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Table 2 Healthcare provider reflections

From: Aligning intuition and theory: enhancing the replicability of behaviour change interventions in cancer genetics

Category

Illustrative quotes

Benefits of the coding exercise and key learnings

‘Personally I found the coding exercise incredibly useful in that it forced me to think in the structured implementation science way and particularly the implementation barriers allowed me to generalise to other services we are introducing.’ Team Member 1

‘The coding allowed us to identify and more clearly describe how the intuitive interventions helped to initiate behaviour change (dissemination).’ Team Member 2

‘The intuitive approaches were initially formulated by contemporary clinical practice informed by many studies. However, these were unstructured. This coding has enabled a structured manual for future staff and existing staff. Having a small number of codes to consider interventions for, was far less daunting, and made a lot of sense. It has given me a greater appreciation of how barriers can be more readily identified, and interventions put in place.’ Team Member 3

‘Whereas we have not continued with the structured patient follow-up calls as in this study due to increased referrals/workload, the staff are motivated to understand identification of these barriers and what interventions to apply.’ Team Member 3

Replicability of coded interventions

‘These interventions came about intuitively and the study interviews were all conducted by the one researcher (myself). So from a research perspective, recording them in the coding table provides consistency if further research is to be conducted (or multiple researchers are to work with families). And from a clinical perspective, we now have a practical manual on how to support families with dissemination challenges, and this may be useful for both current genetic counsellors and as training for new genetic counsellors.’ Team Member 2

‘This coding has enabled a structured manual for future staff and existing staff. One such practical example was the ad hoc nature of each of the genetic counsellors having their own incomplete lists of international genetics contacts. <The study genetic counsellor> collated these from far and wide outside of the study hospitals to produce an excellent resource which continues to be used and added to.’ Team Member 3

Perceived generalisability

‘While the interventions were used on a specific BRCA cohort, the same theories are applicable to other familial cancer conditions and other genetic conditions. At this stage the process has not been used to address other clinical problems, but could potentially be used to consider how to motivate patients to overcome other barriers, such as reluctance to have a risk-reducing surgery, breast screening, colonoscopy, or compliance issues with risk-reducing medication such as tamoxifen or aspirin.’ Team Member 2

‘The intervention strategies helped to reassure us we were going ok and it allowed us to generalise the interventions so other services can pick up on what we were doing that worked.’ Team Member 1

Future use of implementation science and behaviour change theory

‘We addressed the problem of not getting appropriate referrals of CRC patients with abnormal immunohistochemistry and set about approaching the problem with implementation science research questions – this has led to a randomised trial.’ Team Member 1

‘I found that after coding so many I was starting to be able to see trends in my day to day work and now think about implementation before I introduce new guidelines. One of the disadvantages is the time it took and the sinking feeling that we had done all this work without having accessed the implementation scientists earlier!’ Team Member 1

‘I personally think about how I am responding to a new problem with a patient by thinking about the TDF and it helps me put a framework around how I approach it.’ Team Member 1

 

‘I am thinking about this in other research and clinical problem areas. We can currently consider this with other studies, such as our newsletter implementation for CRC/polyposis cohort-planned 2020, and our CONTACT study -genetic counselling via telehealth currently completing its pilot before the RCT roll out.’ Team Member 3

Training and support needs

‘Using behaviour change theory in the future, or more widely amongst the genetic counselling profession, would require some training and input from staff with prior experience. The process/theory is not common knowledge, but is very practical and useful in application.’ Team Member 2

‘Training and support is needed for clinical staff. Although when I've done this, it is very straight forward, I still find the lines blurry differentiating between identifying the problem (coded) and then applying the intervention.’ Team Member 3