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Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory

BACKGROUND: Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviou...

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Autores principales: Michie, Susan, Pilling, Stephen, Garety, Philippa, Whitty, Paula, Eccles, Martin P, Johnston, Marie, Simmons, Jemma
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864990/
https://www.ncbi.nlm.nih.gov/pubmed/17386102
http://dx.doi.org/10.1186/1748-5908-2-8
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author Michie, Susan
Pilling, Stephen
Garety, Philippa
Whitty, Paula
Eccles, Martin P
Johnston, Marie
Simmons, Jemma
author_facet Michie, Susan
Pilling, Stephen
Garety, Philippa
Whitty, Paula
Eccles, Martin P
Johnston, Marie
Simmons, Jemma
author_sort Michie, Susan
collection PubMed
description BACKGROUND: Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviour change are seldom used to try to understand difficulties in implementation or to develop interventions to overcome them. OBJECTIVES: This study applied psychological theory to examine explanations for difficulties in implementation. It used a theoretical framework derived from an interdisciplinary consensus exercise to code interviews across 11 theoretical domains. The focus of the study was a National Institute for Health and Clinical Excellence's Schizophrenia guideline recommendation that family intervention should be offered to the families of people with schizophrenia. METHODS: Participants were recruited from community mental health teams from three United Kingdom National Health Service (NHS) Trusts; 20 members (social workers, nurses, team managers, psychologists, and psychiatrists) participated. Semi-structured interviews were audio-taped and transcribed. Interview questions were based on the theoretical domains and addressed respondents' knowledge, attitudes and opinions regarding the guideline. Two researchers independently coded the transcript segments from each interview that were related to each theoretical domain. A score of 1 indicated that the transcript segments relating to the domain did not appear to contain description of difficulties in implementation of the family therapy guidelines; similarly a score of 0.5 indicated possible difficulties and a score of 0 indicated definite difficulties. RESULTS: Coding respondents' answers to questions related to the three domains 'beliefs about consequences,' 'social/professional role and identity,' and 'motivation' produced the three highest total scores indicating that factors relating to these domains were unlikely to constitute difficulties in implementation. 'Environmental context and resources' was the lowest scoring domain, with 'Emotion' scoring the second lowest, suggesting that these were likely to be areas for considering intervention. The two main resources identified as problems were time and training. The emotions that appeared to potentially influence the offer of family therapy were self-doubt and fear. CONCLUSION: This exploratory study demonstrates an approach to developing a theoretical understanding of implementation difficulties.
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spelling pubmed-18649902007-05-03 Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory Michie, Susan Pilling, Stephen Garety, Philippa Whitty, Paula Eccles, Martin P Johnston, Marie Simmons, Jemma Implement Sci Research Article BACKGROUND: Evaluations of interventions to improve implementation of guidelines have failed to produce a clear pattern of results favouring a particular method. While implementation depends on clinicians and managers changing a variety of behaviours, psychological theories of behaviour and behaviour change are seldom used to try to understand difficulties in implementation or to develop interventions to overcome them. OBJECTIVES: This study applied psychological theory to examine explanations for difficulties in implementation. It used a theoretical framework derived from an interdisciplinary consensus exercise to code interviews across 11 theoretical domains. The focus of the study was a National Institute for Health and Clinical Excellence's Schizophrenia guideline recommendation that family intervention should be offered to the families of people with schizophrenia. METHODS: Participants were recruited from community mental health teams from three United Kingdom National Health Service (NHS) Trusts; 20 members (social workers, nurses, team managers, psychologists, and psychiatrists) participated. Semi-structured interviews were audio-taped and transcribed. Interview questions were based on the theoretical domains and addressed respondents' knowledge, attitudes and opinions regarding the guideline. Two researchers independently coded the transcript segments from each interview that were related to each theoretical domain. A score of 1 indicated that the transcript segments relating to the domain did not appear to contain description of difficulties in implementation of the family therapy guidelines; similarly a score of 0.5 indicated possible difficulties and a score of 0 indicated definite difficulties. RESULTS: Coding respondents' answers to questions related to the three domains 'beliefs about consequences,' 'social/professional role and identity,' and 'motivation' produced the three highest total scores indicating that factors relating to these domains were unlikely to constitute difficulties in implementation. 'Environmental context and resources' was the lowest scoring domain, with 'Emotion' scoring the second lowest, suggesting that these were likely to be areas for considering intervention. The two main resources identified as problems were time and training. The emotions that appeared to potentially influence the offer of family therapy were self-doubt and fear. CONCLUSION: This exploratory study demonstrates an approach to developing a theoretical understanding of implementation difficulties. BioMed Central 2007-03-26 /pmc/articles/PMC1864990/ /pubmed/17386102 http://dx.doi.org/10.1186/1748-5908-2-8 Text en Copyright © 2007 Michie et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Michie, Susan
Pilling, Stephen
Garety, Philippa
Whitty, Paula
Eccles, Martin P
Johnston, Marie
Simmons, Jemma
Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title_full Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title_fullStr Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title_full_unstemmed Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title_short Difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
title_sort difficulties implementing a mental health guideline: an exploratory investigation using psychological theory
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1864990/
https://www.ncbi.nlm.nih.gov/pubmed/17386102
http://dx.doi.org/10.1186/1748-5908-2-8
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