A qualitative study of physicians’ perceptions and preferences for implementing Venous Thromboembolism (VTE) clinical practice guidelines informed by the Theoretical Domains Framework (TDF)

Abstract

Background This study used the Theoretical Domains Framework to explore the beliefs and perceptions of physicians to influence the uptake of Venous Thromboembolism prevention guidelines.Methods Semi-structured interviews were conducted with a stratified purposive sample of internal medicine physicians in an acute hospital. The interview topic guide was developed using the Theoretical Domains Framework to identify the factors perceived to influence practice. Two researchers coded the interview transcripts using thematic content analysis. Emerging relevant themes were mapped to TDF domains.Results A total of sixteen medical physicians were interviewed over a six-month period. Nine theoretical domains derived from thirty-three belief statements were identified as relevant to the target behaviour; knowledge (education about the importance of VTE guidelines); beliefs about capabilities (with practice VTE tool easier to implement); beliefs about consequences ( positive consequences in reducing the development of VTE, length of stay, financial burden and support physician decision) and (negative consequence risk of bleeding); reinforcement (recognition and continuous reminders); goals (patient safety goal); environmental context and resources (workload and availability of medications were barriers, VTE coordinator and electronic medical record were enablers); social influences (senior physicians and patient/family influence the VTE practice); behavioural regulation (monitoring and mandatory hospital policy); and nature of the behaviour.Conclusions Using the Theoretical Domains Framework, factors thought to influence the implementation of VTE clinical practice guidelines in the internal medicine department were identified. These factors present theoretically based targets for future interventions.