scholarly journals Can a complex vocational rehabilitation intervention be delivered with fidelity? Fidelity assessment in the FRESH feasibility trial

2021 ◽  
Author(s):  
Jain Anne Holmes ◽  
Joanna Clare Fletcher-Smith ◽  
Jose Antionio Merchán-Baeza ◽  
Julie Phillips ◽  
Kathryn Radford
Keyword(s):  
Mixed Methods ◽  
Vocational Rehabilitation ◽  
Qualitative Data ◽  
Implementation Fidelity ◽  
Feasibility Trial ◽  
Clinical Report ◽  
Intervention Fidelity ◽  
Factors Affecting ◽  
Fidelity Assessment ◽  
Clinical Records

Abstract Background:Determining whether complex rehabilitation interventions are delivered with fidelity is important as differences can occur between sites, therapists delivering the intervention and over time; threatening trial outcomes and increasing the risk of Type II and Type III errors. Aims: to (1) evaluate implementation fidelity of vocational rehabilitation delivered in Facilitating Return to work through Early Specialist Health-based interventions (FRESH), a multi-centre feasibility randomised controlled trial; and (2) understand factors affecting delivery. Methods:Mixed methods evaluation. Fidelity was measured quantitatively using intervention case report forms, fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with the intervention therapists, participants and their employers and National Health Service (NHS) staff at each site explored moderators of implementation fidelity. The quantitative and qualitative data informed data collection tools and analysis. Data were examined against a logic model and benchmarked against an earlier cohort study. Results:Analysis of 38 clinical records (one per participant), 699 content clinical report form (CRF) (42-248 per therapist) and 12 fidelity checklists suggest intervention was delivered as intended. The core intervention process was followed in each case despite therapist variation. Qualitative data from clinical records, fidelity checklists, 183 mentoring records and 38 interviews (4 therapists, 15 trial participants, 6 employers and 13 NHS staff) explained factors affecting intervention fidelity. Fidelity moderators were similar across sites. Facilitators included therapists’ community rehabilitation experience, expert mentoring, and ability to individually tailor intervention. Barriers involved a lack of access to NHS systems no backfill and limited line-manager support. Factors that both helped or hindered intervention delivery were effective communication with participants, intervention acceptability, participants’ changing needs and interagency working. Different fidelity measures answered different questions. Fidelity checklists determined whether intervention processes were followed and explained moderators. Interviews provided insights into acceptability. Adherence was determined by content forms. Mentoring records described implementation barriers and how they were overcome.Conclusions:Mixed methods fidelity assessments enable trialists to identify factors likely to affect intervention fidelity in a definitive trial and longer-term clinical implementation. Mentoring provided insight into engagement and fidelity deviations that could be addressed in real-time, facilitating fidelity and offering a window on trial processes

scholarly journals Can a Complex Vocational Rehabilitation Intervention Be Delivered With Fidelity? Fidelity Assessment in the Fresh Feasibility Trial

2020 ◽  
Author(s):  
Jain Anne Holmes ◽  
Joanna Clare Fletcher-Smith ◽  
Jose Antionio Merchán-Baeza ◽  
Julie Phillips ◽  
Kathryn Radford
Keyword(s):  
Mixed Methods ◽  
Vocational Rehabilitation ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Implementation Fidelity ◽  
Feasibility Trial ◽  
Intervention Fidelity ◽  
Factors Affecting ◽  
Fidelity Assessment ◽  
Clinical Records

