Related Experiment Video
Updated: Mar 21, 2026
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
"I Can't Do It All, Even Though I Want To": A Qualitative Investigation of Implementation Barriers and Facilitators
Katy H O'Brien1,2, Amy M Kemp3, Yalian Pei4
1Courage Kenny Rehabilitation Institute, Allina Health, Minneapolis, MN.
Purpose:
The purpose of this study was to examine implementation barriers and facilitators related to evidence-based concussion management among school-based speech-language pathologists (SLPs). Using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, we explored how innovation, recipient, context, and facilitation factors influence SLPs' ability to bridge the know-do gap in return-to-learn (RTL) care for students with concussion.
Method:
We conducted qualitative semistructured interviews with 10 school-based SLPs purposively selected to reflect varying confidence levels regarding concussion management using a framework-informed hybrid deductive-inductive approach. The i-PARIHS framework guided interview development and thematic analysis to identify barriers and facilitators across framework constructs.
Results:
Implementation barriers and facilitators mapped to all four i-PARIHS constructs. Innovation barriers included limited awareness of RTL protocols (only one of 10 participants knew district protocols) and assessment challenges in establishing baselines and differentiating concussion-related difficulties. Recipient facilitators encompassed professional growth mindset and consultation model preferences, with nine of 10 participants expressing confidence in providing concussion services despite acknowledging knowledge gaps. Context was the primary barrier domain, involving resource constraints including large (up to 150 students) or complex caseloads, high workload demands, and communication gaps between medical and educational settings. Facilitation included peer networks as primary knowledge sources, but limited access to concussion-specific continuing education created barriers. A cross-cutting professional growth mindset demonstrated SLPs' readiness to participate in RTL implementation despite current limitations.
Discussion:
While SLPs possess strong individual characteristics supporting RTL and concussion care delivery, significant organizational barriers limit evidence-based concussion care delivery. Implementation strategies should leverage SLPs' growth mindset and peer consultation preferences while addressing multilevel contextual barriers through systematic training programs, consultation-based service models, and improved medical-school communication protocols.
Supplemental Material:
https://doi.org/10.23641/asha.31449640.
Related Concept Videos
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:30Barriers to Effective Communication I
Communication barriers include the following:
Physiological barriers: They are limitations caused by a person's health condition or disability, such as hearing loss, poor eyesight, illness, or unconsciousness. An example to overcome this...