Article Text

Original research
Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway
  1. Jade Kettlewell1,
  2. Kate Radford2,
  3. Denise Kendrick1,
  4. Priya Patel3,
  5. Kay Bridger4,
  6. Blerina Kellezi1,4,
  7. Roshan Das Nair3,
  8. Trevor Jones1,
  9. Stephen Timmons5
  10. On behalf of the ROWTATE team
  1. 1Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
  2. 2Centre for Rehabilitation & Ageing Research, University of Nottingham School of Medicine, Nottingham, UK
  3. 3Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK
  4. 4Department of Psychology, Nottingham Trent University, Nottingham, UK
  5. 5Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Jade Kettlewell; Jade.Kettlewell2{at}nottingham.ac.uk

Abstract

Objectives This study aimed to: (1) understand the context for delivering a trauma vocational rehabilitation (VR) intervention; (2) identify potential barriers and enablers to the implementation of a VR intervention post-trauma.

Design Qualitative study. Data were collected in person or via phone using different methods: 38 semistructured interviews, 11 informal ‘walk-through care pathways’ interviews, 5 focus groups (n=25), 5 codesign workshops (n=43). Data were thematically analysed using the framework approach, informed by the Consolidated Framework for Implementation Research.

Setting Stakeholders recruited across five UK major trauma networks.

Participants A variety of stakeholders were recruited (n=117) including trauma survivors, rehabilitation physicians, therapists, psychologists, trauma coordinators and general practitioners. We recruited 32 service users (trauma survivors or carers) and 85 service providers.

Results There were several issues associated with implementing a trauma VR intervention including: culture within healthcare/employing organisations; extent to which healthcare systems were networked with other organisations; poor transition between different organisations; failure to recognise VR as a priority; external policies and funding. Some barriers were typical implementation issues (eg, funding, policies, openness to change). This study further highlighted the challenges associated with implementing a complex intervention like VR (eg, inadequate networking/communication, poor service provision, perceived VR priority). Our intervention was developed to overcome these barriers through adapting a therapist training package, and by providing early contact with patient/employer, a psychological component alongside occupational therapy, case coordination/central point of contact, and support crossing sector boundaries (eg, between health/employment/welfare).

Conclusions Findings informed the implementation of our VR intervention within the complex trauma pathway. Although we understand how to embed it within this context, the success of its implementation needs to be measured as part of a process evaluation in a future trial.

  • rehabilitation medicine
  • trauma management
  • neurological injury
  • public health
  • primary care

Data availability statement

Data are available on reasonable request. The data that participants have consented to share will become available to potential researchers at the end of this study. Requests detailing the research aims and use of the data should be sent to the research team via email: ROWTATE@nottingham.ac.uk.

https://creativecommons.org/licenses/by/4.0/

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Data availability statement

Data are available on reasonable request. The data that participants have consented to share will become available to potential researchers at the end of this study. Requests detailing the research aims and use of the data should be sent to the research team via email: ROWTATE@nottingham.ac.uk.

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Footnotes

  • Twitter @jade_kettlewell, @rehab_research, @Kay_Bridger, @Blerina_Kellezi

  • Collaborators The following collaborators contriuted to the acquisition of funding for the associated programme grant and/or are members of the programme management group:

    Professor Marilyn James, Professor Amanda Farrin, Ms Ivana Holloway, Dr Karen Hoffman, Mr Adam Brooks, Dr Matthew Smith, Ms Miriam Duffy, Professor Richard Morris, Dr Edward Carlton, Dr Judith Allanson, Dr Fahim Anwar.

  • Contributors JK: methodology, formal analysis, writing, data collection, review and editing; KR: conceptualisation, funding acquisition, project administration, methodology, formal analysis and review; DK: conceptualisation, funding acquisition, project administration, methodology, writing, review and editing; PP: methodology, formal analysis, data collection, review and editing; KB: methodology, formal analysis, data collection, review and editing; BK: funding acquisition, project administration, methodology, formal analysis, review and editing; RDN: funding acquisition, methodology, writing, review and editing; TJ: funding acquisition, methodology, formal analysis and review; ST: guarantor, funding acquisition, methodology, data collection, formal analysis, writing, review and editing; All authors have read and agreed to the published version of the manuscript.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference number RP-PG-0617-20001).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.