Pilot trial of The Living Well Toolkit: qualitative analysis and implications for refinement and future implementation

Abstract

Background: Following a neurological event, people's long-term health and well-being is hampered by a system that struggles to deliver person-centred communication and coordinated care and fails to harness individual and family capability to live well with the condition. We aimed to implement and evaluate a toolkit package to support these processes for people with long-term neurological conditions. Methods: This is a multi-phased study drawing on the principles of participatory research. In this pilot phase, the toolkit package was introduced to clinicians, who introduced it to clients in four neurorehabilitation settings (inpatient and community-based). Individual and focus group interviews were carried out with clients (n = 10) and clinicians (n = 9). Data were categorised by the four components of Normalisation Process Theory (NPT), and data within each component was then coded inductively. This analysis was used to inform revisions to the toolkit package and wider implementation processes. Results: There was widespread support for the principles underpinning the toolkit package from clients and clinicians. However, it was less clear how the client toolkit could support these principles in clinical practice which impacted buy-in. The flexibility of use of the client toolkit, which we encouraged, made it difficult for clinicians and clients to be clear about its purpose and for clinicians to operationalise in practice. Clinicians and clients identified a number of barriers that limited the time, energy and work users were able or prepared to invest, to the extent that uptake of the toolkit package was modest. Use of the toolkit package appeared more likely when clinicians perceived it to augment existing processes (e.g. goal setting) rather than detract from 'doing' therapy. This analysis was used to inform revisions to the toolkit package, including simplification of the client toolkit, development of videos with examples of use and a modular and reflective training package for clinical services. The refinements were intended to improve sense-making and minimise the cognitive barriers associated with implementation of a new intervention. Conclusion: Understanding how supporting the client toolkit could add value to the therapeutic encounter was necessary for clinicians to invest time and perceive the worth of the toolkit package.

Evaluation of a leadership development impact assessment toolkit: a comparative case study of experts’ perspectives in three Canadian provinces

“…In line with these attributes' merits, a recent systematic review showed that barriers might hinder LHS 36,3 toolkit uptake consisted of but not limited to time restrictions, costs, difficulty to use and dissatisfaction with the toolkit's content (Hempel et al, 2019). The iterative refinement process suggests that the continuous supports tailored to organizations' needs likely increases a toolkit's uptake (Mudge et al, 2020).…”

Physiotherapists’ views on their role in self-management approaches: A qualitative systematic review

“…Furthermore, there are calls to move away from seeing biomedical approaches and person-centred care as dichotomous but rather on a continuum (Mudge et al, 2020;Terry and Kayes, 2019). Adopting a view of person-centredness as a continuum would encourage an understanding that improvements are possible (Mudge et al, 2020;Terry and Kayes, 2019).…”

“…Furthermore, there are calls to move away from seeing biomedical approaches and person-centred care as dichotomous but rather on a continuum (Mudge et al, 2020;Terry and Kayes, 2019). Adopting a view of person-centredness as a continuum would encourage an understanding that improvements are possible (Mudge et al, 2020;Terry and Kayes, 2019). This view would help physiotherapists make small, incremental changes within biomedical healthcare environments, towards approaches that support the empowerment of patients in actively selfmanaging their long-term conditions such as seeking to involve patients in decision making or seeing patients as people and collaborative partners.…”

Transitions from healthcare to self-care: a qualitative study of falls service practitioners' views on self-management

“…This could indicate that practitioners were aware of patient choice and autonomy, or suggestive of a paternalistic, reductionist approach to exercise for falls prevention which was not as patient centred as was first thought. It is important to recognise that views on person-centredness are on a continuum and as such practitioners will be at varying points on that continuum [19,20].…”