Kuiper Daphne, Steverink Nardi, Stewart Roy E, Reijneveld Sijmen A, Sanderman Robbert, Goedendorp Martine M
Service Desk Clinical Research Office, UMC staff, University Medical Center Groningen, P.O. Box 30.001, AB41, 9700 RB, Groningen, The Netherlands.
Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands.
BMC Health Serv Res. 2019 Jan 25;19(1):67. doi: 10.1186/s12913-019-3891-x.
When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account.
Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher's exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level.
Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were 'ownership', 'relative advantage', 'support from colleagues' and 'compatibility'. Determinants on the organizational level were 'organizational size' and 'innovation-task orientation fit'. Multilevel analysis showed that 'compatibility', a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model.
This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals' perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers' perception of 'innovation-task orientation fit' were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.
在实施循证干预措施（ESI）时，一系列影响因素在专业人员和组织层面发挥作用，但到目前为止，这些层面之间的依存关系常常被忽视。本研究的目的是描述幸福自我管理（SMW）小组干预措施的实施速度，并确定其实施的决定因素，同时考虑专业人员与组织之间的依存关系。
实施速度以专业人员培训与首次使用SMW干预措施之间的时间（月）来衡量。首次使用的决定因素源自弗勒伦框架，并通过基于网络的问卷和电话访谈进行评估。首先，进行单变量分析、费舍尔精确检验和t检验，以分别确定个体专业人员层面和组织层面首次使用SMW干预措施的决定因素。其次，进行多层次分析以校正专业人员与组织之间的依存关系。以单变量分析中发现的显著决定因素为自变量、首次使用为因变量，进行简单的多层次逻辑回归分析，专业人员作为第一层，组织作为第二层。
来自18个组织的48名专业人员接受了实施SMW干预措施的培训。32名专业人员实现了首次使用，平均速度为7.5个月±4.2个月。专业人员层面的决定因素包括“自主性”“相对优势”“同事支持”和“兼容性”。组织层面的决定因素包括“组织规模”和“创新-任务导向匹配度”。多层次分析表明，专业人员层面的因素“兼容性”是多层次模型中促成首次使用的唯一显著决定因素。
本实施研究揭示了专业人员与组织之间存在很强的依存关系。结果表明，大多数专业人员在约8个月内使用了SMW干预措施。考虑到专业人员与组织之间的依存关系后，专业人员对兼容性的认知是专业层面实施的唯一剩余决定因素。组织规模和管理者对“创新-任务导向匹配度”的认知是组织层面实施的决定因素。在采用新干预措施之前，建议管理者和专业人员讨论新任务与当前任务之间的兼容性。
