Adapting the determinants of implementation behavior questionnaire to evaluate implementation of a structured low back pain programme using mixed-methods

Intrinsic Motivation and Institutional Limitations: Key Implementation Determinants of Psychological First Aid Training

Psychological first aid (PFA) trainings are conducted to train frontline care workers in practical and emotional support to people who have been recently affected by stressful events. The aim of this study was to describe the determinants of the implementation behavior of a PFA training strategy in Chile and to provide theoretical information on the factors that influence trainers' self-efficacy. For this purpose, the Determinants of Implementation Behavior Questionnaire, administered online to a sample of 117 PFA trainers throughout Chile, was used. The results indicate that the main facilitators for implementation originate in the intrinsic motivation of the trainers, while the barriers are mainly found in the limited institutional opportunities offered by the context. Evidence was also found on the effect of motivation and context on trainer self-efficacy. PFA trainers may need to invest a lot of psychological resources to overcome the barriers encountered during implementation.

Measuring the determinants of implementation behavior in multiprofessional rehabilitation

BACKGROUND

The Determinants of Implementation Behavior Questionnaire (DIBQ) measures facilitators or barriers of healthcare professionals' implementation behaviors based on the current implementation research on practice and policy. The DIBQ covers 18 domains of the Theoretical Domains Framework and consists of 93 items. A previously tailored version (DIBQ-t) covering 10 domains and 28 items focuses on implementing best-practice low back pain care.

AIM

To tailor a shortened version of DIBQ to multiprofessional rehabilitation context with cross-cultural adaptation to Finnish language.

DESIGN

A two-round Delphi study.

SETTING

National-level online survey.

POPULATION

Purposively recruited experts in multiprofessional rehabilitation (N.=25).

METHODS

Cross-cultural translation of DIBQ to Finnish was followed by a two-round Delphi survey involving diverse experts in rehabilitation (physicians, physiotherapists, occupational therapists, psychologists, nursing scientists, social scientists). In total, 25 experts in Round 1, and 21 in Round 2 evaluated the importance of DIBQ items in changing professionals' implementation behavior by rating on a 5-point Likert Scale (1 = Strongly Disagree, 5 = Strongly Agree) of including each item in the final scale. Consensus to include an item was defined as a mean score of ≥4 by ≥75% of Delphi participants. Open comments were analyzed using inductive content analysis. Items with agreement of ≤74% were either directly excluded or reconsidered and modified depending on qualitative judgements, amended with experts' suggestions. After completing an analogous second-round, a comparison with DIBQ-t was performed. Lastly, the relevance of each item was indexed using content validity index on item-level (I-CVI) and scale-level (S-CVI/Ave).

RESULTS

After Round 1, 17 items were included and 48 excluded by consensus whereas 28 items were reconsidered, and 20 items added for Round 2. The open comments were categorized as: 1) "modifying"; 2) "supportive"; and 3) "critical". After Round 2, consensus was reached regarding all items, to include 21 items. After comparison with DIBQ-t, the final multiprofessional DIBQ (DIBQ-mp) covers 11 TDF domains and 21 items with I-CVIs of ≥0.78 and S-CVI/Ave of 0.93.

CONCLUSIONS

A Delphi study condensed a DIBQ-mp with excellent content validity for multiprofessional rehabilitation context.

CLINICAL REHABILITATION IMPACT

A potential tool for evaluating determinants in implementing evidence-based multiprofessional rehabilitation interventions.

Development and Psychometric Properties of the Community Implementation Behaviour Questionnaire (CIBQ) in the Context of Supporting Caring Relatives of People with Dementia

The Theoretical Domains Framework (TDF) investigates the determinants influencing the implementation behaviour of actors in healthcare. Caring for people with dementia (PWD) can be burdensome. Therefore, caring relatives (CRs) often rely on support of various actors in their community (CAs). However, the support of this target group is not sufficient, and the implementation of support services needs to be optimised. As it stands, there is no German-language questionnaire to investigate the factors that influence the implementation behaviour of CAs. Therefore, based on the TDF, the Community Implementation Behaviour Questionnaire (CIBQ) was developed in this study. A total of 205 CAs from 16 German communities were surveyed. The 34-item CIBQ asked about their implementation behaviour regarding support services for CRs of PWD. To identify the best model fit, the internal consistency and construct validity were computed. After adaptation, the final CIBQ consisted of ten domains and thirty-one items. The psychometric properties of the questionnaire are as follows: CMIN/DF = 1.63; SRMR = 0.05; RMSEA = 0.07; CFI = 0.92; Cronbach's alpha 0.74-0.89; inter-item correlation 0.38-0.88. The initial results show satisfactory internal consistency and construct validity of the CIBQ. Using the CIBQ enables the health and care optimisation of CRs of PWD.

Ditching the Driving: A Cross-Sectional Study on the Determinants of Remote Work From Home for Sign Language Interpreters

Background

The coronavirus disease 2019 (COVID-19) pandemic dramatically impacted the working conditions for sign language interpreters, shifting the provision of interpreting services from onsite to remote. The goal of this cross-sectional study was to examine the perceptions of determinants of remote interpreting implementation from home by sign language interpreters during the pandemic. We hypothesized that interpreters working across the primary settings of staff (agency, government, business, or hospital employees), educational (K-12 or postsecondary), community/freelance (independent contractor), video remote (the two-way connection between onsite participants and remote interpreter), and video relay (three-way telecommunication) would present with differing experiences of the implementation process.

