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Table 1 Behaviour change techniques (including their relevant numbers from the taxonomy), intervention functions, modes of delivery (bold), examples of the mechanisms of action, expected dose, and intended implementation outcome

From: Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP)

BCTs

Intervention functions

Mechanism of action

Target barrier(s)/facilitator(s) (TDF domain)

Expected dose

Intended implementation outcome

1.9. Commitment

Incentivisation, enablement

Staff appear in a video promoting ChIP

Remembering to use protocol (memory, attention, and decision processes)

At least one staff member from each of the disciplines involved

Increase fidelity/acceptability from all disciplines

2.2. Feedback on behaviour

Education, persuasion, incentivisation

Staff compliance monitored through audits and staff will be informed of the results informally by clinical champions, through newsletters and emails

Belief of consequences of care bundle (belief about consequences)

Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)

Audits to be done monthly for 12 months

Increase fidelity

2.7. Feedback on outcome(s) of behaviour

Education, incentivisation, training

Feedback given to staff from audit results on patients treated with the care bundle through clinical champions

Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)

Belief of consequences of care bundle (belief about consequences)

Emotions relating to commencing new protocol (emotion)

Remembering to use protocol (memory, attention, and decision processes)

Confidence in patient assessment skills (physical skills)

For audits after 1, 2, and 3 months then if issues

Increase sustainability

3.1. Social support

Enablement

Clinical champions chosen from each area receive extra training to be able to provide extra support

Social supports (social influences)

2 clinical champions from each ED

Increase fidelity

4.1. Instruction on how to perform behaviour

Training

Staff receive instructions on behaviour via a video, educational sessions, and clinical champions

Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)

Remembering to use protocol (memory, attention, and decision processes)

Education sessions to be attended by staff

Increased fidelity

5.1. Information about health consequences

Education, persuasion

Staff informed about the improvement in pneumonia rate reduction with the protocol from the previous study through video, educational sessions, flyers, newsletters, and emails

Belief of consequences of care bundle (belief about consequences)

Understanding of evidence-informed interventions for a patient with blunt chest injury (knowledge)

All relevant staff

Increased acceptability

6.1. Demonstration of behaviour

Training, modelling

Staff receive demonstrations of behaviour via a video, educational sessions, and clinical champions

Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)

Remembering to use protocol (memory, attention, and decision processes)

Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)

Emotions relating to commencing new protocol (emotion)

All relevant staff

Increased fidelity

6.3. Information about others’ approval

Education, persuasion

Local staff appear in the ChIP video showing support

Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)

Senior staff from each discipline

Increase acceptabilty

7.1. Prompts/cues

Education, environmental restructuring

A visual prompt (screen icon) developed for the electronic medical record to flag to staff that patient is eligible for care bundle

Remembering to use protocol (memory, attention, and decision processes)

On computer system

Increase fidelity and sustainability

Flyers put up around the workplace to remind staff of the care bundle

In both EDs, ICUs, trauma wards

Increase fidelity

8.3. Habit formation

Training

Staff encouraged to assess all potentially eligible patients systematically in the video and educational sessions

Confidence in patient assessment skills, confidence in skills needed for evidence-informed management of blunt chest injury, adequate skill in regional analgesia prescription and management (physical skills)

Remembering to use protocol (memory, attention, and decision processes)

Staff from relevant disciplines

Increase fidelity

9.1. Credible source

Persuasion

Senior local staff appear in a video informing staff about and promoting ChIP

Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)

At least one staff member from each discipline

Increase acceptability

12.1. Restructuring the physical environment

Environmental restructuring, enablement

Equipment necessary for ChIP placed in a location that ensures ease of access

Remembering to use protocol (memory, attention, and decision processes)

Access to protocol, the protocol design, access to equipment (environmental context and resources)

Emotions relating to commencing new protocol (emotion)

HFNC machines and incentive spirometry in ED

Increase fidelity

Equipment adequately labelled with instructions

All new HFNC machines

Increase fidelity

Additional equipment supplied to ensure adequate supply (high-flow machines and incentive spirometry)

  

ChIP tested by staff to ensure ease of use

Tested once prior to go live

Increased fidelity

12.5. Adding objects to the environment

Environmental restructuring, enablement

An icon added for the electronic medical record to flag to staff that patient is eligible for care bundle

Remembering to use protocol (memory, attention, and decision processes)

Access to protocol (environmental context and resources)

Emotions relating to commencing new protocol (emotion)

Add prior to go live

Increased fidelity

 

A pager setup to be able to contact staff responding to ChIP

 

Set up prior to go live

Increased fidelity

13.1. Identification of self as a role model

Persuasion, enablement

Staff asked to volunteer for the roles of clinical champions and to be in the video

Emotions relating to commencing new protocol (emotion)

Identify with professional role associated with care of blunt chest injury patients (professional/social role and identity)

Champions at each site

Increased fidelity and sustainability

15.1. Verbal persuasion about capability

Persuasion, enablement

Staff encouraged during educational sessions and by clinical champions that they are capable of following ChIP

Emotions relating to commencing new protocol (emotion)

At each session

Increased fidelity and acceptability

  1. Definitions for intervention functions: Education: increasing knowledge or understanding, Persuasion: using communication to induce positive or negative feelings or stimulate action, Incentivisation: creating an expectation of reward, Training: imparting skills, Environmental restructuring: changing the physical or social context, Modelling: providing an example to aspire to, Enablement: increasing means/reducing barriers