Evaluating the implementation process of a new telerehabilitation modality in three rehabilitation settings using the normalization process theory: study protocol

Kairy, Dahlia; Messier, Frédéric; Zidarov, Diana; Ahmed, Sara; Poissant, Lise; Rushton, Paula W.; Vincent, Claude; Fillion, Brigitte; Lavoie, Véronique

doi:10.1080/20479700.2017.1314119

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…25 When these technologies are applied to rehabilitation within a large healthcare system, the complexity increases. 26 Moreover, these complexities are compounded when extended to providing telerehabilitation to rural and highly rural areas. 27,28 As part of a broader evaluation, we investigated barriers and facilitators to the implementation of a VHA-wide TR program for rural Veterans.…”

Section: Introductionmentioning

confidence: 99%

<p>Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation</p>

Hale–Gallardo¹,

Kreider²,

Jia³

et al. 2020

JMDH

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Purpose Telerehabilitation (TR) is increasingly being used to meet the rehabilitation needs of individuals living in rural areas. Nevertheless, reports on TR implementation for rural patients remain limited. As part of a broader evaluation, this study investigated barriers and facilitators to the implementation of a national TR program to meet the needs of rural Veterans Health Administration (VHA) patients. Methods This study applied a qualitative approach to the RE-AIM framework to investigate barriers and facilitators impacting TR implementation. We conducted in-depth, semi-structured interviews with ten program managers and medical directors within the VHA at three time points during the first 18 months of implementation. Interviews were analyzed using thematic analysis. Results Three themes were identified describing key cultural, infrastructural and logistical, and environmental barriers impacting the reach, adoption, and implementation of TR. Within the themes, facilitators for TR were also identified to include, allowing providers flexibility in implementing TR, mentorship and development of creative approaches to TR training, overcoming infrastructural and logistical TR barriers through championing, and continuous sharing of lessons learned in a community of practice. Discussion This study explicates salient barriers and facilitators encountered during the first 18 months of implementation of a TR program within a national healthcare system in the United States. Implementing TR to meet the rehabilitation needs of Veterans in resource-limited rural environments requires creative approaches and flexibility, as well as perseverance and consistent championing in order to overcome cultural challenges. This, in combination with infrastructural challenges, such as lack of broadband, adds greater complexity to meeting the needs of rural patients. This study provides new and in-depth understanding of the processes by which TR is implemented in a large healthcare system and points to practical real-world lessons in implementing TR for rural patients.

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Section: Introductionmentioning

confidence: 99%

<p>Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation</p>

Hale–Gallardo¹,

Kreider²,

Jia³

et al. 2020

JMDH

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“…The search identified 46 articles with mention of SIC and one or both of the two frameworks. Only 12 of these articles combined use of the SIC with either CFIR (Albers et al, 2020; Ford et al, 2018; Kairy et al, 2019; Spoelstra et al, 2019) or EPIS (Aalsma et al, 2019; Aarons et al, 2017; Bowser et al, 2019; Dickson et al, 2020; Hartzler et al, 2017; Nadeem et al, 2018; Stadnick et al, 2019; Willging et al, 2016) in some fashion. None of these studies had enough detail to understand either how the SIC and qualitative data would be integrated/mixed, with the majority of descriptions suggesting the SIC was only used to measure the process component of implementation within a study guided by the chosen framework.…”

Section: The Need To Investigate the Intersection Between Implementatmentioning

confidence: 99%

A longitudinal mixed method approach for assessing implementation context and process factors: Comparison of three sites from a Housing First implementation strategy pilot

Watson

Snow-Hill

Saldana

et al. 2020

Implementation Research and Practice

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Background: Implementation science’s focus on establishing implementation strategy effectiveness has overshadowed the need to understand differential performance of such strategies under various conditions. Methods allowing for assessment between implementation context and process can help address this gap. This article provides a detailed description of a mixed method procedure for assessing factors related to the implementation context and process intersection, which was developed as part of the pilot study of the Housing First Technical Assistance and Training (HFTAT) program, a multifaceted strategy designed to support Housing First model implementation. Methods: The HFTAT was pilot tested among a sample of three organizations. Our mixed method approach combines two tools often used in implementation research—the Stages of Implementation Completion (SIC) and the Consolidated Framework for Implementation Research—in a novel way. Several stages to analysis were completed, starting with a separate analysis of data pertaining to each measure and then two levels of mixed method analysis. Results: The approach provided a better understanding of the issues that impacted the implementation guided by the HFTAT, suggesting (1) individual determinants seemed to have a bigger impact based on the number of SIC phases they affected, (2) implementation context and process were connected through climate-related factors in the inner setting that made the sites more or less responsive to addressing identified barriers, and (3) there is a need to better assess context factors to identify areas where implementation drivers should be better targeted to facilitate change, and this is supported by prior research. Conclusions: Understanding the underlying factors impacting a setting’s performance related to a specific implementation strategy has potential to improve decision-making and optimize future implementation efforts. The approach likely be as successful combining the SIC with other determinant frameworks and should be utilized at the onset of an implementation project to maximize its usefulness. Plain language summary The field of implementation science needs better approaches for understanding how context (i.e., constraints and opportunities in the implementation setting) and process (i.e., the actions and steps taken during implementation) interact over the course of implementation. Such information would be very useful for understanding the success or failure of specific implementation strategies, which are specific techniques used to increase the adoption, implementation, and sustainability of a specific intervention. This article explains a method to assess the intersection of implementation context and implementation process that we developed to better understand issues that could help explain the effectiveness of an implementation strategy for an intervention for housing people who are experiencing chronic homelessness and who have both a diagnosed substance use disorder and serious mental illness. The method combines two popular implementation tools, the Stages of Implementation Completion and the Consolidated Framework for Implementation Research. Using this method resulted in a better understanding of differences in implementation performance at each of the organizations and how we might improve the implementation strategy. This understanding was better than what we had learned from other approaches we had used before this. We provide some suggestions for how the method can be strengthened for use in other studies.

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“…It applies to new and emergent situations and complicated interventions, such as new working processes or the implementation of new technologies. In the context of technological innovation, NPT has largely been used by researchers and practitioners in hospitals and health care organizations in the fields of cardiology [ 7 ], telerehabilitation [ 8 ], patient-held health IT adoption [ 9 ], electronic health records [ 10 ], or web-based patient feedback [ 11 ]. A published systematic review presented results from studies using NPT as the primary approach for the collection, analysis, and reporting of data in studies in the health care sector, showing that it can effectively assist in the explanation of the success or failure of specific implementation projects [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study

Seguí¹,

Codina²,

Ríos³

et al. 2023

JMIR Hum Factors

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Background The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. Objective This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. Methods We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. Results In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. Conclusions The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation.

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Evaluating the implementation process of a new telerehabilitation modality in three rehabilitation settings using the normalization process theory: study protocol

Cited by 8 publications

References 34 publications

<p>Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation</p>

<p>Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation</p>

A longitudinal mixed method approach for assessing implementation context and process factors: Comparison of three sites from a Housing First implementation strategy pilot

Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study

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