Abstract Background:Determining whether complex rehabilitation interventions are delivered with fidelity is important as differences can occur between sites, therapists delivering the intervention and over time; threatening trial outcomes and increasing the risk of Type II and Type III errors. Aims: to (1) evaluate implementation fidelity of vocational rehabilitation delivered in FRESH, a multi-centre feasibility randomised controlled trial; and (2) understand factors affecting delivery. Methods:Mixed methods evaluation. Fidelity was measured quantitatively using intervention case report forms, fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with the intervention therapists, participants and their employers and NHS staff at each site explored moderators of implementation fidelity. The quantitative and qualitativedata informed data collection tools and analysis. Data were examined against a logic model and benchmarked against an earlier cohort study. Results:Analysis of 38 clinical records (one per participant), 699 content CRFs (42-248 per therapist) and 12 fidelity checklists suggest intervention was delivered as intended. The core intervention process was followed in each case despite therapist variation. Qualitative data from clinical records, fidelity checklists, 183 mentoring records and 38 interviews (4 therapists, 15 trial participants, 6 employers and 13 NHS staff) explained factors affecting intervention fidelity. Fidelity moderators were similar across sites. Facilitators included therapists’ community rehabilitation experience, expert mentoring, and ability to individually tailor intervention. Barriers involved a lack of access to NHS systems no backfill and limited line-manager support. Factors that both helped or hindered intervention delivery were effective communication with participants, intervention acceptability, participants’ changing needs and interagency working. Different fidelity measures answered different questions. Fidelity checklists determined whether intervention processes were followed and explained moderators. Interviews provided insights into acceptability. Adherence was determined by content forms. Mentoring records described implementation barriers and how they were overcome.Conclusions:Mixed methods fidelity assessments enable trialists to identify factors likely to affect intervention fidelity in a definitive trial and longer-term clinical implementation. Mentoring provided insight into engagement and fidelity deviations that could be addressed in real-time, facilitating fidelity and offering a window on trial processesTrial registration: ISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014) (https://doi.org/10.1186/ISRCTN38581822)

scholarly journals Can a Complex Vocational Rehabilitation Intervention Be Delivered With Fidelity? Fidelity Assessment in the Fresh Feasibility Trial

2020 ◽  
Author(s):  
Jain Anne Holmes ◽  
Joanna Clare Fletcher-Smith ◽  
Jose Antionio Merchán-Baeza ◽  
Julie Phillips ◽  
Kathryn Radford
Keyword(s):  
Mixed Methods ◽  
Vocational Rehabilitation ◽  
Qualitative Data ◽  
Controlled Trial ◽  
Implementation Fidelity ◽  
Feasibility Trial ◽  
Intervention Fidelity ◽  
Factors Affecting ◽  
Fidelity Assessment ◽  
Clinical Records

Abstract Background:Determining whether complex rehabilitation interventions are delivered with fidelity is important as differences can occur between sites, therapists delivering the intervention and over time; threatening trial outcomes and increasing the risk of Type II and Type III errors. Aims: to (1) evaluate implementation fidelity of vocational rehabilitation delivered in FRESH, a multi-centre feasibility randomised controlled trial; and (2) understand factors affecting delivery. Methods:Mixed methods evaluation. Fidelity was measured quantitatively using intervention case report forms, fidelity checklists and clinical records. Qualitative data from mentoring records, interviews with the intervention therapists, participants and their employers and NHS staff at each site explored moderators of implementation fidelity. The quantitative and qualitative data informed data collection tools and analysis. Data were examined against a logic model and benchmarked against an earlier cohort study. Results:Analysis of 38 clinical records (one per participant), 699 content CRFs (42-248 per therapist) and 12 fidelity checklists suggest intervention was delivered as intended. The core intervention process was followed in each case despite therapist variation. Qualitative data from clinical records, fidelity checklists, 183 mentoring records and 38 interviews (4 therapists, 15 trial participants, 6 employers and 13 NHS staff) explained factors affecting intervention fidelity. Fidelity moderators were similar across sites. Facilitators included therapists’ community rehabilitation experience, expert mentoring, and ability to individually tailor intervention. Barriers involved a lack of access to NHS systems no backfill and limited line-manager support. Factors that both helped or hindered intervention delivery were effective communication with participants, intervention acceptability, participants’ changing needs and interagency working. Different fidelity measures answered different questions. Fidelity checklists determined whether intervention processes were followed and explained moderators. Interviews provided insights into acceptability. Adherence was determined by content forms. Mentoring records described implementation barriers and how they were overcome.Conclusions:Mixed methods fidelity assessments enable trialists to identify factors likely to affect intervention fidelity in a definitive trial and longer-term clinical implementation. Mentoring provided insight into engagement and fidelity deviations that could be addressed in real-time, facilitating fidelity and offering a window on trial processesTrial registration: ISRCTN Registry, ISRCTN38581822 (Registered: 02/01/2014) (https://doi.org/10.1186/ISRCTN38581822)

Working With Business: Counselor Expectations, Actions, and Challenges

2017 ◽  
Vol 31 (2) ◽  
pp. 135-145 ◽  
Author(s):  
Michele C. McDonnall
Keyword(s):  
Mixed Methods ◽  
Vocational Rehabilitation ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Rehabilitation Counseling ◽  
Master's Programs ◽  
Mixed Methods Approach ◽  
Workforce Innovation ◽  
Almost All

