Examining drivers of self‐harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework

Abstract

Objectives: This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. Design: Qualitative interview study. Methods: Twenty-one telephone interviews, semistructured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified.Results: GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), andThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Could behaviour change techniques be used to address under-recognition of work-related asthma in primary care? A systematic review

“…Two authors undertook qualitative interview studies, analysed using the TDF framework, to identify barriers and enablers to adoption of clinical practice guidelines by HCPs, for any chronic disease [Kredo et al, 2018] and specifically for self-harm [Leather et al, 2022]. Both studies mapped findings to BCI functions using COM-B/BCW matrices, and identified multiple BCI groups of relevance for clinical practice guideline adherence (including feedback and monitoring, shaping knowledge, natural consequences, associations, repetition and substitutions, antecedents, goals and planning, and self-belief; Leather et al, 2022), stopping short of selection. Kredo et al specified a number of BCIs suitable for further evaluation including design improvements, accessibility, digital formatting, and patient engagement materials.…”

“…(2) Implementation of diagnostic guidelines Two authors undertook qualitative interview studies, analysed using the TDF framework, to identify barriers and enablers to adoption of clinical practice guidelines by HCPs, for any chronic disease [Kredo et al, 2018] and specifically for self-harm [Leather et al, 2022]. Both studies mapped findings to BCI functions using COM-B/BCW matrices, and identified multiple BCI groups of relevance for clinical practice guideline adherence (including feedback and monitoring, shaping knowledge, natural consequences, associations, repetition and substitutions, antecedents, goals and planning, and self-belief; Leather et al, 2022) A subsequent effectiveness study by the same group [Porcheret et al, 2018] described an uncontrolled trial of the final workshop, with GP competency measured through review of a video-recorded simulated consultation, before and after the intervention; competency score increased significantly at two time points, one month (p=0.001) and five months (p=0.001) after the workshop.…”

Barriers and facilitators to parents’ engagement with and perceived impact of a childhood obesity app: A mixed-methods study

“…RE-AIM and NASSS informed the data collection plan, to capture a comprehensive set of individual-and system-level factors (Table 1 [49,50,53,54]). The COM-B model was used to analyse how various factors influenced engagement and behaviour [55][56][57][58][59]. The SRQR [60] (S1 Table ) and TREND [61] checklists (S2 Table ) were used to ensure completeness of reporting.…”