Nursing, Midwifery and Allied Health Profession Research Unit, Govan Mbeki Building, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 OBA,, Scotland.
Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF, Scotland.
BMC Health Serv Res. 2020 Aug 25;20(1):791. doi: 10.1186/s12913-020-05651-2.
High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation.
We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively.
We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%, 51/55) participated in G-AP training; of those, 80% (n = 41/51) completed the training questionnaire. Training was rated as 'good' or 'very good' by almost all staff (92%, n = 37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP 'made sense'; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor 'fit' between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records.
The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation "deal breakers". Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.
高质量的目标设定在中风康复中至关重要，但实现起来具有挑战性。G-AP 框架（包括员工培训和由中风幸存者持有的 G-AP 记录）指导社区康复团队中的以患者为中心的目标设定。我们发现 G-AP 在一个团队中是可以接受的、可行的和临床有用的。本研究的目的是在大规模评估之前，对不同社区团队中 G-AP 的实施情况进行混合方法调查。
我们联系了苏格兰社区康复团队参与。在培训之后，G-AP 在参与团队中的中风幸存者中实施了 6 个月。我们通过焦点小组和培训问卷调查了员工对 G-AP 培训和实施的经验。我们通过病历审查调查了 G-AP 交付的保真度。焦点小组数据使用框架方法进行分析；确定的主题被映射到正常化过程理论结构中。问卷和病历数据进行描述性分析。
我们招募了三支由 55 名康复工作人员组成的团队。几乎所有工作人员（93%，51/55）都参加了 G-AP 培训；其中，80%（n=41/51）完成了培训问卷。培训几乎被所有工作人员（92%，n=37/41）评为“好”或“非常好”。G-AP 在两支团队中得到了广泛的实施。实施促进因素包括-G-AP“有意义”；在实践中反复使用 G-AP；灵活的 G-AP 交付和工作人员对 G-AP 影响的积极评价。G-AP 在第三支团队中没有取得进展。实施障碍包括-G-AP 培训和实施之间的延迟；领导参与有限；G-AP 与团队组织结构之间的“不匹配”；同时实施其他目标设定方法。工作人员建议（i）发展培训以包括实施计划；（ii）持续进行本地实施审查和调整；（iii）开发电子和失语友好的 G-AP 记录。
G-AP 与实践环境的相互作用对实施的成败至关重要。虽然促进因素支持实施成功，但障碍可以共同成为实施的“绊脚石”。应计划、监测和调整本地 G-AP 实施工作。这些见解可以为在社区康复环境中实施其他复杂干预措施提供信息。
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