Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services

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Abstract

Background

Seven housing and health services organizations were guided through a process of translating Chapter Six of the Canadian Guidelines for Recovery-Oriented Practice into a recovery-oriented innovation and plan for its implementation. At the time of the COVID-19 outbreak and lockdown measures, six of the seven organizations had begun implementing their chosen innovation (peer workers, wellness recovery action planning facilitator training, staff training and a family support group). This mid-implementation study used the Consolidated Framework for Implementation Research (CFIR) to identify contextual factors that influenced organizations to continue or postpone implementation of recovery-oriented innovations in the early months of the COVID-19 pandemic.

Methods

Twenty-seven semi-structured 45-min interviews were conducted between May and June 2020 (21 implementation team members and six providers of the innovation (trainers, facilitators, peer workers). Interview guides and analysis were based on the CFIR. Content analysis combined deductive and inductive approaches. Summaries of coded data were given ratings based on strength and valence of the construct’s impact on implementation. Ratings were visualized by mid-implementation outcome and recovery innovation to identify constructs which appear to distinguish between sites with a more or less favorable mid-implementation outcomes.

Results

Four mid-implementation outcomes were observed at this snapshot in time (from most to least positive): continued implementation with adaptation (one site), postponement with adaptation and estimated relaunch date (four sites), indefinite postponement with no decision on relaunch date (one site), and no implementation of innovation yet (one site). Two constructs had either a negative influence (external policies and incentives—renamed COVID-19-related external policy for this study) or a positive influence (leadership engagement), regardless of implementation outcome. Four factors appeared to distinguish between more or less positive mid-implementation outcome: adaptability, implementation climate and relative priority, available resources, and formally appointed internal implementation leaders (renamed “engaging implementation teams during the COVID-19 pandemic” for this study).

Conclusions

The COVID-19 pandemic is an unprecedented outer setting factor. Studies that use the CFIR at the mid-implementation stage are rare, as are studies focusing on the outer setting. Through robust qualitative analysis, we identify the key factors that shaped the course of implementation of recovery innovations over this turbulent time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-021-00206-w.

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Most cited references 48

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Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

A Tong, P SAINSBURY, J. Craig (2007)

Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.

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Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Laura Damschroder, David Aron, Rosalind E Keith … (2009)

Background Many interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services researchers recognize the need to evaluate not only summative outcomes but also formative outcomes to assess the extent to which implementation is effective in a specific setting, prolongs sustainability, and promotes dissemination into other settings. Many implementation theories have been published to help promote effective implementation. However, they overlap considerably in the constructs included in individual theories, and a comparison of theories reveals that each is missing important constructs included in other theories. In addition, terminology and definitions are not consistent across theories. We describe the Consolidated Framework For Implementation Research (CFIR) that offers an overarching typology to promote implementation theory development and verification about what works where and why across multiple contexts. Methods We used a snowball sampling approach to identify published theories that were evaluated to identify constructs based on strength of conceptual or empirical support for influence on implementation, consistency in definitions, alignment with our own findings, and potential for measurement. We combined constructs across published theories that had different labels but were redundant or overlapping in definition, and we parsed apart constructs that conflated underlying concepts. Results The CFIR is composed of five major domains: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. Eight constructs were identified related to the intervention (e.g., evidence strength and quality), four constructs were identified related to outer setting (e.g., patient needs and resources), 12 constructs were identified related to inner setting (e.g., culture, leadership engagement), five constructs were identified related to individual characteristics, and eight constructs were identified related to process (e.g., plan, evaluate, and reflect). We present explicit definitions for each construct. Conclusion The CFIR provides a pragmatic structure for approaching complex, interacting, multi-level, and transient states of constructs in the real world by embracing, consolidating, and unifying key constructs from published implementation theories. It can be used to guide formative evaluations and build the implementation knowledge base across multiple studies and settings.

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Saturation in qualitative research: exploring its conceptualization and operationalization

Benjamin Saunders, Julius Sim, Tom Kingstone … (2017)

Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation—as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.

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Author and article information

Contributors

Myra Piat:

ORCID: http://orcid.org/0000-0002-5933-0974

myra.piat@mcgill.ca

Journal

Journal ID (nlm-ta): Implement Sci Commun

Journal ID (iso-abbrev): Implement Sci Commun

Title: Implementation Science Communications

Publisher: BioMed Central (London )

ISSN (Electronic): 2662-2211

Publication date (Electronic): 15 September 2021

Publication date PMC-release: 15 September 2021

Publication date Collection: 2021

Volume: 2

Electronic Location Identifier: 101

Affiliations

[1 ]GRID grid.412078.8, ISNI 0000 0001 2353 5268, Department of Psychiatry, , McGill University and Douglas Mental Health University Institute, ; 6875, boul. LaSalle, Montréal, Québec, H4H 1R3 Canada

[2 ]GRID grid.8250.f, ISNI 0000 0000 8700 0572, Department of Anthropology, , Durham University, ; Dawson Building, South Road, Durham, DH1 3LE UK

[3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Factor-Inwentash Faculty of Social Work, , University of Toronto, ; 246 Bloor St W, Toronto, Ontario M5S 1V4 Canada

[4 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, École de travail social, , Université de Moncton, ; 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick E1A 3E9 Canada

[5 ]GRID grid.14709.3b, ISNI 0000 0004 1936 8649, Department of Psychiatry, , McGill University, ; Ludmer Research & Training Building, 1033 Avenue des Pins, Montréal, QC, H3A 1A1 Canada

[6 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, École de travail social, , Université de Moncton, ; 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick E1A 3E9 Canada

[7 ]GRID grid.265686.9, ISNI 0000 0001 2175 1792, École de travail social, , Université de Moncton, ; 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick E1A 3E9 Canada

[8 ]GRID grid.17091.3e, ISNI 0000 0001 2288 9830, Department of Occupational Science and Occupational Therapy, Faculty of Medicine, , The University of British Columbia, ; T-325, 2211 Westbrook Mall, Vancouver, British Columbia V6T 2B5I Canada

[9 ]GRID grid.412078.8, ISNI 0000 0001 2353 5268, Douglas Mental Health University Institute, ; 6875, boul. LaSalle, Montréal, Québec, H4H 1R3 Canada

Author information

Myra Piat http://orcid.org/0000-0002-5933-0974

Article

Publisher ID: 206

DOI: 10.1186/s43058-021-00206-w

PMC ID: 8441235

PubMed ID: 34526136

SO-VID: 9dfd752f-1df4-481b-920f-75431cdb866f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 8 February 2021

Date accepted : 25 August 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;

Award ID: 148172

Award Recipient : Myra Piat

Funded by: FundRef http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;

Funded by: FundRef http://dx.doi.org/10.13039/100008794, Research Manitoba;

Funded by: FundRef http://dx.doi.org/10.13039/501100000245, Michael Smith Foundation for Health Research;

Funded by: FundRef http://dx.doi.org/10.13039/100013123, Fondation de la recherche en santé du Nouveau-Brunswick;

Custom metadata

Keywords: canada,consolidated framework for implementation research,covid-19,guidelines,recovery-oriented services,mental health recovery,mid-implementation,outer setting,pandemic,supported housing

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Keywords: canada, consolidated framework for implementation research, covid-19, guidelines, recovery-oriented services, mental health recovery, mid-implementation, outer setting, pandemic, supported housing

Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services

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Abstract

Background

Methods

Results

Conclusions

Supplementary Information

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Novel Coronavirus Disease COVID-19

Most cited references 48

Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science

Saturation in qualitative research: exploring its conceptualization and operationalization

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