Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services

Abstract

Background Seven housing and health services organizations were guided through a process of translating Chapter Six of the Canadian Guidelines for Recovery-Oriented Practice into a recovery-oriented innovation and plan for its implementation. At the time of the COVID-19 outbreak and lockdown measures, six of the seven organizations had begun implementing their chosen innovation (peer workers, wellness recovery action planning facilitator training, staff training and a family support group). This mid-implementation study used the Consolidated Framework for Implementation Research (CFIR) to identify contextual factors that influenced organizations to continue or postpone implementation of recovery-oriented innovations in the early months of the COVID-19 pandemic. Methods Twenty-seven semi-structured 45-min interviews were conducted between May and June 2020 (21 implementation team members and six providers of the innovation (trainers, facilitators, peer workers). Interview guides and analysis were based on the CFIR. Content analysis combined deductive and inductive approaches. Summaries of coded data were given ratings based on strength and valence of the construct’s impact on implementation. Ratings were visualized by mid-implementation outcome and recovery innovation to identify constructs which appear to distinguish between sites with a more or less favorable mid-implementation outcomes. Results Four mid-implementation outcomes were observed at this snapshot in time (from most to least positive): continued implementation with adaptation (one site), postponement with adaptation and estimated relaunch date (four sites), indefinite postponement with no decision on relaunch date (one site), and no implementation of innovation yet (one site). Two constructs had either a negative influence (external policies and incentives—renamed COVID-19-related external policy for this study) or a positive influence (leadership engagement), regardless of implementation outcome. Four factors appeared to distinguish between more or less positive mid-implementation outcome: adaptability, implementation climate and relative priority, available resources, and formally appointed internal implementation leaders (renamed “engaging implementation teams during the COVID-19 pandemic” for this study). Conclusions The COVID-19 pandemic is an unprecedented outer setting factor. Studies that use the CFIR at the mid-implementation stage are rare, as are studies focusing on the outer setting. Through robust qualitative analysis, we identify the key factors that shaped the course of implementation of recovery innovations over this turbulent time.

Implementation of a Statewide Web-Based Caregiver Resource Information System (CareNav): Mixed Methods Study

“…This study echoes the recent implementation literature underscoring the COVID-19 pandemic as an outer-setting construct inconclusively affecting implementation [ 35 - 37 ]. In fact, the pandemic may have facilitated and accelerated the technology implementation process with significant effects on CareNav characteristics, the inner setting, characteristics of the CRC staff, and the outer setting.…”

“…Similarly, the implementation of other web-based technologies encountered significant barriers, explained by time constraints and competing priorities associated with the COVID-19 pandemic [ 38 ]. Effective leadership engagement, as demonstrated in our study, might have played a mediating role in buffering the COVID-19 pandemic slowing effect by maintaining commitment and resources to the implementation and ultimately reducing behavioral resistance to change [ 35 , 36 , 39 ]. Taken together, these factors must be considered in the interpretation of the findings of this evaluation, particularly in light of the perceived success of the implementation from the staff perspective.…”

The impacts of implementing recovery innovations: a conceptual framework grounded in qualitative research

“…The site that implemented Wellness Recovery Action Planning (WRAP), a service user-led mental health self-management programme [ 31 ], contracted certified WRAP trainers to train WRAP facilitators within the organisation (both members of staff and service users). All but one site experienced delays or periods of postponement due to the COVID-19 pandemic [ 17 ], with only one site unable to resume the implementation of their innovation following the resignation of the hired peer support worker two weeks after the start of implementation (Manitoba 1). Due to the COVID-19 pandemic and related policies, some form of adaptation (for example switching to online formats) occurred in all sites [ 17 ].…”

“…All but one site experienced delays or periods of postponement due to the COVID-19 pandemic [ 17 ], with only one site unable to resume the implementation of their innovation following the resignation of the hired peer support worker two weeks after the start of implementation (Manitoba 1). Due to the COVID-19 pandemic and related policies, some form of adaptation (for example switching to online formats) occurred in all sites [ 17 ].…”

“…The strategy has since been developed into an online toolkit ( www.walkthetalktoolkit.ca ). Our research project outputs have so far included a study of the experiences of the implementation strategy [ 15 ], an evaluation of the CFIR Card Game we developed to translate implementation science for real-world use [ 16 ], and an analysis of the contextual factors that affected mid-implementation outcomes during the COVID-19 pandemic [ 17 ]. In this article we report on a conceptual framework for understanding the impact of recovery-oriented innovations grounded in an in-depth qualitative analysis of stakeholders’ perspectives.…”