Factors influencing implementation of the GLA:D Back, an educational/exercise intervention for low back pain: a mixed-methods study

Abstract

Introduction and aims: Guidelines for low back pain (LBP) management recommend patient education and exercises. GLA:D Back, a structured group-based patient-education exercise program for LBP, facilitates evidence-based care implementation. This study aimed to inform on the implementation processes, assessing clinician-related factors. Objectives were to describe profiles of implementers and nonimplementers by demographics, and responses to the tailored version of the Determinants of Implementation Behaviour Questionnaire (DIBQ-t) qualitatively explore clinician perspectives on implementation, and compare the results of the DIBQ-t with the interview data to evaluate their fit of integration for facilitators, barriers, and new insights. Methods: A mixed-methods parallel design study was conducted. Physiotherapists and chiropractors, educated in the GLA:D Back program, were asked to complete the DIBQ-t (measuring theoretical determinants of implementation) 6 months after their training. Implementers and nonimplementers of the program were selected for interviews. Qualitative data were used to understand clinicians’ viewpoints on implementation, providing a broader perspective on the quantitative data and exploring new aspects. Results: More physiotherapists than chiropractors implemented the program. Implementers responded more positively on most domains of the DIBQ-t. The interviews revealed three themes important for implementation: personal gain , practicalities, and buying-in on the program. Clinicians’ attitudes to the program appeared additionally as relevant to implementation. Conclusion: The profession of the clinician was associated with implementation behavior. Implementers and nonimplementers identified the same themes but perceived them as either positive or negative. Both groups reported high levels of knowledge and skills, indicating that training alone is insufficient for implementation.

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

“…The previous studies have applied the DIBQ-t in evaluating the expectations of the implementation process in profession-specific interventions. 40 , 41 In the Swedish study, facilitating role of most domains of DIBQ-t was reported. 41 The Danish study investigated clinician-level factors related to implementing evidence-based care for LBP patients in primary care using DIBQ-t and qualitative assessments.…”

The Determinants of Implementation Behavior Questionnaire in multiprofessional rehabilitation context (DIBQ-mp): A mixed methods tailoring study with Finnish cross-cultural adaptation

“…Qualitative data was valuable in understanding why competence of knowledge and skills were reported both by clinicians that implemented and by those that did not implement the intervention after evidencebased training. The study indicated that training alone is insu cient for implementation (51).…”

“…The authors are not aware of other tools that are intended to be used for the research on implementation of multiprofessional rehabilitation interventions. The previous studies have applied the tailored version of DIBQ in evaluating the expectations of the implementation process (51,52). In the Swedish study, facilitating role of most domains of DIBQ-t was reported (52).…”

The GLA:D BACK self‐management adherence and competence checklist (SMAC Checklist)—Development, content validity and feasibility

“…However, implementation is not straightforward. Some clinicians do not buy in on the underlying cognitive-behavioural principles, and some of those who do, find it challenging to deliver (Ris et al, 2023). Also, the patient receipt indicates potential challenges in targeting individual needs ( Joern et al, 2022).…”