Evaluation of the Implementation of a Day-Treatment Program for Executive Functioning for Individuals With Traumatic Brain Injury in Rehabilitation Settings Using the Consolidated Framework for Implementation Research

Abstract

Objective: To identify barriers and facilitators to implementation of a cognitive rehabilitation intervention (Short-Term Executive Plus [STEP]) into routine clinical practice using the Consolidated Framework for Implementation Research (CFIR) by comparing high (HI) and low implementation (LI) sites. Setting: Qualitative interviews conducted with professionals who work with people who have sustained brain injuries at various rehabilitations sites across the United States. Participants: Seven sites completed training, consultation, and agreed to implement STEP. Design: Retrospective qualitative study. Main Measure(s): Qualitative interview developed for the purposes of this study and the CFIR for evaluation of implementation efforts and identification of barriers and facilitators. Results: Out of 7 sites, 6 completed interviews. Out of the 39 CFIR constructs, 4 distinguished between HI and LI sites. Four distinguishing factors included evidence strength and quality, needs and resources of those served by the organization, leadership engagement, and engaging champions. Five common factors were identified (4 positive and 1 negative) across HI and LI sites, which may reflect aspects of implementation that could inform future implementation efforts. Ten inconclusive factors were identified, having both a positive and a negative influence on implementation. Conclusions: While there were several factors that were viewed positively by all sites, only 4 factors made a difference in implementation outcomes. These distinguishing factors can help inform future implementation efforts, highlighting a need for strong evidence supporting an intervention, a match between the intervention and the needs of the population served, engaging those in leadership and decision-making roles and ensuring their buy-in, and having a strong champion directly involved in implementation. In addition, taking a closer look at common and inconclusive factors may enable us to identify areas in which the implementation efforts could be strengthened.