Using Behaviour Change Theories to Understand Pediatric Emergency Discharge Communication Interventions
Bibliographic record
Abstract
Abstract Background Interventions to improve discharge communication in emergency practice settings are inherently complex and incorporate multiple strategies aimed at patient, caregiver and healthcare provider behaviours. Behaviour change theories, including the capability-opportunity-motivation-behaviour (COM-B) model and Behaviour Change Technique Taxonomy version 1 (BCTTv1), provide consistent language for identifying and evaluating the active components of interventions. The objectives of this study were to: (1) identify common barriers and enablers to discharge communication interventions and (2) describe behaviour change techniques (BCTs) present in pediatric emergency discharge communication interventions aimed at patients, caregivers and health care providers. Methods We conducted a secondary analysis of 35 experimental and quasi-experimental studies included in a narrative synthesis of discharge communication interventions in pediatric emergency care. Included studies were reviewed to identify reported barriers and enablers to implementation and intervention effectiveness, which were then mapped to the COM-B model. Trained BCT coders independently coded intervention descriptions using the BCTTv1 as a coding framework. Consensus was used to resolve any discrepancies. BCTs were analyzed using descriptive statistics to determine the frequency of the 93 individual BCTs and 16 BCT categories for patient/caregiver and health care provider interventions. Results Barriers and enablers were identified at the patient/caregiver, health care provider, intervention and health system levels. Psychological capability was the most frequently coded COM-B component. Of the 33 studies that included BCTs, 29 interventions targeted patients or caregivers. A total of 20 different individual BCTs were identified across the interventions in the 33 studies. The number of BCTs identified in each study ranged from 1-9 BCTs, with most (n=14, 42%) interventions containing one BCT. Reporting deficiencies were noted related to adequate details of intervention components and implementation fidelity.Conclusions The COM-B model and BCTTv1 proved to be useful tools to provide a foundational understanding of the common mechanisms used in pediatric discharge communication interventions. With only a fraction of the available BCTs were used in the included studies, future research is needed to explore the utility of other BCTs to address common implementation barriers and improve the effectiveness of discharge communication interventions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.004 |
| Scholarly communication | 0.004 | 0.006 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".