Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods
Abstract 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, i...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | Implementation Science |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13012-019-0942-y |
| _version_ | 1811294577705877504 |
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| author | Johanna Fritz Lars Wallin Anne Söderlund Lena Almqvist Maria Sandborgh |
| author_facet | Johanna Fritz Lars Wallin Anne Söderlund Lena Almqvist Maria Sandborgh |
| author_sort | Johanna Fritz |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-04-13T05:19:38Z |
| format | Article |
| id | doaj.art-d2d731d5f3994964bb81bf07690cf115 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-04-13T05:19:38Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-d2d731d5f3994964bb81bf07690cf1152022-12-22T03:00:48ZengBMCImplementation Science1748-59082019-11-0114111210.1186/s13012-019-0942-yImplementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methodsJohanna Fritz0Lars Wallin1Anne Söderlund2Lena Almqvist3Maria Sandborgh4School of Health, Care and Social Welfare, Mälardalen UniversitySchool of Education, Health and Social Studies, Dalarna UniversitySchool of Health, Care and Social Welfare, Mälardalen UniversitySchool of Health, Care and Social Welfare, Mälardalen UniversitySchool of Health, Care and Social Welfare, Mälardalen UniversityAbstract 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.http://link.springer.com/article/10.1186/s13012-019-0942-yPhysiotherapySocial learning theorySelf-regulationImplementation scienceKnowledge translationPrimary health care |
| spellingShingle | Johanna Fritz Lars Wallin Anne Söderlund Lena Almqvist Maria Sandborgh Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods Implementation Science Physiotherapy Social learning theory Self-regulation Implementation science Knowledge translation Primary health care |
| title | Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods |
| title_full | Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods |
| title_fullStr | Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods |
| title_full_unstemmed | Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods |
| title_short | Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods |
| title_sort | implementation of a behavioral medicine approach in physiotherapy a process evaluation of facilitation methods |
| topic | Physiotherapy Social learning theory Self-regulation Implementation science Knowledge translation Primary health care |
| url | http://link.springer.com/article/10.1186/s13012-019-0942-y |
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