Research output

Article in Journal ()

Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy

Citation
Kolehmainen N, MacLennan G, Ternent L, Duncan E, Duncan EM, Ryan SB, McKee L & Francis J (2012) Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy, Implementation Science, 7 (76).

Abstract

Background: Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services.

Methods: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations.

Results: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands.

Conclusions: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.

Subject headings
Occupational therapy for children

StatusPublished
AuthorsKolehmainen Niina, MacLennan Graeme, Ternent Laura, Duncan Edward, Duncan Eilidh M, Ryan Stephen B, McKee Lorna, Francis Jill
Publication date16/08/2012
PublisherBioMed Central Ltd
ISSN 1748-5908
LanguageEnglish

Journal
Implementation Science: Volume 7, Issue 76 (AUG 16 2012)

© University of Stirling FK9 4LA Scotland UK • Telephone +44 1786 473171 • Scottish Charity No SC011159
My Portal