Development of the Cardiovascular Assessment Screening Program (CASP) Using the Qualitative Findings of a Mixed Methods Study and Applying the TDF to Address the Barriers of and Facilitators to Comprehensive Screening for Cardiovascular Disease

Overview

Journal BMC Prim Care

Specialties Health Services
Public Health

Date 2023 Mar 7

PMID 36882713

Authors

Jill Bruneau

Karen Parsons

Donna Moralejo

Catherine Donovan

Affiliations

Soon will be listed here.

Abstract

Background: There is inconsistent utilisation of clinical practice guidelines (CPGs) for cardiovascular disease (CVD) screening and management by healthcare professionals to identify CVD risk factors early and to intervene using current recommendations. This manuscript reports on the first phase of an exploratory sequential mixed methods study describing the integration of the qualitative study findings with the Theoretical Domains Framework (TDF) that led to the development of the Cardiovascular Assessment Screening Program (CASP). The main objective of the qualitative study was to inform the development of CASP.

Methods: Focus groups (5) and interviews (10) were conducted in rural and urban settings in one Canadian province with target health professionals, managers in health care organizations, and the public to obtain different perspectives to inform the CASP intervention. Three focus groups were held with nurse practitioners and two with members of the public; individual interviews were conducted with target groups as well. Application of the TDF provided a comprehensive approach to determine the main factors influencing clinician behaviour, to assess the implementation process, and to support intervention design. Behaviour change techniques, modes of delivery, and intervention components were selected for the development of the CASP.

Results: Themes identified such lack of knowledge about comprehensive screening, ambiguity around responsibility for screening, lack of time and commitment to screening were addressed in the components of the CASP intervention that were developed, including a website, education module, decision tools, and a toolkit.

Conclusion: CASP is a theory-informed intervention developed through the integration of the findings from the focus groups and interviews with selected TDF domains, behaviour change techniques, and modes of delivery available in the local context that may be a useful approach for knowledge translation of evidence into practice.

Citing Articles

Evaluating the effectiveness of the cardiovascular assessment screening program with nurse practitioners and patients: results of a cluster randomised controlled trial.

Bruneau J, Moralejo D, Parsons K BMC Prim Care. 2024; 25(1):185.

PMID: 38789927 PMC: 11127425. DOI: 10.1186/s12875-024-02432-2.

References

Hobbs F, Jukema J, da Silva P, McCormack T, Catapano A . Barriers to cardiovascular disease risk scoring and primary prevention in Europe. QJM. 2010; 103(10):727-39. DOI: 10.1093/qjmed/hcq122. View

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren W . European guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice.... Int J Behav Med. 2012; 19(4):403-88. DOI: 10.1007/s12529-012-9242-5. View

Backman R, Foy R, Michael B, Defres S, Kneen R, Solomon T . The development of an intervention to promote adherence to national guidelines for suspected viral encephalitis. Implement Sci. 2015; 10:37. PMC: 4373454. DOI: 10.1186/s13012-015-0224-2. View

Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W . The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013; 46(1):81-95. DOI: 10.1007/s12160-013-9486-6. View

Jeffery R, To M, Hayduk-Costa G, Cameron A, Taylor C, Van Zoost C . Interventions to improve adherence to cardiovascular disease guidelines: a systematic review. BMC Fam Pract. 2015; 16:147. PMC: 4619086. DOI: 10.1186/s12875-015-0341-7. View

Bruneau J, Moralejo D, Donovan C, Parsons K . Recruitment of Healthcare Providers into Research Studies. Can J Nurs Res. 2021; 53(4):426-432. DOI: 10.1177/0844562120974911. View

Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A . Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005; 14(1):26-33. PMC: 1743963. DOI: 10.1136/qshc.2004.011155. View

Unverzagt S, Oemler M, Braun K, Klement A . Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review. Fam Pract. 2013; 31(3):247-66. DOI: 10.1093/fampra/cmt080. View

Cane J, OConnor D, Michie S . Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012; 7:37. PMC: 3483008. DOI: 10.1186/1748-5908-7-37. View

10.

Arnett D, Blumenthal R, Albert M, Buroker A, Goldberger Z, Hahn E . 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 74(10):e177-e232. PMC: 7685565. DOI: 10.1016/j.jacc.2019.03.010. View

11.

Holt T, Thorogood M, Griffiths F, Munday S, Stables D . Identifying individuals for primary cardiovascular disease prevention in UK general practice: priorities and resource implications. Br J Gen Pract. 2008; 58(552):495-8. PMC: 2441511. DOI: 10.3399/bjgp08X319468. View

12.

Patton M . Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999; 34(5 Pt 2):1189-208. PMC: 1089059. View

13.

Thorne S . The Great Saturation Debate: What the "S Word" Means and Doesn't Mean in Qualitative Research Reporting. Can J Nurs Res. 2020; 52(1):3-5. DOI: 10.1177/0844562119898554. View

14.

Brindle P, Beswick A, Fahey T, Ebrahim S . Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review. Heart. 2006; 92(12):1752-9. PMC: 1861278. DOI: 10.1136/hrt.2006.087932. View

15.

Atkins L, Francis J, Islam R, OConnor D, Patey A, Ivers N . A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017; 12(1):77. PMC: 5480145. DOI: 10.1186/s13012-017-0605-9. View

16.

French S, Green S, OConnor D, McKenzie J, Francis J, Michie S . Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012; 7:38. PMC: 3443064. DOI: 10.1186/1748-5908-7-38. View

17.

Tobe S, Stone J, Anderson T, Bacon S, Cheng A, Daskalopoulou S . Canadian Cardiovascular Harmonized National Guidelines Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2018 update. CMAJ. 2018; 190(40):E1192-E1206. PMC: 6175624. DOI: 10.1503/cmaj.180194. View

18.

Dodgson J . Reflexivity in Qualitative Research. J Hum Lact. 2019; 35(2):220-222. DOI: 10.1177/0890334419830990. View

19.

Lee H, Cho J, Shin D, Lee S, Hwang S, Oh J . Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: a nationwide cohort study. Prev Med. 2014; 70:19-25. DOI: 10.1016/j.ypmed.2014.11.007. View

20.

Brett J, Staniszewska S, Mockford C, Herron-Marx S, Hughes J, Tysall C . Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expect. 2012; 17(5):637-50. PMC: 5060910. DOI: 10.1111/j.1369-7625.2012.00795.x. View