Table 1 Description of the multifaceted implementation strategy as planned based on the framework of Hulscher et al. [14, 15]

1.

Global typing of the implementation strategy

1.1.

Interventions orientated towards occupational therapists

 (a) Dissemination of educational materials using a website aimed at occupational therapists.

 (b) Educational meetings for occupational therapists (including regional network meetings).

 (c) Outreach visits for occupational therapists.

Interventions orientated towards physicians and managers

 (a) Dissemination of educational materials using a website and newsletters aimed at physicians and managers.

 (b) Telephone calls to managers and physicians serving as reminders and providing an opportunity to ask questions about the intervention and the implementation.

1.2.

Organizational interventions

Change in the patient-reporting system by offering a web-based reporting system structured according to the steps of the COTiD program.

1.3.

Regulatory interventions

Accreditation for occupational therapists who are exposed to the entire implementation strategy.

2.

Target group / participants

2.1.

Professional status

The intervention is developed for occupational therapists working in private practices, nursing homes, hospitals, and mental health organizations. The multifaceted intervention was developed to reach different types of physicians including general practitioners, nursing home physicians, neurologists, and geriatricians. Lastly, aimed to reach different types of manager including direct managers, such as managers of the occupational therapy department or managers of allied healthcare services and non-direct managers, such as cluster / unit managers.

2.2.

Interaction between participants

Components of the implementation strategy will be aimed at the individual disciplines. However, it is assumed that each professional is part of a functional unit existing of at least two occupational therapists, one physician, and one manager. Especially the interventions toward occupational therapists are intended to encourage therapists to interact with the managers and physicians within their functional unit. In addition, we will encourage occupational therapists within the same region to interact with each other using regional network meetings.

2.3.

Size of the target group

The target groups of the implementation strategy are 36 occupational therapists, 36 physicians, and 20 managers. Educational meetings will be offered in two groups (approximately 18 per group), and regional meetings will be offered in three regions (approximately 12 OTs per region). Each educational outreach visit will be offered to all occupational therapists within one functional unit at the same time (which is assumed to be two OTs per functional unit). The website is targeted at the entire group of professionals and telephone calls will be offered to the individual physicians and managers.

2.4.

Motivation for participation

Accreditation points can be obtained for both participation in the study and for completing the minimum required components of the implementation strategy (minimum requirements: two educational meetings, three regional meetings, and five coaching sessions). This is done to motivate occupational therapists. Participation of all professionals is voluntarily.

3.

The ‘Implementers’

3.1.

Professional status

All components of the implementation strategy aimed at occupational therapists will be executed by two ‘implementers,’ who are expert occupational therapists in executing the COTiD program as well as in teaching about the COTiD program. Both are educated in using motivational interviewing as a coaching technique.

A third ‘implementer’ will execute the implementation strategies toward the managers and physicians. She has a background in occupational therapy and is the researcher of this study. She is also trained in using motivational interviewing.

3.2.

Opinion leaders

We suspect that the ‘implementers’ providing the strategies toward the OTs will be perceived as opinion leaders and role models as they contributed to the development and testing of the COTiD program. The ‘implementer’ that will provide the strategies toward physicians and managers is not likely to be considered an opinion leader.

3.3.

Authority

The researcher who developed and tested the COTiD program initiated the implementation by requesting funding for this implementation. The funding agency (Zorg Onderzoek Nederland en Medische Wetenschappen; ZONMW) is therefore also initiator of the implementation.

4.

Frequency

Occupational therapists

 1) Two educational meetings (eight hours each) will be provided at the start of the intervention period with an interval of eight weeks between meetings.

 2) Outreach visits (90 minutes each): five to seven sessions depending on the individual needs. These sessions will start after the two training days with intervals between sessions depending on individual needs (approximately six to eight week intervals).

 3) Regional network meetings (2,5 hours each): four meetings in each of the three regions will be provided with intervals of approximately 12 weeks between meetings.

Physicians and managers

 1) Telephone calls (duration will vary per individual): one or two telephone calls within a one year period.

 2) Newsletters: four newsletters with intervals of approximately 12 weeks.

The website will be continuously available from the start of the intervention.

5.

Information about the innovation

5.1.

Type of information about the innovation or guideline

A prerequisite for occupational therapists for starting the implementation strategy is to complete a postgraduate course on the COTiD program. During this course all OTs should have been provided with information on the entire COTiD program.

Information on the innovation for occupational therapists

 1) Educational meetings:

 - Information and skills regarding the COTiD program: practicing communication skills (role-playing)

 - Information and skills regarding implementation of the program: inventorize barriers, elevator pitch, product description, promoting the program to physicians and managers (role-playing), and instructions on using the web-based reporting system and discussion forum.

 2) Outreach visits: variation is possible, but the content of the sessions needs to be a mix of improving skills to practice according to the COTiD program and skills to implement / promote the COTiD program.

 3) Regional network meetings: variation is possible, the meetings are intended to discuss cases and difficulties experienced in using the COTiD program and promoting the program.

Information on the innovation for physicians and managers

 1) Telephone calls: content can vary depending on needs of physicians and managers.

 2) Newsletters: will include information on experiences with the COTiD program of various types of professionals.

Information on the innovation for all professionals

Website: will provide information on the COTiD program and publications on the effects of the program.

5.2.

Presentation form and medium

Occupational therapists

 1) Educational meetings: a mixture of lectures, discussion, and role-playing.

 2) Outreach visits: variation is possible depending on the needs of the participants.

 3) Regional network meetings: lectures and discussions will be used.

Physicians and managers

Newsletters: newsletters will be sent by email to managers and physicians.

6.

Information about target group management/performance

Occupational therapists will be provided with verbal feedback on their performance after role-playing during the educational training days. During the educational outreach visits performance and achievements will be discussed regarding both skills in executing the COTiD program and promoting the COTiD program (by addressing the number of referrals). Physicians and managers will be provided with feedback on the number of referrals that are made in the preceding period during the telephone calls.

No information will be provided that enables participating professionals or organizations to compare their achievements with others.