Understanding capacity for implementing new interventions: A qualitative study of speech and language therapy services for children with speech sound disorder.
Background: Many speech sound disorder (SSD) interventions with a long‐term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research...
| Publicado en: | International Journal of Language & Communication Disorders (John Wiley & Sons, Inc.) Vol. 59; no. 3; pp. 1002 - 1018 |
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| Autores principales: | , , , |
| Formato: | Artículo |
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John Wiley & Sons, Inc.
May2024
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=hlh&AN=177114449&site=ehost-live header: @attributes: shortDbName: hlh uiTerm: 177114449 longDbName: Humanities International Complete uiTag: AN controlInfo: bkinfo: jinfo: jid: 14606984 NRNM jtl: International Journal of Language & Communication Disorders (John Wiley & Sons, Inc.) issn: 14606984 maglogo: N pubinfo: dt: May2024 vid: 59 iid: 3 pid: 52269 pub: John Wiley & Sons, Inc. artinfo: ui: 177114449 10.1111/1460-6984.12979 ppf: 1002 ppct: 16 formats: tig: atl: Understanding capacity for implementing new interventions: A qualitative study of speech and language therapy services for children with speech sound disorder. aug: au: Nicoll, Avril Roulstone, Sue Williams, Brian Maxwell, Margaret affil: Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, Aberdeen, UK Bristol Speech & Language Therapy Research Unit, Southmead Hospital, Bristol, UK UHI Institute of Health Research and Innovation, Centre for Health Science, Inverness, UK NMAHP‐RU, Pathfoot Building, University of Stirling, Stirling, UK su: Speech therapy Speech therapists National health services Qualitative research Research funding Interviewing Medical care Treatment effectiveness Descriptive statistics Attitudes of medical personnel Comparative studies Medical practice Children sug: subj: Speech therapy Speech therapists National health services Qualitative research Research funding Interviewing Medical care Treatment effectiveness Descriptive statistics Attitudes of medical personnel Comparative studies Medical practice Children keyword: implementation science practice change speech sound disorder ab: Background: Many speech sound disorder (SSD) interventions with a long‐term evidence base are 'new' to clinical practice, and the role of services in supporting or constraining capacity for practice change is underexplored. Innovations from implementation science may offer solutions to this research–practice gap but have not previously been applied to SSD. Aim: To explain variation in speech and language therapy service capacity to implement new SSD interventions. Methods & Procedures: We conducted an intensive, case‐based qualitative study with 42 speech and language therapists (SLTs) in three NHS services (n = 39) and private practice (n = 3) in Scotland. We explored therapists' diverse experiences of SSD practice change through individual interviews (n = 28) or self‐generated paired (n = 2) or focus groups (n = 3). A theoretical framework (Normalization Process Theory) helped us understand how the service context contributed to the way therapists engaged with different practice changes. Outcomes & Results: We identified six types ('cases') of practice change, two of which involved the new SSD interventions. We focus on these two cases ('Transforming' and 'Venturing') and use Normalization Process Theory's Cognitive participation construct to explain implementation (or not) of new SSD interventions in routine practice. Therapists were becoming aware of the new interventions through knowledge brokers, professional networks and an intervention database. In the Transforming case, new SSD interventions for selected children were becoming part of local routine practice. Transforming was the result of a favourable service structure, a sustained and supported 'push' that made implementation of the new interventions a service priority, and considerable collective time to think about doing it. 'Venturing' happened where the new SSD interventions were not a service priority. It involved individual or informal groups of therapists trying out or using one or more of the new interventions with selected children within the constraints of their service context. Conclusions & implications: New, evidence‐based SSD interventions may be challenging to implement in routine practice because they have in common a need for therapists who understand applied linguistics and can be flexible with service delivery. Appreciating what it really takes to do routine intervention differently is vital for managers and services who have to make decisions about priorities for implementation, along with realistic plans for resourcing and supporting it. WHAT THIS PAPER ADDS: What is already known on the subject: Many SSD interventions have an evidence base but are not widely adopted into routine clinical practice. Addressing this is not just about individual therapists or education/training, as workplace pressures and service delivery models make it difficult to change practice. What this paper adds to the existing knowledge: This paper applies innovations from implementation science to help explain how what is going on in services can support or constrain capacity for implementing evidence‐based SSD interventions. What are the potential or actual clinical implications of this work?: Service managers and therapists will have a clearer idea of the time and support they may realistically have to invest for new SSD interventions to be used routinely. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: Y dt: @attributes: year: 2024 holdings: @attributes: islocal: N |
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