To Örebro University

BACKGROUND: The implementation of interventions in clinical practices is a challenge in healthcare settings, particularly in the field of habilitation. Although research on interventions in this area has increased, research on the implementation of these interventions has been slow. Exploring staff experience of implementation is therefore crucial to optimize the likelihood that interventions will be adopted and sustained in habilitation settings. The purpose of this systematic review is to synthesize the experiences of staff in implementing interventions for adults with congenital disabilities into a comprehensive overview. METHODS: Studies were included if they provided empirical data on staff experiences of implementing interventions for adults with congenital disabilities in health and social care settings, regardless of study design. Non-empirical studies and grey literature were excluded. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we conducted a search using the Medline, CINAHL, PsycInfo, Sociological Abstract, Applied Social Sciences Index and Abstracts (ASSIA), and Web of Science databases. The last search update was conducted in February 2024. The Critical Appraisal Skills Program (CASP) tool was used for qualitative studies, and the Mixed-Method Assessment Tool (MMAT) for the quantitative and mixed-method studies. The Convergent Integrated Approach (CIA) was employed to synthesize the data. RESULTS: Of the 5855 studies initially retrieved, eight met the inclusion criteria. The analysis and integration of all included studies were categorized into three themes: (1) conditions for implementation, (2) acceptability of the intervention, and (3) approaches for change. The results underscore the importance of organizational resources, vision, and collaboration in successful implementation. CONCLUSIONS: Active participation of professionals and alignment of interventions with existing practices were identified as key factors for success. The consideration of external factors that can influence the implementation of interventions is also important. In general, these findings provide information to guide future planning and implementation of interventions within habilitation settings. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework (OSF): https://doi.org/10.17605/OSF.IO/SBV9E.

People with disabilities have unequal access to healthcare services and greater unmet healthcare needs compared with the general population; moreover, a so-called ‘implementation gap’ exists between recommended practices and the care that is actually provided. This gap is partly due to a lack of context-specific evidence and partly due to challenges in translating existing evidence into practice. Thus, addressing this gap requires a deeper understanding of the contextual and organizational factors that influence implementation. The aim of this dissertation is to explore the roles of context and organizational readiness from the perspective of managers and staff for the implementation of interventions within disability healthcare. The methods comprise qualitative individual interviews (Study 1), focusgroup interviews (Study 2), a mixed-methods systematic literature review (Study 3), and a survey with an embedded mixed-methods design (Study 4).The overall findings showed that workplace culture, staff attitudes, and openness to change facilitated implementation at the micro (local) level, while balancing managerial tasks and managing resistance among staff posed challenges at the meso (organizational) level. Appropriate organizational structure and support systems increased the feasibility and acceptability of new interventions, but barriers such as complex processes, lack of support and time, and insufficient resources were common at the meso level and macro (system) level. Managers’ beliefs about their organization’s readiness for implementation varied depending on management level, organizational type, and experience. To conclude, for successful implementation within disability healthcare, it is necessary to recognize and address contextual and organizational factors at the micro, meso, and macro levels. The findings suggest that effective implementation of interventions depends on supportive leadership, adequate resources, and a culture open to change. When these conditions are met, health outcomes and the quality of care for people with disabilities can be improved.

BACKGROUND: People with disabilities experience significant health inequities compared with the general population. Addressing these inequities requires the development and implementation of tailored interventions, but a gap often exists between recommended best practices and the actual care provided. Successful implementation is complex, involving multiple organizational factors. Assessing organizational readiness for change is crucial to overcome barriers and improve health outcomes for people with disabilities. This study aims to examine managers' perceptions of their organization's readiness for change regarding the implementation of interventions within disability healthcare in Sweden.

METHODS: This descriptive cross-sectional study employs an embedded mixed-methods approach. The primary approach for the overall study is based on quantitative data, while qualitative data is analyzed to provide supplementary deepened information. Both types of data were collected simultaneously through a web-based survey. The data analysis involves various statistical techniques for the quantitative data and inductive content analysis for the qualitative data.

RESULTS: Several key factors influence managers' perceptions of their organization's readiness for change, including gender, age, tenure, organizational type, managerial level, and experience. Enabling factors for implementation include trust-based leadership, staff involvement, motivation, and engagement. Barriers include complex processes, lack of support, resistance and fear, and insufficient time and resources.

CONCLUSIONS: This study highlights the complexity of organizational readiness for disability healthcare interventions, shaped by both individual and organizational factors. In particular, managerial characteristics, organizational dynamics, and resource availability play key roles. These findings suggest that a comprehensive strategy can strengthen healthcare organizations' ability to navigate implementation challenges effectively.

Background: The implementation of interventions in clinical practices is a challenge across healthcare settings, particularly in the field of habilitation. To improve access to research-based treatment, there is a need to understand and explain factors affecting the implementation of interventions. The purpose of this systematic review is to identify, appraise and synthesise staff experience of the implementation of interventions for adults with congenital disabilities into a comprehensive overview.

