2012, Article / Letter to editor (Wetenschappelijk Tijdschrift voor Ergotherapie, vol. 2012, iss. 5, (2012), pp. 5-14)Het doel van deze studie, die in 2007-2008 werd uitgevoerd, was het vaststellen van bevorderende en belemmerende factoren voor implementatie van dit EDOMAH-programma. Met een kwalitatieve onderzoeksmethode werden data verzameld: focusgroepen met 17 ergotherapeuten en telefonische interviews met 10 verwijzers en 4 managers. De analyses werden uitgevoerd op basis van de constante vergelijkingsmethode waarbij codes, categorieën en thema’s werden vastgesteld. De belangrijkste thema’s bij de belemmerende factoren waren het gebrek aan zelfvertrouwen bij ergotherapeuten om de doelgroep volgens het programma te behandelen, moeite met prioriteiten stellen binnen deze intensieve behandelwijze en het gebrek aan gerichte verwijzingen. Voor verwijzers en managers waren gebrek aan kennis over (deze vorm) van ergotherapie, over de vergoedingsmogelijkheden en gebrek aan beschikbare ergotherapeuten belemmerende factoren. Bevorderend waren de inhoud en doel van het programma, bewezen effectiviteit en externe ondersteuning. Op basis van deze resultaten kunnen gerichte implementatiestrategieën ontwikkeld worden.
2011, Article / Letter to editor (International Journal of Geriatric Psychiatry, vol. 27, iss. 7, (2011), pp. 742-748)Implementing evidence-based guidelines is not a simple task. This study aimed to define barriers to and facilitators for implementing the proven and effective Community Occupational Therapy in Dementia (COTiD) guideline for older people with dementia and their carers. The qualitative method we used was the grounded theory. We collected data from focus group interviews with 17 occupational therapists (OTs) and telephone interviews with 10 physicians and 4 managers. We analysed the data with the constant comparative method by identifying codes, categories, and main themes. The main themes in barriers that OTs encountered were that they did not feel competent in treating older people with dementia at home according to the guideline; they had difficulties prioritising in this complex treatment, both for the client and themselves; and they were unsure about the minimal criteria for guideline adherence. The intensity of this programme was the main barrier. The barriers that confronted physicians and managers were lack of knowledge about occupational therapy and its reimbursement and lack of available trained OTs. For the OTs, the guidelines content and focus, evidence, and external support facilitated the use of the guideline. For physicians and managers, the guidelines evidence base and its benefits for clients and carers were the main facilitators. This study generates knowledge for applying innovations in health care settings. Improvement of the OTs knowledge and self-confidence is needed for using the guideline. We expect that more competent OTs will motivate their physicians and managers to use this successful COTiD intervention