The development of implementation management instruments for a new complex stroke caregiver intervention based on systematic stakeholder and risk analyses

Abstract

Background Stakeholders are important contributors in the implementation of a complex public health intervention. During the development phase of an implementation, alongside careful design of its components and investing in the exploration of the dynamic multi‐stakeholder stroke rehabilitation setting, it is essential to assess possible implementation risks. Systematic stakeholder and risk analyses can guide the exploration process and enable teams involved in complex interventions to develop context‐tailored implementation management instruments. Purpose To develop instruments that facilitate the implementation of the complex stroke caregiver intervention project in the real‐life support system. Methods Systematic stakeholder and risk analyses were conducted composing five activities. Project stakeholders were identified, classified and assessed using a top‐down approach, while implementation risks were identified and assessed by applying a bottom‐up approach. Data were collected through interviews and focus groups. Results Based on the knowledge provided by the stakeholders, two context‐tailored implementation management instruments were designed with a top‐down approach: (1) a comprehensive ‘stakeholder‐risk atlas’ providing individual stakeholder information, such as role, access, contribution, power and interest, expectations, perceived risks and specific engagement activities and (2) an overall ‘project implementation strategy’ concentrating on communication, transparency, network building and professionalism. Conclusion Complex interventions will benefit from early and comprehensive stakeholder and risk analyses. The early involvement of stakeholders, with their insightful knowledge, enables the research team to develop context‐tailored implementation management instruments. Instruments will support the team during implementation and may impact positively on the outcome of the intervention. Knowledge can be obtained by combining top‐down and bottom‐up working approaches.

Optimising a complex stroke caregiver support programme in practice: a participatory action research study

“…This situation poses several challenges for the support system, the patient, and the caregiver (Schuler and Oster 2004). A new primary prevention programme -The Caregivers' Guidewas recently developed by the Institute for Health Research and Social Psychiatry (igsp) -Catholic University of Applied Sciences North Rhine-Westphalia in Aachen, Germany (Krieger et al, 2017;Krieger et al 2019). The programme aims to maintain the quality of life and reduce stroke caregivers´burdens by offering professional support parallel to the current rehabilitation trajectory.…”

“…Secondly, we invested in gaining a comprehensive understanding of the stakeholders and of possible implementation risks in order to develop implementation management instruments. Stakeholder-and risk-analyses were conducted using top-down and bottomup working approaches (Krieger et al, 2019). Directed by the principal investigator, the programme´s stakeholders were identified, classified and assessed top-down and new knowledge was generated ( Figure 1, right side).…”

“…It provides the base for disseminating knowledge and exchanging ideas, as well as safeguarding and connecting the intervention programme with the system. The implementation of the`stakeholder-risk atlas´ (Krieger et al, 2019) was a helpful instrument in guiding the counsellor during her day-to-day interaction with the multiple stakeholders. `Social safety-net´consists of two components: peer group and emergency assistance.…”

“…During our optimisation process, the key stakeholders of the new programme (Krieger et al, 2019) were considered to possess the power to facilitate or hinder the implementation of the new programme (Caron 2014). Consequently, we invested in stakeholder engagement, which led to achieve mutual understanding and trust among the participants, as proposed by Jeffery (2019) and Pandi-Perumal et al (2015).…”

Contextual Exploration of a New Family Caregiver Support Concept for Geriatric Settings Using a Participatory Health Research Strategy

“…The concept of the Caregivers’ Guide was aligned with the real-world system before implementation using participative action research. The program’s stakeholders played a crucial role in this process [ 26 , 27 ].…”