Till Örebro universitet

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.