Healthcare professional behaviour change using technological supports: A realist literature review
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1
University of Manchester, Manchester Pharmacy School, United Kingdom
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2
University of Manchester, Manchester Centre for Health Psychology, United Kingdom
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3
University of Manchester, Manchester Medical School, United Kingdom
Background
Changing healthcare professional behaviour is fundamental to effective patient management. Recent systematic reviews examining healthcare professional behaviour change interventions (such as audit and feedback) suggest that technological support is likely to be crucial in helping healthcare professionals to improve patient outcomes. However we know little about the effectiveness of technological support interventions, and whether the design of technological support interventions has been informed by appropriate theories of behaviour change.
Aims
To synthesise existing cross-disciplinary research around behaviour change interventions that use technological solutions (such as computer-generated reminders or feedback via email) to support behaviour change among patient-facing healthcare professionals (including doctors, nurses and pharmacists).
Four specific aims were addressed in the review: (1) to determine the success of behaviour change interventions using technological supports aimed at changing the behaviour of healthcare professionals; (2) to determine whether interventions are informed by psychological theory relating to behaviour change; (3) whether interventions explicitly informed by theory are more effective at changing healthcare professionals’ behaviour; and (4) to examine the practical aspects of implementing technological support interventions aimed at changing the behaviour of healthcare professionals.
Methods
A realist literature review was conducted, which aims to explore interactions between context, mechanisms and outcomes. We chose this method to provide an explanatory analysis aimed at determining which interventions work and the circumstances in which they are effective. Systematic searches for articles in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ISI Web of Science, and Cochrane Library, using keywords relating to healthcare professional behaviour change and technological supports. The reference lists of key systematic review papers were included as part of the hand search of all relevant papers. The search strategy was designed using Medical Subject Headings (MeSH) terms and key words relating to healthcare professional behaviour change and technological supports. The type of interventions used (format) and the circumstances under which they were effective (target behaviour and setting) were analysed.
In order to examine the practical aspects of implementing technological support interventions a thematic analysis of included studies was conducted, which included identifying and categorising prominent themes. Studies included were both qualitative (e.g. semi-structured interviews) and quantitative (e.g. surveys) in nature.
Results
Fifty studies were identified. The largest group was based within primary care (n=24; 48%). Interventions mainly targeted General Practitioners (n=24; 48%), followed by multiple healthcare professionals (n=17; 34%), therapists (n=2; 4%), pharmacists (n=2; 4%), surgeons (n=1; 2%), paediatricians (n=1; 2%), dentists (n=1; 2%) and nurses (n=1; 2%).
The largest group of interventions was computerised decision support (n=19; 38%), followed by reminders and alerts (n=12; 24%). Other groups of interventions included reminder systems within patient electronic health records (n=4; 8%), computer-based training (n=4; 8%), and diagnostic/risk assessment tools (n=3; 6%).
Interventions were mainly designed to support adherence to clinical guidelines for patient management (n=18; 36%), medicine prescribing behaviours (n=14; 28%), and increase uptake of screening/testing (n=8; 16%).
Thirteen of the 19 (68%) studies using computerised decision support showed positive effects; 8 of the 12 (67%) studies using reminders alone showed positive effects. One of 3 (33%) studies using diagnostic/risk assessment tools showed positive effects. Only two (4%) of the fifty studies identified were informed by recognised behaviour change theories in the design of the intervention, both of which showed positive effects in changing professional behaviour. One study (2%) used recognised behaviour change theory to inform the analysis of study findings.
Twenty-two papers were identified addressing the practicalities associated with the design and implementation of technology-based interventions. Four major themes were identified that addressed a different aspect of the practical issues associated with implementation of technological behaviour change interventions: (1) Practice and workload issues, (2) Design, content and technical issues, (3) Role of the clinician, and (4) Usability and benefit for patient care.
A number of key recommendations/considerations were identified. Intervention recipients were seen as playing an important role in the development of interventions, with appropriate training to use the technology seen as an important part of implementation. Interventions must also be closely aligned with organisational goals/initiatives and, and could be easily integrated within existing clinical practice. The role of the healthcare professional was seen as a key part of successful implementation of interventions. Positive attitudes towards interventions were associated with uptake, as was assigning responsibility to one healthcare professional only.
Conclusions
Technological supports aiming to change the behaviour of healthcare professionals show considerable promise, particularly those involving computer-generated reminders and feedback. Due to the lack of theoretically-informed interventions, we were unable to draw conclusions around the effectiveness of theory-behaviour change interventions in this context. Interventions currently lack consistency in delivery method and content, which future research should address.
Keywords:
healthcare professional behaviour change,
Technology,
realist review,
intervention,
Technological support
Conference:
2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016.
Presentation Type:
Oral presentation
Topic:
Academic
Citation:
Keyworth
C,
Hart
J,
Armitage
CA and
Tully
MP
(2016). Healthcare professional behaviour change using technological supports: A realist literature review.
Front. Public Health.
Conference Abstract:
2nd Behaviour Change Conference: Digital Health and Wellbeing.
doi: 10.3389/conf.FPUBH.2016.01.00073
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Received:
27 Nov 2015;
Published Online:
09 Jan 2016.
*
Correspondence:
Dr. Chris Keyworth, University of Manchester, Manchester Pharmacy School, Manchester, M13 9PT, United Kingdom, c.keyworth@leeds.ac.uk