Characterising an implementation intervention in terms of behaviour change techniques and theory: the 'Sepsis Six' clinical care bundle
Characterising an implementation intervention in terms of behaviour change techniques and theory: the 'Sepsis Six' clinical care bundle
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DOI：
10.1186/s13012-015-0300-7
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发表时间：
2015-08-08
影响因子：
7.2
通讯作者：
Michie, Susan
中科院分区：
文献类型：
--
作者：
Steinmo, Siri;Fuller, Christopher;Michie, Susan
背景：脓毒症是感染死亡的主要原因，死亡率为36%。这可以通过在1小时内实施“败血症六”循证护理包减半。英国的一项审计显示，实施率中位数为27- 47%，而改善这一情况的干预措施效果甚微。为了制定更有效的执行干预措施，有必要详细描述当前干预措施的特点，并利用行为理论来确定变革机制。本研究的目的是通过使用行为改变轮来说明这一过程;行为改变技术（BCT）分类法;行为的能力，机会，动机模型;和理论领域框架来描述现有干预措施的内容和理论机制，以实施脓毒症六。数据来自英国一家医院几个病房的干预措施交付的文献，访谈和观察分析。使用干预描述和复制框架模板创建了干预的广泛描述。具体内容包括：（i）使用BCT分类法的BCT组件;（ii）使用行为改变轮的干预功能。行动机制指定使用的能力，机会，动机模型和理论领域Framework.Results：干预包括19个BCT，8个确定使用所有三个数据源。通过行为改变轮的七个功能提供了最佳现金流量，其中四个功能（“教育”、“扶持”、“培训”和“环境重建”）得到三个数据源的支持。最常见的行动机制是反思的动机（特别是“信念的后果”和“信念的能力”）和心理能力（特别是“知识”）。结论：干预包括广泛的BCT针对广泛的行动机制。这项研究表明，效用的行为改变轮，BCT分类和理论领域框架，工具公认的干预设计提供指导，为现有的干预措施，实施循证护理的特点。
Background: Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the 'Sepsis Six' evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27-47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to identify mechanisms of change. The aim of this study was to illustrate this process by using the Behaviour Change Wheel; Behaviour Change Technique (BCT) Taxonomy; Capability, Opportunity, Motivation model of behaviour; and Theoretical Domains Framework to characterise the content and theoretical mechanisms of action of an existing intervention to implement Sepsis Six.Methods: Data came from documentary, interview and observational analyses of intervention delivery in several wards of a UK hospital. A broad description of the intervention was created using the Template for Intervention Description and Replication framework. Content was specified in terms of (i) component BCTs using the BCT Taxonomy and (ii) intervention functions using the Behaviour Change Wheel. Mechanisms of action were specified using the Capability, Opportunity, Motivation model and the Theoretical Domains Framework.Results: The intervention consisted of 19 BCTs, with eight identified using all three data sources. The BCTs were delivered via seven functions of the Behaviour Change Wheel, with four ("education', "enablement', 'training' and 'environmental restructuring') supported by the three data sources. The most frequent mechanisms of action were reflective motivation (especially 'beliefs about consequences' and 'beliefs about capabilities') and psychological capability (especially 'knowledge').Conclusions: The intervention consisted of a wide range of BCTs targeting a wide range of mechanisms of action. This study demonstrates the utility of the Behaviour Change Wheel, the BCT Taxonomy and the Theoretical Domains Framework, tools recognised for providing guidance for intervention design, for characterising an existing intervention to implement evidence-based care.