Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction...

Area of Science:

• Implementation Science
• Clinical Psychology
• Childhood Conduct Problems Treatment

Background:

• Parent-Child Interaction Therapy (PCIT) is an effective treatment for childhood conduct problems.
• Sustaining PCIT delivery by trained clinicians in routine care settings presents significant challenges.
• Clinician training in PCIT is increasing in Aotearoa/New Zealand.

Purpose of the Study:

• To systematically identify and prioritize barriers and facilitators for PCIT implementation.
• To develop a theory-driven intervention for re-implementing PCIT among trained clinicians.
• To refine understanding of PCIT implementation determinants using integrated qualitative data.

Main Methods:

• Qualitative study integrating previously unanalyzed survey data (n=54) with new focus group data (n=15).
• Deductive content analysis using the Theoretical Domains Framework (TDF).
• Application of the Theory and Techniques Tool to identify behavior change techniques.

Main Results:

• Eight of 14 TDF domains influenced PCIT implementation; 'Environmental Context and Resources' and 'Social/Professional Role and Identity' were most salient.
• Key barriers included lack of suitable PCIT equipment/clinic rooms and concerns about time-out efficacy and cultural suitability for Māori families.
• Clinicians reported isolation and obligation in advocating for PCIT.

Conclusions:

• Re-implementation of stalled PCIT programs is feasible and practical.
• Intervention components should include peer support, access to appropriate facilities (e.g., time-out rooms), and targeted training on time-out safety.
• Future trials will assess the feasibility and acceptability of these re-implementation strategies.