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What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework
  1. Trish A Gray1,2,
  2. Paul Wilson2,3,
  3. Jo C Dumville1,2,
  4. Nicky A Cullum1,2,4
  1. 1 Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
  2. 2 NIHR CLAHRC Greater Manchester, Salford Royal NHS Foundation Trust, Manchester, UK
  3. 3 Alliance Manchester Business School, University of Manchester, Manchester, UK
  4. 4 Research and Innovation Division, Manchester University NHS Foundation Trust, Manchester, UK
  1. Correspondence to Dr Trish A Gray; trish.gray{at}


Objectives Research has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no known patient benefit. This study explored the factors that influence care in community settings for people with complex wounds, to develop a deeper understanding of the current context of wound care and variation in practice.

Design Qualitative focus group study using the Theoretical Domains Framework (TDF) to structure the questions, prompts and analyses.

Setting Community healthcare settings in the North of England, UK.

Participants Forty-six clinical professionals who cared for patients with complex wounds and eight non-clinical professionals who were responsible for procuring wound care products participated across six focus group interviews.

Results We found the TDF domains: environmental context and resources, knowledge, skills, social influences and behaviour regulation to best explain the variation in wound care and the underuse of research evidence. Factors such as financial pressures were perceived as having a negative effect on the continuity of care, the availability of wound care services and workloads. We found practice to be mainly based on experiential knowledge and personal preference and highly influenced by colleagues, patients and the pharmaceutical industry, although not by research evidence.

Conclusions Our study provides new insight into the role that experiential learning and social influences play in determining wound care and on the limited influence of research. Workforce pressures and limited resources are perceived to impede care by reducing patient access to services and the ability to provide holistic care. Participative collaboration between university and healthcare organisations may offer a supportive route to addressing issues, implementing sustainable changes to practice and service delivery and a resolute commitment to research use among clinical professionals.

  • qualitative research
  • focus group
  • wound management
  • healthcare professional
  • healthcare quality
  • theoretical domains framework

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  • Contributors NAC, JCD and TAG conceived the idea and design for the overall project. PW contributed to further development of the study design. TAG, PW and JCD collected the data. TAG and PW were responsible for data analyses. TAG created the original draft of the manuscript. All authors contributed to the interpretation of study findings, critical revision of the manuscript for important intellectual content and approval of the final manuscript.

  • Funding This project was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester. The NIHR CLAHRC Greater Manchester is a partnership between providers and commissioners from the NHS, industry and the third sector, as well as clinical and research staff from the University of Manchester.

  • Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health.

  • Competing interests None declared.

  • Ethics approval Ethics approval was sought and granted from the University of Manchester Research Ethics Committee (Refs 15272, 15327 and 2017-0559-1767) and HRA approval was sought and granted (Refs IRAS 174691, 184865 and 219918). Written informed consent was obtained from all participants

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Requests for access to data should be addressed to the corresponding author.

  • Patient consent for publication Not required.

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