The aims of the study were, in workshop 1, to prioritize and define necessary changes in the contextual framework (targets) based on identified barriers for adherence to recommendations. Additionally, to propose who should take specific actions and how (behaviors and actions) to achieve these targets. In workshop 2, the aim was to systematically evaluate and refine the proposed solutions.
In this pragmatic, qualitative project we conducted an iterative developmental process building on previous identification of barriers and facilitators for delivery of and adherence to recommendations (Poulsen et al., 2024). The project was conducted in a participatory design using co-design workshops and participant field observations to guide development and evaluation. Twelve participants (Physiotherapists and medical doctors) from all Danish regions were purposively recruited as an expert panel. The theoretical framework the Behavior Change Wheel was applied to systematize data collection and interpretation. In workshop 1, participants prioritized and defined targets and behaviors, and proposed actions to achieve these targets. The theory of Behavior Change Techniques (BCTs) was following applied in data analyses to specify proposed actions. In workshop 2, participants used the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects/Safety, and Equity) critical evaluation method.
Prioritized targets of particular relevance to enhance adherence to recommendations through minimized contextual barriers were: 1) Improved patient motivation for exercise-based treatment, 2) Changing patient beliefs about treatment effects from negative to positive, 3) Changing patient expectations about treatment courses to align with recommendations, 4) Decreasing complications in the cross-sectoral communication. We identified 24 specified behaviors (needed to achieve these targets) with 25 adjacent actions proposed to promote these behaviors. Of these, 8 behaviors and 18 actions were positively evaluated in APEASE critical evaluation. The prioritized actions fell within the BCTs Enablement (n=6), Environmental restructuring (n=4), Education (n=4), Modeling (n=2) and Persuasion (n=2).
We identified 18 actions deemed likely to promote 8 specific behaviors and thereby contribute to four prioritized targets. Implementation of these results require actions from both clinicians, organizations and politicians respectively. Given implementation, the contextual changes are likely to enhance patient- and clinician- adherence with recommendations and promote optimization of future care for people with SAPS.
This study used a novel approach to solve clinical challenges by examining the context of clinical pathways from the clinician’s point of view and letting clinicians design realistic, innovative solutions to tackle complex challenges. The results provide clinicians and organizations with a specific set of actions to help overcome the contextual barriers to guideline adherence. The theory-based program development approach provided relevant output and seems applicable across conditions.
Exercise-based treatment
Programme optimization
