Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework
Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework
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DOI：
10.1007/s00787-018-1230-0
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发表时间：
2019-05-01
影响因子：
6.4
通讯作者：
Midgley, N.
中科院分区：
文献类型：
--
作者：
Hayes, D.;Edbrooke-Childs, J.;Midgley, N.
共同决策（SDM）越来越多地被建议作为心理健康服务的一个组成部分。然而，几乎没有研究临床医生认为实践中的障碍和促进因素是什么。与此同时，人们也越来越认识到该领域的理论与实践之间的差距，呼吁更多地务实地使用理论来指导和改善临床实践。使用的理论领域框架（TDF），一个全面的，理论为主导的框架，支持33个行为改变理论和128个结构，临床医生感知的障碍和促进SDM进行了调查。样本包括15名临床医生在英格兰的两个网站，谁参加了定性半结构化访谈和焦点小组。成绩单进行了分析，使用演绎主题分析，并根据每个理论域的主题进行编码。总体而言，在TDF的10个领域中确定了SDM在儿童和青少年心理健康方面的21个障碍和促进因素。根据能力，障碍和促进者被发现的知识，技能，记忆/注意力/决策过程，和行为监管。对于机会，障碍和促进者被发现的社会影响，以及环境背景和资源。最后，对于动机，涵盖的领域包括：对后果的信念，对能力的信念，情感，职业角色和身份。研究结果表明，一系列的障碍和促进者影响临床医生的能力，从事SDM与年轻人和家长。应制定针对能力、机会和动机等不同领域的干预措施，以更好地协助青年人及其家人作出护理和治疗决定。
Shared decision making (SDM) is increasingly being suggested as an integral part of mental health provision. Yet, there is little research on what clinicians believe the barriers and facilitators around practice to be. At the same time, there is also increasing recognition of a theory-practice gap within the field, with calls for more pragmatic uses of theory to inform and improve clinical practice. Using the Theoretical Domains Framework (TDF), a comprehensive, theoretical-led framework, underpinned by 33 behaviour change theories and 128 constructs, clinician perceived barriers and facilitators to SDM are investigated. The sample comprised of 15 clinicians across two sites in England, who took part in qualitative semi-structured interviews and focus groups. Transcripts were analysed using a deductive thematic analysis, and themes were coded under each theoretical domain. Overall, 21 barriers and facilitators for SDM in child and youth mental health were identified across ten domains of the TDF. Under capability, barriers and facilitators were found for knowledge, skills, memory/attention/decision making processes, and behavioural regulation. For opportunity, barriers and facilitators were found for social influences, as well as environmental context and resources. Finally, for motivation, domains covered included: beliefs about consequences, beliefs about capabilities, emotions, and professional role and identity. Findings suggest that a range of barriers and facilitators affect clinicians' abilities to engage in SDM with young people and parents. Interventions which target different domains related to capability, opportunity and motivation should be developed to better facilitate young people and their families in care and treatment decisions.