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      Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews

      research-article
      1 , 2 ,   2 , 3
      BMJ Open
      BMJ Publishing Group
      Professional practice, Behaviour, Health Services, Implementation

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          Abstract

          Objectives

          Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare.

          Design

          We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015.

          Setting

          Primary and secondary care.

          Participants

          Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes.

          Interventions

          Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group.

          Primary and secondary outcome measures

          Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered.

          Results

          Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes.

          Conclusions

          This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the expectations of an external reference group (eg, Reminders, Audit and Feedback), offer the best chances of success. Combining such interventions is most likely to change behaviour.

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          Most cited references65

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            • Book Chapter: not found

            Qualitative data analysis for applied policy research

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              Is Open Access

              Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews

              Background Our objective was to develop an instrument to assess the methodological quality of systematic reviews, building upon previous tools, empirical evidence and expert consensus. Methods A 37-item assessment tool was formed by combining 1) the enhanced Overview Quality Assessment Questionnaire (OQAQ), 2) a checklist created by Sacks, and 3) three additional items recently judged to be of methodological importance. This tool was applied to 99 paper-based and 52 electronic systematic reviews. Exploratory factor analysis was used to identify underlying components. The results were considered by methodological experts using a nominal group technique aimed at item reduction and design of an assessment tool with face and content validity. Results The factor analysis identified 11 components. From each component, one item was selected by the nominal group. The resulting instrument was judged to have face and content validity. Conclusion A measurement tool for the 'assessment of multiple systematic reviews' (AMSTAR) was developed. The tool consists of 11 items and has good face and content validity for measuring the methodological quality of systematic reviews. Additional studies are needed with a focus on the reproducibility and construct validity of AMSTAR, before strong recommendations can be made on its use.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2015
                30 September 2015
                : 5
                : 9
                : e008592
                Affiliations
                [1 ]National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and University of Southampton , Southampton, UK
                [2 ]University Hospital Southampton NHS Foundation Trust , Southampton, UK
                [3 ]Faculty of Health Sciences, University of Southampton , Southampton, UK
                Author notes
                [Correspondence to ] Professor Carl R May; C.R.May@ 123456soton.ac.uk
                Article
                bmjopen-2015-008592
                10.1136/bmjopen-2015-008592
                4593167
                26423853
                8d29ce74-6ade-4d74-91bb-129fd8379e8d
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 27 April 2015
                : 27 August 2015
                : 4 September 2015
                Categories
                Health Services Research
                Research
                1506
                1704
                1735

                Medicine
                professional practice,behaviour,health services,implementation
                Medicine
                professional practice, behaviour, health services, implementation

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