Datasheet3_Implementation strategies for occupational therapists to advance goal setting and goal management.docx

BackgroundThere is a need for an effective evidence-based system to support high-quality goal setting and goal management implementation. We developed a new system for community-based rehabilitation, MyGoals, along with implementation strategies to support occupational therapists (OTs) in its administration. This study evaluates the acceptability, appropriateness, and feasibility of the implementation strategies, Clinician Education and Audit & Feedback. It also explores whether OTs achieve the change objectives of the MyGoals implementation strategies and MyGoals intervention fidelity.MethodsThis mixed-methods case series study evaluated the MyGoals implementation strategies developed using Implementation Mapping (IM), specifically IM Task 5 – Implementation Outcome Evaluation. Seven OTs and 13 adults with chronic conditions participated in this study. OTs participated in two Clinician Education sessions, delivered two MyGoals interventions, and participated in two Audit & Feedback sessions. We evaluated the implementation strategies using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), Feasibility of Intervention Measure (FIM), and semi-structured interviews and explored the OTs' self-rated MyGoals change objectives achievement and the intervention fidelity using quantitative MyGoals intervention fidelity measures and interviews. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed by two independent coders using content analysis.ResultsSeven OTs participated in this study (mean years of professional experience = 9.3, SD = 5.9). Clinician Education and Audit & Feedback had high AIM (M = 17.9, SD = 2.7), IAM (M = 17.3, SD = 3.60), and FIM scores (M = 17.3, SD = 3). The OTs also had high mean scores on self-perceived achievement of change objectives and intervention fidelity. Qualitative interviews suggested that the time commitment for Clinician Education is a key barrier to its acceptability, appropriateness, and feasibility. Participants also provided suggestions on how to improve the strategies (e.g., providing recorded Clinician Education, etc.).ConclusionsThe MyGoals implementation strategies are acceptable, appropriate, and feasible to OTs working in community-based rehabilitation. They support OTs in achieving the change objectives necessary to deliver MyGoals completely and competently. Thus, the MyGoals implementation strategies may support clinicians in implementing a theory-based, client-engaged goal setting and goal management for adults with chronic conditions in community-based rehabilitation. This can ultimately help improve the integration of evidence-based interventions into practice.

背景：鉴于对一套有效且基于证据的系统以支持高质量的目标设定与实施管理的需求，本研究开发了一套新的社区康复支持系统——MyGoals，并配套实施策略以辅助职业治疗师（OTs）进行系统管理。本研究旨在评估实施策略——临床教育及审计与反馈的接受度、适宜性和可行性，并探究OTs是否能够实现MyGoals实施策略中的变革目标以及干预措施的严谨性。方法：本研究采用混合方法案例系列研究，评估了利用实施映射（IM）方法开发的MyGoals实施策略，具体为IM任务5——实施结果评估。共有七名OTs和13名慢性病患者参与了本研究。OTs参与了两次临床教育会议，实施了两次MyGoals干预，并参与了两次审计与反馈会议。我们运用干预措施接受度量表（AIM）、干预适宜度量表（IAM）、干预可行性量表（FIM）、半结构化访谈等方法对实施策略进行评估，并探究OTs自我评估的变革目标实现程度及干预措施的严谨性，使用量化的MyGoals干预严谨性指标及访谈进行探索。定量数据采用描述性统计分析。定性数据由两名独立编码者进行内容分析。结果：七名OTs参与了本研究（平均专业经验年数=9.3，标准差=5.9）。临床教育和审计与反馈在AIM（M=17.9，SD=2.7）、IAM（M=17.3，SD=3.60）、FIM评分（M=17.3，SD=3）方面均表现出高接受度。OTs在自我感知的变革目标实现和干预严谨性方面的平均得分也较高。定性访谈表明，临床教育的时耗是其接受度、适宜性和可行性的关键障碍。参与者还提出了改进策略的建议（例如，提供录制的临床教育等）。结论：MyGoals实施策略对于在社区康复中工作的OTs而言，具有可接受性、适宜性和可行性。这些策略支持OTs实现实现MyGoals所需变革目标，以完全且熟练地交付MyGoals。因此，MyGoals实施策略可能有助于临床医生在社区康复中为慢性病患者实施基于理论、患者参与的设定目标和目标管理，从而最终有助于提高基于证据的干预措施在实践中的应用整合。