Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors

被引：9

作者：

Craven, Kristelle ^{[1
]}

Holmes, Jain ^{[1
]}

Powers, Katie ^{[1
]}

Clarke, Sara ^{[1
]}

Cripps, Rachel L. ^{[2
]}

Lindley, Rebecca ^{[1
]}

Phillips, Julie ^{[1
]}

Tyerman, Ruth ^{[1
]}

McKevitt, Christopher ^{[2
]}

Clarke, David ^{[3
]}

Radford, Kathryn ^{[1
]}

机构：

[1] Univ Nottingham, Sch Med, Rehabil & Ageing Res Grp, Injury Inflammat & Recovery Sci, Nottingham NG7 2UH, England

[2] Kings Coll London, Sch Populat Hlth & Environm Sci, Addison House, London SE1 1UL, England

[3] Univ Leeds, Acad Unit Ageing & Stroke Res, Leeds Inst Hlth Sci, Woodhouse Lane, Leeds LS2 9UT, W Yorkshire, England

来源：

BMC MEDICAL RESEARCH METHODOLOGY | 2021年 / 21卷 / 01期

关键词：

Mentoring; Occupational therapy; Stroke; Vocational rehabilitation; Randomised controlled trial; Trial processes; Adherence; Implementation fidelity; Process evaluation; CLINICIAN; KNOWLEDGE; CARE;

D O I：

10.1186/s12874-021-01382-y

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: Little guidance exists regarding how best to upskill and support those delivering complex healthcare interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed to explore mentors' roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting the mentoring process and intervention delivery. Methods: Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were calculated per trial site. Qualitative data were analysed thematically. Results: Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was provided by phone or Microsoft Teams (range: 88.6-100%), with the remainder via email and SMS (Short Message Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs' understanding of- and adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving. Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time for mentoring. Conclusions: Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS would have been able to deliver the intervention without mentoring support, or how this might have impacted fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires testing in a future trial.

引用

页数：15

共 47 条

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