Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: Development work for an implementation trial
Using theories of behaviour to understand transfusion prescribing in three clinical contexts in two countries: Development work for an implementation trial
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DOI：
10.1186/1748-5908-4-70
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发表时间：
2009-10-24
影响因子：
7.2
通讯作者：
Eccles, Martin P.
中科院分区：
文献类型：
--
作者：
Francis, Jill J.;Tinmouth, Alan;Eccles, Martin P.
背景：输血是医疗保健的重要组成部分，可以改善患者的预后。然而，与大多数疗法一样，它也与重大临床风险相关。此外，还有一些过度使用的证据。了解减少血液制品处方的潜在障碍和推动因素将有助于选择可能有效的干预成分，从而减少评估不同实施策略的昂贵试验的数量。使用理论基础来理解有针对性的改变行为，将有助于“基础科学”有关的专业行为的决定因素，以及如何告知这些改变行为的技术的选择。然而，目前尚不清楚哪些行为理论与临床医生的滥用行为有关。本研究的目的是使用一个理论领域的框架，以确定相关的理论，并使用这些理论来确定因素的预测决定transfus.Methods：本研究包括两个步骤：访谈研究和问卷调查。使用先前确定的框架，我们将与临床医生进行半结构化访谈，以了解他们对哪些因素与等待和进一步监测患者有关，而不是使用红细胞进行检查。访谈将涵盖以下理论领域：知识;技能;社会/职业角色和身份;对能力的信念;对后果的信念;动机和目标;记忆，注意力和决策过程;环境背景和资源;社会影响;情感;行为调节;行为的性质。访谈将在加拿大和英国独立进行，涉及每个国家的两组医生（英国：成人和新生儿重症监护医生;加拿大：重症监护医生和整形外科医生）。我们将：分析访谈记录内容，选择相关的理论领域;使用共识过程将这些领域映射到行为理论;根据这些理论制定问卷;并将其邮寄给两国的每组医生。从我们以往的工作来看，这些理论可能包括：计划行为理论、社会认知理论和循证策略、实施意图。问卷数据将测量预测变量（理论结构）和结果变量（意图和临床决策），并将使用多元回归分析进行分析。我们的目标是在每项邮递调查中，以四个组别各150名受访者为对象。
Background: Blood transfusion is an essential part of healthcare and can improve patient outcomes. However, like most therapies, it is also associated with significant clinical risks. In addition, there is some evidence of overuse. Understanding the potential barriers and enablers to reduced prescribing of blood products will facilitate the selection of intervention components likely to be effective, thereby reducing the number of costly trials evaluating different implementation strategies. Using a theoretical basis to understand behaviours targeted for change will contribute to a 'basic science' relating to determinants of professional behaviour and how these inform the selection of techniques for changing behaviour. However, it is not clear which theories of behaviour are relevant to clinicians' transfusing behaviour. The aim of this study is to use a theoretical domains framework to identify relevant theories, and to use these theories to identify factors that predict the decision to transfuse.Methods: The study involves two steps: interview study and questionnaire study. Using a previously identified framework, we will conduct semi-structured interviews with clinicians to elicit their views about which factors are associated with waiting and further monitoring the patient rather than transfusing red blood cells. Interviews will cover the following theoretical domains: knowledge; skills; social/professional role and identity; beliefs about capabilities; beliefs about consequences; motivation and goals; memory, attention, and decision processes; environmental context and resources; social influences; emotion; behavioural regulation; nature of the behaviour. The interviews will take place independently in Canada and the UK and involve two groups of physicians in each country (UK: adult and neonatal intensive care physicians; Canada: intensive care physicians and orthopaedic surgeons). We will: analyse interview transcript content to select relevant theoretical domains; use consensus processes to map these domains on to theories of behaviour; develop questionnaires based on these theories; and mail them to each group of physicians in the two countries. From our previous work, it is likely that the theories will include: theory of planned behaviour, social cognitive theory and the evidence-based strategy, implementation intention. The questionnaire data will measure predictor variables (theoretical constructs) and outcome variables (intention and clinical decision), and will be analysed using multiple regression analysis. We aim to achieve 150 respondents in each of the four groups for each postal survey.