2.2.1 Improving the evaluation of complex healthcare interventions: the contribution of theory (362)

Jacqueline Chandler-Oatts, Research Fellow, Research Team, Royal College of Nursing Institute, Oxford, United Kingdom Co authors: Claire Hawkes, Joanne Rycroft-Malone, Kate Seers & Ian Bullock jacqueline.chandler-oatts@rcn.org.uk

Abstract:

Background:

Implementation Science is a developing field of healthcare research, however, to date it has lacked a theoretical base (ICEBerg, 2006, Rycroft-Malone 2007). Additionally there is little good quality evidence to support or refute the effectiveness of specific implementation strategies (e.g. Thompson et al 2007). It has been argued that the explicit use of theoretically-informed interventions will improve the evaluation of implementation interventions (ICEBerg, 2006).

Aim:

This presentation draws on the experience of conducting an implementation study to explore and analyse the use of theory in intervention development and evaluation. Approach The study, which is a UK-wide randomised trial including nineteen acute NHS Trusts, is implementing recommendations from a guideline on peri-operative fasting in adults and children (completion March 2009). It is designed to evaluate three implementation strategies, including standard dissemination, opinion leadership and quality improvement cycles. Previous research and existing theory was used to design the interventions being tested.

Discussion:

As is the case with the current study more than one theory is likely to be needed to implement complex interventions. This presentation will include a discussion of the literature and theories that underpin the three interventions (e.g. social influence theory, diffusion theory, change management theory).Linking the choice of theories to an overarching theoretical framework is proposed as a way forward in improving our understanding of implementing evidence into practice (Rycroft-Malone, 2007). The current study is theoretically underpinned by the PARIHS framework, with the key concepts of evidence, context and facilitation. We will also describe the development, delivery and evaluation of the key components of the interventions and how these relate to the PARIHS framework. The challenges of identifying both the potential and limitations of the interventions and their associated theoretical concepts, once they have been translated into practice settings, will also be explored.

Biography:

Jacqueline has a background in general and psychiatric nursing. She has worked in the voluntary sector in alcohol counselling services. She has been a project developer in the mental health voluntary sector developing ‘care in the community’ projects. She is currently working at RCN Research Institute, Warwick University. She has previously worked on the NICE guideline development programme at the RCN Institute at Oxford. Her current post is on a project funded by The Health Foundation to evaluate guideline implementation strategies and patients’ experiences of fasting before elective surgery.