Perspective Of Service Providers Research Articles

A Qualitative Study of Implementation Outcomes of a Group-Based Intervention for Immigrant Parents

Abstract Background Inequities in service utilization between immigrant families and native populations have emerged within the Nordic welfare countries, highlighting the need for culturally sensitive parenting support. Despite the proven efficacy of parenting interventions, their implementation phases have not been adequately addressed in extant implementation research, particularly regarding structural racism and inequities. This study aims to contribute to the literature from an implementation perspective by describing a pilot of ‘Being a Parent in Finland,’ a culturally sensitive group-based intervention for migrant parents. Its specific focus is on investigating barriers to and facilitators of implementation outcomes from the perspectives of service providers. Methods The qualitative data consisted of thematic interviews (N = 6) with service providers (N = 9) compiled at distinct phases of the pilot from 2021 to 2023. In addition, data triangulation was utilized through document analysis of 125 pages of various documents regarding the pilot as a supplementary data collection method. Content analysis was conducted on the data using Atlas.ti 23. Results The findings stress the alignment of the target group, service placement, and preventive measures for enhancing parenting intervention’s acceptability, appropriateness, and feasibility. Implicit objectives, such as perceiving the target group as ‘at-risk,’ can impede intervention success and exacerbate stigmatization of the target group. Culture- and context-specific adaptations, and community engagement foster parental trust and intervention accessibility. Conclusions The findings underscore the significance of congruent objectives, community engagement, and adaptive iterations in preventive parenting interventions. Advocating for these elements in implementation strategies is crucial for reducing stigmatization and enhancing equity and efficacy in services tailored to minority parents. Key messages • Acknowledging equity in both implementation research and strategies is paramount. • Implementing trust-building is crucial for culturally sensitive parenting interventions.

Do police make you feel safe? A qualitative comparison of youth and youth service provider perspectives

Do police make you feel safe? A qualitative comparison of youth and youth service provider perspectives

Exploring the effects of COVID-19 outbreak control policies on services offered to people experiencing homelessness

BackgroundThe COVID-19 pandemic and subsequent implementation of public health policies exacerbated multiple intersecting systemic inequities, including homelessness. Housing is a key social determinant of health that played a significant part in the front-line defence against COVID-19, posing challenges for service providers working with people experiencing homelessness (PEH). Public health practitioners and not-for-profit organizations (NFPs) had to adapt existing COVID-19 policies and implement novel measures to prevent the spread of disease within congregate settings, including shelters. It is essential to share the perspectives of service providers working with PEH and their experiences implementing policies to prepare for future public health emergencies and prevent service disruptions.MethodsIn this qualitative case study, we explored how service providers in the non-profit sector interpreted, conceptualized, and implemented COVID-19 public health outbreak control policies in Nova Scotia. We interviewed 11 service providers between September and December 2020. Using thematic analysis, we identified patterns and generated themes. Local, provincial, and national policy documents were useful to situate our findings within the first year of the COVID-19 pandemic and contextualize participants’ experiences.ResultsImplementing policies in the context of homelessness was difficult for service providers, leading to creative temporary solutions, including pop-up shelters, a dedicated housing isolation phone line, comfort stations, and harm reduction initiatives, among others. There were distinct rural challenges to navigating the pandemic, which stemmed from technology limitations, lack of public transportation, and service closures. This case study illustrates the importance of flexible and context-specific policies required to support PEH and mitigate the personal and professional impact on service providers amid a public health emergency. Innovative services and public health collaboration also exemplified the ability to enhance housing services beyond the pandemic.ConclusionsThe results of this project may inform context-specific emergency preparedness and response plans for COVID-19, future public health emergencies, and ongoing housing crises.

Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study.

Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L&MICs. Cronbach ɑ will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an "observation checklist" of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L&MICs. This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. DERR1-10.2196/59836.

Economic evaluation of the prevention of falls resulting from missed care in polish hospitals.

