Characterising an implementation intervention in terms of behaviour change techniques and theory: the 'Sepsis Six' clinical care bundle

Sepsis is a major cause of death from infection, with a mortality rate of 36 %. This can be halved by implementing the 'Sepsis Six' evidence-based care bundle within 1 h of presentation. A UK audit has shown that median implementation rates are 27-47 % and interventions to improve this have demonstrated minimal effects. In order to develop more effective implementation interventions, it is helpful to obtain detailed characterisations of current interventions and to draw on behavioural theory to identify mechanisms of change. The aim of this study was to illustrate this process by using the Behaviour Change Wheel; Behaviour Change Technique (BCT) Taxonomy; Capability, Opportunity, Motivation model of behaviour; and Theoretical Domains Framework to characterise the content and theoretical mechanisms of action of an existing intervention to implement Sepsis Six

Trust in Government: Narrowing the Ideological Gap over the Federal Budget

This is the final version. Available from Journal of Behavioral Public Administration via the DOI in this record.Do liberals and conservatives who trust the government have more similar preferences regarding the federal budget than liberals and conservatives who do not? Prior research has shown that the ideological gap over spending increases and tax cuts narrows at high levels of trust in government. We extend this literature by examining whether the dampening effect of trust operates when more difficult budgetary decisions (spending cuts and tax increases) have to be made. Although related, a tax increase demands greater material and ideological sacrifice from individuals than tax cuts. The same logic can be applied to support for spending cuts. We test the trust-as-heuristic hypothesis using measures of revealed budgetary preferences from a population-based survey containing an embedded budget simulation. Our findings show that trusting liberals and conservatives share similar preferences toward spending cuts and tax increases, adding an important empirical addendum to a theory based on sacrificial costs.European Research CouncilEconomic and Social Research Council (ESRC

Bridging the gap between pragmatic intervention design and theory: using behavioural science tools to modify an existing quality improvement programme to implement "Sepsis Six"

BACKGROUND: Sepsis has a mortality rate of 40 %, which can be halved if the evidence-based "Sepsis Six" care bundle is implemented within 1 h. UK audit shows low implementation rates. Interventions to improve this have had minimal effects. Quality improvement programmes could be further developed by using theoretical frameworks (Theoretical Domains Framework (TDF)) to modify existing interventions by identifying influences on clinical behaviour and selecting appropriate content. The aim of this study was to illustrate using this process to modify an intervention designed using plan-do-study-act (P-D-S-A) cycles that had achieved partial success in improving Sepsis Six implementation in one hospital. METHODS: Factors influencing implementation were investigated using the TDF to analyse interviews with 34 health professionals. The nursing team who developed and facilitated the intervention used the data to select modifications using the Behaviour Change Technique (BCT) Taxonomy (v1) and the APEASE criteria: affordability, practicability, effectiveness, acceptability, safety and equity. RESULTS: Five themes were identified as influencing implementation and guided intervention modification. These were:(1) "knowing what to do and why" (TDF domains knowledge, social/professional role and identity); (2) "risks and benefits" (beliefs about consequences), e.g. fear of harming patients through fluid overload acting as a barrier to implementation versus belief in the bundle's effectiveness acting as a lever to implementation; (3) "working together" (social influences, social/professional role and identity), e.g. team collaboration acting as a lever versus doctor/nurse conflict acting as a barrier; (4) "empowerment and support" (beliefs about capabilities, social/professional role and identity, behavioural regulation, social influences), e.g. involving staff in intervention development acting as a lever versus lack of confidence to challenge colleagues' decisions not to implement acting as a barrier; (5) "staffing levels" (environmental context and resources), e.g. shortages of doctors at night preventing implementation. The modified intervention included six new BCTs and consisted of two additional components (Sepsis Six training for the Hospital at Night Co-ordinator; a partnership agreement endorsing engagement of all clinical staff and permitting collegial challenge) and modifications to two existing components (staff education sessions; documents and materials). CONCLUSIONS: This work demonstrates the feasibility of the TDF and BCT Taxonomy (v1) for developing an existing quality improvement intervention. The tools are compatible with the pragmatic P-D-S-A cycle approach generally used in quality improvement work

Bidirectional association between mental health and physical activity in older adults: Whitehall II prospective cohort study.

