title: Factors that influence effective perioperative temperature management by anesthesiologists: a qualitative study using the Theoretical Domains Framework.
abstract: OBJECTIVE
  Inadvertent perioperative hypothermia (IPH) is associated with a range of adverse outcomes. Safe and effective warming techniques exist to prevent IPH; however, IPH remains common. This study aimed to identify factors that anesthesiologists perceive may influence temperature management during the perioperative period.
  
  
  METHODS
  After Research Ethics Board approval, semi-structured interviews were conducted with staff anesthesiologists at a Canadian academic hospital. An interview guide based on the Theoretical Domains Framework (TDF) was used to capture 14 theoretical domains that may influence temperature management. The interview transcripts were coded using direct content analysis to generate specific beliefs and to identify relevant TDF domains perceived to influence temperature management behaviour.
  
  
  RESULTS
  Data saturation was achieved after 15 interviews. The following nine theoretical domains were identified as relevant to designing an intervention for practices in perioperative temperature management: knowledge, beliefs about capabilities, beliefs about consequences, reinforcement, memory/attention/decision-making, environmental context and resources, social/professional role/identity, social influences, and behavioural regulation. Potential target areas to improve temperature management practices include interventions that address information needs about individual temperature management behaviour as well as patient outcome (feedback), increasing awareness of possible temperature management strategies and guidelines, and a range of equipment and surgical team dynamics that influence temperature management.
  
  
  CONCLUSIONS
  This study identified several potential target areas for future interventions from nine of the TDF behavioural domains that anesthesiologists perceive to drive their temperature management practices. Future interventions that aim to close the evidence-practice gap in perioperative temperature management may include these targets.
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing 1401, Ottawa, ON, K1H 8L6, Canada. sboet@toh.ca.|Department of Innovation in Medical Education (DIME), University of Ottawa, Faculty of Medicine, Ottawa, ON, Canada. sboet@toh.ca.|Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada. sboet@toh.ca.
authors.forename: Sylvain
authors.identifier: http://orcid.org/0000-0002-1679-818X
authors.initials: S
authors.lastname: Boet
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.|School of Health Sciences, City, University of London, Northampton Square, London, UK.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Patey
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Justine S
authors.initials: JS
authors.lastname: Baron
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing 1401, Ottawa, ON, K1H 8L6, Canada.
authors.forename: Karim
authors.initials: K
authors.lastname: Mohamed
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Ashlee-Ann E
authors.initials: AE
authors.lastname: Pigford
authors.affiliation: Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, 501 Smyth Road, Critical Care Wing 1401, Ottawa, ON, K1H 8L6, Canada.|Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Bryson
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.|School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada.
authors.forename: Jamie C
authors.initials: JC
authors.lastname: Brehaut
authors.affiliation: Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada.|Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: Grimshaw
mesh_terms: D000072080:Anesthesiologists; D000776:Anesthesiology / Q000379:methods; D001831:Body Temperature; D002170:Canada; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000517:prevention & control*; D007407:Interviews as Topic; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D019990:Perioperative Care / Q000379:methods*