Falls are associated with increased morbidity, mortality, prolonged hospitalization and an increase in the cost of treatment in hospitals. They contribute to the deterioration of fitness and quality of life, especially among older patients, thus posing a serious social and economic problem. They increase the risk of premature death. Falls are adverse, costly, and potentially preventable. The aim of the study was to analyze the cost-effectiveness of avoiding one fall by nurse care provided by the nurses with higher education, from the perspective of the health service provider. The economic analysis included and compared only the cost of nurse intervention measured by the hours of care provided with higher education in non-surgical departments (40.5%) with higher time spend by nurses with higher education level an increase in the number of hours by 10% (50.5%) to avoid one fall. The time horizon for the study is 1 year (2021). Cost-effectiveness and Cost-benefit analysis were performed. All registered falls of all hospitalized patients were included in the study. In the analyzed was based on the case control study where, 7,305 patients were hospitalized, which amounted to 41,762 patient care days. Care was provided by 100 nurses, including 40 nurses with bachelor's degrees and nurses with Master of Science in Nursing. Increasing the hours number of high-educated nurses care by 10% in non-surgical departments decreased the chance for falls by 9%; however, this dependence was statistically insignificant (OR = 1.09; 95% CI: 0.72-1.65; p = 0.65). After the intervention (a 10% increase in Bachelor's Degrees/Master of Science in Nursing hours), the number of additional Bachelor's Degrees/Master of Science hours was 6100.5, and the cost was USD 7630.4. The intervention eliminated four falls. The cost of preventing one fall is CER = USD 1697.1. The results of these studies broaden the understanding of the relationship among nursing education, falls, and the economic outcomes of hospital care. According to the authors, the proposed intervention has an economic justification.

Understanding the Health Literacy Experiences and Practices of Australian-Resettled Myanmar Refugees: Relevance for Nutrition and Dietetics Practice.

Background/Objectives: Refugees typically experience poorer health compared with people from non-refugee backgrounds, and health literacy may play a part in this discrepancy. Using the WHO's revised health literacy definitions as a framework, this qualitative study sought to examine the health literacy experiences and practices of Australian resettled refugees from Myanmar from refugee and service provider perspectives. Methods: Four refugee participant focus groups (n = 27) along with one focus group and four interviews with service providers (n = 7) were conducted in Melbourne, Australia, and analysed using deductive content analysis. Results: Our study found that in addition to individual health literacy, community literacy was practiced by Myanmar refugees, thus highlighting the relevance of social support to health literacy. Furthermore, our study found gaps in healthcare service provision and resourcing related to health literacy development and responsiveness by the healthcare system. Conclusions: Our study confirms the relevance of WHO's revised health literacy definitions to Myanmar refugees while also discussing, in the context of nutrition and dietetics practice, the importance of understanding the different aspects of health literacy and how this relates to working with those who are most marginalised to improve their health and wellbeing.

Supporting Women after Obstetric Fistula Surgery to Enhance Their Social Participation and Inclusion.

Obstetric fistula is a childbirth complication causing abnormal openings between the urinary, bowel, and genital tracts, leading to involuntary leakage and potential long-term disability. Even after surgical repair, women continue to face psychological and social challenges that affect their social inclusion and participation. This study explored family and service provider perspectives on current support systems and identified gaps affecting women's inclusion and participation post-fistula surgery. Building on a prior study of women who underwent obstetric fistula surgical repair, we qualitatively examined available formal and informal post-surgical supports in Ethiopia. We conducted 20 interviews with family members and service providers and analyzed them using Charmaz's grounded theory inductive analysis approach. We identified four themes that indicated the available formal support in fistula care, the impact of formal support on women's social participation and inclusion, the gaps in formal support systems, and post-surgery informal supports and their challenges. Both groups believed support needs for women after surgery remain unmet, highlighting the need to strengthen holistic support services to improve women's social inclusion and participation. This study contributes to limited research on formal and informal support for women, emphasizing the need for enhanced economic, psychological, and sexual health-related support post-obstetric fistula surgery.

