Examining drivers of self-harm guideline implementation by general practitioners: A qualitative analysis using the theoretical domains framework.
evidence-based guidelines
general practice
self-harm
Journal
British journal of health psychology
ISSN: 2044-8287
Titre abrégé: Br J Health Psychol
Pays: England
ID NLM: 9605409
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
13
09
2021
accepted:
29
03
2022
pubmed:
14
4
2022
medline:
7
10
2022
entrez:
13
4
2022
Statut:
ppublish
Résumé
This study aimed to (1) examine barriers and enablers to General Practitioners' (GP) use of National Institute for Health and Care Excellence (NICE) guidelines for self-harm and (2) recommend potential intervention strategies to improve implementation of them in primary care. Qualitative interview study. Twenty-one telephone interviews, semi-structured around the capabilities, opportunities and motivations model of behaviour change (COM-B), were conducted with GPs in the United Kingdom. The Theoretical Domains Framework was employed as an analytical framework. Using the Behaviour Change Wheel, Behaviour Change Techniques (BCTs), intervention functions and exemplar interventions were identified. GPs valued additional knowledge about self-harm risk assessments (knowledge), and communication skills were considered to be fundamental to high-pressure consultations (cognitive and interpersonal skills). GPs did not engage with the guidelines due to concerns that they would be a distraction from patient cues about risk during consultations (memory, attention and decision processes), and perceptions that following the guidance is difficult due to time pressures and lack of access to mental health referrals (environmental context and resources). Clinical uncertainty surrounding longer term care for people that self-harm, particularly patients that are waiting for or cannot access a referral, drives GPs to rely on their professional judgement over the guidance (beliefs about capabilities). Three key drivers related to information and skill needs, guideline engagement and clinical uncertainty need to be addressed to support GPs to be able to assess and manage self-harm. Five intervention functions and ten BCT groups were identified as potential avenues for intervention design.
Identifiants
pubmed: 35416355
doi: 10.1111/bjhp.12598
pmc: PMC9790562
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1275-1295Subventions
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2022 The Authors. British Journal of Health Psycholog y published by John Wiley & Sons Ltd on behalf of British Psychological Society.
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