Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions

Abstract

Background Interventions to improve discharge communication in emergency practice settings are inherently complex and incorporate multiple strategies aimed at patient, caregiver and healthcare provider behaviours. Behaviour change theories, including the capability-opportunity-motivation-behaviour (COM-B) model and Behaviour Change Technique Taxonomy version 1 (BCTTv1), provide consistent language for identifying and evaluating the active components of interventions. The objectives of this study were to: (1) identify common barriers and enablers to discharge communication interventions and (2) describe behaviour change techniques (BCTs) present in pediatric emergency discharge communication interventions aimed at patients, caregivers and health care providers. Methods We conducted a secondary analysis of 35 experimental and quasi-experimental studies included in a narrative synthesis of discharge communication interventions in pediatric emergency care. Included studies were reviewed to identify reported barriers and enablers to implementation and intervention effectiveness, which were then mapped to the COM-B model. Trained BCT coders independently coded intervention descriptions using the BCTTv1 as a coding framework. Consensus was used to resolve any discrepancies. BCTs were analyzed using descriptive statistics to determine the frequency of the 93 individual BCTs and 16 BCT categories for patient/caregiver and health care provider interventions. Results Barriers and enablers were identified at the patient/caregiver, health care provider, intervention and health system levels. Psychological capability was the most frequently coded COM-B component. Of the 33 studies that included BCTs, 29 interventions targeted patients or caregivers. A total of 20 different individual BCTs were identified across the interventions in the 33 studies. The number of BCTs identified in each study ranged from 1-9 BCTs, with most (n=14, 42%) interventions containing one BCT. Reporting deficiencies were noted related to adequate details of intervention components and implementation fidelity.Conclusions The COM-B model and BCTTv1 proved to be useful tools to provide a foundational understanding of the common mechanisms used in pediatric discharge communication interventions. With only a fraction of the available BCTs were used in the included studies, future research is needed to explore the utility of other BCTs to address common implementation barriers and improve the effectiveness of discharge communication interventions.

Relationship between parents' health literacy and child health: systematic review

“…The parental health literacy of parents from Hong Kong helped them manage and promote healthy behaviours in their children (Lam, 2016). Health literacy in terms of discharge communication interventions of caregivers or parents post-pediatric discharge from emergency services is crucial to child health outcomes (Gallant et al, 2020). Therefore, health literacy is a requirement of parents with hospitalised children (Hoang et al, 2020).…”