Background
Methods
Study design
Implementation frameworks
Data collection
Data mapping
Data analysis
Results
Mapping of AMDE reporting themes to TDF and TICD
Determinant themes from AMDE study | TDF domains selected by mappers | ||
---|---|---|---|
LD | ARG | Domain Match | |
PHYSICIAN BELIEFS | |||
AMDEs considered expected or unavoidable and not adverse unless outcomes catastrophic; viewed as more severe in other specialties | Beliefs about consequences | Beliefs about consequences | Yes |
Social-professional role and identity | – | No | |
AMDEs within 2 years of use were considered unusual | Beliefs about consequences | Beliefs about consequences | Yes |
Views about cause of AMDEs confounded by multiple factors | Beliefs about consequences | – | No |
– | Knowledge | No | |
Incidence of AMDEs has decreased, thus devices were thought to be improved | Beliefs about consequences | – | No |
– | Optimism | No | |
Sub-total unique or matching domains | 2 | 3 | 2/7 (28.6%) |
POLICIES, PROCESSES or SYSTEMS | |||
Follow-up of device-related outcomes beyond short-term results done elsewhere | Environmental context and resources | Environmental context and resources | Yes |
Social-professional role and identity | – | No | |
Devices implanted not recorded in patient records | Environmental context and resources | Environmental context and resources | Yes |
No hospital, national or international systems for AMDE reporting | Environmental context and resources | Environmental context and resources | Yes |
– | Reinforcement | No | |
Knowledge | – | No | |
Behavioural regulation | – | No | |
Sub-total unique or matching domains | 4 | 2 | 3/7 (42.9%) |
DEVICE MARKET | |||
Use of specific devices often determined by purchase group contract obligations | Environmental context and resources | Environmental context and resources | Yes |
Lack of responsiveness to AMDEs from industry | Reinforcement | Reinforcement | Yes |
Knowledge | – | No | |
Optimism | – | No | |
Beliefs about consequences | – | No | |
– | Environmental context and resources | No | |
Sub-total unique or matching domains | 5 | 2 | 2/6 (33.3%) |
Total unique or matching domains | 6 | 5 | 7/20 (35.0%) |
Determinant themes from AMDE study | TICD domains:determinants selected by mappers | ||
---|---|---|---|
LD | ARG | Determinant Match | |
PHYSICIAN BELIEFS | |||
AMDEs considered expected or unavoidable and not adverse unless outcomes catastrophic; viewed as more severe in other specialties | Health professional cognitions: expected outcome | Health professional cognitions: expected outcome | Yes |
Health professional cognitions: agreement with the recommendation | – | No | |
AMDEs within 2 years of use were considered unusual | Health professional cognitions: expected outcome | Health professional cognitions: expected outcome | Yes |
Health professional cognitions: agreement with recommendations | – | No | |
Views about cause of AMDEs confounded by multiple factors | Health professional cognitions: agreement with the recommendation | – | No |
– | Health professional knowledge and skills: domain knowledge | No | |
Incidence of AMDEs has decreased, thus devices were thought to be improved | Health professional cognitions: expected outcome | Health professional cognitions: expected outcome | Yes |
Health professional cognitions: agreement with recommendations | – | No | |
Sub-total unique or matching determinants | 3 | 2 |
3/8 (37.5%)
|
POLICIES, PROCESSES or SYSTEMS | |||
Follow-up of device-related outcomes beyond short-term results done elsewhere | Recommended behaviour: observability | Recommended behaviour: observability | Yes |
Health professional cognitions: intention and motivation | – | No | |
Health professional behaviour: nature of the behaviour | – | No | |
– | Health professional knowledge and skills: knowledge about own practice | No | |
– | Health professional behaviour: self-monitoring or feedback | No | |
– | Professional interactions: referral processes | No | |
Devices implanted not recorded in patient records | Incentives and resources: information system | Incentives and resources: information system | Yes |
– | Health professional knowledge and skills: knowledge about own practice | No | |
– | Health professional behaviour: capacity to plan change | No | |
– | Health professional behaviour: self-monitoring or feedback | No | |
No hospital, national or international systems for AMDE reporting | Incentives and resources: information system | Incentives and resources: information system | Yes |
Incentives and resources: availability of necessary resources | Incentives and resources: availability of necessary resources | Yes | |
Capacity for organizational change: regulations, rules and policies | Capacity for organizational change: regulations, rules and policies | Yes | |
Health professional knowledge and skills: domain knowledge | – | No | |
– | Health professional cognitions: intention and motivation | No | |
– | Health professional behaviour: self-monitoring or feedback | No | |
– | Incentives and resources: non-financial incentives and disincentives | No | |
– | Incentives and resources: quality assurance and patient safety systems | No | |
– | Capacity for organization change: monitoring and feedback | No | |
Sub-total unique or matching determinants | 7 | 11 | 5/19 (26.3%) |
