Tailored interventions to address determinants of practice
Richard Baker,Janette Camosso-Stefinovic,Clare L Gillies,Elizabeth J. Shaw,Francine M Cheater,Signe Flottorp,Noelle Robertson,Michel Wensing,Michelle Fiander,Martin P Eccles,Maciek Godycki-Cwirko,Jan van Lieshout,Cornelia Jäger +12 more
Reads0
Chats0
TLDR
This review compared interventions tailored to address the identified determinants of practice with either no intervention or interventions not tailored to the determinants to determine whether tailored intervention strategies are effective in improving professional practice and healthcare outcomes.Abstract:
Background
Tailored intervention strategies are frequently recommended among approaches to the implementation of improvement in health professional performance. Attempts to change the behaviour of health professionals may be impeded by a variety of different barriers, obstacles, or factors (which we collectively refer to as determinants of practice). Change may be more likely if implementation strategies are specifically chosen to address these determinants.
Objectives
To determine whether tailored intervention strategies are effective in improving professional practice and healthcare outcomes. We compared interventions tailored to address the identified determinants of practice with either no intervention or interventions not tailored to the determinants.
Search methods
We conducted searches of The Cochrane Library, MEDLINE, EMBASE, PubMed, CINAHL, and the British Nursing Index to May 2014. We conducted a final search in December 2014 (in MEDLINE only) for more recently published trials. We conducted searches of the metaRegister of Controlled Trials (mRCT) in March 2013. We also handsearched two journals.
Selection criteria
Cluster-randomised controlled trials (RCTs) of interventions tailored to address prospectively identified determinants of practice, which reported objectively measured professional practice or healthcare outcomes, and where at least one group received an intervention designed to address prospectively identified determinants of practice.
Data collection and analysis
Two review authors independently assessed quality and extracted data. We undertook qualitative and quantitative analyses, the quantitative analysis including two elements: we carried out 1) meta-regression analyses to compare interventions tailored to address identified determinants with either no interventions or an intervention(s) not tailored to the determinants, and 2) heterogeneity analyses to investigate sources of differences in the effectiveness of interventions. These included the effects of: risk of bias, use of a theory when developing the intervention, whether adjustment was made for local factors, and number of domains addressed with the determinants identified.
Main results
We added nine studies to this review to bring the total number of included studies to 32 comparing an intervention tailored to address identified determinants of practice to no intervention or an intervention(s) not tailored to the determinants. The outcome was implementation of recommended practice, e.g. clinical practice guideline recommendations. Fifteen studies provided enough data to be included in the quantitative analysis. The pooled odds ratio was 1.56 (95% confidence interval (CI) 1.27 to 1.93, P value < 0.001). The 17 studies not included in the meta-analysis had findings showing variable effectiveness consistent with the findings of the meta-regression.
Authors' conclusions
Despite the increase in the number of new studies identified, our overall finding is similar to that of the previous review. Tailored implementation can be effective, but the effect is variable and tends to be small to moderate. The number of studies remains small and more research is needed, including trials comparing tailored interventions to no or other interventions, but also studies to develop and investigate the components of tailoring (identification of the most important determinants, selecting interventions to address the determinants). Currently available studies have used different methods to identify determinants of practice and different approaches to selecting interventions to address the determinants. It is not yet clear how best to tailor interventions and therefore not clear what the effect of an optimally tailored intervention would be.read more
Citations
More filters
Journal ArticleDOI
A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems
Lou Atkins,Jill J Francis,Jill J Francis,Rafat Islam,Denise O'Connor,Andrea M. Patey,Noah Ivers,Robbie Foy,Eilidh Duncan,Heather Colquhoun,Jeremy M. Grimshaw,Jeremy M. Grimshaw,Rebecca Lawton,Susan Michie +13 more
TL;DR: This guide offers practical guidance for those who wish to apply the Theoretical Domains Framework to assess implementation problems and support intervention design, and provides a brief rationale for using a theoretical approach to investigate and address implementation problems.
Journal ArticleDOI
Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews
Mark J. Johnson,Carl May +1 more
TL;DR: This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations and relational restructuring, reinforcing modifiedpeer group norms by emphasising the expectations of an external reference group offer the best chances of success.
Journal ArticleDOI
Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions
TL;DR: The wide heterogeneity of endorsements obtained in this study’s task suggests that there are relatively few consistent relationships between CFIR-based barriers and ERIC implementation strategies.
Journal ArticleDOI
Enhancing the Impact of Implementation Strategies in Healthcare: A Research Agenda.
Byron J. Powell,Maria E. Fernandez,Nathaniel J. Williams,Gregory A. Aarons,Rinad S. Beidas,Cara C. Lewis,Sheena McHugh,Bryan J. Weiner +7 more
TL;DR: The need to enhance methods for designing and tailoring implementation strategies, and conduct more effectiveness research on discrete, multi-faceted, and tailored implementation strategies is suggested, to advance implementation science.
Journal ArticleDOI
Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes
TL;DR: Researchers and health professionals engaged in designing patient-focused interventions need to consider barriers and facilitators across all three identified domains to increase the likelihood of implementation success.
References
More filters
Journal ArticleDOI
Measuring inconsistency in meta-analyses
TL;DR: A new quantity is developed, I 2, which the authors believe gives a better measure of the consistency between trials in a meta-analysis, which is susceptible to the number of trials included in the meta- analysis.
Journal ArticleDOI
Grading quality of evidence and strength of recommendations.
David C. Atkins,Dana Best,Peter A. Briss,Martin P Eccles,Yngve Falck-Ytter,Signe Flottorp,Gordon H. Guyatt,Robin Harbour,Margaret C Haugh,David Henry,Suzanne Hill,Roman Jaeschke,Gillian Leng,Alessandro Liberati,Nicola Magrini,James Mason,Philippa Middleton,Jacek Mrukowicz,Dianne L. O'Connell,Andrew D Oxman,Bob Phillips,Holger J. Schünemann,Tessa Tan-Torres Edejer,H. Varonen,Gunn Elisabeth Vist,John W Williams,Stephanie Zaza +26 more
TL;DR: A system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts is developed, and a summary of the approach from the perspective of a guideline user is presented.
Journal ArticleDOI
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Michael D. Cabana,Cynthia S. Rand,Neil R. Powe,Albert W. Wu,Modena E. H. Wilson,Paul Andre C. Abboud,Haya R. Rubin +6 more
TL;DR: A differential diagnosis for why physicians do not follow practice guidelines is offered, as well as a rational approach toward improving guideline adherence and a framework for future research are offered.
Journal ArticleDOI
Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide
Tammy Hoffmann,Paul Glasziou,Isabelle Boutron,Ruairidh Milne,Rafael Perera,David Moher,Douglas G. Altman,Virginia Barbour,Helen Macdonald,Marie Johnston,Sarah E Lamb,Mary Dixon-Woods,Peter McCulloch,Jeremy C Wyatt,An-Wen Chan,Susan Michie +15 more
TL;DR: The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
Journal ArticleDOI
Audit and feedback: effects on professional practice and healthcare outcomes
Noah Ivers,Gro Jamtvedt,Signe Flottorp,Jane M. Young,Jan Odgaard-Jensen,Simon D. French,Mary Ann O’Brien,Marit Johansen,Jeremy M. Grimshaw,Andrew D Oxman +9 more
TL;DR: The results indicated that feedback may be more effective when baseline performance is low, the source is a supervisor or colleague, it is provided more than once, and the role of context and the targeted clinical behaviour was assessed.