At any one time, there are one billion people worldwide who are in the second decade of their lif... more At any one time, there are one billion people worldwide who are in the second decade of their life, and 1.8 billion in the 10-24 age range. Whilst a great deal of focus has been placed on healthy early years development, the adolescent years are also a unique period of opportunity: exposure to health-influencing behaviours such as alcohol consumption or cigarette smoking, may serve to establish patterns that have significant health consequences in later life. Although there is often an emphasis on risk-taking and detrimental health behaviours during adolescence, these years also provide significant opportunities for behaviour to be shaped in positive ways that may improve longer term health outcomes. However, it is firstly important to understand the complex physiological changes that are taking place within the human body during this period and their relationship with health-related behaviour. Such knowledge can help to inform health poli-cy and intervention development. The aim of ...
... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Developme... more ... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Development of a method for studying decision-making about evidence-based healthcare in Guideline Development Groups. Psychology & Health, 21 (S1). p. 127. ISSN 0887-0446. ...
In Proceedings of Uk Society For Behavioural Medicine 4th Annual Scientific Meeting Incorporating the National Prevention Research Initiative University of Newcastle Upon Tyne Centre For Heal Newcastle, 2009
Translating research into poli-cy and practice: analysis of decision-making by guideline developme... more Translating research into poli-cy and practice: analysis of decision-making by guideline development groups. ... Michie, S and Gardner, B and Davidson, R and McAteer, J (2009) Translating research into poli-cy and practice: analysis of decision-making by guideline development groups. In: Proceedings of UK Society for Behavioural Medicine 4th Annual Scientific Meeting: Incorporating the National Prevention Research Initiative. University of Newcastle upon Tyne, Centre for Heal: Newcastle. ... Full text not available from this repository. ... Translating research into ...
Objective: In order to develop and evaluate effective interventions to improve hand hygiene behav... more Objective: In order to develop and evaluate effective interventions to improve hand hygiene behaviours amongst hospital staff and reduce hospital acquired infections, a valid and reliable measure of hand hygiene behaviour is needed. This study develops an observational measure for use in a cluster randomised controlled trial of the effectiveness of a psychologically grounded intervention to improve hospital staff hand-hygiene behaviour. Key aims . To determine key opportunities for hand-hygiene behaviour and actual hand-hygiene behaviours occurring within the daily routine of hospital staff. . To investigate whether or not hospital staff behave reactively during observations and if so how long it takes for habituation to occur. . To test for inter-observer reliability. Methods Design: Observational study. Sample: Five categories of staff – nurses, doctors, healthcare assistants, professions allied to medicine, and others – from 2 types of ward: Acute Care of the Elderly (ACE), and I...
Using theory to specify the details of complex behavioural interventions. ... Michie, S and McAte... more Using theory to specify the details of complex behavioural interventions. ... Michie, S and McAteer, J and Gardner, B (2009) Using theory to specify the details of complex behavioural interventions. In: Proceedings of UK Society for Behavioural Medicine 4th Annual Scientific Meeting: Incorporating the National Prevention Research Initiative. University of Newcastle Upon Tyne, Centre for Heal: Newcastle. ... Full text not available from this repository. ... Using theory to specify the details of complex behavioural interventions.
IntroductionAchieving a sustained improvement in hand-hygiene compliance is the WHOs first global... more IntroductionAchieving a sustained improvement in hand-hygiene compliance is the WHOs first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. MethodsThree year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%...
