Oral Presentation Smart Strokes Annual Scientific Meeting 2025

A Novel, Practical Method for Analysing and Presenting Barrier and Enabler Data Aligned to the Theoretical Domains Framework- Case Study of the SCAMP Implementation Project. (127034)

Dianne Lesley Marsden 1 2 3 , Kerry Boyle 2 , Jaclyn Birnie 2 3 , Amanda Buzio 4 , Judith Dunne 2 , Kelvin Hill 5 , David Lambkin 1 , Sandra Lever 6 , Fiona Minett 2 , Sally Ormond 2 , Jodi Shipp 2 , Jenni Steel 4 , Amanda Styles 2 , John Wiggers 1 2 3 , Dominique A Cadilhac 7 , Jed Duff 8 9
  1. Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
  2. Hunter New England Local Health District, New Lambton Heights, NSW, Australia
  3. University of Newcastle, Callaghan, NSW, Australia
  4. Mid North Coast Local Health District, Coffs Harbour, NSW, Australia
  5. The Stroke Foundation, Melbourne, Vic, Australia
  6. Northern Sydney Local Health District, St Leonards, NSW, Australia
  7. Monash University, Clayton, VIC, Australia
  8. Queensland University of Technology, Brisbane, Qld, Australia
  9. Royal Brisbane and Womens Hospital, Queensland Health, Brisbane, Qld, Australia

Background:Implementation clinicians/researchers often use pre-implementation Likert scale questionnaires aligned to the Theoretical Domains Framework (TDF) to identify clinician-perceived barriers. Results are often reported as means which do not typically assist with diagnostics. The questionnaires are rarely re-administered post-implementation. We present our novel approach to categorising clinicians’ perceptions of care as barriers/enablers, and the changes observed post-implementation.

Methods:Our questionnaire comprised 57 Likert scale questions (Q) regarding continence care, mapped to 13 of 14 TDF domains. Responses were categorised into two groups: positive (agree/strongly agree) and neutral/negative (unsure/disagree/strongly disagree). Percentages for each question was calculated, labelled and colour-coded based on response rates: barrier (<60% positive responses/red), neutral (60-69% positive/orange), or enabler (>69% positive/green). Pre- to post-implementation changes were evaluated.

Clinicians from fifteen adult wards that adopted the SCAMP practice-change package (12 Australian hospitals: metropolitan=4, regional=8) were invited to complete the online questionnaire both before and immediately after the 6-month implementation phase. The practice-change package focused on inpatient clinicians, employing strategies to address barriers identified pre-implementation.

Results:Clinician participation pre-implementation: hospitals=12/12, n=291, female=82%, nurses=88%. onset. Post-implementation: hospitals=10/12 (no implementation phase at 2/12 hospitals as coincided with onset COVID-19), n=195, female=86%, nurses=94%.

Post-implementation seven TDF domains (25/27 questions) had improved by 11-30% (p-value<0.05): skills (4/4), knowledge (6/6), memory (1/1), beliefs about capabilities (2/2), emotion (3/3), environmental context/resources (6/7), and social/professional role (3/4). Three domains were high-scoring enablers at both timepoints (≥87% positive, p-value>0.05): goals (10/10), beliefs about consequences (6/6) and reinforcement (1/1). Three domains were mainly unchanged (p-value>0.05): social influences (4/4), intentions (5/6) and behaviour regulation (3/4).

Conclusion:Categorising and colour-coding responses offered a practical, visual method for stakeholders to interpret Likert data, prioritise barriers to address, identify changes in perceptions post-implementation, help explain which implementation strategies appeared successful in changing practice and which ones need refining.

Implications:Our novel methods are useful for clinicians/researchers driving practice-change.