Adaptation and implementation of a shared decision-making tool from one health context to another: Partnership Approach Using Mixed Methods

Background:

Osteoarthritis (OA) is a leading cause of pain and disability worldwide. Knee OA accounts for nearly four fifths of the burden of OA internationally, and 10% of United Kingdom adults have the condition. Recommended treatments for osteoarthritis include information, education, exercise, physiotherapy, weight-loss, medication, and surgery. There are concerns that knee replacement surgery is overused, while non-surgical treatments are underutilized. Shared Decision-Making (SDM) has been proposed to support patients to make more informed choices about their care, whilst reducing inequities in access to treatment. We evaluated the experience of a team adapting a SDM tool for knee OA from one health service to another, and the implementation potential of the tool in the Bristol North Somerset and South Gloucestershire (BNSSG) area. The tool aims to prepare patients’ and clinicians for SDM, by providing evidence-based information about treatment options.

Objective:

To explore the experiences of a team adapting a SDM tool from one health context to another, and the implementation potential of the tool in the BNSSG area.

Methods:

An agile methodology was used to respond to recruitment challenges and to ensure study aims could be addressed within time restrictions. An online survey was disseminated to clinicians to gain feedback on experiences of using the SDM tool. Qualitative interviews were conducted by phone or videocall with a purposive sample of stakeholders involved in adapting and implementing the tool in the BNSSG area. Survey findings were summarised as frequencies and percentages. Content analysis was conducted on qualitative data using framework analysis, and data mapped directly to the 14 domains of the Theoretical Domains Framework.

Results:

This study highlights barriers and facilitators to adapting tools from one health context to another and implementing them in the new health context. We recommend tools selected for adaptation should have a has a strong evidence base, and evidence of effectiveness and acceptability to the target users in the original context. Legal advice should be sought and agreements draw up among collaborators at the beginning of the project. Existing guidance for the development and adaptation of interventions should be utilised. Co-design methods should be applied to improve the accessibility and acceptability of the adapted tool.

Conclusions:

This study highlights barriers and facilitators to adapting a tools from one health context to another, and implementing them in the new health context. Consequently, we have several recommendations for teams undertaking similar work. Candidate tools selected for adaptation should have a has a strong evidence base, and evidence of effectiveness and acceptability to the target users in the original context. Legal advice should be sought at the beginning of the project, and agreements draw up among collaborators, to ensure all parties are clear on expectations. Existing guidance for the development and adaptation of interventions should be utilised. Co-design methods can be used to improve the accessibility and acceptability of the adapted tool. Clinical Trial: Not applicable