Author (year) and country | Study design and population | TDF Domain | Description of reported barrier | TDF Domain | Description of reported enabler |
---|---|---|---|---|---|
Broom et al. (2018) [77] Australia | Qualitative | Social/professional role and identity | Personal barriers (interpersonal): Relationship between surgeon and anaesthetist: - Poor communication between surgeons and anaesthetist - Lack of task delegation in regards to antibiotic use Hierarchy within and between surgical and anaesthetist teams: - Hierarchy affects whether a colleague’s decision would be “challenged” | Skills | Effective communication: - Working in a private hospital sector as communication was seen as better. Improved responsibility sharing between surgeon and anaesthetist |
Surgeons Anaesthetists | Social influences | Environmental context and resources | |||
Environmental context and resources | |||||
Beliefs about capabilities | Personal barrier (intrapersonal): - Surgeon level of experience influences whether or not they choose to prescribe SAP (junior vs senior staff) | ||||
Skills | |||||
Knowledge | |||||
Environmental context and resources | Organisational barriers: - Workflow – especially emergency settings, communication and consultation may not occur. SAP may not be considered a priority - Effect of influential staff members on local cultures of prescribing (again the effect of hierarchy influencing correct SAP use) | ||||
Social influences | |||||
Giusti et al. (2016) [78] Italy | Mixed methods | Environmental context and resources | Personal barriers (intrapersonal): - Disagreement between health care professionals and content in guidelines - Belief that antibiotics listed in guidelines are not efficacious - Individual understanding of the meaning of prophylaxis; poorer understanding meant that antibiotic use was extended as a precautionary measure - Poor knowledge of local hospital data on how SAP is used and the incidence of SSIs - Level of experience: older, more experienced staff more likely to follow personal experience over guidelines | Knowledge | Guideline dissemination: - Dissemination of guidelines, particularly when shared and communicated appropriately |
Anaesthesiologists Surgeons Nurse coordinators | Knowledge | Environmental context and resources | |||
Beliefs about capabilities | Social influences | Multidisciplinary collaboration: - Trust in guideline developers. Multidisciplinary collaboration to develop guidelines | |||
Beliefs about consequences | Other enablers: - Belief that guideline adherence can act as a protective tool if legal action is taken against practitioner | ||||
Environmental context and resources | External barriers: - Parental expectation that SAP would be used - Pharmaceutical company pressure in regards to choice of antibiotic Organisational barriers: - Availability of hand hygiene facilities – overcrowding of patient rooms during visiting hours can lead to extended prophylaxis | ||||
Nobile et al. (2014) [79] Italy | Quasi-experimental (pre-post), Quantitative descriptive | Environmental context and resources | Organisational barrier: - Lack of guideline presence on wards | Social influences | Multidisciplinary collaboration: - Collaboration to review and update existing guidelines |
Orthopaedic surgeons | Knowledge | Educational services: - Educational sessions to explain SSI prevention, | |||
Nurses Pharmacists | Environmental context and resources | guidelines as well as the correct administration of SAP Guideline dissemination: - Development of pocket sized guidelines for quick reference | |||
Behavioural regulation | Audit and feedback: - Feedback given to staff when deviation from practice detected (regular monitoring and evaluation of practice) |