A cost-consequence analysis of the Queensland specialist palliative rural telehealth (SPaRTa) service

Background Telehealth can extend the reach of specialist palliative care providers to ensure that patients can access specialist services closer to home. Aim To examine the cost and consequences of the Specialist Palliative Rural Telehealth (SPaRTa) service compared to the traditional non-specialist general practice-based services for people requiring palliative care. Design The costs and outcomes for SPaRTa were compared using cost-consequence analysis principles, with a focus on net benefit and return on investment. Costs were estimated from the perspective of the health service provider for the 2020/2021 financial year, and cost-offsets associated with change in location of death and change in hospital transfers. Setting/participants Patients of the SPaRTa in Queensland Australia. Results During study period 5472 consultations were conducted from four major metropolitan hub sites to regional, rural, and remote areas at a total cost of $4 426 644. When remuneration for consultations, change to location of death and reduction in ambulance transfers were taken into account, the net-benefit to the state health system was $1 244 060, giving a return on investment of $1.28 for every dollar spent. SPaRTa complimented existing local care services, and enabled access to specialist care into the home. Conclusions SPaRTa resulted in potential cost savings for the health service by enabling more convenient access to palliative care services outside of hospital settings. Decisions regarding funding for telepalliative care should consider not only the costs, but also the potential benefits to both the service providers, and the patients and families receiving this care.

Constrains for attending District Early Intervention Centre (DEIC) of Purba Bardhaman district, West Bengal: Perspectives of both service providers and caregivers of the beneficiaries, a Mixed-Method Study.

This study was conducted to assess the clinicosocial profile characteristics of the beneficiaries attending DEIC and to explore the challenges faced by both the caregivers and service providers. A facility-based, mixed-method study with phenomenological approach was conducted in Burdwan Medical College of Purba Bardhaman district, West Bengal, from January 2023 to April 2023. For quantitative part, record analysis was conducted involving all children enrolled at DEIC from January 2022 to December 2022, and for qualitative part, caregivers and service providers were selected purposively and interviewed using the in-depth-interview (IDI) guide. Inductive thematic analysis was conducted simultaneously till data saturation was achieved. The principles of descriptive statistics were applied to organize and present the quantitative data in tables and diagrams. Qualitative data were transcribed into verbatim and analyzed thematically with inductive approach. Out of 3332 children enrolled, 58.4% were males, and 44.2% were aged between 0 and 1 month. 59.3% of them had developmental delays, 7.9% had defects, 42.9% had diseases, and 21.3% had some deficiencies. Major hindering factors in service provision among service providers were resource deficiency, inadequate capacity building, administrative bottlenecks, limited supportive supervision, inadequate advocacy, and awareness deficit. No major constraints were found from caregivers' perspective in accessing healthcare. DEIC is running with shortage of proper infrastructure and adequate supervision. Periodic training, appropriate awareness building, and continuous flow of logistics are needed to ensure a better quality of life among beneficiaries.

Family member and service provider experiences and perspectives of a digital surveillance and service navigation approach in multicultural context: a qualitative study in identifying the barriers and enablers to Watch Me Grow-Electronic (WMG-E) program with a culturally diverse community

BackgroundChildren and families from priority populations experienced significant psychosocial and mental health issues to the COVID-19 pandemic. Yet they also faced significant barriers to service access, particularly families from culturally and linguistically diverse (CALD) backgrounds. With most child and family health nurse clinics ceasing in-person consultations due to the pandemic, many children missed out on health and developmental checks. The aim of this study was to investigate the perspectives and experiences of family members and service providers from an urban, CALD community regarding the implementation of a digital, developmental surveillance, Watch Me Grow-Electronic (WMG-E) program.MethodsSemi-structured interviews were conducted with 17 family members, service navigators, and service providers in a multicultural community in South Western Sydney, Australia. This qualitative study is an implementation evaluation which formed as part of a larger, two-site, randomised controlled trial of the WMG-E program. A reflexive thematic analysis approach, using inductive coding, was adopted to analyse the data.ResultsParticipants highlighted the comprehensive and personalised support offered by existing child and family health services. The WMG-E was deemed beneficial because the weblink was easy and quick to use and it enabled access to a service navigator who support family access to relevant services. However, the WMG-E was problematic because of technology or language barriers, and it did not facilitate immediate clinician involvement when families completed the weblink.ConclusionsFamilies and service providers in this qualitative study found that using WMG-E empowered parents and caregivers to access developmental screening and learn more about their child’s development and engage with relevant services. This beds down a new and innovative solution to the current service delivery gap and create mechanisms that can engage families currently not accessing services, and increases knowledge around navigating the health and social care services. Notwithstanding the issues that were raised by families and service providers, which include accessibility challenges for CALD communities, absence of clinical oversight during screening, and narrow scope of engagement with available services being offered, it is worth noting that improvements regarding these implementation factors must be considered and addressed in order to have longevity and sustainability of the program.Trial registration.The study is part of a large randomised controlled trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Towards sustainable urban logistics: Exploring the implementation of city hubs through system dynamics

