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Factors Affecting Implementation of Guideline Updates for the Management of Adolescent Hypertension using the Theoretical Domains Framework
Nacy, Diana Kathryn
Nacy, Diana Kathryn
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Abstract
Background: Adolescent hypertension is a health problem that may go unrecognized, often persists into adulthood and increases the risk of adverse cardiovascular conditions. Implementation science provides the basis for dissemination, implementation, and adoption of guidelines. Specifically, the Theoretical Domains Framework (TDF) can be applied to assess facilitators and barriers of implementation and evidence-based management of hypertension in an at-risk population of adolescents who receive routine healthcare at a school-based clinic. Objectives: The objectives of this project were to apply the Theoretical Domains Framework-based Determinants of Implementation Behavior Questionnaire to: (1) identify the factors or determinants that facilitate or present barriers to the implementation of the American Academy of Pediatrics hypertension guideline updates; and (2) develop recommendations for addressing the facilitators and barriers of implementation of the updated guidelines to be presented to the clinic board. Methods: A Quick Response code was emailed to clinic providers with a link to a structured REDCap electronic survey consisting of twenty-eight questions. Participants were asked to complete the TDF-based Determinants of Implementation Behavior Questionnaire on their personal mobile device linked to a secure REDCap server. Results: Domains identified as potential barriers included, Skills, Goals, Innovation Strategies, Social Influences, Positive Emotions, and Nature of Behaviors. This suggests that more training is needed to increase provider’s knowledge and skills in order to effectively deliver guideline-based management of adolescent hypertension. Results also suggested that it would be beneficial for clinic managers to place more emphasis on providing guideline-based care and provide resources, support, and encouragement to providers at the BullDoc clinic. Conclusion: This project provided the first step in identifying the providers’ perspective on the factors facilitating or preventing implementation of the updated guidelines for hypertension management for adolescents in the BullDoc clinic.
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2020-05-31
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University of Kansas
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Health care management