Using a dark logic model to explore adverse effects in audit and feedback: a qualitative study of gaming in colonoscopy.

Abstract Background Audit and feedback (A&F) interventions improve patient care but may result in negative effects. To evaluate plausible harms and maximise benefits, a-priori theorisation using dark logic models can be useful. We aimed to assess the unintended adverse effects of A&F in colonoscopy using Feedback Intervention Theory (FIT) based dark logic model. Methods As part of the National Endoscopy Database Automated Performance Reports to Improve Quality Outcomes Trial we undertook a qualitative study exploring current A&F practices in colonoscopy. Interviews were undertaken with endoscopists from six NHS endoscopy centres across England, purposively sampled for clinical background and professional experience. A framework method analysis of A&F in endoscopy was performed, mapping themes of paradoxical outcomes and patient harm to FIT and the theory of planned behaviour (TPB). Results Data saturation was achieved on 19th participant, with endoscopists from nursing, surgical and medical professional backgrounds and a median of 7 years’ endoscopy experience (range 2–29 years).