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Implementing professional behaviour change in teams under pressure – results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)

Implementing professional behaviour change in teams under pressure – results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)
Implementing professional behaviour change in teams under pressure – results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)
Objectives: to evaluate implementation of a new procedure for screening and treatment of malnutrition for older people in community settings; to identify factors promoting or inhibiting its implementation as a routine aspect of care.

Design: prospective process evaluation using mixed methods with pre/post-implementation measures.

Setting and participants: community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre and post-implementation surveys.

Main outcome measures: NoMad survey for pre-post intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.

Methods: data prior to implementation of training, baseline (T0 – survey and telephone interview), and 2 months following training (T1 – follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group, and total study sample; analysis using Wilcoxon rank-sum (sub-group comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using Normalization Process Theory.

Results: high support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational, and specialist dietetic support. Pre-post training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between sub-groups (training participants vs. non-participants). Implementation barriers included: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance; lack of access to dietetic support.

Conclusion: greater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions.
community care, implementation, malnutrition, normalisation process theory, nutrition, process evaluation, screening
2044-6055
Bracher, Mike
e9e2fbd6-af5f-4f6e-8357-969aaf51c52e
Steward, Katherine
8ac40e0a-e3a2-498b-b190-6f3263e4f21c
Wallis, Kathy
89f0afa3-3f12-4cc4-8a73-4d5b0dbabf1e
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Aburrow, Annemarie
6819f4a2-f78b-454b-9f4a-e50653323534
Murphy, Jane
f035926b-6ce7-425a-8752-0bfc2fc81550
Bracher, Mike
e9e2fbd6-af5f-4f6e-8357-969aaf51c52e
Steward, Katherine
8ac40e0a-e3a2-498b-b190-6f3263e4f21c
Wallis, Kathy
89f0afa3-3f12-4cc4-8a73-4d5b0dbabf1e
May, Carl R.
17697f8d-98f6-40d3-9cc0-022f04009ae4
Aburrow, Annemarie
6819f4a2-f78b-454b-9f4a-e50653323534
Murphy, Jane
f035926b-6ce7-425a-8752-0bfc2fc81550

Bracher, Mike, Steward, Katherine, Wallis, Kathy, May, Carl R., Aburrow, Annemarie and Murphy, Jane (2019) Implementing professional behaviour change in teams under pressure – results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project). BMJ Open, 9 (8), [e025966]. (doi:10.1136/bmjopen-2018-025966).

Record type: Article

Abstract

Objectives: to evaluate implementation of a new procedure for screening and treatment of malnutrition for older people in community settings; to identify factors promoting or inhibiting its implementation as a routine aspect of care.

Design: prospective process evaluation using mixed methods with pre/post-implementation measures.

Setting and participants: community teams (nursing and allied health professionals) within a UK National Health Service Community Trust. 73 participants were recruited, of which 32 completed both pre and post-implementation surveys.

Main outcome measures: NoMad survey for pre-post intervention measures; telephone interviews exploring participant experiences and wider organisational/contextual processes.

Methods: data prior to implementation of training, baseline (T0 – survey and telephone interview), and 2 months following training (T1 – follow-up survey). Quantitative data described using frequency tables reporting team type, healthcare provider role group, and total study sample; analysis using Wilcoxon rank-sum (sub-group comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using Normalization Process Theory.

Results: high support for nutrition screening and treatment indicated by participants. Concerns expressed around logistical, organisational, and specialist dietetic support. Pre-post training measures indicated a positive impact of training on knowledge of the new procedure; however, most implementation measures saw no significant changes between time points or between sub-groups (training participants vs. non-participants). Implementation barriers included: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance; lack of access to dietetic support.

Conclusion: greater support necessary to support implementation in relation to monitoring of training completion, and organisational support for nutrition screening and treatment activity. Recommended changes to implementation design are: appointment of a key person to support and monitor procedure compliance; adoption of training as an e-learning module within the existing organisational platform to increase participation in changeable working conditions.

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More information

Accepted/In Press date: 1 July 2019
e-pub ahead of print date: 10 August 2019
Published date: 10 August 2019
Keywords: community care, implementation, malnutrition, normalisation process theory, nutrition, process evaluation, screening

Identifiers

Local EPrints ID: 432650
URI: http://eprints.soton.ac.uk/id/eprint/432650
ISSN: 2044-6055
PURE UUID: bfdc7514-25ce-4491-80cd-9961778f58a7
ORCID for Mike Bracher: ORCID iD orcid.org/0000-0001-5861-2657
ORCID for Carl R. May: ORCID iD orcid.org/0000-0002-0451-2690

Catalogue record

Date deposited: 23 Jul 2019 16:30
Last modified: 26 Nov 2021 02:56

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Contributors

Author: Mike Bracher ORCID iD
Author: Katherine Steward
Author: Kathy Wallis
Author: Carl R. May ORCID iD
Author: Annemarie Aburrow
Author: Jane Murphy

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