Please use this identifier to cite or link to this item: http://ahro.austin.org.au/austinjspui/handle/1/21676
Title: A novel counterbalanced implementation study design: methodological description and application to implementation research.
Authors: Sarkies, Mitchell N;Skinner, Elizabeth H;Bowles, Kelly-Ann;Morris, Meg E;Williams, Cylie;O'Brien, Lisa;Bardoel, Anne;Martin, Jenny;Holland, Anne E;Carey, Leeanne M;White, Jennifer;Haines, Terry P
Affiliation: Department of Community Emergency Health and Paramedic Practice, Monash University, Building H Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
Department of Management and Marketing, Swinburne University, BA Buidling John Street, Hawthorn Campus, Hawthorn, Victoria, 3122, Australia
Department of Occupational Therapy, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
Peninsula Health, 4 Hastings Road, Frankston, Victoria, 3199, Australia
Allied Health Research Unit, Monash Health, 400 Warrigal Road, Cheltenham, Victoria, 3092, Australia
Alfred Health and La Trobe University, 99 Commercial Road, Melbourne, Victoria, 3004, Australia
Swinburne University, John Street, Hawthorn, Victoria, 3122, Australia
School of Primary and Allied Health Care, Monash University, Building G Peninsula Campus, McMahons Road, Frankston, Victoria, 3199, Australia
Department of Physiotherapy, Monash Health, 400 Warrigal Road, Cheltenham, Victoria, 3092, Australia
La Trobe Centre for Sport and Exercise Medicine Research, La Trobe University, Bundoora, Victoria, 3086, Australia
North Eastern Rehabilitation Centre, Healthscope, Ivanhoe, Victoria, 3079, Australia
Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Issue Date: 2-May-2019
EDate: 2019-05-02
Citation: Implementation science : IS 2019; 14(1): 45
Abstract: Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementation phase of knowledge transfer, as differences between individual and organisational readiness for change combined with small sample sizes can lead to imbalances in factors that impede or facilitate change between intervention and control groups. Within-cluster repeated measure designs could control for variance between intervention and control groups by allowing the same clusters to receive a sequence of conditions. Although in implementation settings, they can contaminate the intervention and control groups after the initial exposure to interventions. We propose the novel application of counterbalanced design to implementation research where repeated measures are employed through crossover, but contamination is averted by counterbalancing different health contexts in which to test the implementation strategy. In a counterbalanced implementation study, the implementation strategy (independent variable) has two or more levels evaluated across an equivalent number of health contexts (e.g. community-acquired pneumonia and nutrition for critically ill patients) using the same outcome (dependent variable). This design limits each cluster to one distinct strategy related to one specific context, and therefore does not overburden any cluster to more than one focussed implementation strategy for a particular outcome, and provides a ready-made control comparison, holding fixed. The different levels of the independent variable can be delivered concurrently because each level uses a different health context within each cluster to avoid the effect of treatment contamination from exposure to the intervention or control condition. An example application of the counterbalanced implementation design is presented in a hypothetical study to demonstrate the comparison of 'video-based' and 'written-based' evidence summary research implementation strategies for changing clinical practice in community-acquired pneumonia and nutrition in critically ill patient health contexts. A counterbalanced implementation study design provides a promising model for concurrently investigating the success of research implementation strategies across multiple health context areas such as community-acquired pneumonia and nutrition for critically ill patients.
URI: http://ahro.austin.org.au/austinjspui/handle/1/21676
DOI: 10.1186/s13012-019-0896-0
ORCID: 0000-0001-7318-3598
0000-0001-6376-8613
PubMed URL: 31046788
Type: Journal Article
Research Support, Non-U.S. Gov't
Subjects: Context
Counterbalanced
Crossover
Design
Implementation
Method
Randomised controlled trial
Research
Strategy
Study
Appears in Collections:Journal articles

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