Exploring implementation processes of a parent-targeted educational video for improving newborn pain treatment: A sequential exploratory mixed-methods study

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Abstract

Despite known analgesic effects of breastfeeding (BF), skin-to-skin care (SSC), and sweet solutions (sucrose) for newborns, these interventions remain underutilized. Our team produced a five-minute parent-targeted video (BSweet2Babies) demonstrating BF, SSC, and sucrose during newborn blood sampling. We conducted a sequential exploratory mixed-methods study with eight maternal-newborn units across Ontario, Canada to identify barriers and facilitators to implementing the video and the three pain management strategies.

Over a 6-month period, data collection included 15 telephone interviews, two email communications, and three community of practice teleconferences with the participating sites ( n = 8). We used the Theoretical Domains Framework as the coding matrix. Participants discussed integrating the video in prenatal education and the importance of involving leadership when planning for practice change. Key barriers included lack of comfort with parental presence, perception of high complexity of the strategies, short postpartum stays, competing priorities, and interprofessional challenges. Key facilitators included alignment with the Baby-Friendly Hospital Initiative, modeling by Lactation Consultants, and frequent reminders.

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Validation of the theoretical domains framework for use in behaviour change and implementation research

James Cane, Denise O’Connor, Susan Michie (2012)

Background An integrative theoretical framework, developed for cross-disciplinary implementation and other behaviour change research, has been applied across a wide range of clinical situations. This study tests the validity of this framework. Methods Validity was investigated by behavioural experts sorting 112 unique theoretical constructs using closed and open sort tasks. The extent of replication was tested by Discriminant Content Validation and Fuzzy Cluster Analysis. Results There was good support for a refinement of the framework comprising 14 domains of theoretical constructs (average silhouette value 0.29): ‘Knowledge’, ‘Skills’, ‘Social/Professional Role and Identity’, ‘Beliefs about Capabilities’, ‘Optimism’, ‘Beliefs about Consequences’, ‘Reinforcement’, ‘Intentions’, ‘Goals’, ‘Memory, Attention and Decision Processes’, ‘Environmental Context and Resources’, ‘Social Influences’, ‘Emotions’, and ‘Behavioural Regulation’. Conclusions The refined Theoretical Domains Framework has a strengthened empirical base and provides a method for theoretically assessing implementation problems, as well as professional and other health-related behaviours as a basis for intervention development.

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A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Lou Atkins, Jill Francis, Rafat Islam … (2017)

Background Implementing new practices requires changes in the behaviour of relevant actors, and this is facilitated by understanding of the determinants of current and desired behaviours. The Theoretical Domains Framework (TDF) was developed by a collaboration of behavioural scientists and implementation researchers who identified theories relevant to implementation and grouped constructs from these theories into domains. The collaboration aimed to provide a comprehensive, theory-informed approach to identify determinants of behaviour. The first version was published in 2005, and a subsequent version following a validation exercise was published in 2012. This guide offers practical guidance for those who wish to apply the TDF to assess implementation problems and support intervention design. It presents a brief rationale for using a theoretical approach to investigate and address implementation problems, summarises the TDF and its development, and describes how to apply the TDF to achieve implementation objectives. Examples from the implementation research literature are presented to illustrate relevant methods and practical considerations. Methods Researchers from Canada, the UK and Australia attended a 3-day meeting in December 2012 to build an international collaboration among researchers and decision-makers interested in the advancing use of the TDF. The participants were experienced in using the TDF to assess implementation problems, design interventions, and/or understand change processes. This guide is an output of the meeting and also draws on the authors’ collective experience. Examples from the implementation research literature judged by authors to be representative of specific applications of the TDF are included in this guide. Results We explain and illustrate methods, with a focus on qualitative approaches, for selecting and specifying target behaviours key to implementation, selecting the study design, deciding the sampling strategy, developing study materials, collecting and analysing data, and reporting findings of TDF-based studies. Areas for development include methods for triangulating data, e.g. from interviews, questionnaires and observation and methods for designing interventions based on TDF-based problem analysis. Conclusions We offer this guide to the implementation community to assist in the application of the TDF to achieve implementation objectives. Benefits of using the TDF include the provision of a theoretical basis for implementation studies, good coverage of potential reasons for slow diffusion of evidence into practice and a method for progressing from theory-based investigation to intervention. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0605-9) contains supplementary material, which is available to authorized users.

