title: The views of health care professionals about selective decontamination of the digestive tract: an international, theoretically informed interview study.
abstract: OBJECTIVE
  Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians' views about SDD in regions with limited or no adoption of SDD.
  
  
  METHODS
  Participants were health professionals with "decisional authority" for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery, and further SDD research were explored. Directed content analysis of interview data identified subthemes, which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored.
  
  
  RESULTS
  One hundred forty-one participants provided interview data. Fifty-six subthemes were identified; 46 were common across regions. Beliefs about consequences were the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as "worry," "anxiety," and "fear" when discussing potential antibiotic resistance associated with SDD.
  
  
  CONCLUSIONS
  We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes.
authors.affiliation: Aberdeen Health Psychology Group, Health Services Research Unit, University of Aberdeen, Aberdeen, UK; Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Eilidh M
authors.initials: EM
authors.lastname: Duncan
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and Department of Anesthesia, University of Toronto, Toronto, Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cuthbertson
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Prior
authors.affiliation: Centre for Health Practice Innovation, Griffith Health Institute, Griffith University, and The Gold Coast Hospital, Griffith, Queensland, Australia.
authors.forename: Andrea P
authors.initials: AP
authors.lastname: Marshall
authors.affiliation: Centre for the Study of Social and Legal Responses to Violence, University of Guelph, Ontario, Canada.
authors.forename: Elisabeth C
authors.initials: EC
authors.lastname: Wells
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Todd
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Denise
authors.initials: D
authors.lastname: Bolsover
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Rumana S
authors.initials: RS
authors.lastname: Newlands
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: Webster
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Rose
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Marion K
authors.initials: MK
authors.lastname: Campbell
authors.affiliation: Intensive Care Unit, University College Hospital, London, UK.
authors.forename: Geoff
authors.initials: G
authors.lastname: Bellingan
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Seppelt
authors.affiliation: School of Health Sciences, City University London, London, UK. Electronic address: Jill.Francis.1@city.ac.uk.
authors.forename: Jill J
authors.initials: JJ
authors.lastname: Francis
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000523:psychology*; D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D003428:Cross Infection / Q000517:prevention & control*; D003657:Decision Making; D003666:Decontamination; D003697:Delphi Technique; D004352:Drug Resistance, Microbial; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units; D008037:Linguistics; D008297:Male; D009520:New Zealand; D011322:Primary Prevention / Q000379:methods*; D036301:Qualitative Research; D006113:United Kingdom
keywords: Antibiotic prophylaxis; Intensive care unit; Qualitative research; Theoretical domains framework