Browsing by Author "Morgan, Debra"
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- ItemOpen AccessBarriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation(2019-10-17) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E; Kirk, Andrew; Stewart, Norma J; Seitz, Dallas; Bayly, Melanie; Froehlich Chow, Amanda; Elliot, Valerie; Daku, Jean; Hack, Tracy; Hoium, Faye; Kennett-Russill, Deb; Sauter, KristenAbstract Background With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. Methods A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. Results Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. Conclusions The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.
- ItemOpen AccessCorrection to: Factors infuencing sustainability and scaleup of rural primary healthcare memory clinics: perspectives of clinic team members(2022-02-15) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E.; Seitz, Dallas; Elliot, Valerie; Bayly, Melanie; Chow, Amanda F.; Cameron, Chelsie
- ItemOpen AccessFactors influencing sustainability and scale-up of rural primary healthcare memory clinics: perspectives of clinic team members(2022-02-04) Morgan, Debra; Kosteniuk, Julie; O’Connell, Megan E.; Seitz, Dallas; Elliot, Valerie; Bayly, Melanie; Chow, Amanda F.; Cameron, ChelsieAbstract Background The aging of rural populations contributes to growing numbers of people with dementia in rural areas. Despite the key role of primary healthcare in rural settings there is limited research on effective models for dementia care, or evidence on sustaining and scaling them. The purpose of this study was to identify factors influencing sustainability and scale-up of rural primary care based memory clinics from the perspective of healthcare providers involved in their design and delivery. Methods Participants were members of four interdisciplinary rural memory clinic teams in the Canadian province of Saskatchewan. A qualitative cross-sectional and retrospective study design was conducted. Data were collected via 6 focus groups (n = 40) and 16 workgroup meetings held with teams over 1 year post-implementation (n = 100). An inductive thematic analysis was used to identify themes. Results Eleven themes were identified (five that influenced both sustainability and scale-up, three related to sustainability, and three related to scale-up), encompassing team, organizational, and intervention-based factors. Factors that influenced both sustainability and scale-up were positive outcomes for patients and families, access to well-developed clinic processes and tools, a confident clinic leader-champion, facilitation by local facilitators and the researchers, and organizational and leadership support. Study findings revealed the importance of particular factors in the rural context, including facilitation to support team activities, a proven ready-to-use model, continuity of team members, and mentoring. Conclusions Interdisciplinary models of dementia care are feasible in rural settings if the right conditions and supports are maintained. Team-based factors were key to sustaining and scaling the innovation.