Purpose:The purpose of this study was to (a) explore state-federal vocational rehabilitation (VR) agency expectations for counselor engagement with business, (b) determine what VR counselors are actually doing in terms of interacting with businesses, and © identify challenges VR counselors experience to working with business.Method:A mixed-methods approach, including both quantitative data from surveys and qualitative data from interviews, was used. Surveys were conducted with 47 VR agency administrators and 121 counselors, and interviews were conducted with 6 administrators and 19 counselors.Results:Almost all VR agencies had a clear expectation that counselors will engage with business, but the specific expectations varied by agency. Counselors spend approximately 20% of their time interacting with businesses, and most counselors reported providing one or more service to businesses on a regular basis. Challenges experienced by counselors were lack of time, lack of comfort, and lack of preparation to engage with business.Conclusion:Given the current expectations for business engagement and the increased importance of business engagement with the passage of the Workforce Innovation and Opportunity Act (2015), it is vital that rehabilitation counseling master’s programs increase their focus on working with business.

scholarly journals Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors 

2021 ◽  
Author(s):  
Kristelle Craven ◽  
Jain Holmes ◽  
Katie Powers ◽  
Sara Clarke ◽  
Rachel L Cripps ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Qualitative Data ◽  
Complex Interventions ◽  
Real Life ◽  
Implementation Fidelity ◽  
Text Messages ◽  
Successful Implementation ◽  
Stroke Survivors ◽  
Intervention Delivery ◽  
Mentoring Support

Abstract Background: Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery.Methods: Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n=6) and OTs (n=19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically.Results: Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6%-100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs’ understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. Conclusions: Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial.Trial registration: ISRCTN, ISRCTN12464275. Registered on 13th March 2018.

scholarly journals Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kristelle Craven ◽  
Jain Holmes ◽  
Katie Powers ◽  
Sara Clarke ◽  
Rachel L. Cripps ◽  
...  
Keyword(s):  
Vocational Rehabilitation ◽  
Qualitative Data ◽  
Complex Interventions ◽  
Real Life ◽  
Implementation Fidelity ◽  
Text Messages ◽  
Successful Implementation ◽  
Stroke Survivors ◽  
Intervention Delivery ◽  
Mentoring Support

Abstract Background Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. Methods Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically. Results Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6–100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs’ understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. Conclusions Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial. Trial registration ISRCTN, ISRCTN12464275. Registered on 13th March 2018.

Factors Affecting the Use and Consequences of Management Accounting Practices in A Transitional Economy: The Case of Vietnam

2016 ◽  
pp. 54-73 ◽  
Author(s):  
Anh Doan Ngoc Phi
Keyword(s):  
Significant Influence ◽  
Quantitative Data ◽  
Structural Equation ◽  
Qualitative Data ◽  
Management Accounting ◽  
Transitional Economy ◽  
Equation Modeling ◽  
Enterprise Performance ◽  
Factors Affecting

This study seeks to help fill an important gap in the literature by investigating factors that have facilitated the use of management accounting practices (MAPs) in Vietnam - a transitional economy. Data were collected from 220 medium-to-large enterprises. Follow-up interviews were conducted with 20 accounting heads/vice heads to obtain further information and clarification. The quantitative data collected was analyzed using both descriptive and inferential statistics (including t-tests and structural equation modeling), while the qualitative data was used to shed further light on the various relationships described by the quantitative analysis. This paper reveals that both decentralization and competition have a positive, significant influence on the use of new MAPs except for the old ones. Consequently, the use of MAPs has a positive, significant influence on enterprise performance.

