Moore Julia E, Mascarenhas Alekhya, Marquez Christine, Almaawiy Ummukulthum, Chan Wai-Hin, D'Souza Jennifer, Liu Barbara, Straus Sharon E
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
Regional Geriatric Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada.
Implement Sci. 2014 Oct 30;9:160. doi: 10.1186/s13012-014-0160-6.
As evidence-informed implementation interventions spread, they need to be tailored to address the unique needs of each setting, and this process should be well documented to facilitate replication. To facilitate the spread of the Mobilization of Vulnerable Elders in Ontario (MOVE ON) intervention, the aim of the current study is to develop a mapping guide that links identified barriers and intervention activities to behaviour change theory.
Focus groups were conducted with front line health-care professionals to identify perceived barriers to implementation of an early mobilization intervention targeted to hospitalized older adults. Participating units then used or adapted intervention activities from an existing menu or developed new activities to facilitate early mobilization. A thematic analysis was performed on the focus group data, emphasizing concepts related to barriers to behaviour change. A behaviour change theory, the 'capability, opportunity, motivation-behaviour (COM-B) system', was used as a taxonomy to map the identified barriers to their root causes. We also mapped the behaviour constructs and intervention activities to overcome these.
A total of 46 focus groups were conducted across 26 hospital inpatient units in Ontario, Canada, with 261 participants. The barriers were conceptualized at three levels: health-care provider (HCP), patient, and unit. Commonly mentioned barriers were time constraints and workload (HCP), patient clinical acuity and their perceived 'sick role' (patient), and lack of proper equipment and human resources (unit level). Thirty intervention activities to facilitate early mobilization of older adults were implemented across hospitals; examples of unit-developed intervention activities include the 'mobility clock' communication tool and the use of staff champions. A mapping guide was created with barriers and intervention activities matched though the lens of the COM-B system.
We used a systematic approach to develop a guide, which maps barriers, intervention activities, and behaviour change constructs in order to tailor an implementation intervention to the local context. This approach allows implementers to identify potential strategies to overcome local-level barriers and to document adaptations.
随着基于证据的实施干预措施的推广，需要对其进行调整以满足每个环境的独特需求，并且这一过程应得到充分记录以促进推广。为促进安大略省弱势老年人动员（MOVE ON）干预措施的推广，本研究旨在制定一份映射指南，将已识别的障碍和干预活动与行为改变理论联系起来。
与一线医护专业人员进行焦点小组讨论，以确定针对住院老年人的早期动员干预措施实施过程中所察觉到的障碍。参与单位随后使用或调整了现有菜单中的干预活动，或开发了新的活动以促进早期动员。对焦点小组数据进行了主题分析，重点关注与行为改变障碍相关的概念。采用一种行为改变理论，即“能力、机会、动机—行为（COM-B）系统”，作为一种分类法，将已识别的障碍映射到其根本原因。我们还将行为结构和干预活动进行了映射以克服这些障碍。
在加拿大安大略省的26个医院住院单元共开展了46个焦点小组讨论，有261名参与者。这些障碍在三个层面进行了概念化：医护人员、患者和单元。常见的障碍包括时间限制和工作量（医护人员层面）、患者的临床急症程度及其所感知的“患病角色”（患者层面），以及缺乏适当的设备和人力资源（单元层面）。各医院实施了30项促进老年人早期动员的干预活动；单元开发的干预活动示例包括“活动时钟”沟通工具和使用员工倡导者。通过COM-B系统创建了一份障碍与干预活动相匹配的映射指南。
我们采用系统方法制定了一份指南，该指南对障碍、干预活动和行为改变结构进行了映射，以便根据当地情况调整实施干预措施。这种方法使实施者能够识别克服当地层面障碍的潜在策略，并记录调整情况。
