Facilitators and “deal breakers”: a mixed methods study investigating implementation of the goal setting and action planning (G-AP) framework in community rehabilitation teams

Lesley Scobbie*, Edward A. S. Duncan, Marian C. Brady, Katie Thomson, Sally Wyke

*Corresponding author for this work

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Abstract

Background: High quality goal setting in stroke rehabilitation is vital, but challenging to deliver. The G-AP framework (including staff training and a stroke survivor held G-AP record) guides patient centred goal setting with stroke survivors in community rehabilitation teams. We found G-AP was acceptable, feasible to deliver and clinically useful in one team. The aim of this study was to conduct a mixed methods investigation of G-AP implementation in diverse community teams prior to a large-scale evaluation.

Methods: We approached Scottish community rehabilitation teams to take part. Following training, G-AP was delivered to stroke survivors within participating teams for 6 months. We investigated staff experiences of G-AP training and its implementation using focus groups and a training questionnaire. We investigated fidelity of G-AP delivery through case note review. Focus group data were analysed using a Framework approach; identified themes were mapped into Normalisation Process Theory constructs. Questionnaire and case note data were analysed descriptively.

Results: We recruited three teams comprising 55 rehabilitation staff. Almost all staff (93%; 51/55) participated in G-AP training; of those, 80% (n=41/51) completed the training questionnaire. Training was rated as ‘good’ or ‘very good’ by almost all staff (92%; n=37/41). G-AP was broadly implemented as intended in two teams. Implementation facilitators included - G-AP ‘made sense’; repetitive use of G-AP in practice; flexible G-AP delivery and positive staff appraisals of G-AP impact. G-AP failed to gain traction in the third team. Implementation barriers included - delays between G-AP training and implementation; limited leadership engagement; a poor ‘fit’ between G-AP and the team organisational structure and simultaneous delivery of other goal setting methods. Staff recommended (i) development of training to include implementation planning; (ii) ongoing local implementation review and tailoring, and (iii) development of electronic and aphasia friendly G-AP records.

Conclusions: The interaction between G-AP and the practice setting is critical to implementation success or failure. Whilst facilitators support implementation success, barriers can collectively act as implementation “deal breakers”. Local G-AP implementation efforts should be planned, monitored and tailored. These insights can inform implementation of other complex interventions in community rehabilitation settings.
Original languageEnglish
Article number791
Number of pages14
JournalBMC Health Services Research
Volume20
DOIs
Publication statusPublished - 25 Aug 2020

Keywords

  • goal setting
  • stroke
  • community rehabilitation
  • implementation
  • mixed methods

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