To investigate longitudinal and bidirectional associations between mental health and physical activity from midlife into old age

Legitimacy gaps, taxpayer conflict, and the politics of austerity in the UK

Following the 2008 financial crisis, fiscal deficit reduction has become the name of the game for many Western states. This article uses focus group data to explore the legitimation of austerity in the United Kingdom. It is argued that fiscal consolidation speaks to real concerns citizens have over unfair redistribution to supposed ‘undeserving’ groups. The undeserving rich and poor are stigmatised during times of austerity since they are assumed to take more than they give from the public purse—leaving taxpayers, the assumption goes, to pick up the bill. By speaking to this legitimacy gap between prudent normative expectations and the lived experiences of state profligacy, fiscal consolidation can appear to speak to the interests of ‘the taxpayer’—a group conceptualised as a sense of group position that arises from collective sense-making rather than a pre-given constituency

A comparative framework: how broadly applicable is a 'rigorous' critical junctures framework?

The paper tests Hogan and Doyle's (2007, 2008) framework for examining critical junctures. This framework sought to incorporate the concept of ideational change in understanding critical junctures. Until its development, frameworks utilized in identifying critical junctures were subjective, seeking only to identify crisis, and subsequent policy changes, arguing that one invariably led to the other, as both occurred around the same time. Hogan and Doyle (2007, 2008) hypothesized ideational change as an intermediating variable in their framework, determining if, and when, a crisis leads to radical policy change. Here we test this framework on cases similar to, but different from, those employed in developing the exemplar. This will enable us determine whether the framework's relegation of ideational change to a condition of crisis holds, or, if ideational change has more importance than is ascribed to it by this framework. This will also enable us determined if the framework itself is robust, and fit for the purposes it was designed to perform — identifying the nature of policy change

Power, norms and institutional change in the European Union: the protection of the free movement of goods

How do institutions of the European Union change? Using an institutionalist approach, this article highlights the interplay between power, cognitive limits, and the normative order that underpins institutional settings and assesses their impact upon the process of institutional change. Empirical evidence from recent attempts to reinforce the protection of the free movement of goods in the EU suggests that, under conditions of uncertainty, actors with ambiguous preferences assess attempts at institutional change on the basis of the historically defined normative order which holds a given institutional structure together. Hence, path dependent and incremental change occurs even when more ambitious and functionally superior proposals are on offer

Historical institutionalism and the politics of sustainable energy transitions: a research agenda

Improving the understanding of the politics of sustainable energy transitions has become a major focus for research. This paper builds on recent interest in institutionalist approaches to consider in some depth the agenda arising from a historical institutionalist perspective on such transitions. It is argued that historical institutionalism is a valuable complement to socio-technical systems approaches, offering tools for the explicit analysis of institutional dynamics that are present but implicit in the latter framework, opening up new questions and providing useful empirical material relevant for the study of the wider political contexts within which transitions are emerging. Deploying a number of core concepts including veto players, power, unintended consequences, and positive and negative feedback in a variety of ways, the paper explores research agendas in two broad areas: understanding diversity in transition outcomes in terms of the effects of different institutional arrangements, and the understanding of transitions in terms of institutional development and change. A range of issues are explored, including: the roles of electoral and political institutions, regulatory agencies, the creation of politically credible commitment to transition policies, power and incumbency, institutional systems and varieties of capitalism, sources of regime stability and instability, policy feedback effects, and types of gradual institutional change. The paper concludes with some observations on the potential and limitations of historical institutionalism, and briefly considers the question of whether there may be specific institutional configurations that would facilitate more rapid sustainable energy transitions

Taxes and Fiscal Sociology

This article reviews recent research in fiscal sociology. We specifically examine contributions to the study of taxation that illuminate core issues in the sociology of contemporary capitalism, including the causes of poverty and inequality in rich countries and of inequality between rich and poor countries. Research on developed countries suggests that tax policy changes are important for explaining rising income inequality, tax policies may structure durable inequalities of race and gender, and earnings-conditional tax subsidies may alleviate poverty more effectively and with less stigma than means-tested social spending. Scholars also find the most generous welfare states rely the most heavily on regressive taxes, although there is disagreement over how this association arises. Comparative research on developing countries shows consumption taxes are more conducive to growth than taxes on income, tax-financed spending benefits growth if it is spent on productive investments, and taxation strengthened democracy and state building in medieval and early modern Europe. However, there is disagreement as to whether taxation contributes to state building in contemporary developing countries and whether foreign aid undermines democracy by undermining taxation. These questions are the focus of considerable current research