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Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention

Craig, Louise E, Churilov, Leonid, Olenko, Liudmyla, Cadilhac, Dominique A, Grimley, Rohan, Dale, Simeon, Martinez-Garduno, Cintia, McInnes, Elizabeth, Considine, Julie, Grimshaw, Jeremy M and Middleton, Sandy 2017, Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention, BMC medical research methodology, vol. 17, pp. 1-14, doi: 10.1186/s12874-017-0298-4.

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Title Testing a systematic approach to identify and prioritise barriers to successful implementation of a complex healthcare intervention
Author(s) Craig, Louise E
Churilov, Leonid
Olenko, Liudmyla
Cadilhac, Dominique A
Grimley, Rohan
Dale, Simeon
Martinez-Garduno, Cintia
McInnes, Elizabeth
Considine, JulieORCID iD for Considine, Julie orcid.org/0000-0003-3801-2456
Grimshaw, Jeremy M
Middleton, Sandy
Journal name BMC medical research methodology
Volume number 17
Article ID 24
Start page 1
End page 14
Total pages 14
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017
ISSN 1471-2288
1471-2288
Keyword(s) acute stroke care
barriers
implementation
prioritisation
science & technology
life sciences & biomedicine
health care sciences & services
randomized controlled-trial
swallowing dysfunction
treatment protocols
hyperglycemia
fever
Summary Multiple barriers may inhibit the adoption of clinical interventions and impede successful implementation. Use of standardised methods to prioritise barriers to target when selecting implementation interventions is an understudied area of implementation research. The aim of this study was to describe a method to identify and prioritise barriers to the implementation of clinical practice elements which were used to inform the development of the T(3) trial implementation intervention (Triage, Treatment [thrombolysis administration; monitoring and management of temperature, blood glucose levels, and swallowing difficulties] and Transfer of stroke patients from Emergency Departments [ED]). A survey was developed based on a literature review and data from a complementary trial to identify the commonly reported barriers for the nine T(3) clinical care elements. This was administered via a web-based questionnaire to a purposive sample of Australian multidisciplinary clinicians and managers in acute stroke care. The questionnaire addressed barriers to each of the nine T(3) trial clinical care elements. Participants produced two ranked lists: on their perception of: firstly, how influential each barrier was in preventing clinicians from performing the clinical care element (influence attribute); and secondly how difficult the barrier was to overcome (difficulty attribute). The rankings for both influence and difficulty were combined to classify the barriers according to three categories ('least desirable', desirable' or 'most desirable' to target) to assist interpretation. All invited participants completed the survey; (n = 17; 35% medical, 35% nursing, 18% speech pathology, 12% bed managers). The barriers classified as most desirable to target and overcome were a 'lack of protocols for the management of fever' and 'not enough blood glucose monitoring machines'. A structured decision-support procedure has been illustrated and successfully applied to identify and prioritise barriers to target within an implementation intervention. This approach may prove to be a useful in other studies and as an adjunct to undertaking barrier assessments within individual sites when planning implementation interventions.
Language eng
DOI 10.1186/s12874-017-0298-4
Field of Research 111003 Clinical Nursing: Secondary (Acute Care)
Socio Economic Objective 920210 Nursing
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30091287

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.