Provider perspectives of barriers and facilitators to the transition from pediatric to adult care: a qualitative descriptive study using the COM-B model of behaviour
Author:
Cassidy Christine E.1ORCID, Kontak Julia C.2ORCID, Pidduck Jacklynn3, Higgins Amanda3, Anderson Scott4, Best Shauna3, Grant Amy4, Jeffers Elizabeth4, MacDonald Sarah3, MacKinnon Lindsay3, Mireault Amy4ORCID, Rowe Liam4, Walls Rose5, Curran Janet1ORCID
Affiliation:
1. School of Nursing , Dalhousie University and IWK Health Centre , Halifax , NS , Canada 2. Maritime SPOR SUPPORT Unit, Nova Scotia Health and Faculty of Health, Dalhousie University , Halifax , NS , Canada 3. IWK Health Centre , Halifax , NS , Canada 4. Maritime SPOR SUPPORT Unit , Nova Scotia Health , Halifax , NS , Canada 5. Mental Health and Addictions, Nova Scotia Health , Halifax , NS , Canada
Abstract
Abstract
Objectives
Transition of care can be a complex process that involves multiple providers working together across the pediatric and adult health care system to support youth. The shift from a primarily family-centred approach to a patient-centred approach that emphasizes more personal responsibility for health care management can be challenging for youth, caregivers and providers to navigate. Despite the importance of transition, there is a lack of evidence about the best practices and types of interventions that support the transition of care process from the perspective of both pediatric and adult health care providers. An exploration of barriers and facilitators is a critical first step to identifying important behavioural determinants for designing and implementing evidence-based interventions. As such, the purpose of this study was to identify the barriers and facilitators to the transition of care from the perspective of pediatric and adult health care providers.
Methods
A qualitative descriptive design was used to conduct semi-structured interviews guided by the COM-B Model of Behaviour – a theoretical model that suggests that for any behaviour to occur there must be a change in one or more of the following domains: capability, opportunity and/or motivation. The study took place in the province of Nova Scotia, Canada and focused on three common conditions: Inflammatory Bowel Disease, Diabetes, and Juvenile Idiopathic Arthritis. Participants were recruited through stratified purposeful and convenience sampling and all interviews were conducted virtually on Zoom. Interviews were audio-recorded, transcribed verbatim and imported into NVivo Qualitative Data Software for analysis. Data were first analyzed using directed content analysis, guided by the COM-B model, then further examined using inductive thematic analysis to identify barriers and facilitators within the three domains.
Results
In total, 26 health care providers participated in this study (pediatric, n=13, adult n=13) including a mix of adult and pediatric physicians, nurses, and allied health care professionals. The participants identified primarily as female (n=19.73%) and had a range of years of experience (3–39, mean = 14.84). We identified a range of interconnected barriers and facilitators across each of the COM-B Model of Behaviour domains such as, degree of formalized training (capability), facilitation and coordination responsibilities (opportunity), collaboration across providers (opportunities), securing attachment to adult care system (motivation) and time (opportunity). Findings were categorized by three overarching themes: (1) Knowledge and Skills to Support Transition of Care; (2) Navigation Role for Youth and Caregivers; and (3) System Coordination.
Conclusions
By using the COM-B Model of Behaviour, we identified key barriers and facilitators that intersect to influence the transition of care process. These findings will be used to inform and adapt initiatives and interventions in Nova Scotia to improve the transition experience, as well as may be transferrable to other jurisdictions.
Publisher
Walter de Gruyter GmbH
Reference45 articles.
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