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What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework

OBJECTIVES: Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community...

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Autores principales: Gray, Trish A, Wilson, Paul, Dumville, Jo C, Cullum, Nicky A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678001/
https://www.ncbi.nlm.nih.gov/pubmed/31371284
http://dx.doi.org/10.1136/bmjopen-2018-024859
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author Gray, Trish A
Wilson, Paul
Dumville, Jo C
Cullum, Nicky A
author_facet Gray, Trish A
Wilson, Paul
Dumville, Jo C
Cullum, Nicky A
author_sort Gray, Trish A
collection PubMed
description OBJECTIVES: Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice. DESIGN: Qualitative focus group study using the Theoretical Domains Framework (TDF) to structure the questions, prompts and analyses. SETTING: Community healthcare settings in the North of England, UK. PARTICIPANTS: Forty-six clinical professionals who cared for patients with complex wounds and eight non-clinical professionals who were responsible for procuring wound care products participated across six focus group interviews. RESULTS: We found the TDF domains: environmental context and resources, knowledge, skills, social influences and behaviour regulation to best explain the variation in wound care and the underuse of research evidence. Factors such as financial pressures were perceived as having a negative effect on the continuity of care, the availability of wound care services and workloads. We found practice to be mainly based on experiential knowledge and personal preference and highly influenced by colleagues, patients and the pharmaceutical industry, although not by research evidence. CONCLUSIONS: Our study provides new insight into the role that experiential learning and social influences play in determining wound care and on the limited influence of research. Workforce pressures and limited resources are perceived to impede care by reducing patient access to services and the ability to provide holistic care. Participative collaboration between university and healthcare organisations may offer a supportive route to addressing issues, implementing sustainable changes to practice and service delivery and a resolute commitment to research use among clinical professionals.
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spelling pubmed-66780012019-08-16 What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework Gray, Trish A Wilson, Paul Dumville, Jo C Cullum, Nicky A BMJ Open Qualitative Research OBJECTIVES: Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice. DESIGN: Qualitative focus group study using the Theoretical Domains Framework (TDF) to structure the questions, prompts and analyses. SETTING: Community healthcare settings in the North of England, UK. PARTICIPANTS: Forty-six clinical professionals who cared for patients with complex wounds and eight non-clinical professionals who were responsible for procuring wound care products participated across six focus group interviews. RESULTS: We found the TDF domains: environmental context and resources, knowledge, skills, social influences and behaviour regulation to best explain the variation in wound care and the underuse of research evidence. Factors such as financial pressures were perceived as having a negative effect on the continuity of care, the availability of wound care services and workloads. We found practice to be mainly based on experiential knowledge and personal preference and highly influenced by colleagues, patients and the pharmaceutical industry, although not by research evidence. CONCLUSIONS: Our study provides new insight into the role that experiential learning and social influences play in determining wound care and on the limited influence of research. Workforce pressures and limited resources are perceived to impede care by reducing patient access to services and the ability to provide holistic care. Participative collaboration between university and healthcare organisations may offer a supportive route to addressing issues, implementing sustainable changes to practice and service delivery and a resolute commitment to research use among clinical professionals. BMJ Publishing Group 2019-07-31 /pmc/articles/PMC6678001/ /pubmed/31371284 http://dx.doi.org/10.1136/bmjopen-2018-024859 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Qualitative Research
Gray, Trish A
Wilson, Paul
Dumville, Jo C
Cullum, Nicky A
What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title_full What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title_fullStr What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title_full_unstemmed What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title_short What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
title_sort what factors influence community wound care in the uk? a focus group study using the theoretical domains framework
topic Qualitative Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678001/
https://www.ncbi.nlm.nih.gov/pubmed/31371284
http://dx.doi.org/10.1136/bmjopen-2018-024859
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