Table 2 Determinants of success and barriers to the OT intervention
Facilitators | Barriers |
|---|---|
Innovation | |
- Computerized decision support system which detects physically frail older adults or older adults at risk of physical frailty - System that links evidence to the electronic health record (e.g., Evidence Linker) - Secure digital information exchange system - Intervention is evidence based | - Lack of supportive electronic devices |
Individual professional | |
- Health professionals involved receive basic education and training in collaborating with patients with complex chronic conditions - Local health professionals know each other - Health professionals have knowledge of the evidence-based practice method - Methodology for health literacy is part of the basic competences of occupational therapist and other involved health professionals - Freely available scientific evidence translated to local context - Professional pride | - Professionals not believing in the added value of the interventions |
User | |
- Congruence between personal expectations of user(s) and set goals - Insight into the problem, potential cause, and potential consequences for user and, if relevant, informal caregiver - Actions tailored to the pace of user with special attention to actions of assessment phase - Experienced support from peers and family | - Denial of the problem - Lack of motivation - Additional costs of intervention such as the purchasing of assistive devices - Experienced social stigma |
Social context | |
- Congruence between expectations of informal caregiver and set goals - Insight into the problem, potential cause, and potential consequences for informal caregiver - Positive attitude of colleagues towards innovation - Opinion leaders who support the innovation - Collaborative leadership | - Denial of the problem - Lack of motivation or interest of informal caregiver - Content and value of OT in primary care not well known by informal caregivers and health professionals |
Organizational context | |
- Structurally embedded procedure which detects physically frail older adults or high-risk individuals - Integrated care is routine in primary care - OT is already integrated in the daily clinical practice - Innovative intervention implemented within routine actions - Innovative intervention adapted to local context - Indicators (effect-process-structure) available at start of implementation of the intervention | - Ingrained, inflexible organizational system |
Economic and political context | |
- Sufficient allowances for assistive devices and home adaptations - Sufficient compensations for OT intervention | - OT not structurally embedded in primary care in Belgium |