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Table 2 Behavior Change Wheel (BCW) framework for adoption of guideline-based clinical practice at ORCI

From: Development of a theory-driven implementation strategy for cancer management guidelines in sub-Saharan Africa

BarriersCOM-B categoryIntervention functionsBehavior change techniques and mode of delivery
Guidelines not easily accessiblePhysical capabilityEnablementDistribute hard copies to every unit and clinic room, soft copies to every provider (via smartphone application). Include algorithms as a reference in clinical “Diagnosis, Staging, Treatment” (DST) forms.
Lack of knowledge of guideline contentPsychological capabilityEducationTeach guideline content, including evidence basis for guidelines, to providers in dedicated education session and integrate into existing curriculum for residents and nurses.
Lack of experience in guideline-based practicePsychological capabilityTraining, environmental restructuringAdminister skills training in how to use guidelines and DST forms in dedicated trainings.
Integrate clinical forms into a workflow that prompt providers to apply guidelines to every patient.
Providers not aware or do not believe that they should be following guidelinesPsychological capabilityEducation
Publicity campaign using branding, awareness raising of regional and international efforts to develop LMIC-specific guidelines.
Selected local Champions will persuade providers that they should adhere to guidelines, and model this behavior during morning conference and in clinical practice.
Consultant/resident/nurse not together when plan is madePhysical opportunityEnvironmental restructuringTeam members, including residents and nurses, should round together and review guideline concordance of treatment plan, review with consultant.
Lack of accountability in patient managementPhysical opportunityEnvironmental restructuringDST forms will be completed for every patient, with documentation of rationale for treatment decisions. One consultant should be assigned to each patient at intake and ultimately responsible for treatment plan.
Current norm is that consultants make decisions based on expertiseSocial opportunityTraining
Champions will model guideline-based practice on an ongoing basis on rounds/in conference. All providers (consultants, residents, nurses) will be trained to discuss or question the guideline concordance of their patients’ treatment plans. Champions will also model this behavior.
Little professional value placed on guideline concordanceSocial opportunityIncentivizationChampions will provide recognition and praise for guideline-concordant management. Planned outcomes evaluation will include audit and feedback.
Belief that expertise-based decisions are better than guidelinesReflective motivationTraining
Train providers in the benefits of guideline-based practice and provide evidence that they should be used in favor of expert opinion.