背景:口咽吞咽困难(OD)难以从口腔到喉咙操纵食物推注。高达70%的老年人发展OD;然而,它在初级保健中得不到管理,导致可避免的住院。
目的:本行为科学现实主义者综述旨在开发计划理论,以描述干预措施如何促进初级保健医疗保健专业人员(HCP)主动管理OD。
方法:我们利用利益相关者的专业知识和理论领域框架(TDF),归纳地开发了初始计划理论(IPT)。搜索数据库以识别有关上下文的证据,与积极管理OD和提供可转移学习的比较行为相关的行为机制和结果。IPT经过测试,有证据证实,提炼或反驳,产生最终的方案理论。
结果:包括36个证据来源。产生了五个最终计划理论,解释了如何促进初级保健HCP主动管理OD:(1)OD教育和培训,(2)有OD体征和症状的检查表,(3)将OD识别纳入现有工作流程,(4)使HCP意识到老年人和护理人员期望他们管理OD;(5)提高对OD不良后果的认识。
结论:五种计划理论提供了行为机制,通过这些机制,干预措施可以促进初级保健HCP主动管理OD。通过程序理论与TDF的联系,可以选择映射到相关TDF域的行为改变技术(BCT)进行干预。应使用共同设计方法将选定的BCT操作成连贯的干预方案。
■CRD42022320327。
BACKGROUND: Oropharyngeal dysphagia (OD) is difficulty manipulating a food bolus from the mouth to the throat. Up to 70% of older adults develop OD; however, it is unmanaged in primary care, leading to avoidable hospitalisation.
OBJECTIVE: This behavioural science realist review aimed to develop programme theories to describe how interventions facilitate primary care healthcare professionals (HCPs) to proactively manage OD.
METHODS: We developed initial programme theories (IPTs) inductively using the expertise of stakeholders and deductively using the theoretical domains framework (TDF). Databases were searched to identify evidence regarding contexts, behavioural mechanisms and outcomes related to proactive management of OD and comparative behaviours which offer transferrable learning. IPTs were tested with the evidence to confirm, refine or refute, to produce final programme theories.
RESULTS: 36 sources of evidence were included. Five final programme theories were generated explaining how primary care HCPs can be facilitated to proactively manage OD: (1) OD education and training, (2) checklists with OD signs and symptoms, (3) incorporating OD identification into existing workflow, (4) making HCPs aware that older adults and carers expect them to manage OD and (5) raising awareness of the adverse outcomes of OD.
CONCLUSIONS: The five programme theories provide the behavioural mechanisms by which an intervention may facilitate primary care HCPs to proactively manage OD. Through the programme theories\' linkage to the TDF, behaviour change techniques (BCTs) mapped to the relevant TDF domain can be selected for an intervention. Operationalisation of selected BCTs into a coherent intervention package should be undertaken using codesign methodology.
UNASSIGNED: CRD42022320327.