Difference-Making Conditions for the Successful Implementation of IDEAS: A Provider Stigma-Reduction Training for and by Occupational Therapy Practitioners.

Abstract

Importance: Identity Development Evolution and Sharing (IDEAS) is an evidence-supported occupational therapy intervention for reducing provider stigma to promote health care equity. Its effectiveness relies on successful implementation. It is therefore critical to identify and examine key difference-makers that facilitate or impede implementation success and effectiveness.

Objective: To determine difference-making conditions for the successful implementation of IDEAS in occupational therapy settings.

Setting: Occupational therapy sites.

Participants: Internal facilitators, occupational therapy staff, and site managers or stakeholders at nine clinical sites (N = 58).

Outcomes and measures: The data sources included interviews generated using the Consolidated Framework for Implementation Research, to assess key implementation constructs; three validated ratings scales (the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure); and the Acceptance and Action Questionnaire-Stigma, a valid and reliable measure of enacted stigma, to assess intervention effectiveness. Coincidence analysis was used to identify difference-makers directly linked to implementation success and effectiveness.

Results: Two implementation-related factors were identified as key difference-makers: design quality and packaging and impact of external facilitation. Sites with successful IDEAS implementation had either a strong positive value for design quality and packaging or a lower positive value for design quality and packaging bundled together with a strong positive value for impact of external facilitation.

Conclusions and relevance: In addition to identifying effective evidence-based interventions to improve clinical practice, occupational therapy practitioners and their clients also stand to gain through a careful consideration of how implementation factors influence the success of evidence-based practices in real-world settings. Plain-Language Summary: This study looks at how to successfully use a program called Identity Development Evolution and Sharing (IDEAS) in occupational therapy settings. IDEAS is a training that helps reduce bias and stigma among health care providers by sharing real stories from people who have experienced discrimination in health care. Bias in health care can lead to unfair treatment and poor outcomes for people receiving health care. Reducing this bias is essential for making health care more fair and inclusive. Occupational therapists want to support equity, but they need effective tools and strategies to do so. IDEAS is one such tool, but it only works well when certain conditions are present. The researchers studied how IDEAS was used in nine occupational therapy clinics across the United States. They looked at what helped or hurt the success of the program, using a method called coincidence analysis to find out which variables made the biggest difference. Two key things helped make IDEAS successful: (1) design quality and packaging (how well the training materials were put together and how easy they were to use) and (2) external facilitation  (support from an outside expert who trained and guided the person who led IDEAS in their clinic). If either of these was strong, the program worked well. If both were strong, it worked even better. Other variables such as a positive impression of the IDEAS program and a receptive workplace culture were also related to how well the IDEAS program worked. Occupational therapists who want to reduce bias in their practice can use IDEAS more effectively by making sure the training materials are clear and easy to use, getting support from someone experienced with the program, and creating a workplace culture that is open to learning and change.