The urban logistics system causes negative externalities, such as pollution, noise and congestion. This study focuses on city hubs as a concept to reduce these externalities by improving consolidation and adopting zero-emission vehicles. Our research employs system dynamics as a method to uncover the dynamics and mechanisms related to the barriers and potentials of city hub implementation in Stockholm from the perspectives of the Logistic Service Providers (LSPs), the receivers and the public sector. Moreover, a mixed method approach is used for data collection, allowing us to extract the knowledge from the real implementation case, co-create a qualitative model as a Causal Loop Diagram (CLD) with the stakeholders involved in the system, and generalise the model. The mixed method approach includes a group model-building workshop, literature review, existing city hub analysis and stakeholder interviews. The main result is a CLD, visualising the dynamics of the introduction of city hubs. The CLD explores three potential incentives and policies: (i) the receivers change address; (ii) shippers oblige LSPs to use the hubs; (iii) the public sector gives monetary incentives to LSPs. The CLD presented in this paper establishes a validated system structure for the urban logistic system and facilitates the policymakers’ understanding of the barriers to implementing city hubs and what policies could help their implementation.

Im/migration, mental health and well-being, and newcomer Filipino families: implications for anti-racist and anti-oppressive policies and practice

ABSTRACT This article draws upon the perspectives of newcomer Filipino families who have migrated through the global domestic work industry, specifically through Canada's Live-in/Caregiver Program (L/CP), and the perspectives of Filipino social service providers in Toronto, Ontario, Canada. I examine how newcomer Filipino families make meaning of, and negotiate, the impact of family separation and reunification through the L/CP on their mental health and well-being. Moreover, I look at how Filipino social service providers center the experiences of newcomer Filipino families within service provision through an anti-racist and anti-oppressive framework, which has implications for policies and praxis in community-based agencies. The paper moves from deficit-focused experiences of ‘trauma’ to centring the voices of newcomer Filipino families as agents of change, in collaboration with Filipino social service providers. This shift illuminates how newcomer Filipino families and their lived experiences are sites of transformation in the policy and practices that impact their mental health and well-being.

Exploring the Effectiveness and Challenges of Community Rehabilitation Service Programs for Children with Developmental Delays: A Qualitative Study from the Perspective of Early Intervention Service Providers in Taiwan.

This qualitative study aimed to investigate the effectiveness of community rehabilitation programs for children with developmental delays from the perspective of early intervention service providers in Taiwan. Adopting a single-case experimental design (ABM design), this study examined the immediate and sustained effects of interventions on individualized goals during baseline, intervention, and maintenance phases. Additionally, data from interviews with parents, special education teachers, and other participants were collected to understand the challenges and improvement strategies of community rehabilitation programs. Results revealed that community rehabilitation programs for children with developmental delays exhibited both immediate and sustained effectiveness. Challenges faced by parents and professionals differed, with parents having less contact and communication with administrative systems, while professionals experienced more pronounced implementation difficulties during interventions. Moreover, strategies for improving community rehabilitation programs for children with developmental delays should vary for parents and professionals to address inconsistencies in attitudes and strategies among parents and administrative obstacles encountered by professionals.

