Using the Theoretical Domains Framework to identify strategies to support the implementation of the guidelines for the physiotherapy management of people with spinal cord injury: a qualitative study.

Abstract

Study design: Qualitative design.

Aim: The aim of the study was to (i) determine the perspectives of therapists and people with spinal cord injury (SCI) on our recently developed Australian and New Zealand Clinical Practice Guidelines for the physiotherapy management of people with SCI, and (ii) understand the barriers and facilitators to the rollout of the Guidelines and identify implementation strategies to support their uptake.

Setting: Hospital and community SCI services, Australia.

Methods: Twenty-one therapists and 10 people with SCI were interviewed one-on-one or within focus groups. The interviews captured perspectives of therapists and people with SCI on the Guidelines as well as barriers and facilitators to the rollout of the Guidelines. The interviews with therapists were guided by the Theoretical Domains Framework (TDF). All interviews were transcribed and thematically coded. Barriers and facilitators were then linked to the COM-B model (Capability, Opportunity, Motivation - Behaviour) to identify implementation strategies.

Results: The barriers to implementation of the Guidelines identified by therapists were lack of knowledge and skill, lack of resources and challenges associated with working within large organisations. Facilitators to the uptake of the Guidelines were providing education, skill training, Guideline champions, awareness, and two-way communication between patient and therapist. Fourteen implementation strategies were identified.

Conclusion: Both therapists and people with SCI thought the Guidelines were a useful tool to improve the quality of care provided to people with SCI across various health settings. Facilitators identified in this study are being used to guide current implementation projects to enhance the uptake of the Guidelines.