Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
BMC Fam Pract. 2010 Aug 23;11:60. doi: 10.1186/1471-2296-11-60.
Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.
A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.
The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.
When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.
在医疗保健领域弥合知识与实践之间的差距是近年来备受关注的一个重要问题。然而，将新方法、指南或工具实施到常规护理中是一个缓慢且不可预测的过程，并且在变革过程中发挥作用的因素尚未得到充分理解。有许多理论涉及各种环境下成功实施的因素预测，但在初级保健（PHC）中这一问题研究不足。本文的目的是应用实施理论来确定影响在瑞典 PHC 中引入的创新采用的关键因素。
在瑞典的六个 PHC 单位进行了一项定性研究，这些单位实施了基于计算机的生活方式干预测试。使用了两种不同的实施策略，即隐性或显性策略。进行了 16 次焦点小组访谈和 2 次个人访谈。在分析中，应用了基于卫生服务组织实施研究的理论框架，以确定影响采用的关键因素。
该理论框架被证明适用于 PHC 的研究。单位的积极期望、对创新与现有常规的兼容性的看法以及感知到的优势对采用产生了积极影响。明确的实施策略和对变革与创新的积极看法也与采用相关。与实施同时发生的组织变革和人员短缺似乎是采用过程的障碍。
当从其他领域的研究中获得的实施理论应用于 PHC 时，它被证明适用于这种特定的环境。根据我们的结果，在规划新工具在 PHC 中的实施时，应考虑评估员工的期望、评估实施创新的潜在需求以及其与现有常规的潜在兼容性。在考虑背景时，我们建议避免在其他重大组织变革同时实施。应仔细考虑实施策略的选择。
