Archives for November 2016
A Theory-Based Process Evaluation Alongside A Randomised Controlled Trial Of Printed Educational Messages To Increase Primary Care Physicians’ Prescription Of Thiazide Diuretics For Hypertension
Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians’ guideline-recommended prescription of thiazide diuretics. The trial found no intervention effect. Using the theory of planned behaviour (TPB), we hypothesised that changes in thiazide prescribing would be reflected in changes in intention, consistent with changes in attitude and subjective norm, with no change to their perceived behavioural control (PBC), and tested this alongside the RCT.
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Why is it so hard to implement change? A qualitative examination of barriers and facilitators to distribution of naloxone for overdose prevention in a safety net environment
The distribution of take home kits of naloxone, an opioid reversal drug, has been shown to be an effective and practical public health intervention to combat the large number of overdose deaths, an epidemic in the United States. However, when one safety net hospital emergency department attempted to increase naloxone kits availability to 24/7, the data showed no increases in take home naloxone kit expansion. In this paper, authors sought to define facilitators and barriers of the implementation of this intervention using focus groups and interviews. Interestingly, despite strong philosophical support and knowledge of the intervention, logistical barriers such as protocol, work-flow, and staff perceptions and roles made this intervention difficult to implement on the floor. Authors use PARiHS framework to analyze these facilitators and barriers and give suggestions for future implementation of interventions in hospital settings. Read more here