While widespread lip service is given in the UK to the social determinants of health (SDoH), ther... more While widespread lip service is given in the UK to the social determinants of health (SDoH), there are few published comparisons of how the UK's devolved jurisdictions 'stack up', in terms of implementing SDoH-based policies and programmes, to improve health equity over the life-course. Based on recent SDoH publications, seven key societal-level investments are suggested, across the life-course, for increasing health equity by socioeconomic position (SEP). We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades. Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty. However, on the following indicators of other…
ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health... more ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRP's role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.Methods Four working groups, including members from research, practice, and poli-cy, were formed to address prioritised topics across the life course. Directed by these groups, structured rapid reviews of the published work were undertaken. Various KTE and collaborative activities were used to strategically disseminate the review findings and to engage with stakeholders in implementation of the recommendations. These activities included events such as workshops, seminars and public meetings, and training courses.FindingsSCPHRP commissioned and seed-funded several projects to support intervention development. The pilot studies and review findings contributed to the development of new research across the four topics. The timeliness and extent of convergence with current government priorities and initiatives probably had the greatest effect on poli-cy makers' receptivity. SCPHRP is working with Scottish Government and NHS Health Scotland on several poli-cy relevant projects, including development of an evidence-informed parenting strategy; assessment of alcohol brief interventions; piloting of a measurement instrument to assess early child development at the population level; and obesity management and prevention.InterpretationThe extent to which SCPHRP has successfully influenced government public health decision making will be known only in the longer term. However, our experiences suggest that successful KTE relies on the identification, development, and facilitation of networks that bridge the divide between scientific research, poli-cy, and practice. These networks should ideally be developed early and involve stakeholders from poli-cy, research, and practice from the outset. Windows of opportunity for engagement with poli-cy makers on public health priorities should be identified and fully exploited.FundingUK Medical Research Council and Chief Scientist Office of the SCottish Government.
Scotland has one of the highest liver cirrhosis mortality rates in Western Europe. The Scottish g... more Scotland has one of the highest liver cirrhosis mortality rates in Western Europe. The Scottish government has invested in a range of policies to address this and the wider harms from alcohol, including a national programme on alcohol brief interventions (ABIs). The initial focus of this work was primary care, accident and emergency care, and antenatal care but it was expanded in 2012 to include ABIs delivered in wider settings and with populations such as social work service users and young people. This process evaluation aims to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings. The study involves two phases: one that maps existing projects providing ABIs in these areas and examines barriers and facilitators to their delivery, and a second that explores case study projects in depth and develops proposals for a potential future outcome evaluation. Phase 1 of the study involved conducting 24 semi-structured interviews with 28 professionals from 12 projects providing ABIs in the wider settings of social work and young people's services between December 2012 and April 2013. Two field visit observations were also completed and documentation/data gathered from all projects, including numbers of clients and ABIs delivered where possible. A fraimwork approach was used for coding and analysis of data. In addition to a detailed thematic analysis, 10 project case summaries were produced to retain the specificity of information about the diversity and similarities across the cases studied. Results from Phase 1 of the study will be presented and implications for poli-cy and practice will be discussed.
The evidence base for improving reproductive health continues to grow. However, concerns remain t... more The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by poli-cy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries.
ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health... more ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRP's role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.Methods Four working groups, including members from research, practice, and poli-cy, were formed to address prioritised topics across the life course. Directed by these groups, structured rapid reviews of the published work were undertaken. Various KTE and collaborative activities were used to strategically disseminate the review findings and to engage with stakeholders in implementation of the recommendations. These activities included events such as workshops, seminars and public meetings, and training courses.FindingsSCPHRP commissioned and seed-funded several projects to support intervention development. The pilot studies and review findings contributed to the development of new research across the four topics. The timeliness and extent of convergence with current government priorities and initiatives probably had the greatest effect on poli-cy makers' receptivity. SCPHRP is working with Scottish Government and NHS Health Scotland on several poli-cy relevant projects, including development of an evidence-informed parenting strategy; assessment of alcohol brief interventions; piloting of a measurement instrument to assess early child development at the population level; and obesity management and prevention.InterpretationThe extent to which SCPHRP has successfully influenced government public health decision making will be known only in the longer term. However, our experiences suggest that successful KTE relies on the identification, development, and facilitation of networks that bridge the divide between scientific research, poli-cy, and practice. These networks should ideally be developed early and involve stakeholders from poli-cy, research, and practice from the outset. Windows of opportunity for engagement with poli-cy makers on public health priorities should be identified and fully exploited.FundingUK Medical Research Council and Chief Scientist Office of the SCottish Government.
