Journal Article

Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation

Alicia C. Bunger, John D. Corrigan, Kathryn A. Hyzak, Jennifer Bogner, Alan K. Davis

2023

Overview

Background Traumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers’ attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings. Methods We used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays. Results Only 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes ( OR : 0.67, p  < .001) and greater subjective norms ( OR : 0.12, p  < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption ( OR : 0.30; p  < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening. Conclusions This study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.

• Publisher: Springer Science and Business Media LLC,BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Addictive behaviors / Attitudes / Behavior / Behavior Therapy / Behavioral health / Behavioral health care / Brain / Brain damage / Brain Injuries, Traumatic / Clinical decision making / Comorbidity / Continuing education / Decision making / Domestic violence / Drug use / Education / Evaluation / Evidence-based medicine / Evidence-based practice / Health Administration / Health behavior / Health care / Health Informatics / Health Policy / Health Promotion and Disease Prevention / Health services / Health Services Research / Humans / Hypothesis testing / Implementation / Injuries / Intention / Intervention / Investigations / Leadership / Locus of control / Magnetic resonance imaging / Medical decision making / Medical screening / Medicine / Medicine & Public Health / Medicine (General) / Mental disorders / Mental health / Methods / Mixed methods / Mixed methods research / Motivation / Norms / OSU TBI-ID / Perceived control / Polls & surveys / Psychiatry / Public Health / R5-920 / Structural equation modeling / Subjectivity / Substance abuse treatment / Tests / Theory / Theory of Planned Behavior / Training / Trauma / Traumatic brain injury / Treatment methods / Uptake