Applying implementation science theories to support practice change in the assessment of cognition by occupational therapists

Jacqueline Wheatcroft; Rebecca J. Nicks; Laura Jolliffe; Danielle Sansonetti; Carolyn Unsworth; Natasha A. Lannin

doi:10.1071/IB23105

RESEARCH ARTICLE

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Applying implementation science theories to support practice change in the assessment of cognition by occupational therapists

Jacqueline Wheatcroft

^A ^E ^* , Rebecca J. Nicks ^A ^B , Laura Jolliffe ^C ^D , Danielle Sansonetti ^A , Carolyn Unsworth A ^E and Natasha A. Lannin

^A ^F ^*

+ Author Affiliations

- Author Affiliations

^A Occupational Therapy Department, Alfred Health, Melbourne, Vic, Australia.

^B Occupational Therapy Department, Eastern Health, Melbourne, Vic, Australia.

^C Department of Occupational Therapy, Monash University, Frankston, Vic, Australia.

^D Occupational Therapy Department, Peninsula Health, Frankston, Vic, Australia.

^E Institute of Health and Wellbeing, Federation University, Churchill, Vic, Australia.

^F Department of Neuroscience, School of Translational Medicine, Monash University, Melbourne, Vic, Australia.

^* Correspondence to: j.wheatcroft@cgmc.org.au, Natasha.Lannin@monash.edu

Handling Editor: Grahame Simpson

Brain Impairment 25, IB23105 https://doi.org/10.1071/IB23105

Submitted: 27 September 2023 Accepted: 28 July 2024 Published: 29 August 2024

Abstract

Background

Understanding cognitive impairments is essential for effective rehabilitation and discharge planning for adults with neurological conditions. The aim of this study was to identify barriers to completing standardised cognitive assessments and evaluate the implementation of an intervention to support practice change.

Methods

A mixed-methods approach was applied to translate cognitive assessment recommendations into clinical practice using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation Behaviour model (COM-B) theories. Occupational therapists at one metropolitan health service in Australia were invited to participate. Pre- and post-implementation file audits and surveys were conducted, along with focus groups that collected qualitative data analysed using the TDF and COM-B.

Results

Survey 1 (n = 40) and focus group data (n = 24) identified barriers in the TDF domains of knowledge (selection of assessments), environment and resources (equipment and time constraints), and social influences (pressure from other disciplines). To address barriers to implementing a cognitive assessment framework, scripts, cue cards, video-recorded training, and posters were developed as guided by the Behaviour Change Wheel (BCW). Survey 2 showed increased capability to physically administer cognitive assessments (53–74%) and improved clinician understanding of relevant clinical practice guideline (CPG) recommendations (22–50%). File audit data indicated a 30% increase in the number of standardised assessments completed.

Conclusions

The application of two implementation theories led to the development of an intervention that increased occupational therapists’ confidence and their adherence to CPG recommendations. This study serves as a potential model for using the TDF and COM-B to create implementation interventions in various clinical practice areas.

Keywords: behaviour change techniques, brain injury rehabilitation, cognitive assessment, implementation science, intervention development, knowledge translation, rehabilitation, stroke rehabilitation.

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