What do clinicians perceive as the effective implementation strategies for TREAT journal clubs? A qualitative study

Journal clubs have long been recognised as a potential tool for supporting evidence-based practice skills and culture, however they can be challenging to implement and sustain in clinical settings. While the TREAT journal club format was developed to address some of these challenges; it is unclear which strategies are most helpful in supporting ongoing sustainability. To further this enquiry, the aim of this study was to identify clinician's perspectives of the most effective implementation strategies for supporting sustainable TREAT journal club attendance, culture and satisfaction.

Clinicians, clinician-facilitators, and research mentors were recruited from six allied health journal clubs who participated in the TREAT journal club format within a single hospital and health service. Participants were invited to attend focus groups at 10 months and 16-months following participation in their journal club. Focus group questions explored which strategies participants felt were most effective during implementation of the journal club, what outcomes they led to and what if any contextual factors influenced these outcomes. Data analysis involved an inductive and deductive approach and the formation of context- mechanism-outcome configurations drawing from elements of a realist evaluation.

Eighteen focus groups were conducted separately with 47 clinician participants, 12 clinician-facilitators, and 6 research mentors. Strategies reported to be the most effective related to clinical relevance and application of the topic, group participation (i.e., group prioritisation of topics, group discussion), consistency, structure (i.e., protected time, structured appraisal tool, timetabling) and mentoring. These were further synthesised within 11 context-mechanism-outcome configurations which identified contexts that influenced outcomes. For example, clinicians reported smaller and single profession journal clubs enhanced outcomes relating to attendance, culture and practice changes when implementing the strategy of discussing the article's application to practice.

Clinicians report several strategies which may enhance journal club attendance and satisfaction, EBP culture, and knowledge and skills of clinicians when implementing a TREAT journal club for up to 16-months. Findings emphasise the importance of journal club topics being identified and prioritised by clinicians as a group to maximise relevance and clinician buy-in. Strategies discussed may be useful for services to consider when implementing journal clubs, taking into consideration specific contexts.