Abstract
BACKGROUND: Patient-reported outcome measures (PROMs) play an important role in promoting and supporting patient and family-centered care (PFCC). To deliver, improve, and sustain PFCC, it is crucial to empower children, families, and communities to identify their self-reported outcomes and experiences with the care received. PROMs play an important role in promoting and supporting PFCC. Asthma is the most common chronic condition in pediatrics requiring complex care plans and is a leading cause of hospitalization. Implementing interventions like PROMs in routine clinical care for asthma would require key stakeholders to change their behaviour. This qualitative descriptive study is part of a larger multi-phase project to develop the KidsPRO program, an electronic platform to administer, collect, and use PROMs in pediatrics. OBJECTIVES: The objective of this study is to identify barriers and enablers to the implementation of PROMs in outpatient asthma clinics using the Theoretical Domains Framework (TDF). DESIGN/METHODS: TDF guided this qualitative descriptive study design. TDF is one of the frameworks used in implementation sciences, which provides a theoretical basis to understanding potential barriers for the slow uptake of evidence into practice and the enablers that may influence the phenomenon. Semi-structured qualitative interviews were conducted with 17 participants from outpatient asthma clinics, which included general pediatricians, pediatric respirologists, nurses, allied health providers, and clinic staff. All the interviews were transcribed, deductively coded, inductively grouped in themes, and categorized into barriers and enablers. RESULTS: We identified 33 themes within 14 TDF domains, which were further categorized and tabulated into 16 barriers and 17 enablers to implementing PROMs in asthma clinics. Seventeen barriers to behavioural change identified in our study were attributed to personal, clinical, non-clinical, and other system-level factors and ranged from limited awareness of PROMs to language barriers and a patient’s complex family background. Clinicians’ commitment to providing patient and family-centered care, excitement, high importance, and optimism about using PROMs to provide comprehensive healthcare were identified as the major enablers. Compatibility of using electronic PROMs with current practice, competency in communication around psychosocial questions, confidence in self-abilities, demonstrate feasibility of implementing PROMs in asthma clinics. CONCLUSION: The implementation of PROMs in pediatrics is lagging compared to adult populations. This implementation science-based systematic inquiry captured the complexity of PROMs implementation in pediatric outpatient clinical care for asthma. Considering the consistency in barriers and enablers to implementing PROMs across patient populations and care settings, many findings of this study will be directly applicable to other pediatric healthcare settings in Canada and beyond.