Factors Affecting The use Of Posbindu PTM Elderly In Medan Puskesmas Rantang Medan District Medan Petisah District In 2018

2020 ◽  
Vol 6 (1) ◽  
pp. 121-128
Author(s):  
Sri Natalia Ginting ◽  
Asriwati Asriwati ◽  
Anto Anto
Keyword(s):  
Mixed Methods ◽  
Factors Affecting

Penyakit tidak menular telah menjadi penyebab utama kematian secara global pada saat ini. Posbindu PTM merupakan suatu bentuk pelayanan yang melibatkan peran serta masyarakat melalui upaya promotif-preventif. Jenis penelitian adalah dengan pendekatan mixed methods dengan tujuan untuk mengetahui faktor yang memengaruhi terhadap pemanfaatan Posbindu PTM pada lansia di Wilayah Kerja Puskesmas Rantang Medan Kecamatan Medan Petisah dengan populasi penelitian adalah sebanyak 653 lansia dengan teknik sampel menggunakan accidental sampling sebanyak 87 lansia. Hasil penelitian menunjukkan bahwa pengetahuan memiliki sig-p 0,011 < 0,05, sikap sig-p 0,017 > 0,05, jarak tempuh sig-p 0,041 < 0,05, dukungan tenaga kesehatan sig-p 0,415 > 0,05 dan dukungan keluarga memilikisig-p 0,028 < 0,05. Kesimpulan ada pengaruh pengetahuan, sikap, jarak tempuh dan dukungan keluarga terhadap pemanfaatan Posbindu PTM pada lansia, sedangkan dukungan tenaga kesehatan tidak memiliki pengaruh terhadap pemanfaatan Posbindu PTM pada lansia. Penelitian ini diharapkan dapat menjadi bahan masukan atau informasi yang bermanfaat bagi Puskesmas, Dinas Kesehatan, maupun instansi lain terkait dengan pemanfaatan Posbindu PTM. Kata Kunci: Faktor yang Memengaruhi, Pemanfaatan Posbindu PTM, Lansi

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697349
Author(s):  
Anna Lalonde ◽  
Emma Teasdale ◽  
Ingrid Muller ◽  
Joanne Chalmers ◽  
Peter Smart ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Information Needs ◽  
Qualitative Data ◽  
Information Provision ◽  
Mixed Methods Study ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Face To Face ◽  
Patient Information Needs ◽  
History Of

BackgroundCellulitis is a common painful infection of the skin and underlying tissues that recurs in approximately a third of cases. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.AimTo explore patients’ perceptions of cellulitis and their information needs.MethodMixed methods study comprising semi-structured, face-to-face interviews and cross-sectional survey, recruiting through primary care, secondary care and advertising. Adults aged 18 or over with a history of cellulitis (first or recurrent) were invited to complete a survey, take part in an interview or both. Qualitative data was analysed thematically.ResultsThirty interviews were conducted between August 2016 and July 2017. Qualitative data revealed low prior awareness of cellulitis, uncertainty around diagnosis, concern/surprise at the severity of cellulitis, and perceived insufficient information provision. People were surprised they had never heard of the condition and that they had not received advice or leaflets giving self-care information. Some sought information from the internet and found this bewildering. Two hundred and forty surveys were completed (response rate 17%). These showed that, while most people received information on the treatment of cellulitis (60.0%, n = 144), they reported receiving no information about causes (60.8%, n = 146) or prevention of recurrence (73.3%, n = 176).ConclusionThere is a need for provision of basic information for people with cellulitis, particularly being informed of the name of their condition, how to manage acute episodes, and how to reduce risk of recurrence.

Analyzing trends in the aural decoding errors of Japanese EFL learners

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Kriss Lange ◽  
Joshua Matthews
Keyword(s):  
Mixed Methods ◽  
Qualitative Data ◽  
Mixed Methods Study ◽  
First Year ◽  
Formulaic Language ◽  
Decoding Skills ◽  
Efl Learners ◽  
Japanese University ◽  
Syntactic Knowledge ◽  
L2 Listening

Abstract Japanese EFL learners’ difficulty with accurately decoding connected English speech motivated this mixed methods study. The aural decoding capacities of 63 first-year Japanese university students, with low to intermediate level English proficiency, were first measured with a battery of paused transcription tests (PTT). The transcriptions were clusters of three-words that each possessed attributes typical of co-articulated speech. In addition, after each test, a subgroup of 10 participants individually listened to the same PTT and recounted introspective self-observations of their perceived difficulties with the aural decoding tasks in their L1. These quantitative and qualitative data were used to identify four trends in decoding errors which were categorized as follows: limited collocation familiarity, syntactic knowledge constraints, difficulties utilizing co-text, and L1 phonological influence. This study investigates some of the difficulties associated with aural decoding, highlights the challenges of identifying the origins of decoding errors and suggests that more focus is needed on developing decoding skills as well as knowledge of formulaic language in L2 listening education.

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