens ▶ Systematic reviews: ‘re-engineering’ interventions to understand what factors they were targeting Using the Theoretical Domains Framework (TDF) to identify barriers and enablers The TDF advantage - Applicable to any target, action, context, time, and actor (TACT-A) - Covers a breadth of factors associated with behaviour - Linked to strategies / techniques for addressing barriers/enablers (informs selection and tailoring of implementation interventions)
- 15. Theoretical Domains Framework TDF Domains Knowledge Skills Beliefs about capabilities Memory, attention and decision processes Behavioural regulation Environmental context and resources Social Influences Intention Goals Social/professional role and identity Beliefs about consequences Reinforcement Emotion Optimism
- 16. Provides a 7-step process to conducting TDF-based assessment of barriers and enablers to implementation 1. Select and specify the target behaviour/s 2. Select the design 3. Develop the materials 4. Decide on the sampling strategy 5. Collect the data 6. Analyse the data 7. Report Findings PRACTICALAPPROACH TO USING THE TDF
- 17. 1 – SELECT AND SPECIFY THE TARGET BEHAVIOUR TACT-A: Atool for specifying behaviours Use alcohol-based hand gel Staff physicians, nurses and residents Patients receiving care at the hospital Patient rooms and hallways Example 1: a ‘do more’ behavior Hand hygiene Now what?
- 18. ▶Range of ways to identify barriers and enablers • 1-1 interviews with your ‘Actors’ • Focus groups • Observations • Questionnaires and surveys Select your design: Practical steps to identifying barriers and enablers
- 19. Select and specify the target behaviour Select study design Questionnaires Develop the study materials Collect the data Analyse the data Report Findings Select study design Semi-structured interviews Develop the study materials Collect the data Analyse the data Report Findings Practical steps to identifying barriers and enablers
- 20. Quantitative approach to identifying barriers and enablers Questionnaires Aims: Descriptively quantify views on each of the TDF domains to assess: ▶Which domains have high vs. low mean scores (is there room for improvement that justifies focusing on that domain?) ▶How much respondents vary in their responses Can also investigate correlations between TDF domains and behaviour you are trying to change
- 21. Quantitative approach to identifying barriers and enablers ▶ Questionnaire: practicalities to be mindful of • Most of the time commitment BEFORE collecting data • Ideally select validated scales where available rather than developing new scale • Can be costly (if using postal surveys) • Recruitment can be challenging, retention/response rates even greater challenge • Data entry time consuming, potential for error (unless online data collection) • Dealing with missing data • Depending on your analysis, may require large number of respondents - Formal stats for sample size calculations should be conducted before recruitment to justify sample
- 22. Design: Quantitative approach to identifying barriers and enablers ▶Questionnaire: 4 steps 1. Define your TACT-A 2. Use an existing TDF scale where possible, adapted to your TACT-A 3. Decide how you will sample your ‘actors’ 4. Get ethics approval Example TACT-A: Physicians and nurses using alcohol-based gel in the hallway before and after entering each patient’s room over the next month
- 23. Develop your materials: Consider using existing TDF questionnaires
- 24. Collect your data: Existing TDF questionnaire 1 • A 23-item measure developed and validated to assess responses to questions on TDF domains particularly within a patient safety setting • 2 items per domain • Designed to be completed in <5 minutes • Adaptable questionnaire available for use (free): Additional File 2 • https://static-content.springer.com/esm/art%3A10.1186%2F1748-5908-8- 81/MediaObjects/13012_2013_678_MOESM2_ESM.docx • Ratings: Respondents asked to rate each item on a Likert scale • Descriptive Analysis: Mean (average) and standard deviation (variability of responses) for each domain
- 25. Theoretical Domains Framework TDF Domains Knowledge Skills Beliefs about capabilities Memory, attention and decision processes Behavioural regulation Environmental context and resources Social Influences Intention Goals Social/professional role and identity Beliefs about consequences Reinforcement Emotion Optimism 1. I know what the guidelines say about the need to… (knowledge) 2. I fully agree with the guidelines which instruct staff to… (knowledge) 3. Training is not adequate to... (skills) 4. Training is not offered to me regularly enough to... (skills) 5. I have previously encountered problems when trying to…(beliefs about capabilities) 6. I do not find it easy to… (beliefs about capabilities) 7. I habitually (or usually)… (memory, attention, decision making) 8. There are justifiable reasons for why I often decide not to…(memory, attention, decision making) 9. Things are too unpredictable to make plans to... (behavioural regulation) 10. Plans in my head often get muddled when trying to... (behavioural regulation) … your TACT-A after each question
