Development and evaluation of tailored, theory-informed training to support the implementation of an outcome measure: an explanatory sequential mixed method study

We aimed to describe the development of a tailored, theory-informed training session for an outcome measure (the Mayo-Portland Adaptability Inventory), and evaluate the session’s impact on clinician reactions, learning, and behavioural intent. We developed the training session using an integrated knowledge translation approach with stroke outpatient rehabilitation clinicians in Québec, Canada. We conducted a mixed-method explanatory sequential evaluation informed by the New World Kirkpatrick Model (reaction, learning, behavioural intent) composed of three surveys followed by interviews. We analyzed survey data using cumulative link mixed models, and interviews using directed content analysis. Eighty clinicians attended the training session, of which 51 responded to the surveys and 6 participated in interviews. Odds ratios indicate that individuals were more likely to rate themselves higher post-training on most outcomes. During the interviews, participants indicated that: they experienced positive reactions, learning and behavioural impacts from the session, negative attitudes and commitment were due to perceived limitations in the outcome measure, and training impacts were affected by contextual factors including a provincial mandate for the measure. Implementation teams could adapt this training design process to their context. Further research to understand how educational strategies work would produce more robust guidance. Outcome measures are underused in rehabilitation settings such that their expected benefits are not being realized.Theory-informed educational strategies could be leveraged to facilitate the uptake of outcome measures into practice.In this study, we identified the specific theory-informed components of the training session that produced positive impacts on clinicians’ learning and behavioural intent up to 8-weeks post-training.The theory-informed components of the training session that had positive effects (i.e., those linked to competence including demonstration of the behaviour and behavioural practice) could be adapted by others implementing outcome measures in their setting. Outcome measures are underused in rehabilitation settings such that their expected benefits are not being realized. Theory-informed educational strategies could be leveraged to facilitate the uptake of outcome measures into practice. In this study, we identified the specific theory-informed components of the training session that produced positive impacts on clinicians’ learning and behavioural intent up to 8-weeks post-training. The theory-informed components of the training session that had positive effects (i.e., those linked to competence including demonstration of the behaviour and behavioural practice) could be adapted by others implementing outcome measures in their setting.

本研究旨在描述针对某结局指标（outcome measure）——梅奥-波特兰适应性量表（Mayo-Portland Adaptability Inventory）的定制化、基于理论的培训课程开发过程，并评估该课程对临床医师反应、学习收获与行为意图的影响。研究联合加拿大魁北克省的脑卒中门诊康复临床医师，采用整合知识转化（integrated knowledge translation）方法开发本次培训课程。本研究采用基于新世界柯克帕特里克模型（New World Kirkpatrick Model，包含反应层、学习层与行为意图层）的混合方法解释性序贯评价设计，先开展三份问卷调查，随后进行访谈。问卷调查数据采用累积链接混合模型（cumulative link mixed models）分析，访谈资料采用定向内容分析（directed content analysis）编码分析。共计80名临床医师参与本次培训，其中51名完成问卷调查，6名参与访谈。优势比（Odds ratios）分析结果显示，培训后多数结局指标的自评得分更高。访谈结果表明：参与者反馈本次培训带来了积极的反应、学习收获与行为影响；对该结局指标的负面态度与投入意愿不足，源于其感知到的量表局限性；培训效果同时受到包括该指标的省级强制使用要求在内的多重情境因素影响。实施团队可根据自身场景适配该培训设计流程。未来可开展研究阐明教育策略的作用机制，以提供更严谨的实践指南。康复场景中结局指标的使用不足，导致其预期效益未能充分发挥。可借助基于理论的教育策略，推动结局指标在临床实践中的应用。本研究明确了培训课程中特定的基于理论的组成部分，这些部分可在培训后8周内对临床医师的学习收获与行为意图产生积极影响。本次培训中产生积极效果的基于理论的组成部分（即与能力培养相关的部分，如行为演示与行为实践环节），可供其他在临床场景中推广结局指标的团队参考适配。康复场景中结局指标的使用不足，导致其预期效益未能充分发挥。可借助基于理论的教育策略，推动结局指标在临床实践中的应用。本研究明确了培训课程中特定的基于理论的组成部分，这些部分可在培训后8周内对临床医师的学习收获与行为意图产生积极影响。本次培训中产生积极效果的基于理论的组成部分（即与能力培养相关的部分，如行为演示与行为实践环节），可供其他在临床场景中推广结局指标的团队参考适配。