Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist
Abstract Background Computerized clinical decision support systems (CDSSs) can improve care by bridging knowledge to practice gaps. However, the real-world uptake of such systems in health care settings has been suboptimal. We sought to: (1) use the Theoretical Domains Framework (TDF) to identify de...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12911-023-02273-6 |
| _version_ | 1797559297452802048 |
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| author | Janet Yamada Andrew Kouri Sarah Nicole Simard Jeffrey Lam Shin Cheung Stephanie Segovia Samir Gupta |
| author_facet | Janet Yamada Andrew Kouri Sarah Nicole Simard Jeffrey Lam Shin Cheung Stephanie Segovia Samir Gupta |
| author_sort | Janet Yamada |
| collection | DOAJ |
| description | Abstract Background Computerized clinical decision support systems (CDSSs) can improve care by bridging knowledge to practice gaps. However, the real-world uptake of such systems in health care settings has been suboptimal. We sought to: (1) use the Theoretical Domains Framework (TDF) to identify determinants (barriers/enablers) of uptake of the Electronic Asthma Management System (eAMS) CDSS; (2) match identified TDF belief statements to elements in the Guideline Implementation with Decision Support (GUIDES) Checklist; and (3) explore the relationship between the TDF and GUIDES frameworks and the usefulness of this sequential approach for identifying opportunities to improve CDSS uptake. Methods In Phase 1, we conducted semistructured interviews with primary care physicians in Toronto, Canada regarding the uptake of the eAMS CDSS. Using content analysis, two coders independently analyzed interview transcripts guided by the TDF to generate themes representing barriers and enablers to CDSS uptake. In Phase 2, the same reviewers independently mapped each belief statement to a GUIDES domain and factor. We calculated the proportion of TDF belief statements that linked to each GUIDES domain and the proportion of TDF domains that linked to GUIDES factors (and vice-versa) and domains. Results We interviewed 10 participants before data saturation. In Phase 1, we identified 53 belief statements covering 12 TDF domains; 18 (34.0%) were barriers, and 35 (66.0%) were enablers. In Phase 2, 41 statements (77.4%) linked to at least one GUIDES factor, while 12 (22.6%) did not link to any specific factor. The GUIDES Context Domain was linked to the largest number of belief statements (19/53; 35.8%). Each TDF domain linked to one or more GUIDES factor, with 6 TDF domains linking to more than 1 factor and 8 TDF domains linking to more than 1 GUIDES domain. Conclusions The TDF provides unique insights into barriers and enablers to CDSS uptake, which can then be mapped to GUIDES domains and factors to identify required changes to CDSS context, content, and system. This can be followed by conventional mapping of TDF domains to behaviour change techniques to optimize CDSS implementation. This novel step-wise approach combines two established frameworks to optimize CDSS interventions, and requires prospective validation. |
| first_indexed | 2024-03-10T17:43:20Z |
| format | Article |
| id | doaj.art-f8e6b31dedba4cd497db4e0621e12bbd |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-03-10T17:43:20Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-f8e6b31dedba4cd497db4e0621e12bbd2023-11-20T09:38:11ZengBMCBMC Medical Informatics and Decision Making1472-69472023-10-0123111710.1186/s12911-023-02273-6Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES ChecklistJanet Yamada0Andrew Kouri1Sarah Nicole Simard2Jeffrey Lam Shin Cheung3Stephanie Segovia4Samir Gupta5Daphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan UniversityDivision of Respirology, Department of Medicine, Women’s College HospitalDaphne Cockwell School of Nursing, Faculty of Community Services, Toronto Metropolitan UniversityKeenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health TorontoDivision of Respirology, Department of Medicine, University of Toronto, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health TorontoDivision of Respirology, Department of Medicine, Women’s College HospitalAbstract Background Computerized clinical decision support systems (CDSSs) can improve care by bridging knowledge to practice gaps. However, the real-world uptake of such systems in health care settings has been suboptimal. We sought to: (1) use the Theoretical Domains Framework (TDF) to identify determinants (barriers/enablers) of uptake of the Electronic Asthma Management System (eAMS) CDSS; (2) match identified TDF belief statements to elements in the Guideline Implementation with Decision Support (GUIDES) Checklist; and (3) explore the relationship between the TDF and GUIDES frameworks and the usefulness of this sequential approach for identifying opportunities to improve CDSS uptake. Methods In Phase 1, we conducted semistructured interviews with primary care physicians in Toronto, Canada regarding the uptake of the eAMS CDSS. Using content analysis, two coders independently analyzed interview transcripts guided by the TDF to generate themes representing barriers and enablers to CDSS uptake. In Phase 2, the same reviewers independently mapped each belief statement to a GUIDES domain and factor. We calculated the proportion of TDF belief statements that linked to each GUIDES domain and the proportion of TDF domains that linked to GUIDES factors (and vice-versa) and domains. Results We interviewed 10 participants before data saturation. In Phase 1, we identified 53 belief statements covering 12 TDF domains; 18 (34.0%) were barriers, and 35 (66.0%) were enablers. In Phase 2, 41 statements (77.4%) linked to at least one GUIDES factor, while 12 (22.6%) did not link to any specific factor. The GUIDES Context Domain was linked to the largest number of belief statements (19/53; 35.8%). Each TDF domain linked to one or more GUIDES factor, with 6 TDF domains linking to more than 1 factor and 8 TDF domains linking to more than 1 GUIDES domain. Conclusions The TDF provides unique insights into barriers and enablers to CDSS uptake, which can then be mapped to GUIDES domains and factors to identify required changes to CDSS context, content, and system. This can be followed by conventional mapping of TDF domains to behaviour change techniques to optimize CDSS implementation. This novel step-wise approach combines two established frameworks to optimize CDSS interventions, and requires prospective validation.https://doi.org/10.1186/s12911-023-02273-6Clinical decision support systemBarriersEnablersUptakeTheoretical domains frameworkGUIDES Checklist |
| spellingShingle | Janet Yamada Andrew Kouri Sarah Nicole Simard Jeffrey Lam Shin Cheung Stephanie Segovia Samir Gupta Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist BMC Medical Informatics and Decision Making Clinical decision support system Barriers Enablers Uptake Theoretical domains framework GUIDES Checklist |
| title | Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist |
| title_full | Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist |
| title_fullStr | Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist |
| title_full_unstemmed | Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist |
| title_short | Improving computerized decision support system interventions: a qualitative study combining the theoretical domains framework with the GUIDES Checklist |
| title_sort | improving computerized decision support system interventions a qualitative study combining the theoretical domains framework with the guides checklist |
| topic | Clinical decision support system Barriers Enablers Uptake Theoretical domains framework GUIDES Checklist |
| url | https://doi.org/10.1186/s12911-023-02273-6 |
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