Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Implementation Science
Published in: Implementation Science 1/2018

Open Access 01-12-2018 | Methodology

To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis

Authors: Liz Glidewell, Thomas A. Willis, Duncan Petty, Rebecca Lawton, Rosemary R. C. McEachan, Emma Ingleson, Peter Heudtlass, Andrew Davies, Tony Jamieson, Cheryl Hunter, Suzanne Hartley, Kara Gray-Burrows, Susan Clamp, Paul Carder, Sarah Alderson, Amanda J. Farrin, Robbie Foy, on behalf of the ASPIRE programme team

Published in: Implementation Science | Issue 1/2018

Login to get access

Abstract

Background

Interpreting evaluations of complex interventions can be difficult without sufficient description of key intervention content. We aimed to develop an implementation package for primary care which could be delivered using typically available resources and could be adapted to target determinants of behaviour for each of four quality indicators: diabetes control, blood pressure control, anticoagulation for atrial fibrillation and risky prescribing. We describe the development and prospective verification of behaviour change techniques (BCTs) embedded within the adaptable implementation packages.

Methods

We used an over-lapping multi-staged process. We identified evidence-based, candidate delivery mechanisms—mainly audit and feedback, educational outreach and computerised prompts and reminders. We drew upon interviews with primary care professionals using the Theoretical Domains Framework to explore likely determinants of adherence to quality indicators. We linked determinants to candidate BCTs. With input from stakeholder panels, we prioritised likely determinants and intervention content prior to piloting the implementation packages. Our content analysis assessed the extent to which embedded BCTs could be identified within the packages and compared them across the delivery mechanisms and four quality indicators.

Results

Each implementation package included at least 27 out of 30 potentially applicable BCTs representing 15 of 16 BCT categories. Whilst 23 BCTs were shared across all four implementation packages (e.g. BCTs relating to feedback and comparing behaviour), some BCTs were unique to certain delivery mechanisms (e.g. ‘graded tasks’ and ‘problem solving’ for educational outreach). BCTs addressing the determinants ‘environmental context’ and ‘social and professional roles’ (e.g. ‘restructuring the social and ‘physical environment’ and ‘adding objects to the environment’) were indicator specific. We found it challenging to operationalise BCTs targeting ‘environmental context’, ‘social influences’ and ‘social and professional roles’ within our chosen delivery mechanisms.

