Hiding in plain sight: communication theory in implementation science
Hiding in plain sight: communication theory in implementation science
复制标题
DOI：
10.1186/s13012-015-0244-y
复制
发表时间：
2015-04-23
影响因子：
7.2
通讯作者：
Graham, Ian D.
中科院分区：
文献类型：
--
作者：
Manojlovich, Milisa;Squires, Janet E.;Graham, Ian D.
背景：医疗保健专业人员之间的沟通不畅是一个紧迫的问题，导致患者安全面临广泛的障碍。 “沟通”一词的意思是分享或共同。在文献中，两种通信范式占主导地位：（1）通信作为负责信息交换的事务过程，（2）通信作为负责引起变化的转换过程。实施科学关注信息交换属性，而很大程度上忽略了通信的转换属性。在本文中，我们讨论了包含这两种范式的优点。讨论：我们进行了两阶段的文献综述，寻找实施科学中的传播概念，以了解传播是如何概念化的。确定了二十七个理论、模型或框架；只有罗杰斯的创新扩散理论提供了传播的定义并包括两种传播范式。大多数模型（值得注意的例外包括创新扩散、渥太华研究使用模型和标准化过程理论）将沟通描述为交易过程。但是，仅仅将通信视为信息传输或交换就歪曲了现实。我们建议实施科学理论（1）在描述沟通时提出并测试共同理解的概念，（2）承认沟通是多层次的，至少确定几个层次，并假设所识别的层次如何影响共同理解的发展，（3）承认沟通发生在社会背景下，为个人和群体提供参考框架，（4）承认沟通（以及一般医疗保健过程）的不可预测性，以及（5）参与并利用沟通所做的工作理论家总结：实施科学文献将沟通概念化为交易过程（当沟通被提及时），从而忽略了实施干预成功的关键因素。当将其概念化为转型过程时，沟通的重点转向共享理解，并以人类互动和我们构建知识的方式为基础。我们建议明确承认沟通在我们的实施工作中所发挥的作用，而不是隐藏在众目睽睽之下。通过使用这两种范式，我们可以调查沟通何时促进实施、何时不促进实施，以及如何改进沟通，以便我们的实施和临床干预措施得到临床医生和患者的认可。
Background: Poor communication among healthcare professionals is a pressing problem, contributing to widespread barriers to patient safety. The word "communication" means to share or make common. In the literature, two communication paradigms dominate: (1) communication as a transactional process responsible for information exchange, and (2) communication as a transformational process responsible for causing change. Implementation science has focused on information exchange attributes while largely ignoring transformational attributes of communication. In this paper, we debate the merits of encompassing both paradigms.Discussion: We conducted a two-staged literature review searching for the concept of communication in implementation science to understand how communication is conceptualized. Twenty-seven theories, models, or frameworks were identified; only Rogers' Diffusion of Innovations theory provides a definition of communication and includes both communication paradigms. Most models (notable exceptions include Diffusion of Innovations, The Ottawa Model of Research Use, and Normalization Process Theory) describe communication as a transactional process. But thinking of communication solely as information transfer or exchange misrepresents reality. We recommend that implementation science theories (1) propose and test the concept of shared understanding when describing communication, (2) acknowledge that communication is multi-layered, identify at least a few layers, and posit how identified layers might affect the development of shared understanding, (3) acknowledge that communication occurs in a social context, providing a frame of reference for both individuals and groups, (4) acknowledge the unpredictability of communication (and healthcare processes in general), and (5) engage with and draw on work done by communication theorists.Summary: Implementation science literature has conceptualized communication as a transactional process (when communication has been mentioned at all), thereby ignoring a key contributor to implementation intervention success. When conceptualized as a transformational process, the focus of communication moves to shared understanding and is grounded in human interactions and the way we go about constructing knowledge. Instead of hiding in plain sight, we suggest explicitly acknowledging the role that communication plays in our implementation efforts. By using both paradigms, we can investigate when communication facilitates implementation, when it does not, and how to improve it so that our implementation and clinical interventions are embraced by clinicians and patients alike.