Identifying health and healthcare priorities in rural areas: A concept mapping study informed by consumers, health professionals and researchers

BackgroundIt is vital that health service delivery and health interventions address patients’ needs or preferences, are relevant for practice and can be implemented. Involving those who will use or deliver healthcare in priority-setting can lead to health service delivery and research that is more meaningful and impactful. This is particularly crucial in rural communities, where limited resources and disparities in healthcare and health outcomes are often more pronounced. The aim of this study was to determine the health and healthcare priorities in rural communities using a region-wide community engagement approach.MethodsThis multi-methods study was conducted in five rural communities in the Grampians region, Western Victoria, Australia. It involved six concept mapping steps: (1) preparation, (2) generation (brainstorming statements and identifying rating criteria), (3) structuring statements (sorting and rating statements), (4) representation of statements, (5) interpretation of the concept map and (6) utilization. Community forums, surveys and stakeholder consultations with community members and health professionals were used in Step 2. An innovative online group concept mapping platform, involving consumers, health professionals and researchers was used in Step 3.ResultsOverall, 117 community members and 70 health professionals identified 400 health and healthcare issues. Six stakeholder consultation sessions (with 16 community members and 16 health professionals) identified three key values for prioritizing health issues: equal access for equal need, effectiveness and impact (number of people affected). Actionable priorities for healthcare delivery were largely related to access issues, such as the challenges navigating the healthcare system, particularly for people with mental health issues; the lack of sufficient general practitioners and other health providers; the high travel costs; and poor internet coverage often impacting technology-based interventions for people in rural areas.ConclusionsThis study identified actionable health and healthcare priorities from the perspective of healthcare service users and providers in rural communities in Western Victoria. Issues related to access, such as the inequities in healthcare costs, the perceived lack of quality and availability of services, particularly in mental health and disability, were identified as priorities. These insights can guide future research, policy-making and resource allocation efforts to improve healthcare access, quality and equity in rural communities.

Re/connecting with “home”: a mixed methods study of service provider and patient perspectives to facilitate implementing rehabilitation in the home for reconditioning

Purpose To explore the views of healthcare professionals and patients about the advantages and disadvantages of rehabilitation in the home (RITH) for reconditioning, and identify factors that should contribute to the successful implementation of a consensus-based RITH model for reconditioning. Materials and methods Interviews with 24 healthcare professionals and 21 surveys (comprising Likert scale and free text responses) of inpatients undergoing rehabilitation for reconditioning provided study data. Interpretive thematic analysis was used to analyse interview data; descriptive statistics analysed Likert scale responses; patient written responses assisted with the interpretation of themes developed from the interview data. Results Two major themes were elicited in this study: the home is a physical setting and the home is a lived space. Advantages and disadvantages of RITH for patients, carers and healthcare professionals were identified within these themes. Appropriate patient selection; effective communication with patients and carers, and within RITH teams; adequate patient and carer support; ensuring the safety of patients and staff; and education of patients, carers and healthcare professionals are essential for the satisfactory implementation of RITH. Conclusion The concept of home shapes the delivery of RITH. Recognising the advantages and disadvantages of RITH highlights important considerations needed to successfully implement RITH for reconditioning.

‘They Had to Relearn How to Live Inside’: Perceptions of Service Providers of Factors to Successful Transition From Homeless to Sustained Housing

Abstract Date Presented 03/23/24 This study examined the perspectives of service providers working with people transitioning from homelessness to becoming and staying housed. Findings will be discussed, as well as identified service gaps that OT can target for intervention. Primary Author and Speaker: Laura Vanpuymbrouck Additional Authors and Speakers: Samantha Bertucci, Megan Hartney, Taylor MacKenzie, Samantha Marsh

Domestic and Family Violence Affecting Children and Young People from Culturally and Racially Marginalized Migrant Backgrounds in Australia: A Scoping Review of Child Experiences and Service Responses.

