QUALITATIVE ANALYSIS AND CATEGORIZATION OF COMMITMENTTOCHANGE STATEMENTS

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QUALITATIVE ANALYSIS AND CATEGORIZATION OF
COMMITMENT-TO-CHANGE STATEMENTS

• Heather Armson University of Calgary
• Stefanie Roder McMaster University
• Sarah Kinzie McMaster University
• Tom Elmslie University of Ottawa
• Jacqueline Wakefield McMaster University
• The Foundation for Medical Practice Education
• SACME Spring Meeting April 22-26 in Rancho
  Mirage, CA

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Background

• Commitment-to-change statements (CTCs) are used
  in a variety of educational activities to promote
  and document practice changes
• CTCs are predictive of implementation of changes
  into practice
• The components of CTCs that contribute to
  implementation of new practice behaviours are not
  known.

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Background

• Phase I
• Development of practice reflection tool (PRT) to
  capture reflection CTCs at the end of small
  group discussions
• The PRT encourages family physicians to
• Reflect on the application of new knowledge to
  their clinical practices
• Document the outcome of their learning session in
  the form of commitment-to-change (CTC)
  statements.
• Review CTC at 3 months to assess successful
  implementation

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PERSONAL PRACTICE REFLECTIONS IMPACT ON MY
PRACTICE (to be completed immediately after
reviewing the module) Name of Module
________________________ __ Date________________
_____ day / month /
year The most useful information for me
was This highlighted the following gap in my
current practice
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Personal Practice Reflections Follow-up Review
Name of Module Date What change(s) did I
make in my practice? What were the barrier(s)
and/or facilitator(s) to my practice
change? What practice change(s) did I make that
I did not anticipate? I can identify other
change(s) I would like to make in my practice?
These are of the following The barrier(s) /
facilitator(s) that I am anticipating are
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Purpose

• Phase II

Can CTC statements be categorized to reflect a
cognitive hierarchy of increasingly complex,
higher level practice changes? Is there a link
between higher cognitive level of the CTC
statements and the likelihood of practice change?
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Methods

• Design Mixed Methods
• Participants Family Physicians participating in
  PBSG / PBIL learning program
• Procedures /Tools
• Review of educational module on a specific topic
• Group discussion of module topic
• Documentation of the outcome of their learning
  session on a personal practice reflection tool
  (PRT)
• most useful information
• gap in my practice
• Guided CTCs will change, considering
  change, confirmed practice, not convinced
• Analysis Principles of grounded theory including
  iterative coding, constant comparison, data
  saturation

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Categorization of PRT statements
Categorizing PRT statements according to the
Cognitive levels of Blooms Taxonomy
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Sample Coding done using Blooms Taxonomy
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Outcome of coding statements according to
Blooms Taxonomy
Questions on the PRT really present stimulus
questions that could be considered as leading the
physicians through a hierarchy of learning.
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Categorization of CTC statements
Tried linking other Models of Physician Change
with Blooms Taxonomy and CTC statements from the
PRT

• Models of Physician Change
• Rogers, 1995 Steps in the Innovation- Decision
  Process
• Fox, Mazmanian Putnam 1989 Stages of Change and
  Learning
• Mazmanian Stages of Commitment-to-Change
• Mazmanian 1999 Hierarchy of Outcomes
• GrolWensing 2004 10 step model for inducing
  change

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Categorization of CTC statements

• The outcome of a learning session differed
  depending on where the physicians started with
  respect to existing practice and how they
  assessed the relative value of a practice change.
• Five categories of outcomes were found in the
  data
• unaware
• scattered
• systematize / construction
• fine-tuning
• confirmation

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Development of coding book
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Data - available
PRT 1 Impact on Practice PRT 2 Follow up
Review
PBSG Practice Based Small Group Learning
Program PBIL Practice Based Individual Learning
Program
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Sample PRT -PBSG year 1 - unable to code
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Sample PRT - PBSG year 1- Fine-tuning
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Sample PRT - PBSG year 2 - Scattered
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Sample PRT - PBIL year 2 Systematize /
construction
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Conclusions

• PRT does capture proposed practice changes
• PRT enhances the development of CTC by using
  questions at different levels of learning
• In process determine to what extent a hierarchy
  of CTCs relate to actual practice change

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This study was in part funded by a grant from
Society for Academic Continuing Medical
Education (SACME) For further information please
contact armson_at_ucalgary.ca
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Data - Demographics