http://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-016-1793-8
- Louise A. ConnellEmail author,
- Naoimh E. McMahon,
- Sarah F. Tyson,
- Caroline L. Watkins and
- Janice J. Eng
BMC Health Services ResearchBMC series – open, inclusive and trusted201616:534
DOI: 10.1186/s12913-016-1793-8
© The Author(s). 2016
Received: 2 February 2016
Accepted: 24 September 2016
Published: 30 September 2016
Abstract
Background
Despite best evidence
demonstrating the effectiveness of increased intensity of exercise after
stroke, current levels of therapy continue to be below those required
to optimise motor recovery. We developed and tested an implementation
intervention that aims to increase arm exercise in stroke
rehabilitation. The aim of this study was to illustrate the use of a
behaviour change framework, the Behaviour Change Wheel, to identify the
mechanisms of action that explain how the intervention produced change.
Methods
We implemented the
intervention at three stroke rehabilitation units in the United Kingdom.
A purposive sample of therapy team members were recruited to
participate in semi-structured interviews to explore their perceptions
of how the intervention produced change at their work place. Audio
recordings were transcribed and imported into NVivo 10 for content
analysis. Two coders separately analysed the transcripts and coded
emergent mechanisms. Mechanisms were categorised using the Theoretical
Domains Framework (TDF) (an extension of the Capability, Opportunity,
Motivation and Behaviour model (COM-B) at the hub of the Behaviour
Change Wheel).
Results
We identified five main
mechanisms of action: ‘social/professional role and identity’,
‘intentions’, ‘reinforcement’, ‘behavioural regulation’ and ‘beliefs
about consequences’. At the outset, participants viewed the research
team as an external influence for whom they endeavoured to complete the
study activities. The study design, with a focus on implementation in
real world settings, influenced participants’ intentions to implement
the intervention components. Monthly meetings between the research and
therapy teams were central to the intervention and acted as prompt or
reminder to sustain implementation. The phased approach to introducing
and implementing intervention components influenced participants’
beliefs about the feasibility of implementation.
Conclusions
The Behaviour Change Wheel,
and in particular the Theoretical Domains Framework, were used to
investigate mechanisms of action of an implementation intervention. This
approach allowed for consideration of a range of possible mechanisms,
and allowed us to categorise these mechanisms using an established
behaviour change framework. Identification of the mechanisms of action,
following testing of the intervention in a number of settings, has
resulted in a refined and more robust intervention programme theory for
future testing.
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