General practitioner views on the determinants of test ordering: A theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care

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dc.contributor.author Cadogan, Sharon L.
dc.contributor.author McHugh, Sheena M.
dc.contributor.author Bradley, Colin P.
dc.contributor.author Browne, John P.
dc.contributor.author Cahill, Mary R.
dc.date.accessioned 2017-06-22T13:55:53Z
dc.date.available 2017-06-22T13:55:53Z
dc.date.issued 2016-07-19
dc.identifier.citation Cadogan, S. L., McHugh, S. M., Bradley, C. P., Browne, J. P. and Cahill, M. R. (2016) 'General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care', Implementation Science, 11, 102 (12pp). doi:10.1186/s13012-016-0465-8 en
dc.identifier.volume 11
dc.identifier.startpage 1
dc.identifier.endpage 12
dc.identifier.issn 1748-5908
dc.identifier.uri http://hdl.handle.net/10468/4166
dc.identifier.doi 10.1186/s13012-016-0465-8
dc.description.abstract Background: Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP’s views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care. Methods: Qualitative semi-structured interviews were conducted with GPs requesting laboratory tests at Cork University Hospital or University Hospital Kerry in the South of Ireland. GPs were identified using a Health Service Executive laboratory list of GPs in the Cork-Kerry region. A random sample of GPs (stratified by GP requesting patterns) was generated from this list. GPs were purposively sampled based on the criteria of location (urban/rural); length of time qualified; and practice size (single-handed/group). Interviews were carried out between December 2014 and February 2015. Interviews were transcribed verbatim using NVivo 10 software and analysed using the framework analysis method. Emerging themes were mapped to the theoretical domains framework (TDF), which outlines 12 domains that can enable or inhibit behaviour change. The behaviour change wheel and behaviour change technique (BCT) taxonomy were then used to identify potential intervention strategies. Results: Sixteen GPs were interviewed (ten males and six females). Findings suggest that intervention strategies should specifically target the key barriers to effective test ordering, while considering the context of primary care practice. Seven domains from the TDF were perceived to influence immunoglobulin test ordering behaviours and were identified as ‘mechanisms for change’ (knowledge, environmental context and resources, social/professional role and identity, beliefs about capabilities, beliefs about consequences, memory, attention and decision-making processes and behavioural regulation). Using these TDF domains, seven BCTs emerged as feasible ‘intervention content’ for targeting GPs’ ordering behaviour. These included instructions on how to effectively request the test (how to perform behaviour), information on GPs’ use of the test (feedback on behaviour), information about patient consequences resulting from not doing the test (information about health consequences), laboratory/consultant-based advice/education (credible source), altering the test ordering form (restructuring the physical environment), providing guidelines (prompts/cues) and adding interpretive comments to the results (adding objects to the environment). These BCTs aligned to four intervention functions: education, persuasion, environmental restructuring and enablement. Conclusions: This study has effectively applied behaviour change theory to identify feasible strategies for improving immunoglobulin test use in primary care using the TDF, ‘behaviour change wheel’ and BCT taxonomy. The identified BCTs will form the basis of a theory-based intervention to improve the use of immunoglobulin tests among GPs. Future research will involve the development and evaluation of this intervention. en
dc.description.sponsorship Health Research Board (Scholars Programme in Health Services Research Grant No. PHD/2007/16) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BioMed Central en
dc.relation.uri https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0465-8
dc.rights © 2016, Cadogan et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. en
dc.rights.uri https://creativecommons.org/licenses/by/4.0/ en
dc.subject Laboratory testing en
dc.subject Primary care en
dc.subject Interventions en
dc.subject Theoretical domains framework en
dc.subject Behaviour change techniques en
dc.subject Behaviour change wheel en
dc.title General practitioner views on the determinants of test ordering: A theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Sharon L. Cadogan, Epidemiology and Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: scadogan@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Health Research Board
dc.contributor.funder Centre for Ageing Research and Development in Ireland
dc.description.status Peer reviewed en
dc.identifier.journaltitle Implementation Science en
dc.internal.IRISemailaddress scadogan@ucc.ie en
dc.identifier.articleid 102


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© 2016, Cadogan et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Except where otherwise noted, this item's license is described as © 2016, Cadogan et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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