Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delive
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(2020) 20:910
RESEARCH ARTICLE
Open Access
Implementing pelvic floor muscle training for women with pelvic organ prolapse: a realist evaluation of different delivery models Purva Abhyankar1* , Joyce Wilkinson1, Karen Berry2, Sarah Wane3, Isabelle Uny2, Patricia Aitchison2, Edward Duncan2, Eileen Calveley2, Helen Mason4, Karen Guerrero5, Douglas Tincello6, Doreen McClurg7, Andrew Elders7, Suzanne Hagen7 and Margaret Maxwell2
Abstract Background: Pelvic Floor Muscle Training (PFMT) has been shown to be effective for pelvic organ prolapse in women, but its implementation in routine practice is challenging due to lack of adequate specialist staff. It is important to know if PFMT can be delivered by different staff skill mixes, what barriers and facilitators operate in different contexts, what strategies enable successful implementation and what are the underlying mechanisms of their action. PROPEL intervention was designed to maximise the delivery of effective PFMT in the UK NHS using different staff skill mixes. We conducted a realist evaluation (RE) of this implementation to understand what works, for whom, in what circumstances and why. Methods: Informed by the Realist and RE-AIM frameworks, the study used a longitudinal, qualitative, multiple case study design. The study took place in five, purposively selected, diverse NHS sites across the UK and proceeded in three phases to identify, test and refine a theory of change. Data collection took place at 4 time points over an 18 month implementation period using focus groups and semi-structured interviews with a range of stakeholders including service leads/managers, senior practitioners, newly trained staff and women receiving care in the new service models. Data were analysed using thematic framework approach adapted to identify Context, Mechanism and Outcome (CMO) configurations of the RE. Results: A heightened awareness of the service need among staff and management was a mechanism for change, particularly in areas where there was a shortage of skilled staff. In contrast, the most established specialist physiotherapist-delivered PFMT service activated feelings of role protection and compromised quality, which restricted the reach of PFMT through alternative models. Staff with some level of prior knowledge in women’s health and adequate organisational support were more comfortable and confident in new role. Implementation was seamless when PFMT delivery was incorporated in newly trained staff’s role and core work. (Continued on next page)
* Correspondence: [email protected] 1 Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative C
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