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Developing a Theory of Change and Implementation Plan to implement a novel child- and family-centred outcome measure
Hannah May Scott1, Inez Gaczkowska1, Debbie Braybrook1
1Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK.
Insights
Developing a Theory of Change and Implementation Plan is crucial for integrating person-centred outcome measures into children
Area of Science:
- Pediatric Palliative Care
- Health Services Research
- Implementation Science
Background:
- Effective implementation of person-centred outcome measures (PCOMs) in children's palliative care requires robust implementation plans.
- Existing frameworks for integrating PCOMs into routine care are limited, necessitating structured approaches.
Purpose of the Study:
- To develop a Theory of Change and Implementation Plan for the sustained integration of a novel PCOM into routine hospital care for children with life-limiting conditions.
- To identify potential causal mechanisms driving the successful implementation and impact of PCOMs.
Main Methods:
- Participatory workshops involving health and social care professionals and parent/carers were conducted.
- Directed content analysis and framework analysis of qualitative data informed the Theory of Change and Implementation Plan.
- Normalisation Process Theory guided the analysis of implementation barriers and facilitators.
Main Results:
- The Theory of Change highlights improved care and quality of life as key impacts, driven by better symptom identification and communication.
- Essential implementation components include education and training on the PCOM, addressing logistical and resource barriers, and stakeholder engagement.
- Seven themes emerged related to Normalisation Process Theory, including education needs, tailored approaches, champion roles, IT support, and evidence for service improvement.
Conclusions:
- A comprehensive Theory of Change and Implementation Plan has been developed for integrating PCOMs in pediatric palliative care.
- Pilot testing of the developed Theory of Change and Implementation Plan is recommended for future research.
Background:
To achieve benefits of person-centred outcome measures within routine children's palliative care, implementation plans and the intended pathways to impact must be established.
Aim:
To develop a Theory of Change and Implementation Plan for sustained implementation of a novel person-centred outcome measure into routine hospital care for children with life-limiting conditions and to identify potential causal mechanisms.
Design:
Participatory workshops and a directed content analysis developed a Theory of Change. Framework analysis of workshop qualitative workshop data, supported by Normalisation Process Theory Informed an implementation plan.
Setting/Participants:
Health and social care professionals and parent/carers were recruited to six online workshops through social media and networks.
Results:
Eight health and social care professionals and eight parents participated. The Theory of Change identified overall impact of improved care and quality of life, through improved identification of symptoms and concerns and improved communication between healthcare teams. However, for this to happen, education and training on the outcome measure, anticipated benefits, how to implement and use it are required. Logistical, resource and staffing barriers must be addressed, alongside the development of a detailed implementation plan. Analysis of workshop transcripts identified seven themes relating to the domains of Normalisation Process Theory: education and information needs, the importance of a tailored approach, stakeholder engagement and the role of champions, healthcare records and IT system support requirements, improved health outcomes, improved experience of care and evidence for service provision, development, evaluation and expansionConclusion:Future work should pilot test the Theory of Change and Implementation Plan.
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