Co-designing organisational improvements and interventions to increase inpatient activity in four stroke units in England: a mixed-methods process evaluation using normalisation process theory

Clarke, David; Gombert-Waldron, Karolina; Honey, Stephanie; Cloud, Geoffrey; Harris, Ruth; Macdonald, Alastair; McKevitt, Christopher; Robert, Glenn; Jones, Fiona

doi:10.1136/bmjopen-2020-042723

Cited by 21 publications

(43 citation statements)

References 44 publications

(42 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…NPT focuses on the work done by staff collectively to understand the processes by which a complex health care intervention is or is not implemented, embedded, and integrated into practice [ 28 ]. NPT has been applied in health care settings [ 40 ], including stroke care and rehabilitation [ 40 - 42 ], allowing us to compare our findings with previous studies. NPT is a sociologically informed theory of how new interventions in health care and social care are implemented and embedded as normal practice.…”

Section: Methodsmentioning

confidence: 94%

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Elf¹,

Klockar²,

Kylén³

et al. 2022

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

Background Self-management programs are recognized as a valuable approach to supporting people with long-term conditions, such as stroke, in managing their daily lives. Bridges Self-Management (Bridges) focuses on how practitioners interact and support patients’ confidence, skills, and knowledge, and it is an example of a complex intervention. Bridges has been developed and used across multiple health care pathways in the United Kingdom and is theoretically informed by social cognition theory and self-efficacy principles. Evidence shows that self-management programs based on the construct of self-efficacy can be effective. There is still much to learn about how health care services or pathways should implement support for self-management in a sustainable way and whether this implementation process is different depending on the context or culture of the team or service provided. Objective The aim of this study is to tailor and evaluate an intervention (Bridges) to support self-management after stroke in a Swedish context. Methods We will use a pretest-posttest design with a case study approach to evaluate the feasibility and implementation of self-management support in two stroke settings. This project includes a complex intervention and depends on the actions of individuals, different contexts, and the adaptation of behavior over time. A mixed methods approach was chosen to understand both outcomes and mechanisms of impact. Data collection will comprise outcome measurements and assessment tools as well as qualitative interviews. Data will be collected concurrently and integrated into a mixed methods design. Results Recruitment and data collection for the first site of the project ran from September 1, 2021, to January 17, 2022. The intervention at the first site was conducted from November 1, 2021, to March 5, 2022. The evaluation will start after the implementation phase. The second site has been recruited, and the baseline data collection will start in spring 2022. The intervention will start in early autumn 2022. Data collection will be completed by the end of 2022. Conclusions This study represents a unique, highly relevant, and innovative opportunity to maximize knowledge and minimize practice gaps in rehabilitation stroke care. The study will produce robust data on the intervention and in-depth data on the contextual factors and mechanisms related to the feasibility of the intervention and for whom it is feasible. Bridges has been used in the United Kingdom for more than 10 years, and this study will explore its contextualization and implementation within a Swedish stroke environment. The evaluation will study results at the patient, staff, and organizational levels and provide recommendations for the adoption and refinement of future efforts to support self-management. International Registered Report Identifier (IRRID) DERR1-10.2196/37672

show abstract

Section: Methodsmentioning

confidence: 94%

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Elf¹,

Klockar²,

Kylén³

et al. 2022

JMIR Res Protoc

Self Cite

View full text Add to dashboard Cite

show abstract

“…Without a designated method or trained facilitator, it is unlikely that clinicians or service managers could effectively lead or allocate time to run codesign processes that have sustainable implementation and impact. 55 The need for codesign to foster a true collaboration that prevents or overcomes power differentials is also a skilled facilitator's task and a major concern aligned with the current health codesign literature. 9,16,69 Finally, the complementary focus on using staff experiences, appreciative inquiries, and efficient solutions that fit busy daily practices was also reported as factors enabling the implementation of the improvement activities.…”

Section: Discussionmentioning

confidence: 99%

“…time and resources), not necessarily participation in every meeting. 55 For example, one chief executive matched the sum of funds raised by one unit's sponsored run to complete the codesigned activities. 55 In another project, funding was made available for hiring a part-time staff member to perform a newly developed follow-up call.…”

