This thesis is a study designed to advance understanding of ‘tailoring’ within the field of implementation research. The study took place in the care home context, where tailoring was examined in action, to adapt the evidence for stroke and to tailor implementation of the adapted evidence-based stroke care guidelines within the United Kingdom care home context.
Study aim and objectives
The aims of the study were to advance implementation theory about tailoring.
A key objective was to perform an in-depth study of tailoring in action to examine the value of tailoring as part of the implementation process.
The second object was to develop a process map for tailoring to advance implementation in practice.
Methods
An interpretive, constructivist approach was employed, to examine tailoring in action, which sought to develop a theoretical map of the tailoring processes examined in action in the care home setting. The qualitative case study approach (Stake, 2006) was chosen to study the phenomena of tailoring, through which stroke best practice recommendation were adapted to and implemented in the care home context. Data were collected from care home staff during interviews (n = 48), to establish the context of existing interventions for residents with stroke living in the care home setting. Consensus workshops (n = 6) were
then undertaken in participating care homes (n = 3) to tailor stroke best practice
recommendations for the local context. The use of cognitive questioning during the workshops helped to identify aspects of tailoring in action to enable the construction of a process map. The use of the case study approach enabled the examination of tailoring in action to determine theoretical constructs.
Findings
Of relevance to the field of implementation research, key theoretical constructs of tailoring, were illuminated. Constructs included feasibility, which sought to create a fit to the local context. This construct was counterbalanced by maintaining the fidelity of the original evidence. The need to balance feasibility and fidelity within the process of tailoring, revealed a ‘sweet spot’ for successful implementation where evidence meets the real world of practice. These findings have implications for other implementation researchers who are seeking methods to facilitate research evidence in to day to day practices, and thereby
reduce the evidence to practice gap. Findings also highlighted aspects of research practice and influencing factors when collaborating with care homes, such as the influence of the customer / provider model, and the constraints of meeting regulators criteria.
Recommendations
The theoretical propositions uncovered in the discovery of a ‘sweet spot’ for implementing evidence into practice within this study provide important new knowledge for implementation research and health care practice, in that they identified theoretical constructs which can be employed by, for example, researchers and practice development facilitators to tailor evidence and implementation strategies for any given context. Of specific interest is the identification of a tailoring map designed to balance feasibility and fidelity, and thus help to reduce the evidence to practice gap, by tailoring evidence to create
a fit for the local setting whilst ensuring fidelity of the original evidence is protected.