Mapping barriers and intervention activities to behaviour change theory for Mobilization of Vulnerable Elders in Ontario (MOVE ON), a multi-site implementation intervention in acute care hospitals.
BACKGROUND
As evidence-informed implementation interventions spread, they need to be tailored to address the unique needs of each setting, and this process should be well documented to facilitate replication. To facilitate the spread of the Mobilization of Vulnerable Elders in Ontario (MOVE ON) intervention, the aim of the current study is to develop a mapping guide that links identified barriers and intervention activities to behaviour change theory.


METHODS
Focus groups were conducted with front line health-care professionals to identify perceived barriers to implementation of an early mobilization intervention targeted to hospitalized older adults. Participating units then used or adapted intervention activities from an existing menu or developed new activities to facilitate early mobilization. A thematic analysis was performed on the focus group data, emphasizing concepts related to barriers to behaviour change. A behaviour change theory, the 'capability, opportunity, motivation-behaviour (COM-B) system', was used as a taxonomy to map the identified barriers to their root causes. We also mapped the behaviour constructs and intervention activities to overcome these.


RESULTS
A total of 46 focus groups were conducted across 26 hospital inpatient units in Ontario, Canada, with 261 participants. The barriers were conceptualized at three levels: health-care provider (HCP), patient, and unit. Commonly mentioned barriers were time constraints and workload (HCP), patient clinical acuity and their perceived 'sick role' (patient), and lack of proper equipment and human resources (unit level). Thirty intervention activities to facilitate early mobilization of older adults were implemented across hospitals; examples of unit-developed intervention activities include the 'mobility clock' communication tool and the use of staff champions. A mapping guide was created with barriers and intervention activities matched though the lens of the COM-B system.


CONCLUSIONS
We used a systematic approach to develop a guide, which maps barriers, intervention activities, and behaviour change constructs in order to tailor an implementation intervention to the local context. This approach allows implementers to identify potential strategies to overcome local-level barriers and to document adaptations.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. MooreJu@smh.ca.
Julia E
JE
Moore
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. MascarenhasA@smh.ca.
Alekhya
A
Mascarenhas
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. MarquezC@smh.ca.
Christine
C
Marquez
Regional Geriatric Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada. ummu.almaawiy@sunnybrook.ca.
Ummukulthum
U
Almaawiy
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. ChanW@smh.ca.
Wai-Hin
WH
Chan
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. DSouzaJe@smh.ca.
Jennifer
J
D'Souza
Regional Geriatric Program of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3 M5, Canada. Barbara.liu@sunnybrook.ca.|Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada. Barbara.liu@sunnybrook.ca.
Barbara
B
Liu
Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada. sharon.straus@utoronto.ca.|Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada. sharon.straus@utoronto.ca.
Sharon E
SE
Straus
D000368:Aged; D004059:Diffusion of Innovation; D017144:Focus Groups; D016330:Frail Elderly; D006299:Health Services for the Aged / Q000458:organization & administration*; D006760:Hospitalization; D006801:Humans; D009864:Ontario; D009936:Organizational Innovation; D011364:Professional Practice; D013997:Time Factors; D016526:Workload