A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

Abstract

BackgroundDeterminants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist).MethodsWe performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers.ResultsWe screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources, capacity for organisational change, and social, political, and legal factors. We also developed five worksheets to facilitate the use of the checklist.ConclusionsBased on a systematic review and a consensus process we developed a checklist that aims to be comprehensive and to build on the strengths of each of the 12 included checklists. The checklist is accompanied with five worksheets to facilitate its use in implementation research and quality improvement projects.

Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators

“…Several overviews have been published on generic implementation determinants in health care (Fleuren et al, 2014;Flottorp et al, 2013). Flottorp and colleagues (Flottorp et al, 2013) developed a comprehensive checklist of 57 determinants.…”

“…Flottorp and colleagues (Flottorp et al, 2013) developed a comprehensive checklist of 57 determinants. When one compares our results with the determinants on this checklist, it is striking that several were not reported in the literature we reviewed.…”

“…When one compares our results with the determinants on this checklist, it is striking that several were not reported in the literature we reviewed. For example, Flottorp and colleagues (Flottorp et al, 2013) reported in their systematic review the following factors: knowledge about own practice in relationship to the innovation, intention and motivation to adhere, and self-efficacy. There are four possible reasons for this apparent discrepancy.…”

Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants

“…In order to maximize the future roll out and to increase the chance that the content of the course becomes an integral part of the health care delivery process for refugees, it is necessary to understand relevant implementation factors for recommended interventions, as well as the extent to which those factors are available in the target area of the online training. Flottorp at al [34]. categorized potential ‘determinants of practice’ into seven domains: guideline factors; individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; and social, political and legal factors [34–36].…”

“…Flottorp at al [34]. categorized potential ‘determinants of practice’ into seven domains: guideline factors; individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; and social, political and legal factors [34–36]. Knowledge about factors like these, that might differ locally and between professional health care disciplines, can increase the potential of the course in optimizing health care provision.…”