Eilidh M Duncan1, Brian H Cuthbertson2, Maria E Prior3, Andrea P Marshall4, Elisabeth C Wells5, Laura E Todd6, Denise Bolsover3, Rumana S Newlands3, Fiona Webster6, Louise Rose7, Marion K Campbell3, Geoff Bellingan8, Ian M Seppelt9, Jill J Francis10. 1. Aberdeen Health Psychology Group, Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Health Services Research Unit, University of Aberdeen, Aberdeen, UK. 2. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Department of Anesthesia, University of Toronto, Toronto, Canada. 3. Health Services Research Unit, University of Aberdeen, Aberdeen, UK. 4. Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, and The Gold Coast Hospital, Griffith, Queensland, Australia. 5. Centre for the Study of Social and Legal Responses to Violence, University of Guelph, Ontario, Canada. 6. Department of Family and Community Medicine, University of Toronto, Toronto, Canada. 7. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. 8. Intensive Care Unit, University College Hospital, London, UK. 9. George Institute for Global Health, University of Sydney, Sydney, Australia. 10. School of Health Sciences, City University London, London, UK. Electronic address: Jill.Francis.1@city.ac.uk.
Abstract
PURPOSE: Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians' views about SDD in regions with limited or no adoption of SDD. MATERIALS AND METHODS: Participants were health professionals with "decisional authority" for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery, and further SDD research were explored. Directed content analysis of interview data identified subthemes, which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored. RESULTS: One hundred forty-one participants provided interview data. Fifty-six subthemes were identified; 46 were common across regions. Beliefs about consequences were the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as "worry," "anxiety," and "fear" when discussing potential antibiotic resistance associated with SDD. CONCLUSIONS: We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes.
PURPOSE: Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians' views about SDD in regions with limited or no adoption of SDD. MATERIALS AND METHODS: Participants were health professionals with "decisional authority" for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery, and further SDD research were explored. Directed content analysis of interview data identified subthemes, which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored. RESULTS: One hundred forty-one participants provided interview data. Fifty-six subthemes were identified; 46 were common across regions. Beliefs about consequences were the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as "worry," "anxiety," and "fear" when discussing potential antibiotic resistance associated with SDD. CONCLUSIONS: We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes.
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