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To determine characteristics, variability and enablers/barriers to evidence-based care and generate recommendations with implementation strategies to improve the management of early pregnancy bleeding in the emergency department (ED).
Multi-method study.
This paper reports the integration phase of a multi-method study conducted in a regional health service with five sites. Quantitative results (characteristics, variabilities in care and barriers/enablers to evidence-based care) and qualitative findings (ED clinicians' perspectives and experiences) were integrated to generate new findings and recommendations, mapped to the Theoretical Domains Framework (TDF) and corresponding intervention strategies using the Behaviour Change Wheel.
This study integrated findings from two cohort studies of 9859 women over 10 years and a mixed-method study of 104 ED clinicians from five sites. The four key findings were (i) ED remains a critical source of assessment, (ii) Improved access to resources is needed to provide evidence-based care, (iii) Gaps in ED clinician knowledge, skill and confidence have potential patient and health service consequences and (iv) A practice guideline is available; however, it needs refinement. These were mapped to five TDF domains: beliefs about capabilities and consequences, environmental context and resources, knowledge and skills and seven intervention functions. Recommended implementation strategies included multimodal education, clinical champions and an updated practice guideline.
Recommendations to improve delivery of care to women with early pregnancy bleeding in the ED focus on clinical skills and resources. An implementation strategy, considering resource availability, clinician knowledge, skills and confidence, was developed using behaviour change theory.
Integration of characteristics, variability of, and influences on evidence-based care generated recommendations that could contribute to more consistent and effective care, improving patient and health service outcomes.
No patient or public involvement.
Physical activity is crucial for young children’s health and development. Many young children do not meet the recommended 3 hours of daily physical activity, including 60 min of energetic play. Early childhood education and care (ECEC/childcare) is a key setting to intervene to improve children’s physical activity. The Play Active programme is a scalable evidence-informed ECEC-specific physical activity policy intervention with implementation support strategies to improve educators’ physical activity-related practices.
This hybrid type III effectiveness-implementation trial will use a quasi-experimental repeated measures design to assess the real-world effectiveness of Play Active’s scalable implementation support strategies in helping ECEC services adopt the practices included in the Play Active policy. Secondary aims will examine changes in educator-reported and device-measured children’s physical activity; assess the sustainability of the programme; identify effective dissemination strategies; assess cost-effectiveness; and involve comprehensive process evaluation. All ECEC services in Western Australia (n=776), Queensland (n=1744) and South Australia (n=445) will be invited to participate. Data will be collected at baseline, 6, 12, 18, 24 and 30 months.
Ethics approval has been provided by The University of Western Australia Human Research Ethics Committee (HREC) (2023/ET000187), the University of Queensland HREC (2024/HE000076) and the University of South Australia HREC (206023). This real-world trial of Play Active is vital for understanding its implementation in practice and to generate evidence for further scale-up and roll-out nationally. Key findings will be disseminated to stakeholders, collaborators, policy-makers as well as families and practitioners in the ECEC sector.
ACTRN12624000406505.
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