Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

Abstract

BackgroundBridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.MethodsA qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.ResultsThe theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.ConclusionWhen implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.

Factors influencing organizational adoption and implementation of clinical genetic services

“…to ours, e.g., that the need for and potential compatibility of the innovation should be assessed in implementation planning 14 and that evidence of effectiveness (in this case, evidence of clinical utility and cost-effectiveness) is a prerequisite for the initiation of innovation. 17,18 Diffusion of innovation theory facilitated the interpretation of our findings and generated essential lessons that demonstrate gaps and inform strategies for improving adoption and implementation of genetic services. Understanding the attributes of genetic services-and how these attributes interrelatecan guide design of active, planned, multilevel implementation efforts 5 with tailored application supports for health-care organizations seeking to adopt these services.…”

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

“…27,36,42 Thus, recruitment of units with concurrent involvement in major organizational changes should probably be avoided in implementation studies. 41 In contrast, a context aspect in the study that seemed to promote the achievement of the goals in the intervention assignment was the presence of a supportive operational management system. In line with this, a previous study has suggested that the presence of a purposeful and active management system supports planning, performing, and follow-up and thus contributes to continuous quality improvements.…”

“…8,29 Particular context aspects were found to have a negative influence on managers' commitment to the intervention assignment, such as if the guideline recommendations corresponded with a unit's mission, and additional major changes were simultaneously taking place. Previous research has shown that the perceived fit between the object of implementation and the units' needs and priorities is of great importance for frontline managers to support implementation, 35 while additional organizational change impedes implementation, 41 as does a lack of time. 27,36,42 Thus, recruitment of units with concurrent involvement in major organizational changes should probably be avoided in implementation studies.…”

Parkinson's disease treatments: focus on transcranial direct current stimulation (tDCS)

“…84 Some of the factors relate to the nature of the innovation itself (eg, the complexity and compatibility of the technology), the characteristics of the adopting organization (eg, attitudes and perceptions), and behavior pattern characteristics of the adopting organization (eg, the size and structure of available resources). This said, tDCS has been around for over 100 years now.…”