Using multiple qualitative methods to inform intervention development: Improving functional status measurement for...

Area of Science:

• Gerontology
• Health Services Research
• Implementation Science

Background:

• Functional status is crucial for older adults' health and quality of life.
• Routine measurement of function is not consistently integrated into healthcare systems.
• Older veterans in primary care face challenges in functional status assessment.

Purpose of the Study:

• To develop a patient-centered, interprofessional intervention to enhance functional status measurement in older veterans within primary care.
• To identify and address barriers and facilitators to functional status measurement in the Veterans Health Administration (VHA).

Main Methods:

• Utilized multiple qualitative methods, including semi-structured interviews with 123 patients, clinicians, and staff across 7 VHA Medical Centers.
• Employed rapid qualitative analysis and a hybrid deductive/inductive thematic analysis informed by the Consolidated Framework for Implementation Science and sociotechnical analysis.
• Mapped qualitative findings to specific intervention components.

Main Results:

• Identified key barriers: time constraints, difficult electronic tools, and perceived lack of utility for patient care improvement.
• Identified facilitators: strong interprofessional collaboration and adaptable workflows.
• Developed a five-component intervention: education, routine measurement, standardized screening, improved electronic tools, and tailored reports.

Conclusions:

• Qualitative methods can create context-responsive interventions, increasing implementation success.
• A conceptually-grounded approach can improve patient and clinician experiences with functional status measurement.
• The developed intervention aims to improve the identification and management of functional impairment in older veterans.