Section: Content Analysis: Implementation Enablers and Study Gapsmentioning

confidence: 99%

See 1 more Smart Citation

The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature

et al. 2022

View full text Add to dashboard Cite

Objective To characterize the literature, reported enablers, and gaps on the use of patient experience feedback for person-centered rehabilitation quality improvement and codesign activities. Design Scoping Review. Data sources Scientific databases (PubMed, CINAHL, Rehabdata, Scopus, Web of Science, ProQuest), website searches (e.g. Beryl Institute), snowballing, and key-informant recommendations. Methods Two independent reviewers performed title and abstract screenings and full-text reviews. Eligibility focused on English-language, peer-reviewed (all time) and gray literature (last five years) that used patient experience feedback in rehabilitation improvement activities. The aims, settings, methods, findings, implications, and reported limitations were extracted, followed by content analyses identifying reported enablers and gaps. Results Among the 901 unique references and 52 full texts reviewed, ten were included: four used patient experience surveys for improving patient experiences; six used codesign methodologies to engage patient feedback in service improvement activities. Implementation enablers included securing managerial support, having a structured methodology and facilitator, using efficient processes, engaging staff experiences, and using appreciative inquiry. Reported study gaps included limited follow-up, low sample sizes, analytical limitations, lack of reported limitations, or narrow range of perspectives (e.g. not from people with severe impairments). Conclusion Few examples of the use of patient experience feedback in quality improvement or codesign activities were found in the rehabilitation literature. Patient experience improvement activities relied exclusively on retrospective survey data, which were not combined with often more actionable forms (e.g. qualitative, real time) of patient experience feedback. Further research might consider design of activities that collect and use patient experience feedback for rehabilitation service improvements.

show abstract

“…There is a need for innovative approaches that can support stroke survivors to reduce SB in a realistic and individualised way. Examples include co-producing interventions with stroke survivors [15,16]. Robust intervention development must be informed by current practice and should take account of the views of service providers and users [17].…”

Section: Introductionmentioning

confidence: 99%

A qualitative study of sedentary behaviours in stroke survivors: non-participant observations and interviews with stroke service staff in stroke units and community services

Morton

Hall

Fitzsimons

et al. 2021

Disability and Rehabilitation

View full text Add to dashboard Cite

Purpose: Sedentary behaviour (SB) is associated with negative health outcomes and is prevalent poststroke. This study explored SB after stroke from the perspective of stroke service staff. Methods: Qualitative mixed-methods study. Non-participant observations in two stroke services (England/ Scotland) and semi-structured interviews with staff underpinned by the COM-B model of behaviour change. Observations were analysed thematically; interviews were analysed using the Framework approach. Results: One hundred and thirty-two observation hours (October -December 2017), and 31 staff interviewed (January -June 2018). Four themes were identified: (1) Opportunities for staff to support stroke survivors to reduce SB; (2) Physical and psychological capability of staff to support stroke survivors to reduce SB; (3) Motivating factors influencing staff behaviour to support stroke survivors to reduce SB; (4) Staff suggestions for a future intervention to support stroke survivors to reduce SB. Conclusions: Staff are aware of the consequences of prolonged sitting but did not relate to SB. Explicit knowledge of SB was limited. Staff need training to support stroke survivors to reduce SB. Sedentary behaviour in the community was not reported to change markedly, highlighting the need to engage stroke survivors in movement from when capable in hospital, following through to home. ä IMPLICATIONS FOR REHABILITATIONStroke survivor sedentary behaviour is influenced, directly and indirectly, by the actions and instructions of stroke service staff in the inpatient and community setting. The built and social environment, both in the inpatient and community settings, may limit opportunities for safe movement and can result in stroke survivors spending more time sedentary. Stroke service staff appreciate the benefit of encouraging stroke survivors to stand and move more, if it is safe for them to do so. Staff would be amenable to encourage stroke survivors to reduce sedentary behaviour, provided they have the knowledge and resources to equip them to support this.

show abstract

Co-designing organisational improvements and interventions to increase inpatient activity in four stroke units in England: a mixed-methods process evaluation using normalisation process theory

Cited by 21 publications

References 44 publications

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

Tailoring and Evaluating an Intervention to Support Self-management After Stroke: Protocol for a Multi-case, Mixed Methods Comparison Study

The use of patient experience feedback in rehabilitation quality improvement and codesign activities: Scoping review of the literature

A qualitative study of sedentary behaviours in stroke survivors: non-participant observations and interviews with stroke service staff in stroke units and community services

Contact Info

Product

Resources

About