DEVICE MARKET | |||
Use of specific devices often determined by purchase group contract obligations | Health professional behaviour: capacity to plan change | Health professional behaviour: capacity to plan change | Yes |
Capacity for organizational change: regulations, rules and policies | – | No | |
– | Incentives and resources: financial incentives and disincentives | No | |
– | Capacity for organizational change: mandate, authority and accountability | No | |
– | Social, political and legal factors: economic constraints on the health care budget | No | |
– | Social, political and legal factors: contracts | No | |
Lack of responsiveness to AMDEs from representatives or manufacturers | Health professional cognitions: expected outcome | – | No |
– | Health professional cognitions: intention and motivation | No | |
– | Health professional behaviour: self-monitoring or feedback | No | |
– | Social, political and legal factors: influential people | No | |
Sub-total unique or matching determinants | 3 | 8 | 1/10 (10.0%) |
Total unique or matching determinants | 10 | 19 | 9/37 (24.3%) |
All themes were successfully mapped to both frameworks
A range of domains and determinants were identified
Domains and determinants were convergent across themes
Comparison across mappers
Comparison across theoretical frameworks
Determinant themes from AMDE study | TDF domains selected | TICD domains:determinants selected | Apparent match in underlying meaning | ||
---|---|---|---|---|---|
Both mappers | One mapper | Both mappers | One mapper | ||
PHYSICIAN BELIEFS | |||||
AMDEs considered expected or unavoidable and not adverse unless outcomes catastrophic; viewed as more severe in other specialties | Beliefs about consequences | Social-professional role and identity | Health professional cognitions: expected outcome | Health professional cognitions: agreement with the recommendation | Yes (expected outcome) |
AMDEs within 2 years of use were considered unusual | Beliefs about consequences | – | Health professional cognitions: expected outcome | Health professional cognitions: agreement with the recommendation | Yes (expected outcome) |
Views about cause of AMDEs confounded by multiple factors | – | Beliefs about consequences, Knowledge | – | Health professional cognitions: agreement with the recommendation, Health professional knowledge and skills: domain knowledge | Yes (knowledge) |
Incidence of AMDEs has decreased, thus devices were thought to be improved | – | Beliefs about consequences, optimism | Health professional cognitions: expected outcome | Health professional cognitions: agreement with the recommendation | Yes (expected outcome) |
POLICIES, PROCESSES OR SYSTEMS | |||||
Follow-up of device-related outcomes beyond short-term results done elsewhere | Environmental context and resources | Social-professional role and identity | Recommended behaviour: observability | Health professional cognitions: intention and motivation, Health professional behaviour: nature of the behaviour, Health professional knowledge and skills: knowledge about own practice, Health professional behaviour: self-monitoring or feedback, Professional interactions: referral processes | Yes (professional role or behaviour, observability or knowledge of own behaviour) |
Devices implanted not recorded in patient records | Environmental context and resources | – | Incentives and resources: information system | Health professional knowledge and skills: knowledge about own practice, Health professional behaviour: self-monitoring or feedback, Health professional behaviour: capacity to plan change | Yes (resources or information system) |
No hospital, national or international systems for AMDE reporting | Environmental context and resources | Knowledge, Reinforcement, Behavioural regulation | Incentives and resources: information system, Incentives and resources: availability of necessary resources, Capacity for organizational change: regulations, rules and policies | Health professional knowledge and skills: domain knowledge, Health professional cognitions: intention and motivation, Health professional behaviour: self-monitoring or feedback, Incentives and resources: non-financial incentives and disincentives, Incentives and resources: quality assurance and patient safety systems, Capacity for organizational change: monitoring and feedback | Yes (resources or information system, knowledge, reinforcement or non-financial incentives or disincentives, regulation or self- or organizational monitoring) |
DEVICE MARKET | |||||
Use of specific devices often determined by purchase group contract obligations | Environmental context and resources | – | Health professional behaviour: capacity to plan change | Capacity for organizational change: regulations, rules and policies, Incentives and resources: financial incentives and disincentives, Capacity for organizational change: mandate, authority and accountability, Social, political and legal factors: economic constraints on the health care budget, Social, political and legal factors: contracts | Yes (context and resources or policies, financial incentives and disincentive, authority, budget, contracts) |
