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'It's like trying to ice a cake that's not been baked': a qualitative exploration of the contextual factors associated with implementing an evidence-based information intervention for family carers at the end of life.

Amy MathiesonKaren LukerGunn Grande
Published in: Primary health care research & development (2020)
Forty-five members of staff participated. Failed implementation was associated with organisational-level characteristics and conditions, including workforce composition and predictability of processes. Unstable work environments meant home care providers focused on short-term rather than long-term goals, precluding practice development. Staff's perceptions of the time available to engage with and implement the intervention inhibited adoption, as many participants were "just getting through the day". Implementation was successful in sites with explicit management support, including proactive implementation attempts by managers, which legitimatised the change process, and if all staff groups were engaged. To encourage uptake of evidence-based interventions in home care settings, practitioners should be given opportunities to critically reflect upon taken-for-granted practices. Future implementation should focus on work pertaining to the NPT construct 'Collective Action', including how staff interact and build confidence in new practices.
Keyphrases
  • primary care
  • healthcare
  • quality improvement
  • randomized controlled trial
  • long term care
  • physical activity
  • health information
  • electronic health record
  • current status