Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods
Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods
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DOI：
10.1186/s13012-019-0942-y
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发表时间：
2019-11-04
影响因子：
7.2
通讯作者：
Sandborgh, Maria
中科院分区：
文献类型：
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作者：
Fritz, Johanna;Wallin, Lars;Sandborgh, Maria
背景在一项准实验研究中，促进被用来支持物理治疗中行为医学方法的实施。促进包括一个单独定制的多方面的干预，包括外展访问，同侪辅导，教育材料，个人目标设定，视频反馈，自我监测的日记，管理人员的支持，和信息传单给病人。行为医学方法意味着关注与健康相关的行为改变。临床行为的变化开始，但没有保持在参与物理治疗师。为了解释这些发现，有必要更深入地了解实施过程。因此，我们的目的是探讨在实施行为医学方法在物理治疗的影响机制，通过检查剂量，达到和参与者的经验。方法采用探索性混合方法设计，作为准实验研究的一部分。24个物理治疗师在初级卫生保健工作被纳入准实验性试验，并在实验组（n = 15）的所有物理治疗师被纳入本研究。主要基于社会认知理论的促进干预进行了为期6个月的测试。在实施期间和之后，通过自我报告的时间分配参与不同的实施方法，个人目标的文件，最重要的实施方法的排名，和半结构化的访谈收集数据。采用描述性统计方法和归纳性内容分析。结果物理治疗师最常参与的实施方法有：外展访问、同侪辅导、教育材料和个人目标设定。他们还认为这些方法对于实施来说是最重要的，有助于支持学习，实践，记忆，情感，自我管理和时间管理。然而，缺乏管理人员的时间管理支持。结论临床行为改变的发生和维持有不同的机制。临床行为改变的影响机制是指使用外部启动的多种方法，如实践反馈，时间管理和外在动机。缺乏自我调节能力，内在动机，实施干预期后的持续支持被解释为可能的机制，随着时间的推移，维持行为变化的失败。
Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.