Implementation of health and social care standards in health and social care services: development and feasibility testing of an implementation support tool

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dc.check.chapterOfThesisChapter one (Background and thesis summary), chapter six (The co-design and feasibility testing of a digitally supported intervention for selecting implementation tools and actions for standards (SITAS)) and chapter seven (Discussion). Appendix six (Appendix 6.1-6.10).en
dc.check.date2027-12-31
dc.check.infoPartial Restriction
dc.contributor.advisorHegarty, Josephine
dc.contributor.advisorexternalO'Rourke, Niamh
dc.contributor.advisorexternalKeyes, Laura M.
dc.contributor.authorKelly Daly, Yvonneen
dc.contributor.funderHealth Information and Quality Authority (HIQA)
dc.contributor.funderHealth Research Board
dc.date.accessioned2024-09-23T11:55:05Z
dc.date.available2024-09-23T11:55:05Z
dc.date.issued2023
dc.date.submitted2023
dc.descriptionPartial Restriction
dc.description.abstractIntroduction Health and social care standards are complex quality improvement interventions. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an outcome or process of care delivery. They involve multiple stakeholders from multiple levels in the health system and apply to diverse services. There is limited evidence to inform implementation strategies specifically tailored to support the implementation of standards. There is a need to apply evidence-based, rigorous and transparent methods when selecting strategies to support the implementation of standards. Researchers have consistently highlighted a research-to-practice gap in this area. This PhD research aimed to develop and test an evidence- and theory-informed intervention to guide the identification of appropriate implementation strategies and the selection of tailored support tools and actions for use when implementing a set of standards. Methods The Medical Research Council (MRC) framework for developing and evaluating complex interventions guided a multi-methods sequential approach. A) Standards were conceptualised by narratively synthesising 12 definitions of standards used by standard-setting bodies internationally. B) The evidence-base was gathered by conducting: a systematic review (n=35 included studies) to identify and describe enablers and barriers to implementing (inter)nationally endorsed standards; and C) a qualitative exploration (focus groups (n=6), individual interviews (n=8)) of individuals’ (n=38) experiences, enablers and barriers to implementing nationally endorsed standards in Ireland. D) These enablers and barriers were used alongside implementation science theory, tools and methodologies to develop a digital intervention. Programme theory guided the development process. The Consolidated Framework for Implementation Research (CFIR), CFIR-ERIC (Expert Recommendations for Implementing Change) matching tool and the Behaviour Change Wheel (BCW) were used to develop a prototype of the content and interactive logic within a digital intervention. E) Co-design workshops (n=3) were held to refine the digital intervention with intended users (n=7). F) A feasibility study was undertaken with end-users (n=14) using a survey that measured acceptability, appropriateness and feasibility. Results A) There was variation in how standard-setting bodies define standards. The commonalities among definitions included the terms ‘quality’, ‘statements’ and ‘performance.’ B) Thematic statements describing enablers (n=22) and barriers (n=24) were created. The most frequently reported enablers related to available support tools, education and shared learning. The most frequently reported barriers related to a lack of knowledge of standards, staffing issues and insufficient funds. C) Six themes were generated from qualitative interviews. Key enablers identified related to teamwork, support tools, leadership and inspections. Key barriers related to workforce issues, a lack of awareness of standards and fear of inspection outcomes. D) Twenty-three enablers and barriers were prioritised using set criteria. E) Iterative feedback led to refinements of the intervention, creating the prototype for the feasibility study. The intervention was entitled SITAS (Selecting Implementation Tools and Actions for Standards). F) SITAS was perceived as acceptable and feasible in preliminary feasibility testing. Conclusion A feasible intervention was developed, enhanced by user involvement. SITAS is a practical digitally enabled intervention that can facilitate bridging the research-to-practice gap. SITAS aims to guide the process of selecting and tailoring implementation strategies to specific contexts, using core concepts of implementation science. Further research is required to undertake formal piloting on SITAS using a larger sample size before spread and scale up.en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationKelly Daly, Y. 2023. Implementation of health and social care standards in health and social care services: development and feasibility testing of an implementation support tool. PhD Thesis, University College Cork.
dc.identifier.endpage467
dc.identifier.urihttps://hdl.handle.net/10468/16420
dc.language.isoenen
dc.publisherUniversity College Corken
dc.relation.projectHealth Research Board Ireland [SPHeRE-2019-1]
dc.rights© 2023, Yvonne Kelly Daly.
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectBarriers
dc.subjectCo-design
dc.subjectDigital intervention
dc.subjectEnablers
dc.subjectFeasibility
dc.subjectHealthcare
dc.subjectImplementation science
dc.subjectImplementation strategy
dc.subjectMetasummary
dc.subjectQualitative
dc.subjectSocial care
dc.subjectStandards
dc.titleImplementation of health and social care standards in health and social care services: development and feasibility testing of an implementation support toolen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD - Doctor of Philosophyen
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