Influence of Implementation Strategies on Nurses' Clinical Practice Behavior: A Comprehensive Meta-Analysis and meta- regression protocol

Abstract

Topic Background: Implementation interventions tailored to practitioners, such as feedback through audits, communities of practice, and local opinion leadership, exhibit potential in reshaping nurses' clinical behavior and enhancing patient well-being. However, their actual effectiveness remains shrouded in uncertainty. Furthermore, our understanding is limited concerning the integration of theoretical frameworks within implementation studies involving nurses, the underlying causal mechanisms directing behavior changes in clinical practice, and the specific behavior modification techniques embedded within these interventions. As such, our objectives encompass three dimensions: (1) to assess the efficacy of practitioner-centric implementation interventions in driving changes in nurses' clinical conduct; (2) to discern the prevalence and extent of theoretical utilization, pinpoint the operative mechanisms of change, and outline the constituent behavior modification techniques in the encompassed studies; and (3) to scrutinize potential correlations between intervention effectiveness, theoretical adoption, targeted mechanisms of action, and behavior modification techniques employed.

METHODS

Employing guidelines set forth by the Cochrane Effective Practice and Organization of Care (EPOC) Group, we will undertake a systematic review. Our quest will encompass six databases—namely, CINAHL, EMBASE, ERIC, PsycINFO, PubMed, and Web of Science—without restricting the search period, focusing on experimental and quasi-experimental studies evaluating practitioner-oriented implementation interventions tailored to induce shifts in nurses' clinical behavior. Furthermore, we will manually scrutinize the reference lists of included studies. Our methodology will encompass distinct phases: screening, comprehensive review of full texts, assessment of bias risk, and extraction of data, all facilitated through the Covidence systematic review software. The quality of evidence will be evaluated through employment of the GRADEpro software. Employing the Theory Coding Scheme, coding guidelines from Michie, and the Behaviour Change Technique Taxonomy v1, we will independently code the included studies for theoretical application, mechanisms of action, and behavior modification techniques, respectively. Meta-analyses will be conducted employing the Review Manager (RevMan) software, and subsequent meta-regression analyses will be executed using IBM SPSS Statistics software.

Discussion

The culmination of this review will prove instrumental for stakeholders and researchers alike, invested in devising, formulating, and appraising implementation interventions geared towards influencing nurses' behavioral shifts within clinical practice. The outcomes will provide crucial insights into the pertinent causal mechanisms warranting intervention focus, in addition to identifying the specific behavior modification components that should be embedded to enhance the interventions' efficacy.