'It's a can of worms': understanding primary care practitioners' behaviours in relation to HPV using the theoretical domains framework
'It's a can of worms': understanding primary care practitioners' behaviours in relation to HPV using the theoretical domains framework
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DOI：
10.1186/1748-5908-7-73
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发表时间：
2012-08-03
影响因子：
7.2
通讯作者：
Sharp, Linda
中科院分区：
文献类型：
--
作者：
McSherry, Lisa A.;Dombrowski, Stephan U.;Sharp, Linda
背景：高危型人乳头状瘤病毒(HPV)感染与宫颈癌的关系正在改变着宫颈癌的预防。人乳头瘤病毒检测和疫苗接种最近已经可用。在爱尔兰，就像在其他地方一样，初级保健从业者在预防方面发挥着关键作用。雅典(HPV教育和支持试验)旨在开发一种基于理论的干预措施，以支持初级保健从业人员的HPV相关实践。这项研究是干预发展过程的第一步，旨在：确定干预将针对的与HPV相关的临床行为；澄清全科医生(GP)和执业护士的角色和责任；并确定潜在影响临床行为的因素。第二个目标是非正式地评估理论领域框架(TDF)在一个证据基础不断变化的领域中理解临床行为的有效性。方法：对全科医生和实习护士进行深入的半结构化电话访谈。该主题指南包括开放问题和HPV相关的临床情景，是通过文献回顾和临床经验制定的。结果：对19名全科医生和14名实习护士进行了访谈。与HPV相关的主要临床行为是：与女性患者展开关于HPV感染的讨论；向适当的患者提供/推荐HPV疫苗接种；以及回答患者关于HPV检测的问题。虽然涂片检查的责任被认为是女性的角色，但男性和女性从业者都处理与HPV相关的问题。所有12个理论领域都与HPV感染有关；被判断为最重要的领域是：知识、情感、社会影响、对能力的信念和对后果的信念。出现了与HPV疫苗接种有关的11个领域，其中关于后果、社会影响、知识和环境背景以及资源的信念被认为是最重要的。与HPV检测相关的九个领域，关于能力的知识和信念被认为是最重要的。结论：研究结果证实了干预的必要性，以支持HPV周围的初级保健从业者，并建议它应该针对一系列理论领域。事实证明，TDF在分析使用主题指南收集的定性数据方面很有价值，该主题指南并不是专门为捕获TDF领域而设计的，并在一个具有不断发展的证据基础的领域中了解临床行为。
Background: The relationship between infection with high-risk human papillomavirus (HPV) and cervical cancer is transforming cervical cancer prevention. HPV tests and vaccinations have recently become available. In Ireland, as elsewhere, primary care practitioners play a key role in prevention. ATHENS (A Trial of HPV Education and Support) aims to develop a theory-based intervention to support primary care practitioners in their HPV-related practice. This study, the first step in the intervention development process, aimed to: identify HPV-related clinical behaviours that the intervention will target; clarify general practitioners' (GPs') and practice nurses' roles and responsibilities; and determine factors that potentially influence clinical behaviour. A secondary objective was to informally assess the utility of the Theoretical Domains Framework (TDF) in understanding clinical behaviours in an area with an evolving evidence-base.Methods: In-depth semi-structured telephone interviews were conducted with GPs and practice nurses. The topic guide, which contained open questions and HPV-related clinical scenarios, was developed through literature review and clinical experience. Interview transcripts were content-analysed using the TDF as the coding framework.Results: 19 GPs and 14 practice nurses were interviewed. The major HPV-related clinical behaviours were: initiating a discussion about HPV infection with female patients; offering/recommending HPV vaccination to appropriate patients; and answering patients' questions about HPV testing. While the responsibility for taking smears was considered a female role, both male and female practitioners dealt with HPV-related issues. All 12 theoretical domains arose in relation to HPV infection; the domains judged to be most important were: knowledge, emotion, social influences, beliefs about capabilities and beliefs about consequences. Eleven domains emerged in relation to HPV vaccination, with beliefs about consequences, social influences, knowledge and environmental context and resources judged to be the most important. Nine domains were relevant to HPV testing, with knowledge and beliefs about capabilities judged to be the most important.Conclusions: The findings confirm the need for an intervention to support primary care practitioners around HPV and suggest it should target a range of theoretical domains. The TDF proved valuable in analysing qualitative data collected using a topic guide not specifically designed to capture TDF domains and understanding clinical behaviours in an area with an evolving evidence-base.