Implementing a training intervention to support caregivers after stroke: a process evaluation examining the initiation and embedding of programme change

Implementation Science

Amanda Farrin²  Josie Dickerson¹  Christopher McKevitt⁴  Anne Forster¹  Geoffrey Harding⁵  Euan Sadler⁴  Rebecca Hawkins³  Mary Godfrey³  David James Clarke¹ 

[1] Academic Unit of Elderly Care and Rehabilitation, Temple Bank House, Bradford Royal Infirmary, Bradford BD9 6RJ, UK;Clinical Trials Research Unit, University of Leeds, Leeds LS2 9JT, UK;Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds, West Yorkshire LS2 9LJ, UK;Department of Primary Care and Public Health Sciences, King’s College London, 7th Floor, Capital House, Guy’s Hospital, 42 Weston Street, London SE1 3QD, UK;Peninsula College of Medicine and Dentistry, University of Exeter, Prince of Wales Road, Exeter, Devon EX4 4SB, UK

关键词: Normalization process theory;    Caregiver training;    Stroke;    Implementation theory;    Process evaluation;   

Others  :  813395
DOI  :  10.1186/1748-5908-8-96

 received in 2012-11-30, accepted in 2013-07-31,  发布年份 2013

【 摘 要 】

Background

Medical Research Council (MRC) guidance identifies implementation as a key element of the development and evaluation process for complex healthcare interventions. Implementation is itself a complex process involving the mobilization of human, material, and organizational resources to change practice within settings that have pre-existing structures, historical patterns of relationships, and routinized ways of working. Process evaluations enable researchers and clinicians to understand how implementation proceeds and what factors impact on intended program change. A qualitative process evaluation of the pragmatic cluster randomized controlled trial; Training Caregivers after Stroke was conducted to examine how professionals were engaged in the work of delivering training; how they reached and involved caregivers for whom the intervention was most appropriate; how did those on whom training was targeted experience and respond to it. Normalization Process Theory, which focuses attention on implementing and embedding program change, was used as a sensitizing framework to examine selected findings.

Results

Contextual factors including organizational history and team relationships, external policy, and service development initiatives, impinged on implementation of the caregiver training program in unintended ways that could not have been predicted through focus on mechanisms of individual and collective action at unit level. Factors that facilitated or impeded the effectiveness of the cascade training model used, whether and how stroke unit teams made sense of and engaged individually and collectively with a complex caregiver training intervention, and what impact these factors had on embedding the intervention in routine stroke unit practice were identified.

Conclusions

Where implementation of complex interventions depends on multiple providers, time needs to be invested in reaching agreement on who will take responsibility for delivery of specific components and in determining how implementation and its effectiveness will be monitored. This goes beyond concern with intervention fidelity; explicit consideration also needs to be given to the implementation process in terms of how program change can be effected at organizational, practice, and service delivery levels. Normalization Process Theory’s constructs help identify vulnerable features of implementation processes in respect of the work involved in embedding complex interventions.

【 授权许可】

   
2013 Clarke et al.; licensee BioMed Central Ltd.

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