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Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff.
Implement Sci. 2019 11 09; 14(1):95.IS

Abstract

BACKGROUND

There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training).

METHODS

Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions.

RESULTS

Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions.

CONCLUSIONS

Variation in capabilities and motivation among clinical and administrative staff, coupled with inconsistent use of the interventions in routine workflow contributed to suboptimal implementation of the interventions. Future trials may benefit by using implementation strategies that embed SDM in the organizational culture of clinical settings.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, Faculty of Medicine, University of British Columbia, E204 - 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada. sarah.munro@ubc.ca. Centre for Health Evaluation and Outcome Sciences, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada. sarah.munro@ubc.ca.Society of Family Planning, 225 South 17th Street, Suite 2709, Philadelphia, PA, 19103, USA.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.Dartmouth College Health Service, 7 Rope Ferry Rd, Hanover, NH, 03755, USA.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.Patient Partner, Tyrone, NY, USA.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.Patient Partner, New York, NY, USA.Patient Partner, Greenwich, CT, USA.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.Our Bodies Ourselves, P.O. Box 590403, Newton Center, MA, 02459, USA.Department of Family and Community Medicine, University of California San Francisco, Natividad Medical Center, 1441 Constitution Blvd, Salinas, CA, 93906, USA.Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.Planned Parenthood Northern California, 2185 Pacheco St, Concord, CA, 94520, USA.Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.Dartmouth College, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.Faculty of Medicine and Health, The University of Sydney, Edward Ford Building (A27), Fisher Road, Camperdown, NSW, 2006, Australia.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31706329

Citation

Munro, Sarah, et al. "Investigation of Factors Influencing the Implementation of Two Shared Decision-making Interventions in Contraceptive Care: a Qualitative Interview Study Among Clinical and Administrative Staff." Implementation Science : IS, vol. 14, no. 1, 2019, p. 95.
Munro S, Manski R, Donnelly KZ, et al. Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implement Sci. 2019;14(1):95.
Munro, S., Manski, R., Donnelly, K. Z., Agusti, D., Stevens, G., Banach, M., Boardman, M. B., Brady, P., Bradt, C. C., Foster, T., Johnson, D. J., Norsigian, J., Nothnagle, M., Shepherd, H. L., Stern, L., Trevena, L., Elwyn, G., & Thompson, R. (2019). Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. Implementation Science : IS, 14(1), 95. https://doi.org/10.1186/s13012-019-0941-z
Munro S, et al. Investigation of Factors Influencing the Implementation of Two Shared Decision-making Interventions in Contraceptive Care: a Qualitative Interview Study Among Clinical and Administrative Staff. Implement Sci. 2019 11 9;14(1):95. PubMed PMID: 31706329.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff. AU - Munro,Sarah, AU - Manski,Ruth, AU - Donnelly,Kyla Z, AU - Agusti,Daniela, AU - Stevens,Gabrielle, AU - Banach,Michelle, AU - Boardman,Maureen B, AU - Brady,Pearl, AU - Bradt,Chrissy Colón, AU - Foster,Tina, AU - Johnson,Deborah J, AU - Norsigian,Judy, AU - Nothnagle,Melissa, AU - Shepherd,Heather L, AU - Stern,Lisa, AU - Trevena,Lyndal, AU - Elwyn,Glyn, AU - Thompson,Rachel, Y1 - 2019/11/09/ PY - 2019/06/27/received PY - 2019/09/21/accepted PY - 2019/11/11/entrez PY - 2019/11/11/pubmed PY - 2020/5/19/medline KW - Contraception KW - Decision aids KW - Decision support techniques KW - Implementation KW - Interviews KW - Organizational culture KW - Program evaluation KW - Question prompt lists KW - Shared decision-making KW - Theoretical Domains Framework SP - 95 EP - 95 JF - Implementation science : IS JO - Implement Sci VL - 14 IS - 1 N2 - BACKGROUND: There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in primary care and family planning clinics. The two SDM interventions comprised a patient-targeted intervention (video and prompt card) and a provider-targeted intervention (encounter decision aids and training). METHODS: Participants were clinical and administrative staff aged 18 years or older who worked in one of the 12 clinics in the intervention arm, had email access, and consented to being audio-recorded. Semi-structured telephone interviews were conducted upon completion of the trial. Audio recordings were transcribed verbatim. Data collection and thematic analysis were informed by the 14 domains of the Theoretical Domains Framework, which are relevant to the successful implementation of provider behaviour change interventions. RESULTS: Interviews (n = 29) indicated that the interventions were not systematically implemented in the majority of clinics. Participants felt the interventions were aligned with their role and they had confidence in their skills to use the decision aids. However, the novelty of the interventions, especially a need to modify workflows and change behavior to use them with patients, were implementation challenges. The interventions were not deeply embedded in clinic routines and their use was threatened by lack of understanding of their purpose and effect, and staff absence or turnover. Participants from clinics that had an enthusiastic study champion or team-based organizational culture found these social supports had a positive role in implementing the interventions. CONCLUSIONS: Variation in capabilities and motivation among clinical and administrative staff, coupled with inconsistent use of the interventions in routine workflow contributed to suboptimal implementation of the interventions. Future trials may benefit by using implementation strategies that embed SDM in the organizational culture of clinical settings. SN - 1748-5908 UR - https://www.unboundmedicine.com/medline/citation/31706329/Investigation_of_factors_influencing_the_implementation_of_two_shared_decision_making_interventions_in_contraceptive_care:_a_qualitative_interview_study_among_clinical_and_administrative_staff_ L2 - https://implementationscience.biomedcentral.com/articles/10.1186/s13012-019-0941-z DB - PRIME DP - Unbound Medicine ER -