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Table 5 Summary of intervention components to improve the prospective assessment of PTA using a validated tool

From: Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department

Key TDF domains Proposed BCTs Intervention components including the proposed BCTs
Knowledge Information regarding behaviour, outcome Training and education including: information on what PTA is and how to use a validated tool (abbreviated Westmead Post-traumatic Amnesia Scale- A-WPTAS) consequences of performing and not performing this behaviour, e.g. the benefits of undertaking an assessment of PTA using the A-WPTAS to patient flow, appropriateness of discharge and time (realistically) it takes to undertake one
Antecedents Information on environmental situations, events that predict performance of the behaviour (i.e. when PTA is not measured)
Health consequences
Environmental context and resources Environmental changes Resources
Make available A-WPTAS tool and clinical pathway to staff—Intranet and hard copy. Incorporation of PTA training materials in staff initiation materials, on the Intranet
Skills Goal/target specified behaviour or outcome Training and education including: skill development (how to do an A-WPTAS), modelling/demonstration by nurses, graded tasks (including scenarios ranging from simple to more complex), behavioural rehearsal with participants role playing, problem solving (how this will work in their hospital, how will they deal with pressures from doctors/wards)
Graded task, starting with easy tasks Set goals to undertake PTA assessments on all mTBI patients and discuss ways of achieving this
Increasing skills: problem solving, decision making, goal setting
Rehearsal of relevant skills
Modelling/demonstration of behaviour of others
Beliefs about consequences Persuasive communication Training and education including: persuasive communication from credible sources/opinion leaders (senior nurses/ED Director) to reinforce the benefits of performing a PTA assessment using the A-WPTAS
Social processes of encouragement, pressure, support
Pros and Cons Include reinforcement messages from ED staff that are already using PTA
Vicarious reinforcement Information/education on the importance of assessing of PTA in the ED and how to use the A-WPTAS tool
Social and environmental consequences Include pros and cons of undertaking PTA assessment in training, persuasive messages
Salience of consequences Include reinforcement messages from staff who are already using PTA
Provide information on the consequences on the ED environment by undertaking PTA assessment—reducing discharge time. Include in education the benefits of undertaking an assessment of PTA using the A-WPTAS to patient flow, appropriateness of discharge and time (realistically) it takes to undertake one. Include memorable consequences, e.g. patient examples
Social professional role and identity Social processes of encouragement, pressure, support Training and education including: persuasive messages from senior nurses/ED Director to convince that an A-WPTAS assessment is needed and it is part of their role
Beliefs about capabilities Graded task, starting with easy tasks Training and education including: emphasise the importance of focusing on previous successes [all other BCTs included in elements above]
Increasing skills: problem solving, decision making, goal setting  
Rehearsal of relevant skills
Social processes of encouragement, pressure, support
Focus on past success