- 26. Theoretical Domains Framework TDF Domains Knowledge Skills Beliefs about capabilities Memory, attention and decision processes Behavioural regulation Environmental context and resources Social Influences Intention Goals Social/professional role and identity Beliefs about consequences Reinforcement Emotion Optimism 11. Verbal and written communication between staff is clear enough for me to... (Environmental context & resources) 12. There is not a good enough system in place to… (Environmental context & resources) 13. I have the necessary resources (e.g., correct/enough equipment, staff, etc.) (Environmental context & resources) 14. Other staff don’t seem to… (social influences) 15. My superiors would like me to…(social influences) … your TACT-A after each question
- 27. Theoretical Domains Framework TDF Domains Knowledge Skills Beliefs about capabilities Memory, attention and decision processes Behavioural regulation Environmental context and resources Social Influences Intention Goals Social/professional role and identity Beliefs about consequences Reinforcement Emotion Optimism 16. Emergencies and other priorities get in the way of me being able to... (motivation and goals) 17. Other guidelines conflict with trying to…(motivation and goals) 18. It isn’t my responsibility to… (social/professional role and identity) 19. I am clear about what my role should be in the process to…(social/professional role and identity) 20. It will be bad for the patient if I do not... (beliefs about consequences) 21. It does not matter too much if I do not... (beliefs about consequences) 22. I feel anxious if I think about having to... (emotions) 23. I worry if I think about having to... (emotions) … your TACT-A after each question
- 28. Analyse your data: Existing TDF questionnaire 1 Analysis option: Descriptive For each domain, create a mean (average) score Example: Motivation and goals Item 1: Emergencies and other priorities get in the way of me being able to... use alcohol-based gel in the hallway before I see each patient Item 2: Other guidelines conflict with trying to… use alcohol-based gel in the hallway before I see each patient Mean = 2.5 Constructing a mean score for each TDF domain can facilitate ’screening’ to identify potential barriers to focus selecting particular strategies
- 29. Alternative TDF questionnaire Generic, adaptable to any TACT-A and draws from existing validated scales for each domain
- 30. Select and specify the target behaviour Select study design Questionnaires Develop the study materials Collect the data Analyse the data Report Findings Select study design Semi-structured interviews Develop the study materials Collect the data Analyse the data Report Findings Practical steps to identifying barriers and enablers
- 31. Qualitative approach to identifying barriers and enablers ▶SEMI STRUCTURED INTERVIEWS 3. Develop the study materials 4. Decide the sampling strategy 5. Collect the data 6. Analyse the data 7. Report Findings
- 32. 3 – DEVELOP THE STUDY MATERIAL Develop Interview Guide INTERVIEW Conduct interviews
- 33. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questionnaire based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL
- 34. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questionnaire based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews • Hand hygiene is recognized globally as a leading measure to reduce healthcare-associated infection. • Hand hygiene compliance, however, is unacceptably low. • Physicians in particular are repeatedly observed as being poor compliers. 3 – DEVELOP THE STUDY MATERIAL
- 35. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL
- 36. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL
- 37. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL TDF Series in Implementation Science https://www.biomedcentral.com/collections/tdf
- 38. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL
- 39. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews • Validation of your Interview Guide • Theoretical Validation • Does your question target the domain you want to investigate? • Clinical Validation • Does your question make sense from a clinical perspective? 3 – DEVELOP THE STUDY MATERIAL
- 40. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Literature review 2. Meet with key informants to identify the core issues in the area of interest 3. Develop questions based on sample questions from TDF-1 to represent each domain (4 drafts) 4. Pilot test the interview guide 5. Make necessary changes based on the pilot interviews 3 – DEVELOP THE STUDY MATERIAL
- 41. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Themes Stage 2 Stage 3Stage 1 ANALYSIS 4 – DEVELOP THE SAMPLING STRATEGY
- 42. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS To Consider • Maximum variation is ideal for exploratory studies • Identify Key participants are those who will, or should perform the behaviour but can also include other stake holders • How do you know you’ve reached saturation? 4 – DEVELOP THE SAMPLING STRATEGY
- 43. How many people to interview?