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Combining the power of stories and the power of numbers: mixed methods research and mixed studies reviews.

Pierre Pluye, Quan Hong (2014)

This article provides an overview of mixed methods research and mixed studies reviews. These two approaches are used to combine the strengths of quantitative and qualitative methods and to compensate for their respective limitations. This article is structured in three main parts. First, the epistemological background for mixed methods will be presented. Afterward, we present the main types of mixed methods research designs and techniques as well as guidance for planning, conducting, and appraising mixed methods research. In the last part, we describe the main types of mixed studies reviews and provide a tool kit and examples. Future research needs to offer guidance for assessing mixed methods research and reporting mixed studies reviews, among other challenges.

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Author and article information

Journal

Journal ID (nlm-ta): J Child Health Care

Journal ID (iso-abbrev): J Child Health Care

Journal ID (hwp): spchc

Journal ID (publisher-id): CHC

Title: Journal of Child Health Care

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Print): 1367-4935

ISSN (Electronic): 1741-2889

Publication date (Electronic): 23 June 2023

Publication date (Print): March 2025

Volume: 29

Issue: 1

Pages: 109-125

Affiliations

[1 ]Ringgold 6363, universityUniversity of Ottawa; , Ottawa, Ontario, Canada

[2 ]Ringgold 574118, universityBetter Outcome Registry and Network; , Ottawa, Ontario, Canada

[3 ]Ringgold 27338, universityChildren’s Hospital of Eastern Ontario Research Institute; , Ottawa, Ontario, Canada

[4 ]Ringgold 3688, universityDalhousie University; , Halifax, Nova Scotia, Canada

[5 ]universityIWK Health Centre; , Halifax, Nova Scotia, Canada

[6 ]Ringgold 60423, universityHeadwaters Health Care Centre; , Orangeville, Ontario, Canada

[7 ]Ringgold 27338, universityChildren’s Hospital of Eastern Ontario; , Ottawa, Ontario, Canada

[8 ]Ringgold 10055, universityThe Ottawa Hospital; , Ottawa, Ontario, Canada

[9 ]Ringgold 6889, universityVirginia Commonwealth University; , Richmond, Virginia, United States of America

[10 ]Ringgold 10033, universityLondon Health Sciences Centre; , London, Ontario, Canada

[11 ]Ringgold 10055, universityArthur Labatt Family School of Nursing; , London, Ontario, Canada

[12 ]Ringgold 10055, universityOttawa Hospital Research Institute; , Ottawa, Ontario, Canada

[13 ]universityChamplain Maternal Newborn Regional Program; , Ottawa, Ontario, Canada

[14 ]universityQueen's University; , Kingston, Ontario, Canada

[15 ]Ringgold 5620, universityMcGIll University; , Montréal, Canada

[16 ]Ringgold 27338, universityThe Hospital for Sick Children; , Toronto, Ontario, Canada

[17 ]Ringgold 483367, universityThe University of Toronto; , Toronto, Ontario, Canada

[18 ]School of Epidemiology and Public Health, universityUniversity of Ottawa; , Ottawa, Ontario, Canada

[19 ]Ringgold 71545, universityBaby-Friendly Initiative Ontario; , Toronto, Ontario, Canada

[20 ]universityUniversity of Melbourne; , Parkville, Victoria, Australia

[21 ]universityMurdoch Children’s Research Institute; , Melbourne, Victoria, Australia

Author notes

[*]Catherine Larocque, School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Rd, Ottawa, ON K1H 8M5, Ottawa, Ontario, Canada. Email: claro007@ 123456uottawa.ca

Author information

Catherine Larocque https://orcid.org/0000-0001-7196-3291

Shokoufeh Modanloo https://orcid.org/0000-0001-8834-7348

Stuart G Nicholls https://orcid.org/0000-0003-0485-9069

Jessica Reszel https://orcid.org/0000-0003-1702-5629

Article

Publisher ID: 10.1177_13674935231176888 Accession ID: 00000

DOI: 10.1177/13674935231176888

PMC ID: 11874468

PubMed ID: 37351924

SO-VID: 96562c5c-4d2b-48c6-999a-2cdf5f743ff4

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).