Evaluating the Implementation of Health Checks for Adults With Intellectual and Developmental Disabilities in Primary Care: The Importance of Organizational Context

Abstract

Compared to other adults, those with intellectual and developmental disabilities have more health issues, yet are less likely to receive preventative care. One strategy that has shown success in increasing prevention activities and early detection of illness is the periodic comprehensive health assessment (the health check). Effectively moving evidence into practice is a complex process that often receives inadequate attention. This qualitative study evaluates the implementation of the health check at two primary-care clinics in Ontario, Canada, and the influence of the clinic context on implementation decisions. Each clinic implemented the same core components; however, due to contextual differences, some components were operationalized differently. Adapting to the setting context is important to ensuring successful and sustainable implementation.

Defining and assessing context in healthcare implementation studies: a systematic review

“…Whilst Chan et al [73] and Chiu and Ku [81] adopt a broader perspective, referring to organisational support or facilitating factors, others specify this support in terms of organisational resources [25,63,64,73,78,80,83,87]. While some studies broadly outline the availability of these resources [50,64,73,83,87], others specify this to include relevant "expertise" [63] and incorporate the ownership of resource allocation [78]. Others specify that organisational resources incorporate adequate training [25], staffing, time and space [80].…”

“…External environment Five studies include aspects of the external setting within their definition of context. Health policy [64], public reporting structures [61], the structure and dynamics of the wider health service [37,80] and the capacity of the community [78] are outlined as influential contextual conditions. For some studies it is unclear whether the contextual driver mentioned was a micro, meso or macro level feature as these factors may be evident across multiple levels of the health system.…”

“…For some studies it is unclear whether the contextual driver mentioned was a micro, meso or macro level feature as these factors may be evident across multiple levels of the health system. Leadership was outlined as a contextual determinant in much of the literature included [61,63,64,73,80]. This concept is further described as the presence of "champions" during implementation [63], or the support of leaders [73] or management [25,61].…”

“…Similarly, social relationships are cited within three definitions [33,36,69]. Additional multi-level contextual factors include culture, feedback mechanisms [80], support [83], learning climate [64], and compatibility [81] with two studies outlining contextual drivers specific to their study [25,77].…”

Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us?

“…These common core components were adapted to fit within the specific context of each setting based on feedback from patients, families and clinicians; more detailed descriptions of intervention selection and development have been published else where. 6,25,26,27 This paper reports staff perspectives on the extent of implementation achieved and barriers and facilitators encountered across the six study sites. Study findings can contribute knowledge about strategies to improve the quality of care for adults with IDD in these key settings and complement prior work from the service user perspective.…”