Table 6 Factors which influence and enhance behaviour change to implement JCs
COM-B Domain and associated factor | Behaviour Change Wheel Intervention Functions | Implementation strategies |
|---|---|---|
Motivation | ||
Perceived relevance of topics linking to clinical practice | Enablement Environmental restructure | • Ensure group engagement during prioritisation of topics (consider topics that relate to current clinical service priorities or Quality Improvement projects) • Longer time dedicated to discussion of application of evidence in each session. • Skilled JC member facilitates discussion |
Clinician ownership, sense of responsibility & accountability | Modelling | • Identify 2–3 clinicians to co-facilitate JC and holder of “JC portfolio” • Presenting clinicians to follow up the action items & feedback at future JC sessions |
Perceived benefit of format | Persuasion Incentivisation | • JC members familiar with TREAT to share positive experiences with others |
Belief that participation in JC improves knowledge and skills in EBP | Persuasion Education | • Use of positive experience stories to encourage belief that capability increases with ongoing JC attendance and engagement |
Other clinicians encourage attendance prior to meeting | Persuasion | • Use of email reminders prior and electronic reminders in electronic calendars to prompt attendance and reduce double-bookings |
Opportunity | ||
Staff changes including planned changes (eg rotations, planned leave & staffing availability) & emergent leave (eg sick leave & workforce shortages) | Education Training | • Consider upskilling non-rotational staff to improve resilience during rotations (i.e. upskilling senior staff who do not rotate) • Increase number of staff exposed to JC, in order to saturate skills across the workforce |
Competing demands leading to JC deprioritised due to clinical demands | Environmental restructuring Enablement | • Timetable of presenters with consistent time and place booked in clinicians’ calendars (updated electronically) • Manager encouragement to engage in JC as part of professional responsibility |
Logistical administration of JC is established (time, venue, recurrent booking) | Enablement | • Allocate a set time, use of regular room and time to reduce clashes • Tie in meeting with another meeting, |
Manager expectation holds staff to account to prioritise JC attendance | Coercion Persuasion | • Departmental leadership to advocate and value JC attendance and see as core business |
Team culture values EBP | Modelling | • Ensure consistent message of value of EBP via members & managers, including new starter orientation |
Increased participation by all JC members during group discussion | Modelling | • Facilitator to encourage participation from all group members during group appraisal, where possible have face to face rather than VC to facilitate interaction |
Support from other clinicians in team | Enablement | • Regularly review topic choice to check relevance of topic to current practice |
Capability | ||
Awareness of how to access Library & academics | Education | • Ensure Librarians available and engaged, to meet with JC and raise awareness of services available to JC members |
Knowledge from academic needs to be pitched at right level | Enablement | • Academic must be skilled in ascertaining and monitoring learners in order to pitch information at a level appropriate to the skills and need of the JC members |
JC members guided to choose topics relevant to all members | Education | • Provide support or education regarding how to prioritise topics and integrate into practice (i.e., relate to QI) |
Skill development (e.g., in critical appraisal, EBP and stats training, statistics, identifying study design) | Training | • Access to regular training opportunities to ensure all staff have access to basic EBP training as they join a JC • Academic mentor attends initially to facilitate session then assists JC portfolio holders to facilitate using “cognitive apprentice model” (particularly upskill in facilitation of club) • Resources to support interpretation of study design and selection of CASP appraisal tool • Through building depth of clinician skill, wider numbers of JC members will have opportunity to build skills and confidence in application of skills |
Access to academic or EBP-skilled clinician | Modelling Enablement | • Academic or skilled clinician available to support JC members in provision of relevant knowledge on-demand. • By providing direct guidance learner can be supported to move from peripheral to full participation. Guide must be able to ascertain readiness of the learner and be monitoring the learner’s development. |