Table 4. Barriers and Implementation Strategies According to CFIR Domain and Construct.
| CFIR Construct | Barrier Description | Implementation strategy/KT Intervention (See Appendix 3 for Detailed Explanations) |
|---|---|---|
| CFIR domain: Intervention characteristics | ||
| Adaptability | Clinicians' concerns about feasibility, specifically related to safety, patient capacity to participate, and potential for pain, aphasia, and/or poor understanding of Norwegian language | Promote adaptability Identification of barriers and facilitators Tailor strategies Conduct educational meetings Visit other sites |
| Cost | Equipment cost | Access new funding |
| CFIR domain: Inner setting | ||
| Available resources | Personnel costs—training, implementation, operations, etc | Access new funding |
| Potential for negative impact on care delivery of patients who were not receiving HIT if resources are limited (eg, PTs sick or on vacation) | Access new funding (attempted but not successful) Local consensus discussions (agreed that these patients would not be prioritized over others) |
|
| Poor accessibility to equipment (from wheelchair to treadmill) | Change physical structure and equipment | |
| Equipment for safety monitoring (alarm, blood pressure, and heart rate monitors) and orthoses | Access new funding Change physical structure and equipment |
|
| Time management—time for documentation, time for education sessions | Purposely reexamine the implementation | |
| Enough equipment and possibilities for mutual exchange between sites/floors | Develop resource-sharing agreements | |
| Compatibility | Distribution of patient needs/care among the interdisciplinary team. A primary goal of PT is related to improving upper extremity function. Increasing time spent gait training would result in decreased time focusing on upper extremity function. | Promote adaptability |
| Changing long established habits/beliefs/experiences related to workflow, interdisciplinary team, and work-related roles. | Revise professional roles Conduct local consensus discussions Use an implementation adviser Change record system |
|
| Culture | Changing long-established habits/beliefs/experiences related to practice beliefs and culture among the PTs | Create a learning collaborative Conduct educational meetings Conduct local consensus discussions |
| CFIR domain: Characteristics of individuals | ||
| Individual stage of change | Little knowledge of the evidence to support HIT (interdisciplinary team) | Conduct educational meetings Involve executive boards |
| Knowledge and beliefs about the intervention | Little knowledge of the evidence to support HIT (PTs) Little knowledge of how to provide HIT to patients (PTs) |
Conduct educational meetings Build a coalition (RKR, City of Oslo, Oslo University Hospital) Use an implementation adviser Organize clinician implementation team meetings Conduct ongoing training Provide clinical supervision Develop educational materials Distribute educational materials Facilitation Obtain and use patients/consumers and family feedback Remind clinicians |
| Little knowledge of the evidence to support HIT (interdisciplinary team) | Conduct educational meetings | |
Abbreviations: CFIR, Consolidated Framework for Implementation Research; HIT, high-intensity training; PTs, physiotherapists; RKR, Regional Center of Knowledge Translation in Rehabilitation.