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. 2025 Jan 21;25(1):115.
doi: 10.1186/s12913-025-12240-8.

Mapping provider and consumer voices using the AACTT framework: a focus group study of advance care planning

Lisa Guccione  1   2 , Stephanie Best  3   4   5 , Sonia Fullerton  3   4   6 , Sanchia Aranda  3   7 , Jill J Francis  3   4   7   8
Affiliations

Mapping provider and consumer voices using the AACTT framework: a focus group study of advance care planning

Lisa Guccione et al. BMC Health Serv Res. .

Abstract

Background: The provision of healthcare is complex. When evidence-practice gaps are identified, interventions to improve practice across multi-level systems are required. These interventions often consist of multiple interacting components and behaviours. To effectively address these complexities, it is crucial to first identify the specific roles and actions required at each stage of the intervention. This approach enables a thorough examination of what is working well and what needs to be optimised. The action, actor, context, target, time (AACTT) framework provides a consistent approach to identifying key elements such as 'who' (actor) does 'what' (action), 'where' (context), 'to or with whom' (target) and 'when' (time). To our knowledge the AACTT has not yet been applied: 1) to specify complex interventions across patient journeys; and 2) to investigate consumer views, despite the importance of patient-centred care.

Aim: Using advance care planning (ACP) as an exemplar complex healthcare process, we describe a method for using the AACTT framework to 1) map a complex model of care across a patient journey 2) capture the consumer perspective; and 3) operationalise these perspectives by comparing across groups and identifying alignments or misalignments.

Methods: Two groups were recruited (healthcare professionals and consumers). Informed by the AACTT framework, four focus groups discussed the process of ACP across existing care pathways. Maps visually representing the perspectives and preferences of healthcare professionals and consumers were co-created iteratively. Qualitative data was deductively coded to the AACTT framework and inductively coded to identify themes within domains. Maps were circulated for critical feedback and refined.

Results: Healthcare professional (n-13) and consumer perspectives (n = 11) highlighted what is 'currently occurring' in practice, what is 'not occurring', and what 'should be occurring' to align practice with consumer preferences of care. Comparing participant perspectives identified that most misalignment occurred within the actor, context, and time domains. Misalignment was found predominantly in actions 'occurring sometimes', with no converging perspectives reported for the context and time domains.

Conclusion: This novel application of the AACTT framework systematically brings in the consumer voice in ways that may influence the delivery of care. This approach to specifying healthcare professional and consumer perspectives across a complex care pathway identifies barriers that are not found with traditional mapping methods or in current applications of the AACTT framework.

Keywords: AACTT Framework; Complex interventions; Methods; Process mapping.

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Conflict of interest statement

Declarations. Ethics approval and informed verbal consent to participate: Verbal informed consent was obtained from all participants. This study has been conducted in accordance with the Declaration of Helsinki and the full ethical approval obtained from the Human Research Ethics Committee of Peter MacCallum Cancer Centre (HREC/88849/PMCC). Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Adapted from the phases of ACP proposed in Guccione et al. (2023)
Fig. 2
Fig. 2
Actions identified across ACP phases from the healthcare professional and consumer groups’ perspectives
Fig. 3
Fig. 3
Healthcare professional and consumer perspectives across AACTT for actions sometimes and not occurring
Fig. 4
Fig. 4
Five-step approach to mapping provider and consumer perspectives using the AACTT framework
See this image and copyright information in PMC

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