Context is key: A tale of two regional public health services implementing best practice occupational therapist-led environmental assessment and modification to prevent falls.
Anna Tynan1,2,3, Alison Pighills4,5, Wendy White1, Alicia Eden5, Sharon Mickan6 1Darling Downs Health, Toowoomba, Queensland, Australia2Southern Queensland Rural Health, The University of Queensland, Toowoomba, Queensland, Australia3The Centre for Health Research, University of Southern Queensland, Springfield, Queensland, Australia4Division of Tropical Health and Medicine, James Cook University, Douglas, Queensland, Australia5Mackay Hospital and Health Service, Mackay, Queensland, Australia6Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
Abstract
Background
Environmental assessment and modification (EAM) is an effective approach to reducing falls, particularly when provided by occupational therapists to high risk populations. EAM has been incorporated into many national and international falls prevention guidelines; however, evidence suggests that it is not being implemented in practice. The aim of this study was to compare the experience of implementing best practice EAM across two regional health services in Queensland, Australia.
Method
A mixed method concurrent study was conducted, commencing in March 2020. Clinicians’ qualitative experiences of implementing best practice EAM were explored using interviews and triangulated with meeting minutes and field-notes. Quantitative data was collected and descriptively analysed before and after 12 months of implementation across chart audits, therapist observation, and a knowledge and attitude survey. Thematic analysis compared barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites Qualitative and quantitative data were analysed separately then merged thematically during a clarification phase.
Results
Context had an important influence on how both sites responded to the practice change and navigated some of the unexpected challenges that emerged, including the COVID-19 pandemic. Site two ceased implementation while site one continued.
Conclusion
The context for implementation has important implications for how a site implements evidence informed best practice and responds to other external influences. Learnings from the study will provide deeper understanding for completing implementation projects in regional and rural contexts and support the future implementation of EAM.
Biography
Anna Tynan is a health service embedded researcher with Darling Downs Health. Dr Tynan is particularly interested in health outcomes and access to health services in rural Australia. A large component of her work with the health service is capability building of front-line clinicians in the regional health service.