Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research.

Abstract

To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators. Qualitative process evaluation substudy. Ten level II NICUs in six cities across Alberta, Canada. HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs. Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data. Key facilitators to implementation of AB-FICare included (1) a receptive <i>implementation climate,</i> (2) <i>compatibility</i> of the intervention with individual and organisational practices, (3) <i>available resources</i> and <i>access to knowledge and information</i> for HCP and hospital administrators, (4) engagement of <i>key stakeholders</i> across the organisation, (5) engagement of and outcomes for <i>intervention participants,</i> and (6) <i>reflecting and evaluating</i> on implementation progress and patient and family outcomes. Barriers were (1) <i>design quality and packaging</i> of the intervention, (2) <i>relative priority</i> of AB-FICare in relation to other initiatives, and (3) <i>learning climate</i> within the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs: <i>intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards,</i> and <i>knowledge, beliefs and attitudes</i>. The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation. NCT02879799.