Barnes-etal2018

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Barnes-etal2018
BibType ARTICLE
Key Barnes-etal2018
Author(s) Rebecca K. Barnes, Marcus Jepson, Clare Thomas, Sue Jackson, Chris Metcalfe, David Kessler, Helen Cramer
Title Using conversation analytic methods to assess fidelity to a talk-based healthcare intervention for frequently attending patients
Editor(s)
Tag(s) EMCA, Primary care, Feasibility trial, Frequent attenders, Implementation fidelity, Medical EMCA
Publisher
Year 2018
Language English
City
Month
Journal Social Science & Medicine
Volume 206
Number
Pages 38–50
URL Link
DOI https://doi.org/10.1016/j.socscimed.2018.04.008
ISBN
Organization
Institution
School
Type
Edition
Series
Howpublished
Book title
Chapter

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Abstract

The study aim was to assess implementation fidelity (i.e., adherence) to a talk-based primary care intervention using Conversation Analytic (CA) methods. The context was a UK feasibility trial where General Practitioners (GPs) were trained to use “BATHE” (Background, Affect, Trouble, Handling, Empathy) – a technique to screen for psychosocial issues during consultations – with frequently attending patients.

35 GPs received BATHE training between July–October 2015. 15 GPs across six practices self-selected to record a sample of their consultations with study patients at three and six months. 31 consultations were recorded. 21/26 patients in four intervention practices gave permission for analysis. The recordings were transcribed and initially coded for the presence or absence of the five BATHE components. CA methods were applied to assess delivery, focusing on position and composition of each component, and patients’ responses.

Initial coding showed most of the BATHE components to be present in most contacts. However the CA analysis revealed unplanned deviations in position and adaptations in composition. Frequently the intervention was initiated too early in the consultation, and the BATHE questions misunderstood by patients as pertaining to their presenting problems rather than the psychosocial context for their problems. Often these deviations resulted in reducing theoretical fidelity of the intervention as a whole.

A CA approach enabled a dynamic assessment of the delivery and receipt of BATHE in situ revealing common pitfalls in delivery and provided valuable examples of more and less efficacious implementations. During the trial this evidence was used in top-up trainings to address problems in delivery and to improve GP engagement. Using CA methods enabled a more accurate assessment of implementation fidelity, a fuller description of the intervention itself, and enhanced resources for future training. When positioned appropriately, BATHE can be a useful tool for eliciting information about the wider context of the medical visit.

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