Conclusion

We have demonstrated a transparent process for selecting, operationalising and verifying the BCT content in implementation packages adapted to target four quality indicators in primary care. There was considerable overlap in BCTs identified across the four indicators suggesting core BCTs can be embedded and verified within delivery mechanisms commonly available to primary care. Whilst feedback reports can include a wide range of BCTs, computerised prompts can deliver BCTs at the time of decision making, and educational outreach can allow for flexibility and individual tailoring in delivery.
Appendix
Available only for authorised users
Literature
1.
Grimshaw JM, Thomas RE, Maclennan G, Fraser C, Ramsay C, Vale L, Eccles M. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2002;8:1–247.
2.
3.
Right Care. NHS Atlas of Variation in Healthcare. London: Public Health England; 2015.
4.
Willis TA, West R, Rushforth B, Stokes T, Glidewell L, Carder P, Faulkner S, Foy R. Variations in achievement of evidence-based, high-impact quality indicators in general practice: an observational study. PLoS One. 2017;12(7):e0177949.CrossRefPubMedPubMedCentral
5.
Foy R, Eccles M, Grimshaw J. Why does primary care need more implementation research? Fam Pract. 2001;18(4):353–5.CrossRefPubMed
6.
Grimshaw J, Shirran L, E T, Mowatt G, Fraser C, Bero L. Changing provider behaviour: an overview of systematic reviews of interventions. Med Care. 2001;39(Suppl 2):II-2–II-45.
7.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Int J Technol Assess Health Care. 2005;21(1):149.CrossRef
8.
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2012;6:1–216.
9.
Eccles MP, Steen IN, Grimshaw JM, Thomas L, McNamee P, Souter J, Wilsdon J, Matowe L, Needham G, Gilbert F, et al. Effect of audit and feedback, and reminder messages on primary-care referrals: a randomised trial. Lancet. 2001;357:1406–9.CrossRefPubMed
10.
Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ, Handler SM, Nieuwlaat R, Souza NM, Beyene J, Van Spall HG, et al. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ. 2013;346:f657.CrossRefPubMed
11.
O’Brien M, Rogers S, Jamtvedt G, Oxman A, Odgaard-Jensen J, Kristofferson D, Forsetlund L, Bainbridge D, Freemantle N, Davis D. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Libr. 2008;3:1–64.
12.
Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009;4:40.
13.
14.
Chalmers I, Bracken MB, Djulbegovic B, Garattini S, Grant J, Gülmezoglu AM, Howells DW, Ioannidis JPA, Oliver S. How to increase value and reduce waste when research priorities are set. Lancet. 2014;383(9912):156–65.CrossRefPubMed
15.
Glasziou P, Altman DG, Bossuyt P, Boutron I, Clarke M, Julious S, Michie S, Moher D, Wager E. Reducing waste from incomplete or unusable reports of biomedical research. Lancet. 2014;383(9913):267–76.CrossRefPubMed
16.
Ivers NM, Grimshaw JM, Jamtvedt G, Flottorp S, O'Brien MA, French SD, Young J, Odgaard-Jensen J. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. J Gen Intern Med. 2014;29(11):1534–41.CrossRefPubMedPubMedCentral
17.
Johnson MJ, May CR. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. BMJ Open. 2015;5(9):e008592.CrossRefPubMedPubMedCentral
18.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, Whitty P, Eccles MP, Matowe L, Shirran L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii–72.CrossRefPubMed
19.
Presseau J, Hawthorne G, Sniehotta FF, Steen N, Francis JJ, Johnston M. Improving diabetes care through examining, advising, and prescribing (IDEA): protocol for a theory-based cluster randomised controlled trial of a multiple behaviour change intervention aimed at primary healthcare professionals. Implement Sci. 2014;9:61.
20.
Baker R, Camosso-Stefinovic J, Gillies C, Shaw EJ, Cheater F, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2010;(Issue 3) (Art. No.: CD005470. DOI: 10.1002/14651858.CD005470.pub2.)
21.
Krause J, Van Lieshout J, Klomp R, Huntink E, Aakhus E, Flottorp S, Jaeger C, Steinhaeuser J, Godycki-Cwirko M, Kowalczyk A, et al. Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods. Implement Sci. 2014;9(1):102.CrossRefPubMedPubMedCentral
22.
Eccles M, Grimshaw J, Walker A, Johnston M, Pitts N. Changing the behavior of healthcare professionals: the use of theory in promoting the uptake of research findings. J Clin Epidemiol. 2005;58(2):107–12.CrossRefPubMed
23.
Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, Eccles MP, Cane J, Wood CE. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed
24.
Davies P, Walker AE, Grimshaw JM. A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations. Implement Sci. 2010;5:14.
25.
Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, Altman DG, Barbour V, Macdonald H, Johnston M, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.CrossRefPubMed
26.
Gallagher KM, Updegraff JA. Health message framing effects on attitudes, intentions, and behavior: a meta-analytic review. Ann Behav Med. 2012;43(1):101–16.CrossRefPubMed
27.
Rushforth B, Stokes T, Andrews E, Willis TA, McEachan R, Faulkner S, Foy R. Developing ‘high impact’ guideline-based quality indicators for UK primary care: a multi-stage consensus process. BMC Fam Pract. 2015;16(1):1–10.CrossRef