Lack of responsiveness to AMDEs from industry | Reinforcement | Knowledge, Optimism, Beliefs about consequences, Environmental context and resources | – | Health professional cognitions: expected outcome, Health professional cognitions: intention and motivation, Health professional behaviour: self-monitoring or feedback, Social, political and legal factors: influential people | Yes (reinforcement or feedback or influential people, expected outcome, optimism or motivation) |
Interventions corresponding to TDF domains and TICD determinants
Many interventions were identified
Convergence of interventions
Direct relevance of interventions
Comparison across theoretical frameworks
Implications for practice
Finding | Implication |
---|---|
All AMDE reporting themes mapped to both TDF and TICD | Both theoretical frameworks were useful for systematically analyzing AMDE reporting determinant themes |
Multiple TDF domains and TICD determinants were relevant | Provide users with flexibility to choose and further prioritize from among the array of relevant domains/determinants but also raises uncertainty about how many to choose and with what precision |
Several TDF domains and TICD determinants chosen by one or both mappers were conceptually similar though labelled differently | Convergence across frameworks could be used to identify a core set of behavioural determinants |
Selected TDF domains and TICD determinants chosen by one or both mappers applied to more than one AMDE reporting theme | Convergence within frameworks could be used to identify a core set of behavioural determinants |
Domains and determinants selected independently by two mappers often did not match; discrepancy rate similar for TDF and TICD | Selection of TDF domains and TICD determinants may be subjective and influenced by mapper familiarity with a given theoretical framework. It is unclear if a process is needed to resolve discrepancies or, instead, if intervention design should be based on only domains/determinants selected by all independent mappers, or on a core set of domains/determinants most commonly selected by all mappers |
Greater number of TICD determinants were applied across themes and mappers compared with TDF domains | Compared with TDF, which focuses on individual level domains, TICD offers multilevel determinants, plus definitions and examples for each, and was thus easier to apply and could be applied with greater precision at a granular level |
Numerous interventions corresponded to common TDF domains and TICD determinants selected by both mappers for each AMDE reporting theme | It is unclear how to choose the intervention (s) that are most relevant from among the large number of options presented by the TDF and TICD |
Additional interventions corresponded to TDF domains and TICD determinants selected by one mapper | It is unclear if intervention (s) should be chosen based on only those associated with domains/determinants selected by all independent mappers, or with a core set of domains and determinants most commonly selected by all mappers |
Given that similar TDF domains and TICD determinants were applied across AMDE reporting themes, corresponding interventions were also convergent | Convergence within frameworks could be used to identify a core set of interventions corresponding to behavioural determinants |
Some interventions recommended by TDF and TICD for the same AMDE reporting themes were conceptually similar though labelled differently | Convergence across frameworks could be used to identify a core set of interventions corresponding to behavioural determinants |
Although more TICD determinants were applied compared with TDF domains, TDF recommended a greater number of interventions compared with TICD | It is unclear if and how interventions that are most relevant for a given context should be screened or prioritized from among the options recommended by either TDF or TICD |
Even when themes mapped to conceptually similar TDF domains and TICD determinants, TDF and TICD often recommended conceptually different interventions | It is unclear how to choose the intervention (s) that are most relevant when two rigorously developed theoretical frameworks differ in the interventions recommended for the same determinant |
Some interventions recommended by TICD seemed more intuitively relevant compared with TDF | Compared with TDF, which recommends interventions corresponding to broad domains, TICD recommends interventions corresponding to specific determinants, and may identify interventions that are more relevant. Following the mapping of themes to theoretical frameworks, consultation with stakeholders is likely needed to deliberate the relevance and feasibility of corresponding interventions for a given context. |
Complex determinants involving interplay among factors were not well-addressed by TDF or TICD | Domains and corresponding interventions in the TDF or TICD did not fully recognize the complex interplay of determinants inherent in some themes. It is unclear if this is because the frameworks are better suited to exploring determinants in some contexts (i.e. adherence with clinical guideline recommendations) and not others (i.e. reporting of AMDEs. |
Neither TDF nor TICD prompt users to prioritize domains or interventions | Neither the TDF nor the TICD prompt users to prioritize among the many potentially applicable domains or interventions as means of limiting or focusing the number and type of interventions |