School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing University of Chinese Medicine Centre for Evidence-based Nursing: A JBI Affiliated Group, Beijing University of Chinese Medicine Best Practice Spotlight Organization of the Registered Nurses' Associationof Ontario, Beijing, China.
School of Nursing, Faculty of Health Sciences, University of Ottawa, Centre for Research on Health and Nursing, University of Ottawa, Ontario, Canada.
JBI Evid Implement. 2022 Jun 1;20(2):117-127. doi: 10.1097/XEB.0000000000000305.
Much attention has been paid to scaling-up evidence-based interventions (EBIs) in previous implementation science studies. However, there is limited research on how stakeholders perceive factors of the scaling-up of EBIs. This study aimed to identify the barriers and facilitators of scaling-up the nurse-led evidence-based practice of post-stroke dysphagia identification and management (EBP-PSDIM) from the stakeholders' perspective, and to assess their importance and feasibility.
This study was conducted using concept mapping. Through purposive sampling, 18 stakeholders were recruited for brainstorming in which they responded to the focus prompt. Here, statements regarding perceived barriers and facilitators to EBI scaling-up were elicited and then sorted by similarity before being rated based on the importance and feasibility. Cluster analysis, multidimensional scaling, and descriptive statistics were utilized to analyze the data.
Ultimately, 61 statements perceived to influence the scaling-up were grouped into four primary clusters, that is, community-related factors, resource team-related factors, evidence-based practice program-related factors, and scaling-up strategy-related factors. The 'perceived needs of the community' was rated as the most important and feasible factor to address, whereas 'costs/resource mobilization' was rated as the least important and feasible one.
From the stakeholders' perspective, factors involved in the EBP-PSDIM program scaling-up were initially validated as being multidimensional and conceptually distinct;The importance and feasibility ratings of the barriers and facilitators could be used to help decision-makers to prioritize the most appropriate factors to be considered when developing implementation strategies.
在以往的实施科学研究中，人们非常关注扩大基于证据的干预措施（EBIs）的规模。然而，关于利益相关者如何看待 EBI 扩大规模的因素的研究有限。本研究旨在从利益相关者的角度确定扩大护士主导的基于证据的脑卒中后吞咽障碍识别和管理（EBP-PSDIM）实践的障碍和促进因素，并评估其重要性和可行性。
本研究采用概念映射法。通过目的抽样，招募了 18 名利益相关者进行头脑风暴，他们对焦点提示做出回应。在此，引出了对 EBI 扩大规模的感知障碍和促进因素的陈述，然后根据相似性进行分类，然后根据重要性和可行性进行评分。聚类分析、多维尺度分析和描述性统计用于分析数据。
最终，61 条被认为影响扩大规模的陈述被分为四个主要聚类，即社区相关因素、资源团队相关因素、基于证据的实践计划相关因素和扩大规模策略相关因素。“社区的感知需求”被评为最重要和最可行的因素，而“成本/资源动员”被评为最不重要和最不可行的因素。
从利益相关者的角度来看，EBP-PSDIM 计划扩大规模所涉及的因素最初被验证为多维度且概念上不同；障碍和促进因素的重要性和可行性评分可用于帮助决策者确定在制定实施策略时应优先考虑哪些最合适的因素。
