1. Identify a patient or community group that contributes to or is involved in the principal behavior you are attempting to improve with your intervention.
Target Population: Pediatric Rheumatologists and Primary care providers that care for female adolescent patients taking teratogenic medications
Target Behavior: improve provision and implementation of reproductive healthcare (by means identified by qualitative work)
2. Using any of the individual explanatory theories in “Theory at a Glance”, develop an explanatory model for the target behavior (above) that you will be attempting to influence with your intervention.
Based on lecture and readings, I think the theory of planned behavior and social cognitive theory are the most applicable for my study (drawing from both individual/intrapersonal and interpersonal levels.)
While there are not studies that assess this issue across subspecialty or amongst adolescents (complicated by needs for confidentiality), there is adult literature that has identified primary care provider perspectives on reproductive health counseling (a subset of the component of implementation of reproductive health care). Barriers identified (adult PCP perspective) include lack of reimbursement, time, ability to identify teratogenic risks of medications and difficulty identifying patient’s pregnancy plans.
Because I plan to interview both primary care providers and pediatric rheumatologists, communication and flow of information between these groups will also be assessed.
3. Identify how one or more of your specific interventions will target one or more of these key factors contributing to the behavior of interest.
While I don’t have a specific intervention in mind yet, these individual interviews will inform a specific intervention in the future. By using these theories and constructs for behavioral change, I will attempt to systematically address these key concepts in semi-structured interview guides: behavioral intention, attitude, subjective norm, perceived behavioral control, reciprocal determinism, behavioral capability, expectations, self–efficacy, observational learning and reinforcements, in order to have a framework for development of targeted intervention.
4. Create a framework that draws upon a socio-ecological framework to orient your target behavior within a larger context. ie, what are some of broader, external forces that influence the individual behavior of interest...see Figure 2 of “Theory at a Glance.”
Provision and implementation of reproductive healthcare is two pronged, being both provider driven and patient driven. Each community has different levels within their socio-ecological framework. For this assignment I will focus (mostly) on provider socio-ecological levels. Though figure 2 is more likely targeted toward patient approaches, there are still applicable levels to healthcare providers. Levels in this framework include:
Social and Economic policies: Hospital policy can drive care
Institutions: Have weight on how providers implement care
Neighborhoods and communities: of pediatric rheumatologists/PCPs as well as the neighborhoods in which providers practice
Living conditions: of patients likely affect how providers can implement care
Social relationships: definitely affect interpersonal skills
Individual risk factors: there are likely risk factors for providers that affect their ability to provide care