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Table 4 Description of the single implementation strategy and multifaceted implementation strategy

From: Effectiveness of a multifaceted implementation strategy for improving adherence to the guideline for prevention of mental ill-health among school personnel in Sweden: a cluster randomized trial

 

Multifaceted implementation strategy

Single implementation strategy

   

Educational meeting

Implementation team

Workshops

Plan-Do-Study-Act cycles

Rationale, theory, or goal of the elements essential to the strategy

COM-B constructs: capability, opportunity, motivation. The meeting was aimed at providing participants with knowledge and skills related to the guideline, barriers, and facilitators. Schools made an action-plan for the implementation of a guideline recommendation of choice.

COM-B constructs: opportunity. The rationale for forming an implementation team at each school was that school principals had indicated to need support from personnel with implementing the guideline.

COM-B constructs: capability, opportunity, motivation. The workshops were aimed at providing teams with knowledge and skills regarding (1) the recommendations of the guideline, (2) implementation processes, and (3) Plan-Do-Study-Act cycles.

COM-B constructs: capability, opportunity, motivation. The goal of this iterative and evaluative strategy was for teams to identify the needed change, facilitate the change, assess its success, and adapt to the change based on feedback to arrive at targeted solutions.

Materials, procedures, activities, and/or processes used

Materials: the guideline and a compendium, which included handouts of the presentations and documents related to exercises. Procedure: the meeting included PowerPoint presentations, plenary discussions, and five different group-exercises.

Materials: school principals received instructions, including a template to support them with forming their implementation team. Procedure: teams participated in workshops, conducted Plan-Do-Study-Act cycles, and met between workshops.

Materials: handouts of the presentations and documents related to exercises. Procedure: workshops included presentations on the guideline, implementation processes and Plan-Do-Study-Act cycles, plenary discussions, and group exercises.

Materials: exercises related to forming SMART-goals, templates of Plan-Do-Study-Act cycles were made for the purpose of the study. Procedure: PDSA-cycles were performed during and between workshops by the implementation teams

Strategy provider’s expertise and background

The meeting was held by an implementation expert and licensed occupational health psychologist

Implementation expert sent instructions by mail to the school principal. School-principal selected team-members, e.g., health and safety officer, union representative etc.

Implementation expert and licensed psychologist with occupational health expertise gave workshops 1–3; the same implementation expert and a researcher with expertise in the guideline recommendations gave workshops 4–5.

Implementation expert introduced the methodology of Plan-Do-Study-Act cycles during the first workshop and supported teams with their cycles during proceeding workshops.

Modes of delivery of the strategy provided individually or in a group.

The meeting was delivered at each municipality face-to-face to all public compulsory schools within that municipality.

Individual instructions sent to school-principals by mail.

The workshops were delivered at each municipality face-to-face to all implementation teams within that municipality.

Introduced face-to-face to all implementation teams during workshop 1.

Type of location where the strategy occurred, including necessary infrastructure

At one of the municipalities the meeting was conducted at the nearby university and at the other municipality at the city hall. Infrastructure included a projector for presentations, tables set up for group-work.

Implementation teams met at each workshop and at their own school between workshops.

At one of the municipalities the workshops were given at one of the participating schools and at the other at the city hall. Infrastructure included a projector for presentations, tables set up for group-work.

The first cycle was started during workshop 1. Cycles continued between and during the remaining workshops.

Number of times the strategy was delivered, period including the number of sessions, schedule, and duration.

One educational meeting was given at each municipality in October 2017. The meeting was given between 9.00 and 16.15.

Teams were formed per school in October 2017 prior to workshop 1. Teams were intended to last the whole study period and preferably beyond.

Five workshops (2.5 h per workshop) were given at each municipality between October 2017 and June 2018.

The number of cycles conducted varied between implementation teams. No instructions were given for a minimum or maximum number of cycles to be conducted.

Personalization of the strategy (what, why, when, and how).

The schedule, presentations and exercises of the educational meeting were the same at each municipality.

Team-members were personally selected by the school principal following instructions given by the implementation expert.

The schedule and exercises of the workshops were the same at each municipality.

Each team conducted personalized Plan-Do-Study-Act cycles adapted to their local needs. Personalization was conducted by the teams

Modification of the strategy during the study - changes made (what, why, when, and how).

No modifications were made

No modifications were made.

No modifications were made

No modifications were made

Planned: Assessment of strategy adherence or fidelity (how, by whom), strategies used to maintain or improve fidelity.

Actual: If strategy adherence or fidelity was assessed, was the strategy delivered as planned.

Fidelity to the educational meeting was assessed by checklist. Overall, the educational meeting was delivered as intended.

The research-team assessed whether each school formed an implementation team. Implementation teams were formed for each school. Teams were instructed to make a communication plan on how to communicate with their municipality. This was executed in one municipality.

Fidelity to workshops was assessed by checklist during the workshops by the research-team. Overall, the workshops were delivered as intended. With exception of one of the exercises of workshop 3, which was not fully delivered as intended in one municipality. Moreover, the municipality did not participate in workshop 2 in one municipality.

Fidelity to the Plan-Do-Study-Act cycles was assessed by letting teams present their progress during the start of workshop 2–5. This was delivered as planned.