An innovative sequential mixed-methods approach to evaluating clinician acceptability during implementation of a standardized labor induction protocol.
An innovative sequential mixed-methods approach to evaluating clinician acceptability during implementation of a standardized labor induction protocol.
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DOI：
10.1186/s12874-023-02010-7
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发表时间：
2023-08-29
影响因子：
4
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中科院分区：
文献类型：
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执行结果，包括可接受性，在执行研究和实践中至关重要。可接受性的黄金标准措施，干预措施的可接受性（AIM），在有限的范围内正偏。在一项正在进行的混合有效性-实施试验中，我们旨在评价临床医生对诱导标准化的可接受性。在这里，我们描述了一种创新的混合方法的方法，以最大限度地提高解释的目的，在孕产妇健康的案例研究。在这项解释性序贯混合方法研究中，我们在2个研究中心（研究中心1：2021年3月;研究中心2：2021年6月）实施后6个月向分娩和分娩临床医生分发了经验证的4问题AIM（共4-20个）。受访者按总分分为三分位。顶部（“高”可接受性）和底部（“低”可接受性）三分位数被邀请参加2021年6月至2021年10月的30分钟半结构化定性访谈，直到每个可接受性组达到主题饱和。参与者是有目的地抽样的角色和网站。访谈编码使用综合方法，将先验属性（实施研究结构的综合框架）到修改后的内容分析方法。104名临床医生完成了初步调查; 24人接受了访谈（12名“高”和12名“低”可接受性）。高可接受性组和低可接受性组的中位AIM总分分别为20 - 20 IQR[20-20]和12.5/20 IQR[11-14]。在这两组中，临床医生都热衷于标准化引产的努力，认为它减少了临床医生之间的差异，并提高了公平，循证护理。在低可接受性组中，临床医生表示需要灵活性并考虑患者的独特性。临床医生很少认为引产不能或不应该标准化，理由是对分娩的医疗化感到不适，并担心用干预措施“推平”病人。克服消极情绪的建议策略包括全面的临床医生教育，以及让患者积极参与产前方案。本研究采用创新的序贯混合方法方法中的AIM来表征临床医生的可接受性，这可能在实施过程中具有普遍性。通过在混合试验期间开展这项工作，第2年出现了提高可接受性的实施策略（临床医生教育侧重于尊重灵活性;让患者在产前积极参与），这将为未来的多中心工作提供信息。
Implementation outcomes, including acceptability, are of critical importance in both implementation research and practice. The gold standard measure of acceptability, Acceptability of Intervention Measure (AIM), skews positively with a limited range. In an ongoing hybrid effectiveness-implementation trial, we aimed to evaluate clinician acceptability of induction standardization. Here, we describe an innovative mixed-methods approach to maximize the interpretability of the AIM using a case study in maternal health. In this explanatory sequential mixed methods study, we distributed the validated, 4-question AIM (total 4–20) to labor and delivery clinicians 6 months post-implementation at 2 sites (Site 1: 3/2021; Site 2: 6/2021). Respondents were grouped by total score into tertiles. The top (“High” Acceptability) and bottom (“Low” Acceptability) tertiles were invited to participate in a 30-minute semi-structured qualitative interview from 6/2021 to 10/2021 until thematic saturation was reached in each acceptability group. Participants were purposively sampled by role and site. Interviews were coded using an integrated approach, incorporating a priori attributes (Consolidated Framework for Implementation Research constructs) into a modified content analysis approach. 104 clinicians completed the initial survey; 24 were interviewed (12 “High” and 12 “Low” Acceptability). Median total AIM scores were 20/20 IQR[20–20] in the High and 12.5/20 IQR[11–14] in the Low Acceptability groups. In both groups, clinicians were enthusiastic about efforts to standardize labor induction, believing it reduces inter-clinician variability and improves equitable, evidence-based care. In the Low Acceptability group, clinicians stated the need for flexibility and consideration for patient uniqueness. Rarely, clinicians felt labor induction could not or should not be standardized, citing discomfort with medicalization of labor, and concerns with “bulldozing” the patient with interventions. Suggested strategies for overcoming negative sentiment included comprehensive clinician education, as well as involving patients as active participants in the protocol prenatally. This study utilized AIM in an innovative sequential mixed-methods approach to characterize clinician acceptability, which may be generalizable across implementation endeavors. By performing this work during a hybrid trial, implementation strategies to improve acceptability emerged (clinician education focusing on respect for flexibility; involving patients as active participants prenatally) for year 2, which will inform future multi-site work.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
社区利益相关者对行为健康中基于证据的实践实施策略的偏好：最佳缩放选择实验。
影响因子：
4.4
作者：
Williams NJ;Candon M;Stewart RE;Byeon YV;Bewtra M;Buttenheim AM;Zentgraf K;Comeau C;Shoyinka S;Beidas RS
通讯作者：
Beidas RS
DOI：
10.3389/frhs.2022.897227
发表时间：
2022
期刊：
FRONTIERS IN HEALTH SERVICES
影响因子：
--
作者：
Pilar, Meagan;Elwy, A Rani;Lushniak, Larissa;Huang, Grace;McLoughlin, Gabriella M;Hooley, Cole;Nadesan-Reddy, Nisha;Sandler, Brittney;Moshabela, Mosa;Alonge, Olakunle;Geng, Elvin;Proctor, Enola
通讯作者：
Proctor, Enola
影响因子：
5.7
作者：
Harris, Alex H. S.;Hagedorn, Hildi J.;Finlay, Andrea K.
通讯作者：
Finlay, Andrea K.
影响因子：
7.2
作者：
Weiner, Bryan J.;Lewis, Cara C.;Halko, Heather
通讯作者：
Halko, Heather