Methods

The Determinants of Implementation Behavior Questionnaire was adapted for sign language interpreters (DIBQ-SLI) and administered to certified interpreters working remotely at least 10 h per week. The DIBQ-SLI included eight constructs (knowledge, skills, self-efficacy, perceived behavioral control, innovation characteristics, organizational resources and support, innovation strategies, and social support) and 30 items. Parametric statistics assessed differences in interpreters' perceptions across settings. Principal component analysis was conducted for data reduction and affirmation of the most critical constructs and items.

Results

One hundred and six interpreters (37 video relay, 27 video remote, 18 educational, 11 community/freelance, 11 staff interpreters, and two from "other" settings) completed the DIBQ-SLI. The video relay and staff interpreters consistently demonstrated the most favorable and the educational interpreters demonstrated the least favorable perceptions. Of the total variance, 58.8% of interpreters' perceptions was explained by organizational (41%), individual (10.7%), and social (7.1%) dimensions. There were significant differences across settings for the organizational and individual principal components; however, no differences were detected for the social principal component.

Conclusions

An administrative infrastructure devoted to ensuring that interpreters receive sufficient managerial support, training, materials and resources, experience with remote interpreting before having to commit, and insights based on the results of their remote work (organizational principal component) may be necessary for improving perceptions. Remote interpreting is expected to continue after the pandemic ends; thus, settings with the least favorable ratings across behavior constructs may borrow strategies from settings with the most favorable ratings to help promote perceptions of the contextual determinants of future remote interpreting implementation.

GLA:D® Back Australia: a mixed methods feasibility study for implementation

Background

Practice-based guidelines recommend patient education and exercise as first-line care for low back pain (LBP); however, these recommendations are not routinely delivered in practice. GLA:D® Back, developed in Denmark to assist clinicians to implement guideline recommendations, offers a structured education and supervised exercise program for people with LBP in addition to a clinical registry to evaluate patient outcomes. In this study we evaluated the feasibility of implementing the GLA:D® Back program in Australia. We considered clinician and patient recruitment and retention, program fidelity, exploring clinicians’ and patients’ experiences with the program, and participant outcome data collection.

Methods

Clinicians (chiropractors and physiotherapists) were recruited and participated in a 2-day GLA:D® Back training course. Patients were eligible to participate if they had persistent or recurrent LBP. Feasibility domains included the ability to: (1) recruit clinicians to undergo training; (2) recruit and retain patients in the program; (3) observe program fidelity; and (4) perceive barriers and facilitators for GLA:D® Back implementation. We also collected data related to: (5) clinician confidence, attitudes, and behaviour; and (6) patient self-reported outcomes related to pain, disability, and performance tests.

Results

Twenty clinicians (8 chiropractors, 12 physiotherapists) participated in the training, with 55% (11/20) offering GLA:D® Back to their patients. Fifty-seven patients were enrolled in the program, with 67% (38/57) attending the final follow-up assessment. Loss to follow up was mainly due to the effects of the COVID-19 pandemic. We observed program fidelity, with clinicians generally delivering the program as intended. Interviews revealed two clinician themes related to: (i) intervention acceptability; and (ii) barriers and facilitators to implementation. Patient interviews revealed themes related to: (i) intervention acceptability; and (ii) program efficacy. At 3 months follow-up, clinicians demonstrated high treatment confidence and biomedical orientation. Patient outcomes trended towards improvement.

Conclusion

GLA:D® Back implementation in Australia appears feasible based on clinician recruitment, program acceptability and potential benefits for patient outcomes from the small sample of participating clinicians and patients. However, COVID-19 impacted patient recruitment, retention, and data collection. To scale-up GLA:D® Back in private and public settings, further work is warranted to address associated barriers, and to leverage facilitators.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00427-3.

The utilisation of regulated standardised care packages by Danish chiropractors: a mixed methods study

Background

In Denmark, chiropractors in primary care work as independent private contractors regulated by the Danish National Health Authorities. The regulation includes partial reimbursement intended for standardised care packages for lumbar and cervical radiculopathy and lumbar spinal stenosis. Random checks have shown lower use than expected. This study aimed to describe and explore the utilisation of standardised chiropractic care packages and identify barriers to uptake.

Methods

A convergent mixed-method design was conceptualised. The use of standardised care packages was collected by register data. Potential determinants of difference in utilisation were assessed using a modified version of the Determinants of Implementation Behaviour Questionnaire (DIBQ) divided into 13 domains and sent to chiropractors in private clinics in Denmark in 2019. An open-ended question was added to the questionnaire, and thematic content analysis was applied. Qualitative findings were used to expand on the DIBQ data providing further insight into the clinicians’ perspective on standardised care packages. 

Results

Registry data of 244 included chiropractic clinics showed limited and inconsistent use of the standardised chiropractic care packages. A total of 269 chiropractors (44%) answered the DIBQ, and 45 provided data for the qualitative analyses. At least 60% of the clinicians answered ‘Strongly agree’ or ‘Agree’ in 10 out of 13 DIBQ domains suggesting a positive attitude towards using the standardised care packages. Three domains were identified as ‘problematic’ as more than 20% of clinicians disagreed or strongly disagreed: ‘Socio-political context’, ‘Goals’ and ‘Innovation’. Qualitative findings indicated that lack of usage of the standardised care packages was mainly related to the practical organization of standardised care, the chiropractor’s role when managing patients, and the patient population of interest to the clinic (e.g., children, athletes).

Conclusion

In general, Danish chiropractors displayed positive attitudes towards standardised packages of care. However, considerable variation in the use of the standardised care programs was observed. Low utilisation seemed mainly related to logistics, the chiropractor’s role, collaboration with GPs, and the patient population of interest to the clinic. These findings should be further explored in more extensive qualitative studies to inform implementation initiatives to increase and rectify utility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12998-022-00423-7.