Method
As the study was exploratory, descriptive and contextual in nature a qualitative study was undertaken, using in-depth, semi-structured interviews. Responsibility for implementation of the SSCB lies with nursing and medical staff, so the convenience sample included both groups. The setting for the study was two hospitals in one Health Board, where stroke patients are admitted via acute medical units (AMU) to their respective stroke units. In both hospitals’ implementation of the SSCB is usually coordinated by AMU or Stroke Unit staff. Therefore participants had to have a minimum of six months’ experience of working in either area to ensure they could respond with detailed information about their experience of SSCB implementation. Posters, flyers and ward meetings were used to recruit eight participants; two medical and two nursing staff from each hospital. Data was collected from participants using one-to-one interviews over a period of 3 months in early 2017.
The Theoretical Domains Framework (TDF) was used to guide the study, including data collection and analysis. The TDF was developed to research barriers to evidence implementation and is useful for providing context-based explanations as to why implementation of evidence-based practice is not being achieved.6 An interview guide was developed and pre-tested to ensure all domains of the TDF were addressed. Interviews lasted approximately one hour and were recorded then transcribed verbatim. Prior to data analysis all interview transcriptions were returned to the participants for review; no changes were requested.
Data analysis used deductive content analysis which is suitable for use with a structured matrix like the TDF.7 Following familiarisation with the data a coding manual was developed that mapped to the fourteen conceptual domains of the TDF. Text that did not fit with any domains was coded as ’other relevant’. The coded data was then refined, and themes identified from within the TDF or ’other relevant’ category. This study was undertaken as part of a Masters degree and the first author is employed as a Quality and Effectiveness Lead with responsibility for improving adherence to the SSCB. Research and Development authorisation (reference number 2016CV07) and University Ethics approvals (UREC Application Number: 2016007_Lancaster) were obtained for this study. Informed consent was obtained prior to the interviews and all data was anonymised and stored securely.