Implementing best practice occupational therapist-led environmental assessment and modification to prevent falls: A qualitative study of two regional and rural public health services in Australia

Article


Tynan, Anna, Pighills, Alison, White, Wendy, Eden, Alicia and Mickan, Sharon. 2022. "Implementing best practice occupational therapist-led environmental assessment and modification to prevent falls: A qualitative study of two regional and rural public health services in Australia." Australian Occupational Therapy Journal. 70 (2), pp. 202-217. https://doi.org/10.1111/1440-1630.12849
Article Title

Implementing best practice occupational therapist-led environmental assessment and modification to prevent falls: A qualitative study of two regional and rural public health services in Australia

ERA Journal ID15771
Article CategoryArticle
AuthorsTynan, Anna (Author), Pighills, Alison (Author), White, Wendy (Author), Eden, Alicia (Author) and Mickan, Sharon (Author)
Journal TitleAustralian Occupational Therapy Journal
Journal Citation70 (2), pp. 202-217
Number of Pages16
Year2022
Place of PublicationAustralia
ISSN0045-0766
1440-1630
Digital Object Identifier (DOI)https://doi.org/10.1111/1440-1630.12849
Web Address (URL)https://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12849
Abstract

Background: Occupational therapist-led environmental assessment and modification (EAM) is effective in reducing falls for populations at high risk. Two regional and rural public health services in Queensland devised an implementation strategy to embed best practice occupational therapist-led EAM.

Methods: A qualitative study was conducted to compare the determinants of implementation success across the different health services, using the COM-B model of behaviour change. Six semi-structured interviews were completed with occupational therapists involved at each site, following 12 months of implementation. Interview data were triangulated with minutes from three combined site steering committee meetings, eight local steering committee meetings, and field notes. Thematic analysis was completed to compare barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites.

Results: Both sites commenced implementation with similar states of capability and motivation. After 12 months, one site considered that practice change had been embedded as noted in steering committee minutes and comments; however, the other site observed limited progress. According to the COM-B analysis, opportunity (the factors that lie outside the individual’s control) had a significant influence on how both sites were able to respond to the practice change and navigate some of the unexpected challenges that emerged, including the COVID-19 pandemic. Existing team structure, multiple responsibilities of key stakeholders, differences in access to resources, and lack of connection between complementary services meant that COVID-19 disruptions were only a catalyst for unveiling other systemic issues.

Conclusion: This study highlights the power of external factors on influencing behaviour change for best practice implementation. Learnings from the study will provide deeper understanding of completing implementation projects in regional and rural contexts and support the future implementation of EAM in occupational therapy clinical settings.

Keywordsbehaviour change, environmental assessment and modification, falls, implementation, rural health services
ANZSRC Field of Research 2020420104. Occupational therapy
Byline AffiliationsCentre for Health Research
James Cook University
Department of Health, Queensland
Bond University
Institution of OriginUniversity of Southern Queensland
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