Method: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we conducted a search using the Medline, CINAHL, PsycINFO, Sociological Abstract, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science databases. To be eligible, studies had to have collected data (qualitative or quantitative) that specifically addressed the implementation process.

Findings: Of the 5430 studies initially retrieved, eight met the inclusion criteria. Staff-identified barriers and facilitators, as well as strategies and outcomes, were grouped into three themes: (1) conditions for implementation, (2) acceptability of interventions and (3) approach for change. The most commonly cited barriers and facilitators were organisation structure and culture, financial and personnel resources, relevance of interventions, and communication and collaboration.

Conclusions: When implementing an intervention, it is necessary to consider barriers and facilitators across all three identified themes to increase the likelihood of implementation success. The compiled results of the included studies provide insights that further our understanding of implementation and our knowledge of the influence of factors on the implementation of interventions within habilitation settings. This review highlights knowledge gaps and areas for future study in the context of habilitation implementation.

Background: Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMDs). Exploring support persons’ and health personnel’s experience of anintervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.

Method: This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Findings: Three themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility, (2) an intervention’s benefit for people with PIMD increases its acceptability and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan.

Conclusions: A training programme should be provided for the recipients and providers of the intervention. Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.

Introduction: Contextual factors influence interventions in healthcare and pose a particular challenge in interventions designed for people with profound intellectual and multiple disabilities (PIMD). Exploring support persons’ and health personnel’s experience of an intervention may improve our understanding of the influence of contextual factors. Such exploration is important for revealing areas and focus points for future implementations. Therefore, the aim of this study is to explore support persons’ and health personnel’s experience of contextual factors during involvement in an intervention for people with PIMD.

Methods: This focus group study includes eight groups, comprising a total of 34 support persons and health personnel, at habilitation centres at four regions in central Sweden. Data were analysed inductively using a content analysis approach.

Results: Three themes emerged from the analysis of the informants’ perspectives on the contextual factors: (1) structure and support enhances intervention feasibility; (2) an intervention’s benefit for people with PIMD increases its acceptability; and (3) being engaged and involved increases support persons’ and health personnel’s motivation. Our findings show that the implementation of an intervention for people with PIMD should focus on the recipients of the intervention in its context, forming a clear communication plan. A training programme should be provided for the recipients and providers of the intervention.

Discussion: Finally, the implementation process can be facilitated by creating space for staff to contribute and by encouraging participation and ownership for everyone involved. Using a co-design strategy can enable a shared responsibility to solve the identified challenges, while contributing to the development and design of future interventions for people with disabilities.

BACKGROUND: Effective implementation processes play a central role in health care organizations and affect the care of patients. Managers are pivotal in facilitating the use of new practices, but their experience and how it affects the implementation outcome are still largely unknown. In the field of disability health care in particular, managers experiences have scarcely been investigated. Therefore, the aim of this study is to explore managers' experiences of the implementation process when transferring new practices into disability health care settings.

METHODS: Semi-structured individual telephone interviews were conducted with managers at disability health care organizations in four administrative regions in central Sweden. A total of 23 managers with formal managerial responsibility from both public and private health care were strategically selected to be interviewed. The interviews were analysed using reflexive thematic analysis with an inductive approach.

RESULTS: The analysis resulted in two themes about factors influencing the implementation process: firstly, Contextual factors set the agenda for what can be achieved, which highlighted aspects that hinder or enable the implementation process, such as internal and external conditions, the workplace culture, the employees and managers' attitudes and openness to change: secondly, Leadership in the winds of change, which described the challenges of balancing managerial tasks with leading the change, and the importance of a leadership that involves the participation of the employees.

CONCLUSIONS: This study explored how and to what extent managers address and manage the implementation process and the many associated challenges. The findings highlight the importance of leadership support and organizational structure in order to transfer new practices into the work setting, and to encourage an organizational culture for leading change that promotes positive outcomes. We suggest that identifying strategies by focusing on contextual factors and on aspects of leadership will facilitate implementation processes.

TRIAL REGISTRATION: The SWAN (Structured Water Dance Intervention) study was retrospectively registered on April 9, 2019 and is available online at ClinicalTrials.gov (ID: NCT03908801).

Background: People with profound intellectual and multiple disabilities (PIMD) have a combination of severe intellectual disability, extensive physical impairment, sensory impairments and medical health problems. There is, however, a lack of evidence-based physical and health-promoting interventions for people with PIMD.

Objective: Structured Water Dance Intervention (SWAN) is a new method developed to fill this gap. This paper reports a protocol for an intervention study which aims to evaluate SWAN with regard to its effects on physiological, psychological and social health-related variables as well as its cost-effectiveness and potential for implementation in health care.

Methods: The evaluation of SWAN is performed in a multi-center randomized crossover study. Data is collected through cortisol measurement, physiological assessments, proxy ratings, video observations and interviews.

Conclusions: This is one of few attempts to evaluate rigorously an innovative intervention for people with PIMD, a group that is rarely considered for health promotion interventions. This study will provide important information about the efficacy, cost-effectiveness and potential to implement SWAN in health care.