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.