Table 4 Specification of implementation strategies
Strategy 1: Clinician implementation team meetings | |
Actor(s) | The team of clinicians who are implementing the NM Bridges intervention |
Action(s) | Reflect on the implementation effort, share lessons learned, support learning, and propose changes to be implemented in small cycles of change. |
Target(s) of the action | Clinicians newly trained in the intervention. |
Knowledge about how to use the intervention in this context, intentions to use the innovation, social influences. | |
Temporality | First meeting should be within two weeks of initial training. |
Dose | Once monthly for 1 h for the duration of the trial. |
Implementation outcome(s) affected | Uptake of the intervention, penetration among eligible clients/patients, fidelity to the protocol of the clinical innovation, sustainability of the innovation. |
Justification | Cooperative learning theory [63] |
Strategy 2: NM Bridges “champion” (develop stakeholder interrelationships) | |
Actor(s) | Individual clinician in the clinical setting |
Action(s) | Facilitating reflection; serving as team leader; motivating staff; engaging in planning activities; persuading staff that the initiative was important and worthwhile; building relationships with key stakeholders; using data to persuade peers |
Target(s) of the action | Clinician newly trained in the intervention |
Temporality | Ongoing input throughout trial, MDT meetings, flexibility to respond and tailor as appropriate |
Dose | Ongoing input throughout trial |
Implementation outcome(s) affected | Uptake of the innovation, fidelity to the protocol of the clinical innovation, acceptability to clinicians. |
Justification | Advocacy for clinical champions with literature [57, 60, 64] |
Strategy 3: Adapt and tailor to context | |
Actor(s) | Intervention development team |
Action(s) | Conduct co-design activities to tailor NM Bridges training to clinical setting and population |
Target(s) of the action | Clinicians newly trained in the intervention |
Knowledge about how to use the intervention in this context, intentions to use the innovation, social influences. | |
Temporality | Co-design sessions to take place 1 month prior to delivery of training, allowing time for appropriate modification of training and materials |
Dose | 2 co-design sessions prior to staff training in intervention |
Implementation outcome(s) affected | Uptake of the intervention, penetration among eligible clients/patients, acceptability to clinicians, fidelity to the protocol of the intervention, appropriateness of intervention to context |
Justification | Research suggests that tailoring interventions to a particular context has positive effect on healthcare outcomes [61, 65] |
Strategy 4: Educational materials | |
Actor(s) | Local opinion leaders (key members of clinical team) |
Action(s) | Email provision of NM Bridges resources, links to Bridges webinars, supporting literature, examples of successful use of intervention to include patient success stories |
Target(s) of the action | Clinicians newly trained in the intervention |
Knowledge about how to use the intervention in this context, intentions to use the innovation | |
Temporality | First educational email within 2 weeks of start of trial |
Dose | Weekly email to provide updates, encouragement, and feedback on intervention implementation |
Implementation outcome(s) affected | Uptake of the intervention, acceptability to clinicians, fidelity to protocol |
Justification | Theoretical Domains Framework (Reinforcement, environmental context & resources, social influences) [66] |