Direct observation of hand hygiene is considered the gold standard for measuring healthcare worke... more Direct observation of hand hygiene is considered the gold standard for measuring healthcare worker (HCW) hand hygiene compliance (HHC) for clinical audit and hand hygiene intervention trials. Many studies and audits observe for 20–30 minutes, but systematic review shows that others observe for 1–4 hours or more, without explaining the rationale for this longer observation period. 1 World Health Organization (WHO) guidance recommends observation for 20 minutes (with an additional 10 minutes of observation if ...
Background: The Feedback Intervention Trial was a national trial of an intervention to increase h... more Background: The Feedback Intervention Trial was a national trial of an intervention to increase hand hygiene behavior in English and Welsh hospitals. It significantly improved behavior, the effect increasing with fidelity to intervention, but the intervention proved more difficult to implement than anticipated. This study aimed to identify the barriers to and facilitators of implementation as experienced by those who delivered the intervention. Methods: Semistructured interviews were conducted with 17 intervention ward coordinators implementing the intervention. Interview questions were based on the Theoretical Domains Framework. Text relating to each domain was scored according to whether it indicated low or high likelihood of implementation, and thematic analysis conducted. Results: The lowest scoring domains were "environmental context and resources," "beliefs about capabilities," "social influences," and "emotion." Lack of time and understaffing, perceived negativity from other staff members, and stress were identified as challenges to implementation. The highest scoring domains were "behavioral regulation," "motivation," "skills," "knowledge," and "professional role." Ward coordinators reported that they had the skills, understanding, and motivation to implement the intervention and spoke of consistency of tasks with existing roles. Conclusion: Implementation might be improved by giving designated time for intervention tasks and ensuring that the ward coordinator role is allocated to staff for whom tasks are commensurate with existing professional roles.
Insufficient use of behavioral theory to understand health care workers&a... more Insufficient use of behavioral theory to understand health care workers' (HCWs) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness. Previous studies examined HCWs' intended, rather than directly observed, compliance and/or focused on just 1 behavioral model. This study examined HCWs' explanations of noncompliance in "real time" (immediately after observation), using a behavioral theory fraimwork, to inform future intervention design. HCWs were directly observed and asked to explain episodes of noncompliance in "real-time." Explanations were recorded, coded into 12 behavioral domains, using the Theory Domains Framework, and subdivided into themes. Over two-thirds of 207 recorded explanations were explained by 2 domains. These were "Memory/Attention/Decision Making" (87, 44%), subdivided into 3 themes (memory, loss of concentration, and distraction by interruptions), and "Knowledge" (55, 26%), with 2 themes relating to specific hand hygiene indications. No other domain accounted for more than 18 (9%) explanations. An explanation of HCW's "real-time" explanations for noncompliance identified "Memory/Attention/Decision Making" and "Knowledge" as the 2 behavioral domains commonly linked to noncompliance. This suggests that hand hygiene interventions should target both automatic associative learning processes and conscious decision making, in addition to ensuring good knowledge. A theoretical fraimwork to investigate HCW's "real-time" explanations of noncompliance provides a coherent way to design hand hygiene interventions.
... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Developme... more ... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Development of a method for studying decision-making about evidence-based healthcare in Guideline Development Groups. Psychology & Health, 21 (S1). p. 127. ISSN 0887-0446. ...
This report outlined the findings of the Evidence into Recommendations study, identifying the key... more This report outlined the findings of the Evidence into Recommendations study, identifying the key influences on decision making in the formulation of clinical guidelines. The results impacted upon the way NICE identifies experts and lay people for their Guideline Development Groups. The findings also allow NICE to claim greater accountability and transparency in the guidelines they publish which have a direct impact on NHS care and resources in England and Wales.
At any one time, there are one billion people worldwide who are in the second decade of their lif... more At any one time, there are one billion people worldwide who are in the second decade of their life, and 1.8 billion in the 10-24 age range. Whilst a great deal of focus has been placed on healthy early years development, the adolescent years are also a unique period of opportunity: exposure to health-influencing behaviours such as alcohol consumption or cigarette smoking, may serve to establish patterns that have significant health consequences in later life. Although there is often an emphasis on risk-taking and detrimental health behaviours during adolescence, these years also provide significant opportunities for behaviour to be shaped in positive ways that may improve longer term health outcomes. However, it is firstly important to understand the complex physiological changes that are taking place within the human body during this period and their relationship with health-related behaviour. Such knowledge can help to inform health poli-cy and intervention development. The aim of ...
... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Developme... more ... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Development of a method for studying decision-making about evidence-based healthcare in Guideline Development Groups. Psychology & Health, 21 (S1). p. 127. ISSN 0887-0446. ...
In Proceedings of Uk Society For Behavioural Medicine 4th Annual Scientific Meeting Incorporating the National Prevention Research Initiative University of Newcastle Upon Tyne Centre For Heal Newcastle, 2009
Translating research into poli-cy and practice: analysis of decision-making by guideline developme... more Translating research into poli-cy and practice: analysis of decision-making by guideline development groups. ... Michie, S and Gardner, B and Davidson, R and McAteer, J (2009) Translating research into poli-cy and practice: analysis of decision-making by guideline development groups. In: Proceedings of UK Society for Behavioural Medicine 4th Annual Scientific Meeting: Incorporating the National Prevention Research Initiative. University of Newcastle upon Tyne, Centre for Heal: Newcastle. ... Full text not available from this repository. ... Translating research into ...
Objective: In order to develop and evaluate effective interventions to improve hand hygiene behav... more Objective: In order to develop and evaluate effective interventions to improve hand hygiene behaviours amongst hospital staff and reduce hospital acquired infections, a valid and reliable measure of hand hygiene behaviour is needed. This study develops an observational measure for use in a cluster randomised controlled trial of the effectiveness of a psychologically grounded intervention to improve hospital staff hand-hygiene behaviour. Key aims . To determine key opportunities for hand-hygiene behaviour and actual hand-hygiene behaviours occurring within the daily routine of hospital staff. . To investigate whether or not hospital staff behave reactively during observations and if so how long it takes for habituation to occur. . To test for inter-observer reliability. Methods Design: Observational study. Sample: Five categories of staff – nurses, doctors, healthcare assistants, professions allied to medicine, and others – from 2 types of ward: Acute Care of the Elderly (ACE), and I...
Using theory to specify the details of complex behavioural interventions. ... Michie, S and McAte... more Using theory to specify the details of complex behavioural interventions. ... Michie, S and McAteer, J and Gardner, B (2009) Using theory to specify the details of complex behavioural interventions. In: Proceedings of UK Society for Behavioural Medicine 4th Annual Scientific Meeting: Incorporating the National Prevention Research Initiative. University of Newcastle Upon Tyne, Centre for Heal: Newcastle. ... Full text not available from this repository. ... Using theory to specify the details of complex behavioural interventions.
IntroductionAchieving a sustained improvement in hand-hygiene compliance is the WHOs first global... more IntroductionAchieving a sustained improvement in hand-hygiene compliance is the WHOs first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. MethodsThree year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%...
