背景:实施取决于医疗保健专业人员能够理解与其常规实践相关的新干预措施。归一化过程理论将其称为连贯性工作。然而,由于新干预措施的变化,规定实现一致性所需的条件是具有挑战性的,常规实践和它们之间的关系。干预描述的框架可能会提供一条前进的道路,因为它们为比较复杂的干预措施提供了广泛的描述性类别。迄今为止,这些框架还没有被实施理论所了解,因此,不要考虑在保持常规练习的各个方面不变而以不同方式进行其他方面所涉及的连贯性工作。使用言语和语言治疗作为经验范例,我们探索了治疗师的实践变化的经验,并开发了一个框架,以显示如何实现儿童言语干预的连贯性。
方法:我们进行了一项基于病例的回顾性定性研究,研究了在苏格兰的三个NHS言语和语言治疗服务以及私人诊所中,儿童言语问题的干预措施如何发生变化。通过与42位治疗师的经验工作之间的相互作用,得出了一致性框架(使用深入访谈,或自组织对或小焦点组)和归一化过程理论的连贯性结构。
结果:治疗师报告了一系列实践变化,这需要不同类型的一致性工作。非传统干预措施在该行业的研究文献中已经出现了多年,但在临床实践中没有出现。与这些干预措施实现连贯性在智力上要求很高,因为它们挑战了支持常规实践的传统语言假设。实施工作也在后勤方面要求很高,和治疗师觉得他们没有什么机构来改变当地传统的服务。此外,实现连贯性需要大量的相关工作。非传统干预措施通常很难向儿童和父母解释,涉及文化上不舒服的重复训练,并要求治疗师为个别儿童进行更多的干预。
结论:干预一致性框架具有实际和理论应用。它旨在帮助治疗师,服务和研究人员在实施非常规干预措施时预测并解决实现一致性的障碍。它也代表了一个使用理论来进行干预描述的工作示例,既以用户为中心,又对实施友好。
BACKGROUND: Implementation depends on healthcare professionals being able to make sense of a new intervention in relation to their routine practice. Normalisation Process Theory refers to this as
coherence work. However, specifying what it takes to achieve coherence is challenging because of variations in new interventions, routine practices and the relationship between them. Frameworks for intervention description may offer a way forward, as they provide broad descriptive categories for comparing complex interventions. To date such frameworks have not been informed by implementation theory, so do not account for the coherence work involved in holding aspects of routine practice constant while doing other aspects differently. Using speech and language therapy as an empirical exemplar, we explored therapists\' experiences of practice change and developed a framework to show how coherence of child speech interventions is achieved.
METHODS: We conducted a retrospective
case-based qualitative study of how interventions for child speech problems had changed across three NHS speech and language therapy services and private practice in Scotland. A
coherence framework was derived through interplay between empirical work with 42 therapists (using in-depth interviews, or self-organised pairs or small focus groups) and Normalisation Process Theory\'s construct of coherence.
RESULTS: Therapists reported a range of practice changes, which had demanded different types of coherence work. Non-traditional interventions had featured for many years in the profession\'s research literature but not in clinical practice. Achieving
coherence with these interventions was intellectually demanding because they challenged the traditional linguistic assumptions underpinning routine practice. Implementation was also logistically demanding, and therapists felt they had little agency to vary what was locally conventional for their service. In addition, achieving
coherence took considerable relational work. Non-traditional interventions were often difficult to explain to children and parents, involved culturally uncomfortable repetitive drills and required therapists to do more tailoring of intervention for individual children.
CONCLUSIONS: The intervention coherence framework has practical and theoretical applications. It is designed to help therapists, services and researchers anticipate and address barriers to achieving coherence when implementing non-routine interventions. It also represents a worked example of using theory to make intervention description both user-focused and implementation-friendly.