Abstract：
BACKGROUND: Venous thromboembolism is a primary cause of morbidity and mortality in hospitalised patients. Clinical practice guidelines were developed to prevent venous thromboembolism events. This study adopted the Theoretical Domains Framework to explore the beliefs and perceptions of physicians adoption of clinical practice guidelines for the uptake of venous thromboembolism prevention guidelines.
METHODS: Semi-structured interviews were conducted with a stratified purposive sample of internal medicine physicians in an acute hospital. The interview topic guide was developed using the Theoretical Domains Framework to identify the factors perceived to influence the practice. Two researchers coded the interview transcripts using thematic content analysis. Emerging relevant themes were mapped to TDF domains.
RESULTS: A total of sixteen medical physicians were interviewed over a six-month period. Nine theoretical domains derived from thirty-three belief statements were identified as relevant to the target behaviour; knowledge (education about the importance of VTE guidelines); beliefs about capabilities (with practice VTE tool easier to implement); beliefs about consequences (positive consequences in reducing the development of VTE, length of stay, financial burden and support physician decision) and (negative consequence risk of bleeding); reinforcement (recognition and continuous reminders); goals (patient safety goal); environmental context and resources (workload and availability of medications were barriers, VTE coordinator and electronic medical record were enablers); social influences (senior physicians and patient/family influence the VTE practice); behavioural regulation (monitoring and mandatory hospital policy); and nature of the behaviour.
CONCLUSIONS: Using the Theoretical Domains Framework, factors thought to influence the implementation of VTE clinical practice guidelines were identified which can be used to design theoretically based interventions by targeting specific psychological constructs and linking them to behaviour change techniques to change the clinical practice of physicians.
METHODS: Semi-structured interviews were conducted with a stratified purposive sample of internal medicine physicians in an acute hospital. The interview topic guide was developed using the Theoretical Domains Framework to identify the factors perceived to influence the practice. Two researchers coded the interview transcripts using thematic content analysis. Emerging relevant themes were mapped to TDF domains.
RESULTS: A total of sixteen medical physicians were interviewed over a six-month period. Nine theoretical domains derived from thirty-three belief statements were identified as relevant to the target behaviour; knowledge (education about the importance of VTE guidelines); beliefs about capabilities (with practice VTE tool easier to implement); beliefs about consequences (positive consequences in reducing the development of VTE, length of stay, financial burden and support physician decision) and (negative consequence risk of bleeding); reinforcement (recognition and continuous reminders); goals (patient safety goal); environmental context and resources (workload and availability of medications were barriers, VTE coordinator and electronic medical record were enablers); social influences (senior physicians and patient/family influence the VTE practice); behavioural regulation (monitoring and mandatory hospital policy); and nature of the behaviour.
CONCLUSIONS: Using the Theoretical Domains Framework, factors thought to influence the implementation of VTE clinical practice guidelines were identified which can be used to design theoretically based interventions by targeting specific psychological constructs and linking them to behaviour change techniques to change the clinical practice of physicians.
摘要：
背景：静脉血栓栓塞是住院患者发病和死亡的主要原因。制定临床实践指南以预防静脉血栓栓塞事件。这项研究采用了理论领域框架，以探讨医生采用临床实践指南以吸收静脉血栓栓塞预防指南的信念和看法。
方法：对某急症医院内科医师的分层目的性样本进行半结构化访谈。面试主题指南是使用“理论域框架”开发的，以确定影响实践的因素。两名研究人员使用主题内容分析对访谈记录进行编码。新兴的相关主题被映射到TDF域。
结果：在6个月的时间里，共采访了16名医生。从三十三个信念陈述中得出的九个理论领域被确定为与目标行为相关；知识（关于VTE指南重要性的教育）；关于能力的信念（实践VTE工具更容易实施）；关于后果的信念（减少VTE发展的积极后果，逗留时间,经济负担和支持医生决策)和(出血的负面后果风险)；强化(识别和持续提醒)；目标(患者安全目标)；环境背景和资源(工作量和药物供应是障碍，VTE协调员和电子病历是推动者）；社会影响（高级医师和患者/家庭影响VTE实践）；行为监管（监测和强制性医院政策）；以及行为性质。
结论：使用理论域框架，确定了被认为会影响VTE临床实践指南实施的因素,这些因素可用于设计基于理论的干预措施,方法是针对特定的心理结构,并将其与行为改变技术联系起来,以改变医生的临床实践.
方法：对某急症医院内科医师的分层目的性样本进行半结构化访谈。面试主题指南是使用“理论域框架”开发的，以确定影响实践的因素。两名研究人员使用主题内容分析对访谈记录进行编码。新兴的相关主题被映射到TDF域。
结果：在6个月的时间里，共采访了16名医生。从三十三个信念陈述中得出的九个理论领域被确定为与目标行为相关；知识（关于VTE指南重要性的教育）；关于能力的信念（实践VTE工具更容易实施）；关于后果的信念（减少VTE发展的积极后果，逗留时间,经济负担和支持医生决策)和(出血的负面后果风险)；强化(识别和持续提醒)；目标(患者安全目标)；环境背景和资源(工作量和药物供应是障碍，VTE协调员和电子病历是推动者）；社会影响（高级医师和患者/家庭影响VTE实践）；行为监管（监测和强制性医院政策）；以及行为性质。
结论：使用理论域框架，确定了被认为会影响VTE临床实践指南实施的因素,这些因素可用于设计基于理论的干预措施,方法是针对特定的心理结构,并将其与行为改变技术联系起来,以改变医生的临床实践.