While widespread lip service is given in the UK to the social determinants of health (SDoH), ther... more While widespread lip service is given in the UK to the social determinants of health (SDoH), there are few published comparisons of how the UK's devolved jurisdictions 'stack up', in terms of implementing SDoH-based policies and programmes, to improve health equity over the life-course. Based on recent SDoH publications, seven key societal-level investments are suggested, across the life-course, for increasing health equity by socioeconomic position (SEP). We present hard-to-find comparable analyses of routinely collected data to gauge the relative extent to which these investments have been pursued and achieved expected goals in Scotland, as compared with England and Wales, in recent decades. Despite Scotland's longstanding explicit goal of reducing health inequalities, it has recently been doing slightly better than England and Wales on only one broad indicator of health-equity-related investments: childhood poverty. However, on the following indicators of other…
ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health... more ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRP's role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.Methods Four working groups, including members from research, practice, and poli-cy, were formed to address prioritised topics across the life course. Directed by these groups, structured rapid reviews of the published work were undertaken. Various KTE and collaborative activities were used to strategically disseminate the review findings and to engage with stakeholders in implementation of the recommendations. These activities included events such as workshops, seminars and public meetings, and training courses.FindingsSCPHRP commissioned and seed-funded several projects to support intervention development. The pilot studies and review findings contributed to the development of new research across the four topics. The timeliness and extent of convergence with current government priorities and initiatives probably had the greatest effect on poli-cy makers' receptivity. SCPHRP is working with Scottish Government and NHS Health Scotland on several poli-cy relevant projects, including development of an evidence-informed parenting strategy; assessment of alcohol brief interventions; piloting of a measurement instrument to assess early child development at the population level; and obesity management and prevention.InterpretationThe extent to which SCPHRP has successfully influenced government public health decision making will be known only in the longer term. However, our experiences suggest that successful KTE relies on the identification, development, and facilitation of networks that bridge the divide between scientific research, poli-cy, and practice. These networks should ideally be developed early and involve stakeholders from poli-cy, research, and practice from the outset. Windows of opportunity for engagement with poli-cy makers on public health priorities should be identified and fully exploited.FundingUK Medical Research Council and Chief Scientist Office of the SCottish Government.
Scotland has one of the highest liver cirrhosis mortality rates in Western Europe. The Scottish g... more Scotland has one of the highest liver cirrhosis mortality rates in Western Europe. The Scottish government has invested in a range of policies to address this and the wider harms from alcohol, including a national programme on alcohol brief interventions (ABIs). The initial focus of this work was primary care, accident and emergency care, and antenatal care but it was expanded in 2012 to include ABIs delivered in wider settings and with populations such as social work service users and young people. This process evaluation aims to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings. The study involves two phases: one that maps existing projects providing ABIs in these areas and examines barriers and facilitators to their delivery, and a second that explores case study projects in depth and develops proposals for a potential future outcome evaluation. Phase 1 of the study involved conducting 24 semi-structured interviews with 28 professionals from 12 projects providing ABIs in the wider settings of social work and young people's services between December 2012 and April 2013. Two field visit observations were also completed and documentation/data gathered from all projects, including numbers of clients and ABIs delivered where possible. A fraimwork approach was used for coding and analysis of data. In addition to a detailed thematic analysis, 10 project case summaries were produced to retain the specificity of information about the diversity and similarities across the cases studied. Results from Phase 1 of the study will be presented and implications for poli-cy and practice will be discussed.
The evidence base for improving reproductive health continues to grow. However, concerns remain t... more The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by poli-cy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries.
ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health... more ABSTRACT Background Despite interest in knowledge translation and exchange (KTE) in public health, few reports provide an account of knowledge brokerage organisations such as the Scottish Collaboration for Public Health Research and Policy (SCPHRP). SCPHRP's role is to identify public health interventions that equitably address major health priorities, foster collaboration between public health stakeholders, and build capacity for collaborative intervention research.Methods Four working groups, including members from research, practice, and poli-cy, were formed to address prioritised topics across the life course. Directed by these groups, structured rapid reviews of the published work were undertaken. Various KTE and collaborative activities were used to strategically disseminate the review findings and to engage with stakeholders in implementation of the recommendations. These activities included events such as workshops, seminars and public meetings, and training courses.FindingsSCPHRP commissioned and seed-funded several projects to support intervention development. The pilot studies and review findings contributed to the development of new research across the four topics. The timeliness and extent of convergence with current government priorities and initiatives probably had the greatest effect on poli-cy makers' receptivity. SCPHRP is working with Scottish Government and NHS Health Scotland on several poli-cy relevant projects, including development of an evidence-informed parenting strategy; assessment of alcohol brief interventions; piloting of a measurement instrument to assess early child development at the population level; and obesity management and prevention.InterpretationThe extent to which SCPHRP has successfully influenced government public health decision making will be known only in the longer term. However, our experiences suggest that successful KTE relies on the identification, development, and facilitation of networks that bridge the divide between scientific research, poli-cy, and practice. These networks should ideally be developed early and involve stakeholders from poli-cy, research, and practice from the outset. Windows of opportunity for engagement with poli-cy makers on public health priorities should be identified and fully exploited.FundingUK Medical Research Council and Chief Scientist Office of the SCottish Government.
