Importance of internal consistency in implementation programmes. A qualitative study of focus-group interviews.

Abstract

Background Programmes for implementing evidence-based treatments (EBTs) reach their goals if they succeed in institutionalizing the EBTs into routine clinical practices. Resistance to change is a common response to such programmes, undermining their ultimate output. This also happened with Ostrobothnia Depression Programme (ODP) in Finland, which was targeted at several regional psychiatric teams. We conducted a process evaluation of it to ascertain how managerial and executive practices enable or inhibit implementation and how to overcome resistance.Methods We conducted focus group interviews to scrutinize the phases of preparation and practical execution of the ODP from the perspectives of management and programme executives. To gather the data, we applied the revised Socratic approach for health technology assessment and the rapid assessment process model. We analysed the data deductively according to the Normalization Process Theory.Results We identified two main critical issues: 1) The ODP comprised two simultaneously administered programmes, one for the implementation of two EBTs and the other to study their effectiveness. Tension between these two programmes was apparent right from the beginning. 2) The programme had a simplistic top-down design and, in the preparation phase, collaboration with its target groups was delayed and minimal. No formal implementation theory or framework was applied. In addition, independent internal processes in the separate teams influenced their reception of the ODP.Conclusion We recommend early collaboration between team leaders and prospective treatment providers right from the preparation phase of an EBT implementation programme. Agreement on goals and the instruments for achieving them is essential. The strategies for execution should be adjusted with respect to the prevailing implementation climates within the separate target teams. A collaborative approach may enhance the implementation climate and mitigate resistance. Applying some appropriate implementation theories and frameworks may facilitate that work.