Skip to main content

Table 2 Modifications to intervention based on themes and corresponding TDF domains identified in interviews

From: Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement “Sepsis Six”

Theme TDF Domains Modification BCTs delivered
New intervention component 1: partnership agreement
 Empowerment and support, working together Belief about capabilities, social/pro role and identity, behavioural regulation, social influences A collaborative partnership agreement between the intervention facilitator and clinical leads of the area is developed. This includes: Behavioural contracta
 Working together Social influences, social professional role and identity Details of when education and feedback sessions will be delivered and who will attend is decided by ward and facilitator collaboratively Commitment,a self-monitoring
 Empowerment and support, working together Belief about capabilities, social/pro role and identity, behavioural regulation, social influences Two sepsis champions (1 doctor/1 nurse) nominated and supported Social support (unspecified)
 Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Commitment to Sepsis Six includes recognition of role model status and staff support Identification of self as role-model,a social support (unspecified)
Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Agreement that signatories will emphasise full group engagement with Sepsis Six Commitment, behavioural contract
 Empowerment and support, working together Belief about capabilities, social/pro role and identity, behavioural regulation, social influences Agreement that signatories will emphasise that challenging others is encouraged Commitment, behavioural contract
 Working together Social influences, social professional role and identity Agreement that staff attendance at training and feedback sessions will be recorded Commitment, self-monitoring
 Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Agreement on iterative nature of the document—all parties are involved it its creation and amendments Commitment
 Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Plan for collecting and sharing implementation data including details of who is responsible how it will be shared/displayed Commitment, action planninga
 Working together Social influences, social/pro role and identity Agreement that information shared at group feedback sessions will be cascaded down to all staff (those not able to attend feedback sessions) Commitment
New intervention component 2: Hospital at Night Co-ordinator education
 Staffing levels Environmental context and resources Hospital at Night Co-ordinators receive sepsis education session including:  
 Risks and benefits Beliefs about consequences Statement about the severity/health consequences of sepsis to patient Information about health consequences
 Risks and benefits Beliefs about consequences Statement about urgency: the consequences of not implementing within one hour Information about health consequences
 Risks and benefits Beliefs about consequences Statement about the importance of finding an on call doctor to attend triggering patients Information about health consequences
 Knowing what to do and why Knowledge, social/pro role and identity Statement of sepsis triggers Instruction on how to perform a behaviour
 Staffing levels Environmental context and resources “Sepsis bags” are made available in the PARRT office Adding objects to environment
 Working together Social influences, social/pro role and identity Instruction on how to perform a sepsis call to doctor Instruction on how to perform a behaviour
 Knowing what to do and why Knowledge, social/pro role and identity Statement about importance of using the six steps together as a bundle Information about health consequences
 Knowing what to do and why, risks and benefits Knowledge, social/pro role and identity, beliefs about consequences At least two “FAQs” are addressed, e.g. appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle Instruction on how to perform a behaviour, information about health consequences
Modifications to existing staff education component
 Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Statement that staff have authority to commence Sepsis Six using clinical discretion Social support (unspecified)
 Empowerment and support Belief about capabilities, social/professional role and identity, behavioural regulation, social influences Statement that full ward/department commitment is expected Information about social consequencesa
 Empowerment and support, working together Belief about capabilities, social/pro role and identity, behavioural regulation, social influences Statement that challenging others should be un-personal and should be normalised Generalisation of behavioura
 Risks and benefits Beliefs about consequences Evidence of patient outcomes presented quantitatively in at least two formats Information about health consequences
 Knowing what to do and why, working together Knowledge, social/pro role and identity, social influences Instruction on how to perform a sepsis call to doctor or Hospital at Night Co-ordinator Instruction on how to perform a behaviour
 Knowing what to do and why Knowledge, social/pro role and identity Statement about importance of implementing the six steps together as a bundle Information about health consequences
 Knowing what to do and why, risks and benefits Knowledge, social/pro role and identity, beliefs about consequences At least two “FAQs” are addressed, e.g. appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle Instruction on how to perform a behaviour, information about health consequences
Modifications to documents and materials component
 Staffing levels Environmental context and resources Sepsis bags made available to Hospital at Night Co-ordinators Prompts/cues
 Knowing what to do and why, risks and benefits Knowledge, social/pro role and identity, beliefs about consequences “FAQ” information sheet addresses: appropriate fluid volumes, evidence for oxygen administration, data on low C. Diff for broad spectrum abx, info about when hour begins, number needed to harm with bundle Instruction on how to perform a behaviour
  1. aNew BCT (not used in original intervention)