Otago exercise programme—from evidence to practice: a qualitative study of physiotherapists’ perceptions of the importance of organisational factors of leadership, context and culture for knowledge translation in Norway

Abstract

Background Falls and fall-related injuries are a major public health problem and an international priority for health services. Despite research showing that evidence-based fall prevention is effective, its translation into practice has been delayed and limited. Although organisational factors such as leadership, culture and context are key factors for implementing evidence-based practice, there is still limited information on whether these factors represent barriers in the Norwegian and international healthcare context. Thus, this study aimed to explore the views of physiotherapists in clinical practice and their leaders’ views on the importance of organisational factors, such as leadership, culture and contextual and human resources, regarding successful knowledge translation of the Otago evidence-based fall programme in a Norwegian community. Methods Four in-depth interviews with physiotherapists and a focus group interview with nine physiotherapists and leaders representing local hospitals and municipalities were conducted to collect data. The data were analysed using a thematic analysis. Results The analysis yielded an overarching theme: an empowering leader as an anchor is needed for successful knowledge translation of physiotherapists’ and leaders’ views about the role of organisational structure, leadership, culture, financial resources and competence in research-based knowledge, as well as how to enhance the clinical staff’s expertise. Four main themes further elaborated on the overarching theme: (1) multifactor leadership—the importance of reinforcement, knowledge, goals and attention; (2) potential for change in professional roles as shaped by culture, context and type of practice; (3) knowledge translation—the tension between real-life capabilities, optimism and learning; and (4) different types of support—environmental resources and social influences. Conclusions This study highlighted the importance of organisational factors in knowledge translation in fall prevention. The findings emphasise the importance of leaders’ role and style in providing a supportive culture and contextual factors during the knowledge translation process. This study provides an understanding of the knowledge translation and sustainability of evidence-based practice and the Otago exercise programme for fall prevention programmes for community-dwelling older adults in Norway.

Contextual determinants influencing the implementation of fall prevention in the community: a scoping review

“…Data-extraction of descriptive data showed that in seven studies ( 38 – 40 , 43 , 46 , 48 , 49 ), only health care professionals (e.g., physical therapists, general practitioners, pharmacists, allied health assistances, occupational therapists) were included. In the other studies, there was a combination of health care and social care professionals (e.g., informal care, social service workers) ( 41 , 47 ) and/or other professionals (e.g., clinical support staff, fitness leaders, practice site leaders, volunteers) ( 42 , 44 , 45 , 50 – 52 ). Furthermore, eleven studies ( 38 – 40 , 42 – 45 , 48 – 50 , 52 ) focused primarily on primary care as setting; the other four studies ( 41 , 46 , 47 , 51 ) concentrated on a broader community-based setting.…”

“…In the other studies, there was a combination of health care and social care professionals (e.g., informal care, social service workers) ( 41 , 47 ) and/or other professionals (e.g., clinical support staff, fitness leaders, practice site leaders, volunteers) ( 42 , 44 , 45 , 50 – 52 ). Furthermore, eleven studies ( 38 – 40 , 42 – 45 , 48 – 50 , 52 ) focused primarily on primary care as setting; the other four studies ( 41 , 46 , 47 , 51 ) concentrated on a broader community-based setting. Ten studies ( 39 – 41 , 44 – 49 , 52 ) used qualitative approaches only, such as semi-structured interviews and focus groups, whereas five studies ( 38 , 42 , 43 , 50 , 51 ) applied mixed methods with a qualitative and quantitative approach (e.g., surveys and documents).…”

“…Ten studies ( 39 – 41 , 44 – 49 , 52 ) used qualitative approaches only, such as semi-structured interviews and focus groups, whereas five studies ( 38 , 42 , 43 , 50 , 51 ) applied mixed methods with a qualitative and quantitative approach (e.g., surveys and documents). Of all included studies, three were conducted in Norway ( 39 , 44 , 45 ), three in Australia ( 40 , 49 , 51 ), three in the Netherlands ( 43 , 48 , 50 ), two in Canada ( 46 , 47 ), two in Switzerland ( 38 , 41 ) and two in the United States of America ( 42 , 52 ) ( Table 1 ).…”

“…“Evidence strength & quality” of the intervention was identified more often in the literature than in the CMs (three studies ( 44 , 45 , 51 ) and one CM d , respectively). The construct “adaptability” was identified in as many CMs as studies [three studies ( 44 , 45 , 52 ) and three CMs a,b,d ]. It seems to be important that interventions are tailored to the context where the implementation takes place ( 44 ).…”

Barriers and facilitators to the implementation of a structured visual assessment after stroke in municipal health care services

“…Regarding being involved in implementing the new vision assessment routines in the project, all the participants agreed it was important for them that their leader supported and facilitated their participation in this implementation project. A recent Norwegian study also highlights that an empowering leader is a facilitator for implementation in municipal health care services [ 55 ].…”