- 44. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS To Consider • Maximum variation is ideal for exploratory studies • Identify Key participants are those who will, or should perform the behaviour but can also include other stake holders • How do you know you’ve reached saturation? 4 – DEVELOP THE SAMPLING STRATEGY
- 45. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Themes Stage 2 Stage 3Stage 1 ANALYSIS 5 – COLLECT THE DATA
- 46. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS To Consider • Important to stick to the framing of the questions in the guide. • Effective interviewing requires standard interviewing competencies and understanding of the theoretical content of each domain 5 – COLLECT THE DATA
- 47. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Themes Stage 2 Stage 3Stage 1 ANALYSIS 6 – ANALYSE THE DATA
- 48. PRACTICALITIES: QUALITATIVE STUDIES ▶Interviewing is a skill that requires practice • Avoid ‘leading’ people, closed questions that generate yes/no answers • How to keep people on track • Pilot / practice ▶The majority of the time commitment for qualitative research tends to be AFTER the data have been collected • Analysis can be more time consuming ▶Need to record (at least audio) and transcribe • Depending on duration, transcription is time consuming ▶Robust analysis often requires independent double coding and theme generation ▶Consider software: N-vivo
- 49. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 6 – ANALYSE THE DATA
- 50. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS • 2 coders • Establish a coding guide with the 2 pilot interviews • Calculate Kappa 6 – ANALYSE THE DATA
- 51. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS • 2 coders • Establish a coding guide with the 2 pilot interviews • Calculate Kappa • Agreement between coders as to what statements will go in what domain. • Started with the guide that had been established from previous studies • 4 interviews to set guide 6 – ANALYSE THE DATA
- 52. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS • 2 coders • Establish a coding guide with the 2 pilot interviews • Calculate Kappa 6 – ANALYSE THE DATA
- 53. EXAMPLES - CODING BY DOMAINS Tie each statement to a domain Does not practicing hand hygiene evoke worry or concern in you? ‘No it wouldn’t.’
- 54. EXAMPLES - CODING BY DOMAINS Tie each statement to a domain Does not practicing hand hygiene evoke worry or concern in you? ‘No it wouldn’t.’ Emotion
- 55. EXAMPLES - CODING BY DOMAINS Tie each statement to a domain Does not practicing hand hygiene evoke worry or concern in you? ‘No it wouldn’t.’ Emotion “I think they [patients and their families] have a reason to expect it [hand hygiene] from us, like I don’t do it to satisfy them, their wishes.”
