A qualitative study exploring perceived barriers and enablers to fidelity of training and delivery for an intervention to reduce non-indicated imaging for low back pain

Chiropractic & Manual Therapies

Research

Andrea M. Patey¹  Daphne To²  Diana De Carvalho²  Holly Etchegary²  Andrea Pike³  Amanda Hall³  Rebecca Lawrence³  Elaine Toomey⁴ 

[1] Centre for Implementation Research, Ottawa Hospital Research Institute – General Campus, Ottawa, ON, Canada;Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, A1B 3V6, Saint John’s, NL, Canada;Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, Saint John’s, NL, Canada;School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland;

关键词: Diagnostic imaging;    Evidence-based practice;    Implementation science;    Intervention fidelity;    Low back pain;    Needs assessment;    Theoretical Domains Framework;   

DOI  :  10.1186/s12998-023-00480-6

 received in 2022-09-12, accepted in 2023-01-23,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundNon-specific low back pain (LBP) commonly presents to primary care, where inappropriate use of imaging remains common despite guideline recommendations against its routine use. Little is known about strategies to enhance intervention fidelity (i.e., whether interventions were implemented as intended) for interventions developed to reduce non-indicated imaging for LBP.ObjectivesWe aim to inform the development of an intervention to reduce non-indicated imaging among general practitioners (GPs) and chiropractors in Newfoundland and Labrador (NL), Canada. The study objectives are: [1] To explore perceived barriers and enablers to enhancing fidelity of training of GPs and chiropractors to deliver a proposed intervention to reduce non-indicated imaging for LBP and [2] To explore perceived barriers and enablers to enhancing fidelity of delivery of the proposed intervention.MethodsAn exploratory, qualitative study was conducted with GPs and chiropractors in NL. The interview guide was informed by the National Institutes of Health Behavior Change Consortium fidelity checklist; data analysis was guided by the Theoretical Domains Framework (TDF). Participant quotes were coded into TDF domains, belief statements were generated at each domain, and domains relevant to enhancing fidelity of provider training or intervention delivery were identified.ResultsThe study included five GPs and five chiropractors from urban and rural settings. Barriers and enablers to enhancing fidelity to provider training related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Reinforcement, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Emotion, and [7] Behavioural regulation. Barriers and enablers to enhancing fidelity to intervention delivery related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Goals, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Social influences, and [7] Behavioural regulation.ConclusionThe largest perceived barrier to attending training was time; perceived enablers were incentives and flexible training. Patient pressure, time, and established habits were perceived barriers to delivering the intervention as intended. Participants suggested enhancement strategies to improve their ability to deliver the intervention as intended, including reminders and check-ins with researchers. Most participants perceived intervention fidelity as important. These results may aid in the development of a more feasible and pragmatic intervention to reduce non-indicated imaging for GPs and chiropractors in NL.

【 授权许可】

CC BY   
© The Author(s) 2023

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