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Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods.
Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Karolinska Institutet, Stockholm / Sahlgrenska Academy, University of Gothenburg.
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2019 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 14, no 1, article id 94Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences.

METHODS: An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used.

RESULTS: The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking.

CONCLUSIONS: The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.

Place, publisher, year, edition, pages
2019. Vol. 14, no 1, article id 94
Keywords [en]
Clinical competence, Implementation science, Knowledge translation, Physiotherapy, Primary health care, Self-regulation, Social learning theory
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
URN: urn:nbn:se:du-31127DOI: 10.1186/s13012-019-0942-yISI: 000494477200001PubMedID: 31684977Scopus ID: 2-s2.0-85074548087OAI: oai:DiVA.org:du-31127DiVA, id: diva2:1372335
Available from: 2019-11-22 Created: 2019-11-22 Last updated: 2019-12-09

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Wallin, Lars

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2728293031323330 of 38
CiteExportLink to record
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