In Australia, children and families from culturally and racially marginalized (CARM) migrant backgrounds experience a range of compounding structural and interpersonal factors that limit help-seeking and exacerbate the impacts of domestic and family violence (DFV). This scoping review examines the current state of knowledge on how children and young people from CARM migrant backgrounds experience DFV, and the services that respond to DFV including child protection services. A systematic search was conducted across PsycINFO, MEDLINE, and CINAHL databases and Google Scholar, alongside a complementary grey literature search. Articles were included in the review if participants were from CARM migrant backgrounds, and the article included information related to children and young people's experiences of DFV, and the DFV service system. The review found 19 articles that met selection criteria. Due to limited research on this topic in Australia, most articles focused on children and young people's experiences shared through parental, carer or service provider perspectives. To our knowledge, this is the first scoping review to examine how children and young people from CARM migrant backgrounds experience DFV. Findings demonstrate children and young people are victim-survivors of multiple forms of DFV. Children and young people's engagement with the DFV service system is often accompanied by feelings of fear and distrust. Findings suggest that to strengthen system responses to DFV, services must build their capability to implement intersectional approaches that simultaneously support the safety and well-being of both the child and the non-violent parent or carer.

The perspectives of caregivers and health service providers on barriers to clubfoot management in Puri-Urban health facility in Ghana.

Clubfoot is a common disabling condition that is prevalent across all populations. Approximately, one out of 750 children globally suffers from clubfoot, and around 150,000 to 200,000 children are born with clubfoot every year with 80% of the cases occurring in developing countries. Clubfoot can result in mobility impairments when not properly managed and researchers have argued that understanding knowledge and perceptions are key components to early identification and effective management of clubfoot. The study explored the barriers to clubfoot management from the perspectives of caregivers and healthcare providers in Duayaw Nkwanta, Ghana. A total of 26 participants made up of 22 caregivers of children with clubfoot and six healthcare providers were purposively sampled for the study guided by a set of inclusion and exclusion criteria. Qualitative data were collected using a semi-structured interview guide through in-depth face-to-face interviews. Interviews were transcribed and analyzed thematically and presented as findings. High cost of treatment, long travel distance, long hours spent at the treatment facility, non-availability of clubfoot treatment services, late reporting of clients for treatment, and non-compliance of parents/caregivers with treatment protocols were identified as the barriers to effective management of clubfoot. These findings have substantial implications for current interventions to effectively manage clubfoot in Ghana.

A deep reinforcement learning-based scheduling framework for real-time workflows in the cloud environment

Benefiting from the flexibility, scalability and many other advantages of cloud computing, an increasing number of research institutions and enterprises are using cloud platforms to deploy their scientific or commercial workflow applications. From the perspective of cloud service providers, how to schedule workflows reasonably to improve user satisfaction and resource utilization is a big challenge. This challenge becomes more prominent in a dynamic cloud environment, where the workload of user-submitted workflows is constantly changing and unpredictable. Traditional scheduling methods designed for fixed workflows or real-time independent tasks are not applicable in such scenarios. In this paper, we present an online scheduling framework for multiple real-time workflows in a dynamic environment. In this framework, the scheduler employs a deep reinforcement learning based algorithm (R-DQN) to assign each task in workflows to a suitable virtual machine instance according to the current situation. Its goal is to achieve optimal task scheduling and resource allocation, so as to minimize workflow makespan and maximize resource utilization. We provide a comprehensive overview of the design and implementation of our approach, and we conduct experiments using various workflow benchmarks with different structures and scales on the WorkflowSim platform. The experimental results demonstrate that our algorithm significantly outperforms the compared algorithms in term of makespan and other metrics. Moreover, our algorithm demonstrates strong performance in generality, robustness and scalability.

What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel

ObjectiveMajor trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DesignOnline survey informed by the TDF and BCW. SettingUK trauma rehabilitation pathway. PopulationRehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). AnalysisMean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. ResultsMost respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). ‘Social/professional role and identity’, 'knowledge’ and ‘emotion’ (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including ‘seen as tick-box exercise’,‘not a priority’, lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. ConclusionsAlthough rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.