Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology

BMC Health Services Research

Sean M Hayes⁵  Brock D Bernsten¹  Judith L Ross⁶  Stephen M Rosenthal²  Mark E Molitch⁴  Beverly MK Biller³  Robert C Bartel⁷  Patrice Lazure⁵ 

[1] Town and Country Pediatric Medical Associates, 3838 California St., #111, San Francisco, CA 94118, USA;Department of Pediatrics, University of California, 513 Parnassus Ave Room S-672, Box 0434, San Francisco, CA 94143-0434, USA;Neuroendocrine Unit, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, Bulfinch 457B, Boston, MA 02114-2096, USA;Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 645 N. Michigan Ave., Suite 530, Chicago, IL 60611-3008, USA;AXDEV Group Inc., 210–8, Place du Commerce, Brossard, QC J4W 3H2, Canada;Pediatric Endocrinology, Jefferson Medical College, 1025 Walnut St Ste 726, Philadelphia, PA 19107-6799, USA;The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD, USA

关键词: Pediatric growth disorders;    Acromegaly;    Adult growth hormone deficiency;    Endocrinology;    Knowledge translation;    Behavioral change techniques;    Mixed–methods;    Needs assessment;    Application of educational research;    Theoretical domains framework;   

Others  :  1126919
DOI  :  10.1186/1472-6963-14-319

 received in 2013-10-15, accepted in 2014-07-16,  发布年份 2014

【 摘 要 】

Background

The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF.

Methods

This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques.

Results

The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain.

Conclusions

The TDF categorization of the needs assessment findings allowed recommendation of appropriate behavior change techniques for each underlying determinant, and facilitated communication and understanding of the identified issues to a broader audience. This approach provides a means for health education researchers to categorize gaps and challenges identified through educational needs assessments, and facilitates the application of these findings by educators and knowledge translators, by linking the gaps to recommended behavioral change techniques.

