The process of occupational therapists implementing client-centred ADL intervention in clinical practice

Abstract

The overall aim: The overall aim of the thesis was to identify and describe the characteristics of the implementation process and what hinders and contributes to the implementation of complex interventions when occupational therapists interact with researchers. The long-term goal of the thesis is to contribute to the development of strategies for the implementation of complex interventions in health care.

Methods: The two studies in the thesis are based on occupational therapists’ (OTs) experience of implementing a client-centred ADL intervention (CADL) in collaboration with researchers within a randomized control study (RCT). In Study I, 33 OTs participated in focus group interviews two, six and 12 months after completing a workshop before implementing the CADL intervention to persons with stroke. By using a grounded theory approach, it was possible to describe the OTs’ implementation process according to their experiences of being involved in a research project. In Study II, two questionnaires with both closed- and open-ended questions were sent out one year after participating in the workshops and five years after the project was ended. Thirty-one of the 41 OTs responded to the first questionnaire and 19 of 39 responded to the second. This study was a cross-sectional study, and a convergent parallel design of mixed methods was used in order to get a broader understanding of the OTs’ attitudes and experiences of being involved in a research project.

Findings: In the analysis of the interviews in Study I, one core category emerged: ‘The implementation of a client-centred intervention enabled the fusion of science and practice’ and three sub-categories followed: 1) Including in the scientific world, 2) Involving as an actor of science, and 3) Integrating in a partnership. The OTs’ attitudes towards engaging in research were changed by support from the researchers, while the OTs acquired more and more experience in using the CADL intervention. The process comprised of being an outsider to the scientific world to being included and then becoming a part of the research as an implementer of science. The findings in Study II explored the OTs’ experience after they ended the participation in the research project. Hindrances like access to clients limited the ability to feel safe in using the CADL in meeting with the client or when the OTs had to update the knowledge given in the workshop. Experience of the team’s limited support was another factor. The majority of the OTs considered support from the researchers during the time that the projected continued to be a factor that facilitated during the implementation of the intervention revealed both one year after participating in the workshop and five years after the project ended. The opportunity to discuss and reflect on the role and experience as implementers to participate in a research project contributed to changes in the meeting with the client. The OTs felt more professional with the support of the CADL. The availability of research-based knowledge, as relayed by the researchers, was a further factor when the CADL intervention became a bridge between practice and science.

Conclusions: To create a context built on a collaborative partnership between practitioners and researchers enabled the fusion of practice and science. Support from the organizations and teams, a sufficient interaction with the researchers, a satisfying self-image, and an accessible context were important and sustainable factors.