Supporting healthcare professionals to offer reproductive genetic carrier screening: a behaviour change theory approach
Stephanie Best
A B C D E * , Janet C. Long A , Zoe Fehlberg A B , Alison D. Archibald F G H and Jeffrey Braithwaite A
A Australian Institute of Heath Innovation, Macquarie University, Sydney, NSW 2113, Australia.
B Australian Genomics, Murdoch Children’s Research Institute, Melbourne, Vic. 3052, Australia.
C Peter MacCallum Cancer Centre, Melbourne, Vic. 3000, Australia.
D Victorian Comprehensive Cancer Centre Alliance, Melbourne, Vic. 3000, Australia.
E Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic. 3000, Australia.
F Department of Paediatrics, University of Melbourne, Melbourne, Vic. 3000, Australia.
G Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Melbourne, Vic. 3052, Australia.
H Genomics in Society, Murdoch Children’s Research Institute, Melbourne, Vic. 3052, Australia.
Australian Journal of Primary Health 29(5) 480-489 https://doi.org/10.1071/PY23022
Submitted: 10 February 2023 Accepted: 12 April 2023 Published: 9 May 2023
Abstract
As reproductive genetic carrier screening (RGCS) becomes more widely accessible, ensuring uptake by primary healthcare professionals (HCPs) is essential to equitable service provision. This study aimed to identify and prioritise implementation strategies to reduce barriers and support HCPs to routinely offer RGCS in Australia.
HCPs (n = 990) involved in a large national research study, offering couples-based RGCS, were surveyed at three time points: prior to offering RGCS through the study (Survey 1: Barriers); 8+ weeks after offering to their patients (Survey 2: Possible supports); and towards the end of the study (Survey 3: Prioritised supports). HCPs were from primary care (e.g. general practice, midwifery) and tertiary care (e.g. fertility, genetics) settings. Results were analysed via a novel approach of using behaviour change theory (Capability, Opportunity and Motivation – COM.B) to align theory to practice.
Survey 1 (n = 599) identified four barrier themes: time constraints, lack of HCP knowledge and skill, patient receptivity, and HCP’s perceived value of RGCS. Survey 2 (n = 358) identified 31 supports that could facilitate HCPs offering RGCS. Survey 3 (n = 390) was analysed separately by speciality and clinic location. Prioritised supports for primary care HCPs were ‘regular continuing professional development activities’ and ‘a comprehensive website to direct patients for information’. There was general accordance with the perceived importance of the supports, although some difference in relation to funding between professional groups and clinic locations.
This study identified a range of supports acceptable to HCPs across specialties and geographic locations that policymakers may use to direct efforts to ensure the roll out of RGCS is equitable across Australia.
Keywords: behaviour change theory, COM-B, general practice, healthcare practitioners, implementation science, implementation strategies, Mackenzie’s Mission, reproductive genetic carrier screening.
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