RESUMO
Background: Implementation and behavioural science are increasingly being used to support development and translation of evidence-based interventions into practice. We used the Behaviour Change Wheel (BCW) approach in two stakeholder forums to identify target behaviours and supporting actions to inform the development of a framework to support deprescribing in long-term care homes. During our planning for these forums, we found many applications of the BCW approach used in healthcare. However, we found no accounts of stakeholders' experiences when the BCW approach was used with large groups of people who were mostly unfamiliar with behavioural science. Objective: The goal of this research was to gain insight into the use of the BCW approach in the context of developing a framework to support deprescribing in long-term care. Methods: This descriptive qualitative study employed one-on-one semi-structured interviews with Ontario long-term care stakeholders who had participated in one or both of two in-person forums that we hosted. Interviews were transcribed verbatim and an inductive content-analysis approach was used to code data and determine themes. Results: Fifteen interviews were conducted. Four themes were identified. First, the BCW was new and made sense, but people found it hard to identify target behaviours before planning solutions. Second, participants varied in their opinions as to whether the 'right' people were participating. Third, participants found that the forum activities, worksheets and facilitators helped people use the approach. Fourth, stakeholder perspectives about potential implementation challenges and strategies to maximize success were identified. Conclusions: Overall, participants were positive about the use of the BCW approach, however, its usefulness could be optimized by enhancing explanations, facilitation and logistics to ensure an initial focus on targeting behaviours. Making stakeholder perspectives transparent and ensuring mechanisms are present to ensure all views are sought and considered are also important to optimizing participant experience.
RESUMO
BACKGROUND: Medications with lifestyle are the cornerstone of diabetes management and routine monitoring and follow-up are essential to the delivery of quality care. Documented follow-up rates by pharmacists for people with diabetes are low despite good uptake of initial medication assessments in medication review programs. OBJECTIVES: Identify the barriers and facilitators to routine monitoring and follow-up for people with diabetes by community pharmacists. METHODS: Pharmacists were invited to complete a survey designed using the Theoretical Domains Framework Version 2 TDF (v2) consisting of 39 questions based on the 14 domains of the TDFv2 with quantitative response options using a 7 point Likert scale and 2 open-ended questions. Baseline information about the respondents and their practice sites were summarized using descriptive statistics. Mean scores and standard deviations were calculated for each of the Likert scale responses. Responses to open-ended questions were analyzed and coded using an inductive thematic approach. RESULTS: 346 pharmacists completed the survey (4.76% response rate). The TDF domains found to be positively influencing the delivery of routine monitoring and follow-up activities were beliefs about consequences for people with diabetes (6.08 ± 1.13), pharmacist knowledge (5.93 ± 0.99), pharmacist skills (5.44 ± 1.44), social influences (5.36 ± 1.32) and optimism (5.20 ± 1.58). The domains found to be negatively influencing were reinforcement (3.0 ± 1.89) and environmental context and resources (3.30 ± 1.81). Themes emerging from the thematic analysis included time and competing priorities, reimbursement, patient engagement, workflow and human resources, access to labs and clinical information, information technology and support from the owner/manager. CONCLUSIONS: Our research concludes that pharmacists report that their knowledge, skills, and beliefs about their role and responsibility, social influences and optimism are positive influences on routine monitoring and follow-up while reinforcement and the environmental context/resources are the greatest negative influences. Strategies to improve follow-up should be focused in these areas.