Jessica Eng, Brie Williams, Deb Barnes, Christine Ritchie, Cyrus Ahalt
HOMEWORK ASSIGNMENT
Part 1
For either of the case studies readings (Foy, Zoellner, or Shafer), please describe the following:
1. How did the authors use theory? Where would you place it on a continuum of uses of theory we discussed?
Zoellner used Theory of Planned Behavior to investigate attitudes, subject norms, and perceived behavioral control constructs related to the consumption of sugar-sweetened beverages, water, and artificially sweetened beverages. Specifically, the moderator for the focus groups used a semi-structured script informed by TPB. By categorizing themes according to TPB constructs (attitudes, subjective norms, perceived behavioral control), the authors informed development of future intervention efforts.
2. How did it relate to the uses of theory as described by Bartholemew and Mulen?
The authors focused on identification of determinants of behavior related to a specified health problem (overconsumption of sugar-sweetened beverages), which is one of the roles described by Bartholemew and Mulen.
3. In you view of the work, how much did the explanation of the data ‘fit’ the theoretical components?
Overall, the data presented fit the TPB constructs well since the semi-structured scripts were informed by TPB. Looking at the representative quotes, they were able to sort attitudes (“taste so good”) from subjective norms (“peer pressure”) and perceived behavioral control (“mostly for the convenience”).
Part 2
1. Select a behavior that is relevant to your area of interest. 1a.Which levels (individual, social, institutional, environmental) are most likely to have a significant role? 1b.Who would you engage to develop a formative project to understand more about this behavior?
We are collectively working on implementing and evaluating Geriatric Resources for the Assessment and Care of Elders (GRACE) at UCSF and the SFVA. GRACE is an interdisciplinary home-based program designed to improve care for older adults with complex illness and support the primary care providers (PCPs) who care for them. The GRACE team includes a Nurse Practitioner/Social Worker dyad that visits the patient in their home. The GRACE dyad is supported by a consulting geriatrician, mental health liaison, and pharmacist. Together, the GRACE team focuses on twelve care areas (e.g., depression, advanced care planning, pain) and then makes recommendations for PCP to follow. The recommendations are based on the most recent evidence-based geriatrics research to date. The main issue we are addressing in this exercise is the variable uptake of GRACE team recommendations by PCPs. The team could engage PCPs to understand better the barriers and facilitators to complying with GRACE team recommendations.
For students who are applying theory to an active project:
2. For one of the behaviors relevant to your outcome, complete a table relating variables relevant to your behavior to theories presented in class and in the readings. Can you expand on these individual factors, to include other factors at the social, institutional and environmental levels?
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Theory of Planned Behavior: Domains translated to PCP compliance with GRACE team recommendations |
Strategies in intervention on individual level. Followed by the social, institutional and environmental factors that may be related to the individual level intervention strategy. |
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Behavioral intention - Intend to comply with most of the team recommendations |
- Previous buy-in on an institutional level and by other PCP colleagues - Other PCPs assert that the GRACE team recommendations can be carried out with ease
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Attitude - Compliance with GRACE team recommendations is only good if it is the right for the patient
- On a social level, PCPs may not recognize GRACE’s capacity to improve patient outcomes - On an institutional level, GRACE recommendations may not be viewed as essential or helpful to optimize primary care for older adults - On an environmental level, there may be a lack of consensus among PCPs that the care of older adults requires improvement
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Individual - Increase PCPs’ exposure to patient’s desire to comply with GRACE team recommendations - To address social factors: Provide case examples of patients served by GRACE and the recommendations made by the team that had a positive effect on patient outcomes; provide local data about gaps in care for older adults - To address institutional factors: institutional support of the GRACE team should be explicit, perhaps announced via email or at a public forum, and employ the voices of individual PCPs who agree that GRACE is an important and effective intervention in clinical practice - To address environmental factors: case examples of the GRACE’s positive effects might include contextual data describing our aging society, related strains on patient care
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Subjective norm - GRACE team expects PCP to comply with recommendation
- On a social level, patients may not know how GRACE fits in with routine primary care - On an institutional level, up-front program support may not translate to ongoing support to ensure PCP compliance - On an environmental level, PCPs may fail to promote GRACE within and across practices
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Individual - Increase PCP exposure to good outcomes related to compliance with team recommendations (on their patients or other PCPs’ patients). - To address social factors: Describe GRACE to patients and their caregivers as added level of coordinated care intended to improve health and quality of life - To address institutional factors: GRACE continues to share compliance and patient outcomes data with institutional champions; institutional communicate GRACE performance data back to PCPs - To address environmental factors: GRACE incorporates PCP feedback in evolving service delivery model
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Perceived control - Too much other work - Hard to understand what GRACE team will do and what PCP is responsible for
- On a social level, other primary care team members may not know how to help PCP with recommendations and GRACE team members may not want to overstep PCP authority
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Individual - Identify behaviors within control and other resources to assist with complying with recommendations, set goals, reinforce, give feedback - To address social factors: Identify other members of PCP’s team (e.g. Medical Assistant, Nurse) who might be able to carry out some of the recommendations and streamline recommendations so that they are easier for PCP to carry out
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