Development of targeted, theory-informed interventions to improve bronchiolitis management

Area of Science:

• Pediatrics
• Implementation Science
• Behavioral Science

Background:

• International guidelines for infant bronchiolitis management exist but are inconsistently applied.
• Practice variations lead to unnecessary, costly, and potentially harmful infant care.
• De-implementation of ineffective therapies is challenging but crucial for improving patient outcomes.

Purpose of the Study:

• To describe a stepped, theory-informed process for developing interventions to de-implement ineffective therapies for infant bronchiolitis.
• To improve the management of infants with bronchiolitis by addressing practice variation.

Main Methods:

• A stepped approach was employed: identifying recommendations and practice variation, identifying influencing factors (barriers/enablers), and developing interventions using behavior change techniques.
• The Theoretical Domains Framework (TDF) guided the identification of factors influencing practice change.
• Intervention delivery methods were informed by implementation science and setting-specific feasibility.

Main Results:

• Five key evidence-based recommendations were targeted for de-implementation: avoiding chest x-ray, salbutamol, glucocorticoids, antibiotics, and adrenaline.
• Interventions addressed seven TDF domains using 23 behavior change techniques.
• Key interventions included stakeholder meetings, clinical lead training, educational materials, provision of tools, and audit/feedback.

Conclusions:

• A stepped, theory-based approach successfully developed interventions to improve infant bronchiolitis management.
• Explicitly describing the intervention development process facilitates the de-implementation of unnecessary treatments in clinical practice.
• This strategy enhances the quality of care for infants with bronchiolitis.