Contextual Factors Influencing the Pathway Implementation
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
Contextual Factors Influencing the Pathway Implementation
Data collection Recorded audio data were transcribed and anonymised. The questionnaire data were similarly transferred to an Excel spreadsheet and anonymised. Both data were stored securely in the University designated folder.
Data analysis A framework analysis was employed for the analysis of obtained data [44, 45]. The approach involved five stages: (a) familiarisation – which involves repeated lis- tening to audio and reading of transcripts for immersion in the data; (b) identifying a thematic framework – which is based on an a priori set of issues related to the research objectives and themes emerging from the data; (c) indexing – which systematically applies the thematic
framework to the transcripts; (d) charting – which ‘lifts’ the data from the transcripts and rearranges them (e.g., in a tabular format) according to the thematic frame- work; and (e) mapping and interpretation – which seeks associations and develops policy-related strategies from the charted data based on a priori issues and emerging themes. Stages (a) to (c) were conducted independently by two authors (JK and YL). All authors contributed to stages (d) and (e). From stage (b) onwards, three frameworks related to
the research objectives were constructed using a priori concepts and themes emerging from the data:
Framework to understand the facilitators and barriers to components of the NICE CG161 falls prevention pathway and cross-component and con- textual factors.
Framework to inform potential commissioning strategies by accounting for causal mechanisms in context, priority setting, need/eligibility, supply and demand.
(III)Framework to understand the key methodological challenges to public health economic model development.
Framework (I): facilitators and barriers and cross- component and contextual factors This framework closely followed the structure of the dis- cussion topics and charted the main themes identified from the data. Facilitators and barriers for the pathway implementation that emerged from the data were ar- ranged by a priori thematic categories corresponding to the NICE CG161 pathway components – i.e., (i) falls risk screening/assessment by professionals; (ii) raising falls risk awareness; (iii) initial uptake of treatments; and (iv) long-term adherence to treatments. Cross-component factors – i.e., facilitators and barriers influencing mul- tiple pathway components – were highlighted.
Fig. 2 Graphical summary of the recommended falls prevention guideline used to introduce the discussion topics to focus group and interview participants
Kwon et al. BMC Health Services Research (2021) 21:1020 Page 5 of 19
Additional contextual factors influencing the pathway implementation were noted as they emerged from the data.
Framework (II): potential commissioning strategies This framework rearranged the main themes under Frame- work (I) into a format that guides commissioning strategies (actual or model-evaluated). An a priori CICI-HNA frame- work was constructed that combined the thematic categor- ies within the CICI [20] and the HNA frameworks [43]. This is illustrated in Fig. A in Supplementary Material with accompanying descriptions. In brief, the CICI framework distinguished between implementation context (e.g., socio- economic, legal) and mechanisms (e.g., provider, funding) [20].
The HNA framework distinguished between supply, demand and need/eligibility [43]: supply corresponded to the CICI implementation mechanisms; demand encom- passed personal and external factors influencing uptake/ad- herence decisions (e.g., health-related motives for healthy behaviour [42], community marketing, self-efficacy promo- tions [52, 53]); need/eligibility was determined by normative clinical and public health guidelines and intervention stud- ies that demonstrated a group’s ability to benefit from an intervention [43]. Further thematic categories that emerged from the data were noted (e.g., priority setting challenges that contextualised commissioning [35]). The mapped themes informed commissioning strategies by highlighting which CICI-HNA factors were modifiable – i.e., lie within the decision space which is defined by the stakeholders in- volved, decision time horizon and budget/capacity con- straints – and to what extent.
Framework (III): challenges for public health economic modelling The thematic categories of key methodological chal- lenges for public health economic modelling were taken from a systematic methodological review [46]: (i) captur- ing non-health outcomes and societal intervention costs; (ii) considering dynamic complexity in health determi- nants and intervention need; (iii) considering theories and models of human behaviour based on psychology and sociology; and (iv) considering social determinants of health and issues of equity. Additional challenges as- sociated with economic modelling and evaluation were also identified from the emerging data.
Results Participant characteristics Twenty-seven persons participated in research across four focus groups (FG1–4) and two interviews (INT1–2) between October 2019 and January 2020. Table 1 sum- marises their characteristics. Regarding current access to falls prevention, 11 re-
ported having spoken to a professional about falls risk.
Nevertheless, 21 reported recent use of services with some falls prevention properties [9], suggesting that the main falls prevention pathway under current practice is self-referral by older persons. Of the 21 users, 13 re- ported accessing multiple interventions. The most widely accessed services were physiotherapy and falls education.
Framework (I): facilitators and barriers and cross- component and contextual factors Table 2 summarises the identified facilitators and bar- riers to implementation by pathway component. The themes are numbered to facilitate re-mapping to later frameworks. Table A in Supplementary Material shows the direct transcript quotes for each theme. Figure B in Supplementary Material graphically illustrates how themes were mapped from qualitative data to Frame- work (I) and subsequently re-mapped to Frameworks (II) and (III).
Falls risk screening and assessment by professionals Factors influencing falls risk screening and assessment by professionals could be divided into three groups: (A) professional competence; (B) system-wide approaches and resources; and (C) motivation and awareness of older persons. Participants were aware of the importance of professional competence in conducting the falls risk screening, particularly incompetence as barriers. For ex- ample, one participant had noticed the narrow scope of professional risk assessment:
(FG1) “I’d think it was important if somebody went to a health professional, the health professional would check on a whole lot of background information apart from immediate health thing – you know, what is your living, housing situation.” (Theme [1–6])
Nevertheless, participants were also aware of the impact of system-level approaches and resources beyond indi- vidual professional competence and made suggestions on improvement. One such suggestion was to adopt a proactive, data-based approach to risk screening akin to mass vaccination:
(FG1) “And with regards to hooking people in, when flu jab time comes up, we all get a text or a message or we get told that we need a flu jab. So, follow that lead, really. I’m sure there’s a record showing age groups and then tell them ‘Look, this service is available. Come on in!’” (Theme [1, 2])
Moreover, a few comments suggested that older person’s motivation to maintain health would facilitate profes- sional efforts to discuss falls risk and prevention:
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Table 1 Summary of participant characteristics Field Variable N (%)
Demographics Sex Female 20 (74)
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