Cargando…

Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation

BACKGROUND: The Canadian CT Head Rule was prospectively derived and validated to assist clinicians with diagnostic decision-making regarding the use of computed tomography (CT) in adult patients with minor head injury. A recent intervention trial failed to demonstrate a decrease in the rate of head...

Descripción completa

Detalles Bibliográficos
Autores principales: Curran, Janet A, Brehaut, Jamie, Patey, Andrea M, Osmond, Martin, Stiell, Ian, Grimshaw, Jeremy M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585785/
https://www.ncbi.nlm.nih.gov/pubmed/23433082
http://dx.doi.org/10.1186/1748-5908-8-25
_version_ 1782261205984870400
author Curran, Janet A
Brehaut, Jamie
Patey, Andrea M
Osmond, Martin
Stiell, Ian
Grimshaw, Jeremy M
author_facet Curran, Janet A
Brehaut, Jamie
Patey, Andrea M
Osmond, Martin
Stiell, Ian
Grimshaw, Jeremy M
author_sort Curran, Janet A
collection PubMed
description BACKGROUND: The Canadian CT Head Rule was prospectively derived and validated to assist clinicians with diagnostic decision-making regarding the use of computed tomography (CT) in adult patients with minor head injury. A recent intervention trial failed to demonstrate a decrease in the rate of head CTs following implementation of the rule in Canadian emergency departments. Yet, the same intervention, which included a one-hour educational session and reminders at the point of requisition, was successful in reducing cervical spine imaging rates in the same emergency departments. The reason for the varied effect of the intervention across these two behaviours is unclear. There is an increasing appreciation for the use of theory to conduct process evaluations to better understand how strategies are linked with outcomes in implementation trials. The Theoretical Domains Framework (TDF) has been used to explore health professional behaviour and to design behaviour change interventions but, to date, has not been used to guide a theory-based process evaluation. In this proof of concept study, we explored whether the TDF could be used to guide a retrospective process evaluation to better understand emergency physicians’ responses to the interventions employed in the Canadian CT Head Rule trial. METHODS: A semi-structured interview guide, based on the 12 domains from the TDF, was used to conduct telephone interviews with project leads and physician participants from the intervention sites in the Canadian CT Head Rule trial. Two reviewers independently coded the anonymised interview transcripts using the TDF as a coding framework. Relevant domains were identified by: the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour. RESULTS: Eight physicians from four of the intervention sites in the Canadian CT Head Rule trial participated in the interviews. Barriers likely to assist with understanding physicians’ responses to the intervention in the trial were identified in six of the theoretical domains: beliefs about consequences; beliefs about capabilities; behavioural regulation; memory, attention and decision processes; environmental context and resources; and social influences. Despite knowledge that the Canadian CT Head Rule was highly sensitive and reliable for identifying clinically important brain injuries and strong beliefs about the benefits for using the rule, a number of barriers were identified that may have prevented physicians from consistently applying the rule. CONCLUSION: This proof of concept study demonstrates the use of the TDF as a guiding framework to design a retrospective theory-based process evaluation. There is a need for further development and testing of methods for using the TDF to guide theory-based process evaluations running alongside behaviour change intervention trials.
format Online
Article
Text
id pubmed-3585785
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-35857852013-03-03 Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation Curran, Janet A Brehaut, Jamie Patey, Andrea M Osmond, Martin Stiell, Ian Grimshaw, Jeremy M Implement Sci Research BACKGROUND: The Canadian CT Head Rule was prospectively derived and validated to assist clinicians with diagnostic decision-making regarding the use of computed tomography (CT) in adult patients with minor head injury. A recent intervention trial failed to demonstrate a decrease in the rate of head CTs following implementation of the rule in Canadian emergency departments. Yet, the same intervention, which included a one-hour educational session and reminders at the point of requisition, was successful in reducing cervical spine imaging rates in the same emergency departments. The reason for the varied effect of the intervention across these two behaviours is unclear. There is an increasing appreciation for the use of theory to conduct process evaluations to better understand how strategies are linked with outcomes in implementation trials. The Theoretical Domains Framework (TDF) has been used to explore health professional behaviour and to design behaviour change interventions but, to date, has not been used to guide a theory-based process evaluation. In this proof of concept study, we explored whether the TDF could be used to guide a retrospective process evaluation to better understand emergency physicians’ responses to the interventions employed in the Canadian CT Head Rule trial. METHODS: A semi-structured interview guide, based on the 12 domains from the TDF, was used to conduct telephone interviews with project leads and physician participants from the intervention sites in the Canadian CT Head Rule trial. Two reviewers independently coded the anonymised interview transcripts using the TDF as a coding framework. Relevant domains were identified by: the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour. RESULTS: Eight physicians from four of the intervention sites in the Canadian CT Head Rule trial participated in the interviews. Barriers likely to assist with understanding physicians’ responses to the intervention in the trial were identified in six of the theoretical domains: beliefs about consequences; beliefs about capabilities; behavioural regulation; memory, attention and decision processes; environmental context and resources; and social influences. Despite knowledge that the Canadian CT Head Rule was highly sensitive and reliable for identifying clinically important brain injuries and strong beliefs about the benefits for using the rule, a number of barriers were identified that may have prevented physicians from consistently applying the rule. CONCLUSION: This proof of concept study demonstrates the use of the TDF as a guiding framework to design a retrospective theory-based process evaluation. There is a need for further development and testing of methods for using the TDF to guide theory-based process evaluations running alongside behaviour change intervention trials. BioMed Central 2013-02-21 /pmc/articles/PMC3585785/ /pubmed/23433082 http://dx.doi.org/10.1186/1748-5908-8-25 Text en Copyright ©2013 Curran 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
Curran, Janet A
Brehaut, Jamie
Patey, Andrea M
Osmond, Martin
Stiell, Ian
Grimshaw, Jeremy M
Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title_full Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title_fullStr Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title_full_unstemmed Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title_short Understanding the Canadian adult CT head rule trial: use of the theoretical domains framework for process evaluation
title_sort understanding the canadian adult ct head rule trial: use of the theoretical domains framework for process evaluation
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585785/
https://www.ncbi.nlm.nih.gov/pubmed/23433082
http://dx.doi.org/10.1186/1748-5908-8-25
work_keys_str_mv AT curranjaneta understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation
AT brehautjamie understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation
AT pateyandream understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation
AT osmondmartin understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation
AT stiellian understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation
AT grimshawjeremym understandingthecanadianadultctheadruletrialuseofthetheoreticaldomainsframeworkforprocessevaluation