Mao Hui-Fen, Tsai Athena Yi-Jung, Yeh Hsin-Chun, Chang Ling-Hui
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.
Gerontologist. 2024 Dec 17;65(2). doi: 10.1093/geront/gnae179.
There is an increasing push for broad implementation of evidence-based interventions (EBIs) targeting older adults. Successful delivery of EBIs in communities requires therapists to adhere to protocols and to be responsive to contextual factors. This study explored the real-world implementation of an EBI, the Multiple-component Cognitive Intervention using Simulated Everyday Tasks (MCI-SET) in Taiwan from therapists' perspectives on fidelity, challenges, and strategies for program delivery.
We used a convergent mixed-methods design. Quantitative data were collected from the 13-item Perceived Fidelity Questionnaire (PFQ), assessing the perceived importance, proficiency, and adherence to the essential skills of MCI-SET. Qualitative data were collected via 2 World Café discussions on implementation challenges and strategies, which were recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative and qualitative findings were then compared and integrated to enrich the interpretation.
47 occupational therapists completed the PFQ. They rated community-oriented skills as more important, demonstrated greater proficiency, and achieved higher adherence. Qualitative analysis revealed that therapists need to increase and sustain participation by strategically introducing the program, adapting the intervention protocol to make it engaging, relevant to everyday issues, and tailored to local needs, and building rapport. Both quantitative and qualitative findings highlighted the importance of community engagement skills and the adaptability of intervention to implementation and sustainability in communities.
Real-world scale-up of EBIs requires tailored adaptations responsive to community contexts, especially when initially introducing an intervention unfamiliar to the community. This emphasizes the need for a dynamic fidelity concept.
针对老年人的循证干预措施（EBIs）的广泛实施正受到越来越多的推动。在社区中成功实施循证干预措施要求治疗师遵守方案并对情境因素做出响应。本研究从治疗师对保真度、挑战及方案实施策略的角度，探讨了循证干预措施——使用模拟日常任务的多成分认知干预（MCI-SET）在台湾的实际实施情况。
我们采用了聚合性混合方法设计。定量数据通过13项感知保真度问卷（PFQ）收集，评估对MCI-SET基本技能的感知重要性、熟练程度和遵守情况。定性数据通过两次关于实施挑战和策略的世界咖啡馆讨论收集，讨论进行了录音、逐字转录，并采用主题分析进行分析。然后对定量和定性研究结果进行比较和整合，以丰富解释。
47名职业治疗师完成了PFQ。他们将面向社区的技能评为更重要，表现出更高的熟练程度，并实现了更高的遵守率。定性分析表明，治疗师需要通过策略性地引入方案、调整干预方案使其具有吸引力、与日常问题相关并根据当地需求进行定制，以及建立融洽关系来增加并维持参与度。定量和定性研究结果均强调了社区参与技能以及干预措施对社区实施和可持续性的适应性的重要性。
循证干预措施在实际中的扩大推广需要根据社区背景进行量身定制的调整，尤其是在最初引入社区不熟悉的干预措施时。这强调了动态保真度概念的必要性。
