Theoretical domains and subthemes.

IntroductionSevere malaria often results in childhood disability. The prevalence of disability related to severe malaria is significant and is estimated to affect up to 53% of severe malaria survivors. In contrast, information is sparse about how healthcare providers in Africa think about or provide rehabilitation support in acute and post-acute phases respectively. Understanding the perceptions and behaviors of healthcare providers treating malaria could help inform malaria-related disability research, policy, and practice, aimed at the providers themselves. This study explored the perceptions and behaviors of healthcare providers towards rehabilitation for children with severe malaria-related disability. The Theoretical Domains Framework was used to describe the findings relative to wider literature on health provider behavior change.MethodsA qualitative descriptive approach was used to interview thirteen healthcare providers recruited purposively based on their clinical professions, roles, and settings. Data were analyzed using directed content analysis. We decided on the most prominent theoretical domains considering the frequency of specific perceptions and behaviors across the participants, the frequency of perceptions and behaviors in each domain, and evidence of strong perceptions and behaviors.ResultsNine out of fourteen theoretical domains were identified. These domains were: Beliefs about consequences, environmental context and resources, goals, knowledge, skills, optimism, reinforcement, social influences, and social or professional role and identity. Healthcare providers’ beliefs about their roles in screening for disability or referring to rehabilitation were less positive.ConclusionsThe findings of this study suggest the need for interventions to support healthcare providers in acute phases (prevention and control of severe malaria) and post-acute phases (disability screening, referral, and rehabilitation care). Recommended interventions should focus on developing clinical guidelines, training clinicians, addressing institutional factors, and modifying external social influences such as socio-cultural factors.引言 重症疟疾常可导致儿童残疾。与重症疟疾相关的残疾患病率颇高，据估计，多达53%的重症疟疾幸存者会出现此类残疾。与之形成对比的是，目前关于非洲医疗服务提供者对急性期及急性期后康复支持的认知与提供情况的相关信息十分匮乏。了解疟疾诊疗医护人员的认知与行为，可为与疟疾相关残疾的研究、政策制定及临床实践提供参考，最终惠及医护人员自身。本研究针对重症疟疾相关性残疾儿童的康复护理，探讨了医护人员的认知与行为表现，并采用理论域框架（Theoretical Domains Framework）结合健康医护人员行为改变的相关广泛文献对研究结果进行阐释。 方法 本研究采用定性描述性研究方法，基于医护人员的临床专业、工作职责及执业场景进行目的性抽样，共访谈13名医护人员。数据采用定向内容分析进行编码分析。我们根据参与者间特定认知与行为的出现频次、各理论域内认知与行为的出现频次，以及存在显著认知与行为表现的证据，确定了最具代表性的理论域。 结果 本研究共识别出14个理论域中的9个，分别为：后果信念、环境背景与资源、目标、知识、技能、乐观性、强化因素、社会影响，以及社会/职业角色与身份认同。医护人员对于自身在残疾筛查或转诊至康复服务方面的职责信念相对消极。 结论 本研究结果表明，需制定相关干预措施，以支持医护人员开展急性期（重症疟疾的预防与控制）及急性期后（残疾筛查、转诊及康复护理）的相关工作。推荐的干预措施应聚焦于制定临床指南、开展临床人员培训、解决机构层面的相关问题，以及改善外部社会影响因素（如社会文化因素）。