Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making.
Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making.
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DOI：
10.1186/s43058-020-00105-6
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发表时间：
2021-01-11
影响因子：
--
通讯作者：
Beidas RS
中科院分区：
文献类型：
--
作者：
Last BS;Schriger SH;Timon CE;Frank HE;Buttenheim AM;Rudd BN;Fernandez-Marcote S;Comeau C;Shoyinka S;Beidas RS
以创伤为中心的认知行为疗法（TF-CBT）是一种针对青少年创伤后应激障碍的循证干预措施。TF-CBT的一个重要组成部分是创伤叙述（TN），这是一个干预阶段，在这个阶段中，青少年被引导处理与他们的创伤经历相关的记忆，思想和感受。以前的工作表明，TF-CBT临床医生完成TN只有一半的客户，但很少有人知道是什么决定TF-CBT临床医生使用TN。行为洞察文献是一个研究判断和决策的跨学科领域，它提供了理论和经验工具来概念化是什么驱动了复杂的人类行为和决策。从行为的见解文献，本研究旨在了解是什么决定了临床医生使用TN和产生的战略，针对这些决定因素。通过半结构化的定性访谈，我们寻求在费城（N = 17）的公共心理健康环境中工作的受过训练的TF-CBT临床医生的观点，以了解他们与客户一起使用TN的决定。我们分析了定性数据使用的编码方法告知的行为见解文献。我们使用了一个迭代的过程，结构化的假设生成，辅助行为的见解指南，和快速验证的行为见解，揭示TN使用的决定因素。然后，我们使用“容易吸引人的社交及时”框架，一种行为洞察设计方法，针对这些决定因素制定了实施策略。我们生成并验证了三个广泛的主题是什么决定了临床医生实施TN：决策的复杂性，临床医生的情感体验和机构规范。我们假设这些实施的决定因素的基础行为的见解，并设计了一个列表的九个相应的行为的见解策略，可能会促进TN的实施。我们的研究调查了为什么循证干预的有效组成部分难以实施。我们利用强大的科学理论和实证研究从行为的见解文献，了解临床医生的观点TN的实施。这些因素在理论上与执行战略有关。我们的工作揭示了在循证干预决定因素的诊断和实施策略的设计中使用行为见解的潜力。在线版本包含补充材料，可通过10.1186/s43058-020-00105-6获得。
Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians’ use of TNs. The behavioral insights literature—an interdisciplinary field studying judgment and decision-making—offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N = 17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies. The online version contains supplementary material available at 10.1186/s43058-020-00105-6.
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影响因子：
6.9
作者：
Caris, M. G.;Labuschagne, H. A.;Vandenbroucke-Grauls, C. M. J. E.
通讯作者：
Vandenbroucke-Grauls, C. M. J. E.
影响因子：
5.9
作者：
Borkovec, TD;Castonguay, LG
通讯作者：
Castonguay, LG
影响因子：
6.3
作者：
Cohen, Keren;Collens, Paula
通讯作者：
Collens, Paula
影响因子：
3.8
作者：
de Arellano, Michael A. Ramirez;Lyman, D. Russell;Delphin-Rittmon, Miriam E.
通讯作者：
Delphin-Rittmon, Miriam E.
影响因子：
11.3
作者：
Damschroder, Laura J.
通讯作者：
Damschroder, Laura J.