A cross-country comparison of intensive care physicians' beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework.
A cross-country comparison of intensive care physicians' beliefs about their transfusion behaviour: a qualitative study using the Theoretical Domains Framework.
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DOI：
10.1186/1748-5908-7-93
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发表时间：
2012-09-21
期刊：
影响因子：
--
通讯作者：
Grimshaw JM
中科院分区：
文献类型：
--
作者：
Islam R;Tinmouth AT;Francis JJ;Brehaut JC;Born J;Stockton C;Stanworth SJ;Eccles MP;Cuthbertson BH;Hyde C;Grimshaw JM
在广泛的临床环境中已经报道了红细胞输注实践变化的证据。加拿大和英国的平行研究旨在探讨重症监护医生的输血行为。本文的目的有三个：首先，探讨影响加拿大重症监护医生输血行为的信念；其次，利用理论领域框架（TDF）系统地选择相关理论和模型，为未来的预测研究提供信息；第三，将其结果与英国的研究进行比较。加拿大各地的十名重症监护病房 (ICU) 医生接受了采访。医生的反应被编码到理论领域，并为每个反应生成特定的信念。确定了与行为改变相关的理论领域，并使用相关领域的具体结构来选择心理学理论。对加拿大和英国的结果进行了比较。由 31 种具体信念组成的 7 个理论领域被确定为与目标行为相关。英国研究中确定的关于能力的信念（如果患者临床状况稳定，有信心不输血）、关于后果的信念（减少感染和节省资源的积极信念以及关于患者临床结果和可能更多工作风险的消极信念）、社会影响（输血决定受到团队成员和患者亲属的影响）和行为调节（鼓励限制性输血的各种方法）在加拿大背景下也相关。本研究还确定了另外三个领域：知识（需要更多证据来支持限制性输血）、社会/职业角色和身份（关于不遵守指南的冲突信念、参考证据、相信限制性输血是专业标准以及相信指南对其他专业人员很重要）以及动机和目标（对限制性输血的重要性和与其他目标的兼容性的反对信念）。与英国的研究类似，计划行为理论、社会认知理论、操作学习理论、行动计划和知识-态度-行为模型被认为是进一步研究的潜在相关理论和模型。加拿大的研究中添加了个人项目分析，以更详细地探索动机和目标领域。加拿大 ICU 医生发现多种信念可能会影响他们的输血行为。我们能够在跨国比较中展示相似但不相同的结果。根据两国医生确定的独特信念设计有针对性的行为改变干预措施更有可能鼓励各自国家的 ICU 医生限制输血。这需要在未来的前瞻性临床试验中进行测试。
Evidence of variations in red blood cell transfusion practices have been reported in a wide range of clinical settings. Parallel studies in Canada and the United Kingdom were designed to explore transfusion behaviour in intensive care physicians. The aim of this paper is three-fold: first, to explore beliefs that influence Canadian intensive care physicians’ transfusion behaviour; second, to systematically select relevant theories and models using the Theoretical Domains Framework (TDF) to inform a future predictive study; and third, to compare its results with the UK study. Ten intensive care unit (ICU) physicians throughout Canada were interviewed. Physicians’ responses were coded into theoretical domains, and specific beliefs were generated for each response. Theoretical domains relevant to behaviour change were identified, and specific constructs from the relevant domains were used to select psychological theories. The results from Canada and the United Kingdom were compared. Seven theoretical domains populated by 31 specific beliefs were identified as relevant to the target behaviour. The domains Beliefs about capabilities (confident to not transfuse if patients’ clinical condition is stable), Beliefs about consequences (positive beliefs of reducing infection and saving resources and negative beliefs about risking patients’ clinical outcome and potentially more work), Social influences (transfusion decision is influenced by team members and patients’ relatives), and Behavioural regulation (wide range of approaches to encourage restrictive transfusion) that were identified in the UK study were also relevant in the Canadian context. Three additional domains, Knowledge (it requires more evidence to support restrictive transfusion), Social/professional role and identity (conflicting beliefs about not adhering to guidelines, referring to evidence, believing restrictive transfusion as professional standard, and believing that guideline is important for other professionals), and Motivation and goals (opposing beliefs about the importance of restrictive transfusion and compatibility with other goals), were also identified in this study. Similar to the UK study, the Theory of Planned Behaviour, Social Cognitive Theory, Operant Learning Theory, Action Planning, and Knowledge-Attitude-Behaviour model were identified as potentially relevant theories and models for further study. Personal project analysis was added to the Canadian study to explore the Motivation and goals domain in further detail. A wide range of beliefs was identified by the Canadian ICU physicians as likely to influence their transfusion behaviour. We were able to demonstrate similar though not identical results in a cross-country comparison. Designing targeted behaviour-change interventions based on unique beliefs identified by physicians from two countries are more likely to encourage restrictive transfusion in ICU physicians in respective countries. This needs to be tested in future prospective clinical trials.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
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影响因子：
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DOI：
10.1111/j.1464-0597.2008.00341.x
发表时间：
2008-10-01
影响因子：
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影响因子：
8.8
作者：
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影响因子：
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