Department of Community Health and Epidemiology, Centre for Clinical Research, Dalhousie University, Room 413, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada.
School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada.
BMC Health Serv Res. 2024 Jan 6;24(1):39. doi: 10.1186/s12913-024-10541-y.
As the Canadian population ages and the prevalence of chronic illnesses increases, delivering high-quality care to individuals with advanced life limiting illnesses becomes more challenging. Community-based navigation programs are a promising approach to address these challenges, but little is known about how these programs are successfully implemented to meet the needs of this population. This study sought to identify the key determinants that contribute to the successful implementation of these programs within Canada.
A qualitative study was undertaken to understand the implementation of eleven innovative, community-based navigation programs that aim to address the needs of individuals with life-limiting illnesses as they approach the end of life. The Consolidated Framework for Implementation Research (CFIR) guided the study design. Key informants (n = 23) within these programs took part in semi-structured interviews where they were asked to discuss how these programs are implemented. Data were analyzed using techniques employed in qualitative description.
We identified key determinants of successful implementation within each CFIR domain. In the outer setting domain, participants emphasized the importance of filling gaps in care to meet client needs, developing strong relationships with clients and community-based organizations, and navigating relationships with healthcare providers. At the inner setting level, leadership support, staff compatibility, and available resources were identified as important factors. In terms of intervention characteristics, the ability to adapt was cited as a facilitator, whereas costs were identified as a barrier. For the characteristics of individuals, participants described the importance of having staff whose values align with the program, and who have the experience and skills necessary to work with complex clients. Finally, having strong champions and evaluation processes were highlighted as important process-oriented determinants of successful implementation.
This study provides valuable insights into the determinants of successful implementation of community-based navigation programs in Canada. Understanding these determinants can guide the future development and integration of navigation programs to successfully meet the needs of those with life-limiting illnesses.
随着加拿大人口老龄化和慢性病患病率的增加，为患有晚期生命限制疾病的个体提供高质量的护理变得更加具有挑战性。基于社区的导航计划是解决这些挑战的一种有前途的方法，但对于这些计划如何成功实施以满足该人群的需求知之甚少。本研究旨在确定有助于这些计划在加拿大成功实施的关键决定因素。
进行了一项定性研究，以了解旨在满足生命有限的个体在生命结束时的需求的十一个创新的基于社区的导航计划的实施情况。实施研究综合框架（CFIR）指导了研究设计。这些计划中的关键信息提供者（n=23）参加了半结构化访谈，要求他们讨论这些计划是如何实施的。使用定性描述中采用的技术分析数据。
我们确定了每个 CFIR 领域内成功实施的关键决定因素。在外围环境领域，参与者强调了填补护理空白以满足客户需求、与客户和基于社区的组织建立强大关系以及管理与医疗保健提供者的关系的重要性。在内部环境层面上，领导力支持、员工兼容性和可用资源被确定为重要因素。就干预措施的特点而言，适应能力被认为是一个促进因素，而成本则被认为是一个障碍。对于个体特征，参与者描述了拥有与计划价值观一致且具有与复杂客户合作所需的经验和技能的员工的重要性。最后，强调了拥有强大的拥护者和评估过程是成功实施的重要面向过程的决定因素。
本研究为了解加拿大基于社区的导航计划成功实施的决定因素提供了有价值的见解。了解这些决定因素可以指导未来导航计划的开发和整合，以成功满足生命有限的患者的需求。
