Table 6 Identified barriers and facilitators to implementation
Domain | Sub-domain | Brief description | Number of included studies citing barriers or facilitators in this domain |
|---|---|---|---|
System | |||
Environmental context | IT, trial staff, time, workload, workflow, competing trials, space, movement and staff turnover | The physical, structural resources of the context, along with its processes and personal resources | 37 |
Culture | Attitude to change (readiness and agents), commitment and motivation, flexibility of roles/trust, champions/role models | The system culture, beliefs and behaviors in relation to change and staffing roles | 28 |
Communication processes | Processes within the context | The processes of conveying information within the system, in terms of both online and in-person methods | 25 |
External requirements | Reporting, standards, guidelines | Any external pressures or expectations that impact on the deliverables of the system | 4 |
Staff | |||
Staff commitment and attitudes | Perceived validity/need, ownership, perceived efficiency, perceived safety, belief in change/readiness for change | The micro-level beliefs, attitudes and behaviors toward change in general, and the intervention specifically | 33 |
Understanding/awareness | Of the goals of the intervention, and of the processes/mechanics | Understanding of the aims and methodology of the intervention | 22 |
Role identity | Flexibility, responsibility | Beliefs and attitudes towards one’s work role and responsibilities | 13 |
Skills, ability, confidence | To engage patients and overcome patient barriers, to carry out the intervention, to manage stress/competing priorities | Staff sense of their capacity to carry out the tasks of the intervention, while managing the barriers posed by the target population and their work environment | 30 |
Intervention | |||
Ease of integration | Complexity, cost and resources required, flexibility (to respond to patient, staff and system), acceptability/suitability to system, staff and patients; fit for context | How well the intervention “fits” with the current system, resources and needs of the population and context, as well as its ability to adapt and respond when changes are needed | 30 |
Face validity/evidence base | Theory and evidence | The extent to which the intervention is grounded in solid evidence regarding a known issue, and how effective it looks to be in terms of meeting its aims | 12 |
Safety/legal/ethical concerns | Patient or staff safety; medico-legal concerns | How well an intervention addresses important issues of safety and legality to protect staff and patients | 6 |
Supportive components | Education/training provided, marketing/awareness, audit/feedback, involvement of end users | The components of the intervention which work to support and facilitate the changes necessary | 38 |