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Table 5 Behaviour change taxonomies (BCTs) with their relating intervention functions and planned implementation strategy specific to the care bundle

From: Designing strategies to implement a blunt chest injury care bundle using the behaviour change wheel: a multi-site mixed methods study

BCTs Intervention Functions Proposed implementation strategy Barrier(s)/Facilitator(s) addressed (TDF domain)
Information about health consequences Education, persuasion Staff will be informed about the improvement in pneumonia rates reduction with the protocol from previous study Belief of consequences of care bundle (Belief about consequences)
Understanding of evidence-informed interventions for patient with blunt chest injury (Knowledge)
Feedback on behaviour Education, persuasion, incentivisation Staff compliance will be monitored through audits and by clinical champions
Staff will be informed of the results informally via clinical champions and formally through email and newsletter correspondence
Belief of consequences of care bundle (Belief about consequences)
Understanding of evidence-informed interventions for patient with blunt chest injury (Knowledge)
Feedback on outcome(s) of behaviour Education, incentivisation, training Feedback will be given to staff on patients treated with the care bundle Understanding of evidence-informed interventions for patient with blunt chest injury (Knowledge)
Belief of consequences of care bundle (Belief about consequences)
Emotions relating to commencing new protocol (Emotion)
Remembering to use protocol (Memory, attention, and decision processes)
Confidence in patient assessment skills (Physical skills)
Information about others’ approval Education, persuasion Local staff will appear in the care bundle video showing support Identify with professional role associated with care of blunt chest injury patients (Professional/ social role and identity)
Credible source Persuasion Senior local staff will appear in a video informing staff about the care bundle Identify with professional role associated with care of blunt chest injury patients (Professional/ social role and identity)
Prompts/cues Education, environmental restructuring A visual prompt (screen icon) will be developed for the electronic medical record to flag to staff that patient is eligible for care bundle
Flyers will be put up around the workplace to remind staff of the care bundle
Remembering to use protocol (Memory, attention, and decision processes)
Verbal persuasion about capability Persuasion, enablement Staff will be encouraged during educational sessions and by change champions that they are capable of following the care bundle Emotions relating to commencing new protocol (Emotion)
Identification of self as role model Persuasion, enablement Staff will be asked to volunteer for the roles of change champions and to be in the video Emotions relating to commencing new protocol (Emotion)
Identify with professional role associated with care of blunt chest injury patients (Professional/ social role and identity)
Commitment Incentivisation, enablement Staff will appear in a video committing to the care bundle Remembering to use protocol (Memory, attention, and decision processes)
Demonstration of behaviour Training, modelling Staff will receive demonstrations of behaviour in a video, in education sessions and at the bedside with the change champions Confidence in patient assessment skills, Confidence in skills needed for evidence-informed management of blunt chest injury, Adequate skill in regional analgesia prescription and management (Physical skills)
Remembering to use protocol (Memory, attention, and decision processes)
Identify with professional role associated with care of blunt chest injury patients (Professional/ social role and identity)
Emotions relating to commencing new protocol (Emotion)
Instruction on how to perform behaviour Training Staff will receive instructions of behaviour in a video, in education sessions and at the bedside with the change champions Confidence in patient assessment skills, Confidence in skills needed for evidence-informed management of blunt chest injury, Adequate skill in regional analgesia prescription and management (Physical skills)
Remembering to use protocol (Memory, attention, and decision processes)
Habit formation Training Staff will be encouraged to assess all potentially eligible patients systematically Confidence in patient assessment skills, Confidence in skills needed for evidence-informed management of blunt chest injury, Adequate skill in regional analgesia prescription and management (Physical skills)
Remembering to use protocol (Memory, attention, and decision processes)
Adding objects to the environment Environmental restructuring, enablement An icon will be added for the electronic medical record to flag to staff that patient is eligible for care bundle
A pager will be setup to be able to contact staff responding to the care bundle
Remembering to use protocol (Memory, attention, and decision processes)
Access to protocol (Environmental context and resources)
Emotions relating to commencing new protocol (Emotion)
Restructuring the physical environment Environmental restructuring, enablement Equipment necessary for the care bundle will be placed in a location that ensures ease of access
Equipment will be adequately labelled with instructions
Additional equipment will be supplied to ensure adequate supply
The protocol will be tested by staff to ensure ease of use
Remembering to use protocol (Memory, attention, and decision processes)
Access to protocol, the protocol design, Access to equipment (Environmental context and resources)
Emotions relating to commencing new protocol (Emotion)
Social Support Enablement Change champions will be chosen from each area who will receive extra training to be able to provide extra support Social supports (Social influences)
  1. Education: increasing knowledge or understanding, Persuasion: using communication to induce positive or negative feelings or stimulate action, Incentivisation: creating an expectation of reward, Training: imparting skills, Environmental restructuring: changing the physical or social context, Modelling: providing an example to aspire to, Enablement: increasing means/reducing barriers
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