Pilot trial of The Living Well Toolkit: Qualitative analysis and implications for refinement and future implementation

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aut.relation.articlenumber69en_NZ
aut.relation.journalBMC Health Services Researchen_NZ
aut.relation.volume20en_NZ
aut.researcherDrabsch, Julie
dc.contributor.authorMudge, Sen_NZ
dc.contributor.authorSezier, Aen_NZ
dc.contributor.authorPayne, Den_NZ
dc.contributor.authorSmith, Gen_NZ
dc.contributor.authorKayes, Nen_NZ
dc.date.accessioned2020-11-23T01:06:59Z
dc.date.available2020-11-23T01:06:59Z
dc.date.copyright2020en_NZ
dc.date.issued2020en_NZ
dc.description.abstractBACKGROUND: Following a neurological event, people's long-term health and well-being is hampered by a system that struggles to deliver person-centred communication and coordinated care and fails to harness individual and family capability to live well with the condition. We aimed to implement and evaluate a toolkit package to support these processes for people with long-term neurological conditions. METHODS: This is a multi-phased study drawing on the principles of participatory research. In this pilot phase, the toolkit package was introduced to clinicians, who introduced it to clients in four neurorehabilitation settings (inpatient and community-based). Individual and focus group interviews were carried out with clients (n = 10) and clinicians (n = 9). Data were categorised by the four components of Normalisation Process Theory (NPT), and data within each component was then coded inductively. This analysis was used to inform revisions to the toolkit package and wider implementation processes. RESULTS: There was widespread support for the principles underpinning the toolkit package from clients and clinicians. However, it was less clear how the client toolkit could support these principles in clinical practice which impacted buy-in. The flexibility of use of the client toolkit, which we encouraged, made it difficult for clinicians and clients to be clear about its purpose and for clinicians to operationalise in practice. Clinicians and clients identified a number of barriers that limited the time, energy and work users were able or prepared to invest, to the extent that uptake of the toolkit package was modest. Use of the toolkit package appeared more likely when clinicians perceived it to augment existing processes (e.g. goal setting) rather than detract from 'doing' therapy. This analysis was used to inform revisions to the toolkit package, including simplification of the client toolkit, development of videos with examples of use and a modular and reflective training package for clinical services. The refinements were intended to improve sense-making and minimise the cognitive barriers associated with implementation of a new intervention. CONCLUSION: Understanding how supporting the client toolkit could add value to the therapeutic encounter was necessary for clinicians to invest time and perceive the worth of the toolkit package. TRIAL REGISTRATION: ANZCTR: ACTRN12614000537651. Registered 21 May, 2014.en_NZ
dc.identifier.citationBMC Health Services Research, 20(1), 69.
dc.identifier.doi10.1186/s12913-020-4920-5en_NZ
dc.identifier.issn1472-6963en_NZ
dc.identifier.issn1472-6963en_NZ
dc.identifier.urihttps://hdl.handle.net/10292/13812
dc.languageengen_NZ
dc.publisherBioMed Centralen_NZ
dc.relation.urihttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-4920-5
dc.rights© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.rights.accessrightsOpenAccessen_NZ
dc.subjectImplementationen_NZ
dc.subjectLong-term conditionsen_NZ
dc.subjectNormalisation process theoryen_NZ
dc.subjectPerson-centreden_NZ
dc.subjectToolkiten_NZ
dc.titlePilot trial of The Living Well Toolkit: Qualitative analysis and implications for refinement and future implementationen_NZ
dc.typeJournal Article
pubs.elements-id370238
pubs.organisational-data/AUT
pubs.organisational-data/AUT/Health & Environmental Science
pubs.organisational-data/AUT/Health & Environmental Science/Clinical Sciences
pubs.organisational-data/AUT/Health & Environmental Science/Nursing
pubs.organisational-data/AUT/PBRF
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences
pubs.organisational-data/AUT/PBRF/PBRF Health and Environmental Sciences/HH Clinical Sciences 2018 PBRF
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