Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial

Louise E. Craig, Natalie Taylor, Rohan Grimley, Dominique A. Cadilhac, Elizabeth McInnes, Rosemary Phillips, Simeon Dale, Denise O'Connor, Chris Levi, Mark Fitzgerald, Julie Considine, Jeremy M. Grimshaw, Richard Gerraty, N. Wah Cheung, Jeanette Ward, Sandy Middleton

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Abstract

Background: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods: A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results: Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions: The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.

Original languageEnglish
Article number88
JournalImplementation Science
Volume12
Issue number1
DOIs
Publication statusPublished - 17 Jul 2017
Externally publishedYes

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Patient Transfer
Triage
Hospital Emergency Service
Stroke
Research Personnel
Therapeutics
Clinical Trials
Education
Research
Theoretical Models

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Craig, Louise E. ; Taylor, Natalie ; Grimley, Rohan ; Cadilhac, Dominique A. ; McInnes, Elizabeth ; Phillips, Rosemary ; Dale, Simeon ; O'Connor, Denise ; Levi, Chris ; Fitzgerald, Mark ; Considine, Julie ; Grimshaw, Jeremy M. ; Gerraty, Richard ; Cheung, N. Wah ; Ward, Jeanette ; Middleton, Sandy. / Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF) : The T3 Trial. In: Implementation Science. 2017 ; Vol. 12, No. 1.
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title = "Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial",
abstract = "Background: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods: A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results: Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions: The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.",
author = "Craig, {Louise E.} and Natalie Taylor and Rohan Grimley and Cadilhac, {Dominique A.} and Elizabeth McInnes and Rosemary Phillips and Simeon Dale and Denise O'Connor and Chris Levi and Mark Fitzgerald and Julie Considine and Grimshaw, {Jeremy M.} and Richard Gerraty and Cheung, {N. Wah} and Jeanette Ward and Sandy Middleton",
year = "2017",
month = "7",
day = "17",
doi = "10.1186/s13012-017-0616-6",
language = "English",
volume = "12",
journal = "Implementation Science",
issn = "1748-5908",
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Craig, LE, Taylor, N, Grimley, R, Cadilhac, DA, McInnes, E, Phillips, R, Dale, S, O'Connor, D, Levi, C, Fitzgerald, M, Considine, J, Grimshaw, JM, Gerraty, R, Cheung, NW, Ward, J & Middleton, S 2017, 'Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial' Implementation Science, vol. 12, no. 1, 88. https://doi.org/10.1186/s13012-017-0616-6

Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF) : The T3 Trial. / Craig, Louise E.; Taylor, Natalie; Grimley, Rohan; Cadilhac, Dominique A.; McInnes, Elizabeth; Phillips, Rosemary; Dale, Simeon; O'Connor, Denise; Levi, Chris; Fitzgerald, Mark; Considine, Julie; Grimshaw, Jeremy M.; Gerraty, Richard; Cheung, N. Wah; Ward, Jeanette; Middleton, Sandy.

In: Implementation Science, Vol. 12, No. 1, 88, 17.07.2017.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF)

T2 - The T3 Trial

AU - Craig, Louise E.

AU - Taylor, Natalie

AU - Grimley, Rohan

AU - Cadilhac, Dominique A.

AU - McInnes, Elizabeth

AU - Phillips, Rosemary

AU - Dale, Simeon

AU - O'Connor, Denise

AU - Levi, Chris

AU - Fitzgerald, Mark

AU - Considine, Julie

AU - Grimshaw, Jeremy M.

AU - Gerraty, Richard

AU - Cheung, N. Wah

AU - Ward, Jeanette

AU - Middleton, Sandy

PY - 2017/7/17

Y1 - 2017/7/17

N2 - Background: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods: A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results: Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions: The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.

AB - Background: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods: A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results: Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions: The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings.

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U2 - 10.1186/s13012-017-0616-6

DO - 10.1186/s13012-017-0616-6

M3 - Article

VL - 12

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

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