【 授权许可】

   
2014 Lazure et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Ramanujam R, Rousseau D: The challenges Are organizational. Not just clinical. J Organ Behav 2006, 27:811-827.
• [2]Harlos K, Tetroe J, Graham ID, Bird M, Robinson N: Mining the management literature for insights into implementing evidence-based change in healthcare. Health Policy 2012, 8(1):33-48.
• [3]Moore DE: Needs assessment in the new healthcare environment: combining discrepancy analysis and outcomes to create more effective CME. J Contin Educ Health Prof 1998, 18:133-141.
• [4]Michie S, Johnston M, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care 2005, 14:26-33.
• [5]Cane J, O’Connor D, Michie S: Validation of the theoretical domains framework for use in behavior change and implementation research. Implement Sci 2012, 7:37.
• [6]Brehaut JC, Eva KW: Building theories of knowledge translation interventions: use the entire menu of constructs. Implement Sci 2012, 7:114.
• [7]Duncan EM, Francis JJ, Johnston M, Davey P, Maxwell S, McKay GA, McLay J, Ross S, Ryan C, Webb DJ, Bond C: Learning curves, taking instructions, and patient safety: using a theoretical domains framework in an interview study to investigate prescribing errors among trainee doctors. Implement Sci 2012, 7:86.
• [8]Islam R, Tinmouth AT, Francis JJ, Brehaut JC, Born J, Stockton C, Stanworth SJ, Eccles MP, Cuthbertson BH, Hyde C, Grimshaw JM: A cross-country comparison of intensive care physicians’ beliefs about their transfusion behavior: a qualitative study using the theoretical domains framework. Implement Sci 2012, 7:93.
• [9]Michie S, Johnston M, Francis J, Hardeman W, Eccles M: From theory to intervention: mapping theoretically derived behavioral determinants to behavior change techniques. Appl Psychol 2008, 57:660-680.
• [10]French SD, Green SE, O’Connor DA, McKenzie JE, Francis JF, Michie S, Buchbinder R, Schattner P, Spike N, Grimshaw JM: Developing theory-informed behavior change interventions to implement evidence into practice: a systematic approach using the theoretical domains framework. Implement Sci 2012, 7:38.
• [11]Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML: Evaluation and treatment of adult growth hormone deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006, 91:1621-1634.
• [12]Schneider HJ, Sievers C, Saller B, Wittchen HU, Stalla GK: High prevalence of biochemical acromegaly in primary care patients with elevated IGF-1 levels. Clin Endocrinol 2008, 69:432-435.
• [13]Lindsay R, Feldkamp M, Harris D, Robertson J, Rallison M: Utah growth study: growth standards and the prevalence of growth hormone deficiency. J Pediatr 1994, 125:29-35.
• [14]Cohen P, Rogol AD, Deal CL, Saenger P, Reiter EO, Ross JL, Chernausek SD, Savage MO, Wit JM, on behalf of the 2007 ISS Consensus Workshop participants: Consensus statement on the diagnosis and treatment of children with idiopathic short stature: a summary of the Growth Hormone Research Society, the Lawson Wilkins Pediatric Endocrine Society and the European Society for Paediatric Endocrinology Workshop. J Clin Endocrinol Metab 2007, 2008(93):4210-4217.
• [15]Nguyen VT, Misra M: Transitioning of children with GH deficiency to adult dosing: changes in body composition. Pituitary 2009, 12:125-135.
• [16]Tashakkori A, Creswell JW: The new era of mixed methods. J Mix Methods Res 2007, 1(1):3-7.
• [17]Johnson RB, Onwuegbuzie AJ: Mixed methods research: a research paradigm whose time has come. Educ Res 2004, 33:14-26.
• [18]Maudsley G: Mixing it but not mixed-up: mixed methods research in medical education (a critical narrative review). Med Teach 2011, 33(2):e92-e104.
• [19]Bogdan RC, Biklen SK: Qualitative Research In Education: An Introduction To Theory And Methods. 5th edition. Boston: Allyn & Bacon; 2006.
• [20]Given LM (Ed): The Sage Encyclopedia of Qualitative Research Methods. Thousand Oaks, CA: Sage; 2008:2008.
• [21]The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research: Ethical Principles and Guidelines for the Protection of Human Subjects of Research. 1979.
• [22]Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Social Sciences and Humanities Research Council of Canada: Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans. 2010.
• [23]Pettya NJ, Thomson OP, Stewa G: Ready for a paradigm shift? part 2: introducing qualitative research methodologies and methods. Manual Ther 2012, 17:378-384.
• [24]Zhang W, Cresswell J: The use of "mixing" procedure of mixed methods in health services research. Med Care 2013, 51(8):e51-e57.
• [25]Murray S, Lazure P, Pullen C, Maltais P, Dorian P: Atrial fibrillation care: challenges in clinical practice and educational needs assessment. Can J Cardiol 2011, 27(1):98-104.
• [26]Cytryn KN, Garvey WT, Hayes SM, Myhal G, Cann L, Murray S: A qualitative assessment of educational opportunities for primary care providers in type 2 diabetes care. Diab Spect 2009, 22:248-253.
• [27]Dupuis M, Marshall JK, Hayes SM, Cytryn KN, Murray S: Assessing the educational needs of Canadian gastroenterologists and gastroenterology nurses: Challenges to optimal care in Crohn’s disease. Can J Gastroenterol 2009, 23:805-810.
• [28]Peabody JW, Luck J, Glassman P, Jain S, Hansen J, Spell M, Lee M: Measuring the quality of physician practice by using clinical vignettes: a prospective validation study. Ann Intern Med 2004, 141:771-780.
• [29]Neuendorf KA: The Content Analysis Guidebook. Thousand Oaks: Sage publications; 2002.
• [30]Boyatzis RE: Thematic Analysis And Code Development: Transforming Qualitative Information. Thousand Oaks: Sage publications; 1998.
• [31]Nasca TJ, Philibert I, Brigham T, Flynn TC: The next GME accreditation system: rationale and benefits. New Eng J of Med 2012, 366:1051-1056.