Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals
Abstract Background Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13012-023-01318-8 |
| _version_ | 1827399383121920000 |
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| author | Jacob Crawshaw Carly Meyer Vivi Antonopoulou Jesmin Antony Jeremy M. Grimshaw Noah Ivers Kristin Konnyu Meagan Lacroix Justin Presseau Michelle Simeoni Sharlini Yogasingam Fabiana Lorencatto |
| author_facet | Jacob Crawshaw Carly Meyer Vivi Antonopoulou Jesmin Antony Jeremy M. Grimshaw Noah Ivers Kristin Konnyu Meagan Lacroix Justin Presseau Michelle Simeoni Sharlini Yogasingam Fabiana Lorencatto |
| author_sort | Jacob Crawshaw |
| collection | DOAJ |
| description | Abstract Background Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change. Methods We conducted a directed content analysis of intervention descriptions in 287 randomized trials included in an ongoing Cochrane systematic review update of A&F interventions (searched up to June 2020). Three trained researchers identified and categorized BCTs in all trial arms (treatment & control/comparator) using the 93-item BCT Taxonomy version 1. The original BCT definitions and examples in the taxonomy were adapted to include A&F-specific decision rules and examples. Two additional BCTs (‘Education (unspecified)’ and ‘Feedback (unspecified)’) were added, such that 95 BCTs were considered for coding. Results In total, 47/95 BCTs (49%) were identified across 360 treatment arms at least once (median = 5.0, IQR = 2.3, range = 1-29). The most common BCTs were ‘Feedback on behaviour’ (present 89% of the time; e.g. feedback on drug prescribing), ‘Instruction on how to perform the behaviour’ (71%; e.g. issuing a clinical guideline), ‘Social comparison’ (52%; e.g. feedback on performance of peers), ‘Credible source’ (41%; e.g. endorsements from respected professional body), and ‘Education (unspecified)’ (31%; e.g. giving a lecture to staff). A total of 130/287 (45%) control/comparator arms contained at least one BCT (median = 2.0, IQR = 3.0, range = 0–15 per arm), of which the most common were identical to those identified in treatment arms. Conclusions A&F interventions to improve healthcare professional practice include a moderate range of BCTs, focusing predominantly on providing behavioural feedback, sharing guidelines, peer comparison data, education, and leveraging credible sources. We encourage the use of our A&F-specific list of BCTs to improve knowledge of what is being delivered in A&F interventions. Our study provides a basis for exploring which BCTs are associated with intervention effectiveness. Trial registrations N/A. |
| first_indexed | 2024-03-08T19:45:10Z |
| format | Article |
| id | doaj.art-2539157ec1f34567ae3e69338d93ffa3 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-03-08T19:45:10Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-2539157ec1f34567ae3e69338d93ffa32023-12-24T12:25:16ZengBMCImplementation Science1748-59082023-11-0118112510.1186/s13012-023-01318-8Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionalsJacob Crawshaw0Carly Meyer1Vivi Antonopoulou2Jesmin Antony3Jeremy M. Grimshaw4Noah Ivers5Kristin Konnyu6Meagan Lacroix7Justin Presseau8Michelle Simeoni9Sharlini Yogasingam10Fabiana Lorencatto11Centre for Evidence-Based Implementation, Hamilton Health SciencesDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College LondonDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College LondonWomen’s College Research Institute, Women’s College HospitalCentre for Implementation Research, Ottawa Hospital Research InstituteWomen’s College Research Institute, Women’s College HospitalDepartment of Health Services, Policy and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, Brown UniversityWomen’s College Research Institute, Women’s College HospitalCentre for Implementation Research, Ottawa Hospital Research InstituteWomen’s College Research Institute, Women’s College HospitalCentre for Implementation Research, Ottawa Hospital Research InstituteDepartment of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College LondonAbstract Background Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimize care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change. Methods We conducted a directed content analysis of intervention descriptions in 287 randomized trials included in an ongoing Cochrane systematic review update of A&F interventions (searched up to June 2020). Three trained researchers identified and categorized BCTs in all trial arms (treatment & control/comparator) using the 93-item BCT Taxonomy version 1. The original BCT definitions and examples in the taxonomy were adapted to include A&F-specific decision rules and examples. Two additional BCTs (‘Education (unspecified)’ and ‘Feedback (unspecified)’) were added, such that 95 BCTs were considered for coding. Results In total, 47/95 BCTs (49%) were identified across 360 treatment arms at least once (median = 5.0, IQR = 2.3, range = 1-29). The most common BCTs were ‘Feedback on behaviour’ (present 89% of the time; e.g. feedback on drug prescribing), ‘Instruction on how to perform the behaviour’ (71%; e.g. issuing a clinical guideline), ‘Social comparison’ (52%; e.g. feedback on performance of peers), ‘Credible source’ (41%; e.g. endorsements from respected professional body), and ‘Education (unspecified)’ (31%; e.g. giving a lecture to staff). A total of 130/287 (45%) control/comparator arms contained at least one BCT (median = 2.0, IQR = 3.0, range = 0–15 per arm), of which the most common were identical to those identified in treatment arms. Conclusions A&F interventions to improve healthcare professional practice include a moderate range of BCTs, focusing predominantly on providing behavioural feedback, sharing guidelines, peer comparison data, education, and leveraging credible sources. We encourage the use of our A&F-specific list of BCTs to improve knowledge of what is being delivered in A&F interventions. Our study provides a basis for exploring which BCTs are associated with intervention effectiveness. Trial registrations N/A.https://doi.org/10.1186/s13012-023-01318-8Audit and feedbackQuality improvementHealthcare professionalsPractice changeBehaviour change techniquesImplementation |
| spellingShingle | Jacob Crawshaw Carly Meyer Vivi Antonopoulou Jesmin Antony Jeremy M. Grimshaw Noah Ivers Kristin Konnyu Meagan Lacroix Justin Presseau Michelle Simeoni Sharlini Yogasingam Fabiana Lorencatto Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals Implementation Science Audit and feedback Quality improvement Healthcare professionals Practice change Behaviour change techniques Implementation |
| title | Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| title_full | Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| title_fullStr | Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| title_full_unstemmed | Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| title_short | Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| title_sort | identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals |
| topic | Audit and feedback Quality improvement Healthcare professionals Practice change Behaviour change techniques Implementation |
| url | https://doi.org/10.1186/s13012-023-01318-8 |
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