What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework

Abstract

Objectives: Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice.

Design: Qualitative focus group study using the Theoretical Domains Framework (TDF) to structure the questions, prompts and analyses.

Setting: Community healthcare settings in the North of England, UK.

Participants: Forty-six clinical professionals who cared for patients with complex wounds and eight non-clinical professionals who were responsible for procuring wound care products participated across six focus group interviews.

Results: We found the TDF domains: environmental context and resources, knowledge, skills, social influences and behaviour regulation to best explain the variation in wound care and the underuse of research evidence. Factors such as financial pressures were perceived as having a negative effect on the continuity of care, the availability of wound care services and workloads. We found practice to be mainly based on experiential knowledge and personal preference and highly influenced by colleagues, patients and the pharmaceutical industry, although not by research evidence.

Conclusions: Our study provides new insight into the role that experiential learning and social influences play in determining wound care and on the limited influence of research. Workforce pressures and limited resources are perceived to impede care by reducing patient access to services and the ability to provide holistic care. Participative collaboration between university and healthcare organisations may offer a supportive route to addressing issues, implementing sustainable changes to practice and service delivery and a resolute commitment to research use among clinical professionals.

Keywords: focus group; healthcare professional; healthcare quality; qualitative research; theoretical domains framework; wound management.

Figure 1

Qualitative analysis using a seven-step framework method.

Figure 2

Coding tree showing the four salient domains with connected subthemes.