Table 1 Description of the multi-faceted implementation strategy
Intervention | Actor | Action | Action target | Temporalitya | Dose | Implementation outcome targetedb | Justification |
|---|---|---|---|---|---|---|---|
Introductory seminar | Intervention developer | The IMR programme was introduced with introductory video and PowerPoint presentation | Motivate clinicians and organizations to prepare for implementation in organizations | Preparation | One-day seminar | Adoption | Rogers [22] Knowledge as the first step to change |
Initiate leadership | External implementation team | The external team had individual meetings with leaders to discuss the implementation process and the research project | Service leaders initiate change in organization to facilitate quality improvement | Preparation | One meeting per service | Feasibility fidelity | Innovative, supportive leaders as important for successful implementation [23] |
Coordinator recruitment | Service leader | Leaders were asked to choose a coordinator among staff to advocate for the programme | To have coordinators advocate for or champion the implementation of IMR | Preparation | Feasibility fidelity | Champions as a driving force behind implementation [24] | |
Distribute educational materials | External implementation team | Distribution of the IMR manual [6] to support clinical care | To increase clinicians’ knowledge and skills of intervention | Implementation | Fidelity | Educational materials better than no materials [25] | |
Ongoing training | IMR trainer | To teach clinicians about the IMR in an ongoing way | To increase clinicians’ knowledge and skills of intervention | Implementation | Four days of training + two booster sessions | Fidelity | Ongoing training better than single one-time strategies [26, 27] |
Clinical consultations | IMR trainer | Answer questions, review case implementation, make suggestions, and provide encouragement | To increase clinicians’ knowledge and skills to use the innovation | Implementation | 20 min per week in group by phone for 9 months, then biweekly for 5 months | Fidelity | Post-training consultations more important than quality of/type of training [28] |
Audit and feedback in consultations | IMR trainer | IMR trainer rated audiotaped sessions and gave verbal and written feedback | Clinicians’ understanding and ability to break down the intervention into more doable steps | Implementation | First session in every module audiotaped and rated | Fidelity Feasibility | a&f leads to improvements in professional practice [29] |
Process monitoring and feedback | External implementation team | Implementation process was assessed after 6 and 12 months and verbal and written feedback was given | To improve the quality of the programme delivery, to prevent drift and maximize effectiveness | Implementation | After six and 12 months of implementation | Fidelity Feasibility | Monitoring can prevent drift and maximize effectiveness [30] |
Outcome monitoring | Clinicians | Consumer outcomes (IMRS) were assessed at the end of every module. Clinicians were encouraged to evaluate the outcomes continuously | To improve the quality of the programme delivery, to prevent drift and maximize effectiveness | Implementation | After each module | Fidelity feasibility | Monitoring can prevent drift and maximize effectiveness [30] |