Fox Mary T, Butler Jeffrey I, Day Adam M B, Durocher Evelyne, Dahlke Sherry, Skinner Mark W, Nowrouzi-Kia Behdin, Yamada Janet, Maimets Ilo-Katryn
School of Nursing, York University, Toronto, Ontario, Canada.
York University Centre for Aging Research and Education, Toronto, Ontario, Canada.
PLoS One. 2025 May 5;20(5):e0322138. doi: 10.1371/journal.pone.0322138. eCollection 2025.
Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities.
This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities.
In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis.
Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities.
This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.
先前的研究表明，农村老年患者及其家人认为，为住院后健康状况恶化的检测和应对做准备是他们最迫切未得到满足的需求，并认为一种基于证据的警示信号干预措施极有可能满足这一需求，该干预措施能让他们做好应对准备。然而，对于医疗保健专业人员对实施警示信号干预措施的潜在障碍和促进因素的看法，尤其是在农村社区，我们了解甚少。
本研究旨在确定医疗保健专业人员在农村社区提供警示信号干预措施的潜在障碍和促进因素。
在这项定性描述性研究中，我们考察了医疗保健专业人员对提供警示信号干预措施的潜在障碍和促进因素的看法。我们选取了一个基于标准的目的性样本，这些医疗保健专业人员按专业类别分层（三个层次——护士、医生和专职医疗保健专业人员），他们在加拿大安大略省为农村居民提供医疗服务，参与了关于提供该干预措施的障碍和促进因素的半结构化电话焦点小组讨论或一对一访谈。数据采用常规定性内容分析法进行分析。
27名医疗保健专业人员参加了焦点小组讨论，15名参加了一对一访谈，共有42名医疗保健专业人员参与。按医疗保健专业人员层次进行的分析揭示了九类障碍和促进因素：物质资源；人力资源；医疗保健专业人员沟通；医疗保健专业人员知识和技能；医疗保健专业人员的认同；农村医疗实践背景；患者及家庭特定特征；风险与责任；以及干预措施实施的时机。其中七类在不同医疗保健专业人员层次中是一致的。然而，不同医疗保健专业人员层次认为这些类别重要的原因，以及他们认为这些类别作为障碍和促进因素发挥作用的方式各不相同。我们的研究结果揭示了为确保该干预措施在农村社区成功实施应考虑的障碍和促进因素。
本研究补充了关于农村医疗保健专业人员对实施警示信号干预措施的障碍和促进因素看法的有限研究。