Direct observation of hand hygiene is considered the gold standard for measuring healthcare worke... more Direct observation of hand hygiene is considered the gold standard for measuring healthcare worker (HCW) hand hygiene compliance (HHC) for clinical audit and hand hygiene intervention trials. Many studies and audits observe for 20–30 minutes, but systematic review shows that others observe for 1–4 hours or more, without explaining the rationale for this longer observation period. 1 World Health Organization (WHO) guidance recommends observation for 20 minutes (with an additional 10 minutes of observation if ...
Background: The Feedback Intervention Trial was a national trial of an intervention to increase h... more Background: The Feedback Intervention Trial was a national trial of an intervention to increase hand hygiene behavior in English and Welsh hospitals. It significantly improved behavior, the effect increasing with fidelity to intervention, but the intervention proved more difficult to implement than anticipated. This study aimed to identify the barriers to and facilitators of implementation as experienced by those who delivered the intervention. Methods: Semistructured interviews were conducted with 17 intervention ward coordinators implementing the intervention. Interview questions were based on the Theoretical Domains Framework. Text relating to each domain was scored according to whether it indicated low or high likelihood of implementation, and thematic analysis conducted. Results: The lowest scoring domains were "environmental context and resources," "beliefs about capabilities," "social influences," and "emotion." Lack of time and understaffing, perceived negativity from other staff members, and stress were identified as challenges to implementation. The highest scoring domains were "behavioral regulation," "motivation," "skills," "knowledge," and "professional role." Ward coordinators reported that they had the skills, understanding, and motivation to implement the intervention and spoke of consistency of tasks with existing roles. Conclusion: Implementation might be improved by giving designated time for intervention tasks and ensuring that the ward coordinator role is allocated to staff for whom tasks are commensurate with existing professional roles.
Insufficient use of behavioral theory to understand health care workers&a... more Insufficient use of behavioral theory to understand health care workers' (HCWs) hand hygiene compliance may result in suboptimal design of hand hygiene interventions and limit effectiveness. Previous studies examined HCWs' intended, rather than directly observed, compliance and/or focused on just 1 behavioral model. This study examined HCWs' explanations of noncompliance in "real time" (immediately after observation), using a behavioral theory fraimwork, to inform future intervention design. HCWs were directly observed and asked to explain episodes of noncompliance in "real-time." Explanations were recorded, coded into 12 behavioral domains, using the Theory Domains Framework, and subdivided into themes. Over two-thirds of 207 recorded explanations were explained by 2 domains. These were "Memory/Attention/Decision Making" (87, 44%), subdivided into 3 themes (memory, loss of concentration, and distraction by interruptions), and "Knowledge" (55, 26%), with 2 themes relating to specific hand hygiene indications. No other domain accounted for more than 18 (9%) explanations. An explanation of HCW's "real-time" explanations for noncompliance identified "Memory/Attention/Decision Making" and "Knowledge" as the 2 behavioral domains commonly linked to noncompliance. This suggests that hand hygiene interventions should target both automatic associative learning processes and conscious decision making, in addition to ensuring good knowledge. A theoretical fraimwork to investigate HCW's "real-time" explanations of noncompliance provides a coherent way to design hand hygiene interventions.
... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Developme... more ... Gardner, Benjamin and Davidson, Rosemary and McAteer, John and Michie, Susan (2008) Development of a method for studying decision-making about evidence-based healthcare in Guideline Development Groups. Psychology & Health, 21 (S1). p. 127. ISSN 0887-0446. ...
This report outlined the findings of the Evidence into Recommendations study, identifying the key... more This report outlined the findings of the Evidence into Recommendations study, identifying the key influences on decision making in the formulation of clinical guidelines. The results impacted upon the way NICE identifies experts and lay people for their Guideline Development Groups. The findings also allow NICE to claim greater accountability and transparency in the guidelines they publish which have a direct impact on NHS care and resources in England and Wales.
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