An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study
An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study
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DOI：
10.1186/1748-5908-4-66
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发表时间：
2009-10-13
影响因子：
7.2
通讯作者：
Eames-Brown, Rosslyn
中科院分区：
文献类型：
--
作者：
Laws, Rachel A.;Kemp, Lynn A.;Eames-Brown, Rosslyn
背景资料：尽管在初级卫生保健（PHC）提供的简短的生活方式干预的有效性，在日常实践中的实施仍然是次优的。信念和态度已被证明是与风险因素管理的做法，但很少有人知道的过程中，临床医生的看法形状的实施。本研究旨在描述一个理论模型，以了解临床医生的看法如何塑造日常实践中的生活方式风险因素管理的实施。该模型的影响，以提高practices.Methods：该研究分析了收集的数据作为一个更大的可行性项目的一部分，在澳大利亚新南威尔士州（NSW）的三个社区卫生团队的风险因素管理。这包括在项目实施过程中保存的日志记录，以及与48名参与者的访谈，其中包括23名临床医生（包括社区护士、专职医疗人员和一名土著卫生工作者）、5名管理人员和2名项目官员。数据进行了分析，使用接地理论原则的开放，集中，理论编码和不断的比较技术，构建一个模型接地的data.Results：该模型表明，实施反映了临床医生的信念，他们是否应该（承诺）和可以（能力）解决生活方式的问题。承诺代表了风险因素管理的优先级，反映了对角色责任一致性、客户接受度和干预可能影响的信念。临床医生对风险因素管理能力的信念反映了他们对自我效能、角色支持以及风险因素管理工作方式之间的契合度的看法。该模型表明，临床医生制定不同的期望和意图，他们将如何干预的基础上，这些信念的承诺和能力和他们的哲学观点，适当的干预方式。这些期望提供了一个认知框架，指导他们的风险因素管理实践。最后，临床医生的整体效益与成本的评估，解决生活方式的问题的行为，积极或消极地加强他们的承诺，实施这些practice.Conclusion：该模型扩展了以前的研究，概述了一个过程，临床医生的看法形状的生活方式的风险因素管理在日常实践中的实施。这提供了新的见解，为制定有效的战略以改进这些做法提供了信息。
Background: Despite the effectiveness of brief lifestyle intervention delivered in primary healthcare (PHC), implementation in routine practice remains suboptimal. Beliefs and attitudes have been shown to be associated with risk factor management practices, but little is known about the process by which clinicians' perceptions shape implementation. This study aims to describe a theoretical model to understand how clinicians' perceptions shape the implementation of lifestyle risk factor management in routine practice. The implications of the model for enhancing practices will also be discussed.Methods: The study analysed data collected as part of a larger feasibility project of risk factor management in three community health teams in New South Wales (NSW), Australia. This included journal notes kept through the implementation of the project, and interviews with 48 participants comprising 23 clinicians (including community nurses, allied health practitioners and an Aboriginal health worker), five managers, and two project officers. Data were analysed using grounded theory principles of open, focused, and theoretical coding and constant comparative techniques to construct a model grounded in the data.Results: The model suggests that implementation reflects both clinician beliefs about whether they should (commitment) and can (capacity) address lifestyle issues. Commitment represents the priority placed on risk factor management and reflects beliefs about role responsibility congruence, client receptiveness, and the likely impact of intervening. Clinician beliefs about their capacity for risk factor management reflect their views about self-efficacy, role support, and the fit between risk factor management ways of working. The model suggests that clinicians formulate different expectations and intentions about how they will intervene based on these beliefs about commitment and capacity and their philosophical views about appropriate ways to intervene. These expectations then provide a cognitive framework guiding their risk factor management practices. Finally, clinicians' appraisal of the overall benefits versus costs of addressing lifestyle issues acts to positively or negatively reinforce their commitment to implementing these practices.Conclusion: The model extends previous research by outlining a process by which clinicians' perceptions shape implementation of lifestyle risk factor management in routine practice. This provides new insights to inform the development of effective strategies to improve such practices.