28.
Willis TA, Hartley S, Glidewell L, Farrin AJ, Lawton R, McEachan RR, Ingleson E, Heudtlass P, Collinson M, Clamp S, et al. Action to support practices implement research evidence (ASPIRE): protocol for a cluster-randomised evaluation of adaptable implementation packages targeting 'high impact' clinical practice recommendations in general practice. Implement Sci. 2016;11:25.CrossRefPubMedPubMedCentral
29.
Abraham C, Wood CE, Johnston M, Francis J, Hardeman W, Richardson M, Michie S. Reliability of identification of behavior change techniques in intervention descriptions. Ann Behav Med. 2015;49(6):885–900.CrossRefPubMed
30.
McCullough AR, Ryan C, O’Neill B, Bradley JM, Elborn JS, Hughes CM. Defining the content and delivery of an intervention to change AdhereNce to treatment in BonchiEctasis (CAN-BE): a qualitative approach incorporating the theoretical domains framework, behavioural change techniques and stakeholder expert panels. BMC Health Serv Res. 2015;15(1):342.CrossRefPubMedPubMedCentral
31.
Foy R, Sales A, Wensing M, Aarons GA, Flottorp S, Kent B, Michie S, O’Connor D, Rogers A, Sevdalis N. Implementation science: a reappraisal of our journal mission and scope. Implement Sci. 2015;10(1):51.CrossRefPubMedPubMedCentral
32.
33.
Lord PA, Willis TA, Carder P, West RM, Foy R. Optimizing primary care research participation: a comparison of three recruitment methods in data-sharing studies. Fam Pract. 2016;33:200–4.CrossRefPubMed
34.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral
35.
Lawton R, Heyhoe J, Louch G, Ingleson E, Glidewell L, Willis TA, McEachan RRC, Foy R. Using the theoretical domains framework (TDF) to understand adherence to multiple evidence-based indicators in primary care: a qualitative study. Implement Sci. 2016;11(1):1–16.
36.
Francis J, O’Connor D, Curran J. Theories of behaviour change synthesised into a set of theoretical groupings: introducing a thematic series on the theoretical domains framework. Implement Sci. 2012;7(1):35.CrossRefPubMedPubMedCentral
37.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
38.
Hoffman T, Glasziou PP, Boutron I, Milne R, Perera R, Moher D. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687.
39.
40.
Presseau J, Ivers NM, Newham JJ, Knittle K, Danko KJ, Grimshaw JM. Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care. Implement Sci. 2015;10:55.CrossRefPubMedPubMedCentral
41.
Peters G-JY. A practical guide to effective behavior change: how to identify what to change in the first place. Eur Health Psychol. 2014;16(5):142–55.
42.
de Bruin M, Crutzen R, Peters G-JY. Everything should be as simple as possible, but this will still be complex: a reply to various commentaries on IPEBA. Health Psychol Rev. 2015;9(1):38–41.CrossRefPubMed
43.
Kok L. A practical guide to effective behavior change: how to apply theory- and evidence-based behavior change methods in an intervention. Eur Health Psychol. 2014;16(5):156–70.
44.
Prestwich A, Webb TL, Conner M. Using theory to develop and test interventions to promote changes in health behaviour: evidence, issues, and recommendations. Curr Opinion in Psychology. 2015;5:1–5.CrossRef
45.
Cane J, O'Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.CrossRefPubMedPubMedCentral
46.
47.
May CR, Mair FS, Dowrick CF, Finch TL. Process evaluation for complex interventions in primary care: understanding trials using the normalization process model. BMC Fam Pract. 2007;8:42.
48.
Murray E, Treweek S, Pope C, MacFarlane A, Ballini L, Dowrick C, Finch T, Kennedy A, Mair F, O'Donnell C, et al. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC Med. 2010;8(1):63.CrossRefPubMedPubMedCentral
Metadata
Title
To what extent can behaviour change techniques be identified within an adaptable implementation package for primary care? A prospective directed content analysis
Authors
Liz Glidewell
Thomas A. Willis
Duncan Petty
Rebecca Lawton
Rosemary R. C. McEachan
Emma Ingleson
Peter Heudtlass
Andrew Davies
Tony Jamieson
Cheryl Hunter
Suzanne Hartley
Kara Gray-Burrows
Susan Clamp
Paul Carder
Sarah Alderson
Amanda J. Farrin
Robbie Foy
on behalf of the ASPIRE programme team
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2018
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0704-7

Other articles of this Issue 1/2018

Implementation Science 1/2018 Go to the issue

Systematic review

Managerial leadership for research use in nursing and allied health care professions: a systematic review

Study protocol

Implementation of a knowledge mobilization model to prevent peripheral venous catheter-related adverse events: PREBACP study—a multicenter cluster-randomized trial protocol

Research

Applying modern measurement approaches to constructs relevant to evidence-based practice among Canadian physical and occupational therapists

Research

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

Research

Defining barriers and enablers for clinical pathway implementation in complex clinical settings

Research

Effectiveness of educational outreach visits compared with usual guideline dissemination to improve family physician prescribing—an 18-month open cluster-randomized trial