- 56. Tie each statement to a domain “I think they [patients and their families] have a reason to expect it [hand hygiene] from us, like I don’t do it to satisfy them, their wishes.” Social influences EXAMPLES - CODING BY DOMAINS Does not practicing hand hygiene evoke worry or concern in you? ‘No it wouldn’t.’ Emotion
- 57. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Themes Stage 2 Stage 3Stage 1 ANALYSIS 6 – ANALYSE THE DATA
- 58. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Themes Stage 2 Stage 3Stage 1 ANALYSIS • Statements (sub-themes) from each participant’s responses that captured the core thought • statements were made by different participants, both were coded as two instances of the same belief. • Statements having same theme or were polar opposites of a theme were grouped together. • Recommend that this strategy be reviewed by the second researcher to ensure accurate representation of content. 6 – ANALYSE THE DATA
- 59. EXAMPLES – GENERATING THEMES (ENABLERS) “In fact, I like to make it [hand hygiene] a very visible part of my patient consultation…I try and make sure that I’m actually still in the process of putting alcohol-based hand rub on my hands so that they know I’m performing hand hygiene.” Med Staff “I think every healthcare professional has to use it [hand hygiene].” Med Res Social professional role and identity Hand hygiene is a standard part of my patient consultations. (n = 40)
- 60. EXAMPLES – GENERATING THEMES (BARRIERS) “I don’t think I was ever trained, no.” Surgery Staff Skills I have not had training in hand hygiene practice (n = 15) “Are you confident that you are following the guidelines when practicing hand hygiene? A: I don’t think so, not strictly, not all of them anyway.” Surgery staff Beliefs about capabilities I am not confident that I am following hand hygiene guidelines when practicing hand hygiene (n = 40)
- 61. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 6 – ANALYSE THE DATA
- 62. Develop Interview Guide Conduct interviews INTERVIEW Coding into Domains Identifying Relevant Domains Generating Specific Beliefs/ Themes Stage 2 Stage 3Stage 1 ANALYSIS 1. Relevant domains should be identified through consensus (2-3 people). 2. 3 factors to consider • frequency of the beliefs across interviews; • presence of conflicting beliefs; • perceived strength of the beliefs impacting the behaviour. 3. All of these factors should be considered concurrently in establishing domain relevance. 6 – ANALYSE THE DATA
- 63. EXAMPLE - DOMAIN SELECTION When there is an emergency situation, I am less likely to practice hand hygiene (n = 14) Life-threatening situations. I mean, I don’t see myself, you know, looking for a sink when a patient is having a cardiac arrest. Med staff Hand hygiene is easy to practice (n = 36) Beliefs about capabilities Hand hygiene is difficult to practice (n = 8) “It couldn’t be any easier. The stuff [alcohol gel] is all over the place.” Med staff “…if you were in a situation where you’re trying to do too much and you’re carrying things in and out of rooms and what have you, it’s not that you wouldn’t be trying to practice hand hygiene but that you might not be able to do it as effectively, right.” Med Res
- 64. AT THE END OF ITALL ▶ You’ll have a list of relevant theoretical domains that are most likely to influence the target implementation problem and associated behaviours.
- 65. SUMMARY – TAKE HOME MESSAGES ▶The TDF can help to structure how you identify the barriers and enablers that may influence the implementation of your initiative in your setting ▶Can use quantitative (questionnaires) and/or qualitative (interview/focus group) approaches ▶There are tools that you can use and quickly adapt • Do not need to re-invent the wheel: questionnaires and interview guides can be adapted to your setting • This is a strength of defining your behaviour using TACT-A ▶Taking this comprehensive, structured approach rooted in what we know influences behaviour and behaviour change helps to select change strategies that are fit for purpose (next webinar!)
- 66. Next Webinar Selecting strategies and techniques best suited to address barriers measurement and evaluation June 19th, 2018 noon EST Lead: Justin and Jeremy In the meantime… Please send us examples of your own planned/ongoing patient safety initiatives so that we can directly inform our examples in the next webinars Send to: jpresseau@ohri.ca
- 67. www.ohri.ca | Affiliated with • Affilié à Justin Presseau Scientist, OHRI Assistant Professor, uOttawa @JPresseau jpresseau@ohri.ca Andrea Patey Senior Clinical Research Associate, OHRI Assistant Professor (Adjunct), Queen’s @andreapatey apatey@ohri.ca Centre for Implementation Research Thank you