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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 the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and 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-implemetation 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 (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation 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 subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and 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 as follows: 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
1-15
Bracher, Mike
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Steward, Katherine
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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), 1-15, [e025966]. (doi:10.1136/bmjopen-2018-025966).

Record type: Article

Abstract

Objectives To evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and 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-implemetation 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 (subgroup comparison) and Wilcoxon signed-rank (within-group observation point comparison) tests. Qualitative interview data (audio and transcription) analysed through directed content analysis using normalisation 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 subgroups (training participants vs non-participants). Implementation barriers included the following: high levels of training non-completion; vulnerability to attrition of trained staff; lack of monitoring of post-intervention compliance and 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 as follows: 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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Accepted/In Press date: 1 July 2019
e-pub ahead of print date: 10 August 2019
Keywords: community care, implementation, malnutrition, normalisation process theory, nutrition, process evaluation, screening

Identifiers

Local EPrints ID: 433464
URI: http://eprints.soton.ac.uk/id/eprint/433464
ISSN: 2044-6055
PURE UUID: 7c28e37e-f32f-43dc-9752-2c52f17c9db4
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

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Date deposited: 23 Aug 2019 16:30
Last modified: 27 Jan 2020 13:44

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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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