Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory.
Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory.
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DOI：
10.1186/1471-2296-11-60
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发表时间：
2010-08-23
影响因子：
2.9
通讯作者：
Andersson A
中科院分区：
文献类型：
--
作者：
Carlfjord S;Lindberg M;Bendtsen P;Nilsen P;Andersson A
弥合医疗保健知识与实践之间的差距是近年来引起人们关注的一个重要问题。然而，在日常护理中实施新方法、指南或工具是一个缓慢且不可预测的过程，并且在变革过程中发挥作用的因素尚未完全了解。有许多理论涉及预测在各种环境中成功实施的因素，但是，这个问题在初级卫生保健（PHC）中尚未得到充分研究。本文的目的是应用实施理论来确定影响瑞典初级卫生保健中采用创新的关键因素。瑞典六个初级卫生保健单位的工作人员进行了一项定性研究，这些单位实施了基于计算机的生活方式干预测试。使用了两种不同的实施策略，隐式的或显式的。进行了十六次焦点小组访谈和两次个人访谈。在分析中，应用基于卫生服务组织实施研究的理论框架来确定影响采用的关键因素。事实证明，该理论框架与初级卫生保健研究相关。采用受到单位的积极期望、对创新与现有惯例兼容的看法以及感知优势的积极影响。明确的实施策略以及对变革和创新的积极意见也与采用相关。与实施同时发生的组织变革和人员短缺似乎是采用过程的障碍。当从其他领域的研究中获得的实施理论应用于初级卫生保健时，它被证明与这一特定环境相关。根据我们的结果，在规划初级卫生保健新工具的实施时要考虑的因素应包括评估工作人员的期望、评估实施创新的感知需求以及其与现有常规的潜在兼容性。关于背景，我们建议应避免与其他重大组织变革同时实施。实施策略的选择应经过充分考虑。
Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden. A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption. The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process. When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.
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影响因子：
3.8
作者：
Glasgow, RE;Klesges, LM;Estabrooks, P
通讯作者：
Estabrooks, P
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
4.2
作者：
Alanen, Seija;Valimaki, Maritta;Kaila, Minna
通讯作者：
Kaila, Minna
DOI：
10.1046/j.1440-172x.2001.00247.x
发表时间：
2001-04-01
影响因子：
1.9
作者：
Lovgren, G;Astrom, G;Engstrom, B
通讯作者：
Engstrom, B
影响因子：
2.8
作者：
Flottorp S;Oxman AD
通讯作者：
Oxman AD