@article{eb1dc193e5cf46ddbbe94b9990405359,
title = "Barriers and Facilitators to the Implementation of Injury Prevention Programs: A Qualitative Exploration and Model Development",
abstract = "Background: In 2006, the American College of Surgeons Committee on Trauma mandated implementation of injury prevention programs as a requirement for Level I and II trauma center designation. Little is known about the factors that facilitate or create barriers to establishing evidence-based injury prevention program implementation. The purpose of this research is to generate hypotheses regarding processes used to implement injury prevention programs at trauma centers, identify the factors that facilitate and serve as a barrier to implementation, and develop a model reflecting these factors and relationships. Methods: This is a qualitative study of injury prevention programs at trauma centers. Study participants were chosen from 24 sites representing trauma centers of different patient volumes, geographic regions, and settings in the United States. Subjects participated in phone interviews based on guides developed from pilot interviews with prevention coordinators. Transcribed interviews from eight subjects were analyzed using a system of member checking to code; analysis informed the identification of factors that influence the establishment of evidence-based injury prevention programs. Results: Five themes emerged from the data analysis: external factors, internal organizational factors, program capacity, program selection, and program success. Analysis revealed that successful program implementation was related to supportive leaders and collaborative, interdepartmental relationships. Additional themes indicated that while organizations were motivated primarily by verification requirements (external factor), strong institutional leadership (internal factor) was lacking. Employee readiness (program capacity) was hindered by limited training opportunities, and programs were often chosen (selection) based on implementation ease rather than evidence base or local data. Conclusions: Data analysis reveals five emerging themes of program implementation; using these data, we suggest an initial model of barriers and facilitators for implementing evidence-based injury prevention programs that could serve as the springboard for additional research involving a larger representative sample.",
keywords = "Injury prevention, Program implementation, Qualitative research, Theoretical model, Trauma centers",
author = "Newcomb, {Anna B.} and Mary Zadnik and Carlini, {Anthony R.} and Francis, {Molly M.} and Frey, {Katherine P.} and Heins, {Sara E.} and Leslie McNamara and Staguhn, {Elena D.} and Castillo, {Renan C.}",
note = "Funding Information: Author Affiliations:Trauma Services, Inova Fairfax Medical Campus, Falls Despite the advancement and proliferation of trauma Church, Virginia (Dr Newcomb); Department of Occupational Therapy, systems over the past five decades, injury remains the University of St. Augustine, Austin, Texas (Dr Zadnik); Center for Injury leading cause of death for persons ages 1 to 44 years (Mr Carlini, Mss Francis and Staguhn, and Drs Frey and Castillo); RANDResearch and Policy, Johns Hopkins University, Baltimore, Maryland (National Center for Health Statistics, 2017; National Corporation, Pittsburgh, Pennsylvania (Dr Heins); and U.S. Government Center for Injury Prevention and Control, 2006). The Accountability Office, Washington, District of Columbia (Ms McNamara). economic burden of traumatic injury in direct health care This work was funded by a grant from the National Center for Injury costs and lost productivity secondary to resulting disability Number 1R49CE002466).Control and Prevention, Centers for Disease Control and Prevention (Grant is estimated to be over $200 billion per year (National We thank Isabel Rickman for her assistance with producing this article. Center for Health Statistics, 2011). Although trauma sys-The authors declare no conflicts of interest. tems have been shown to save lives and improve out-Supplemental digital content is available for this article. Direct URL comes, prevention is still a central objective to reduce the citations appear in the printed text and are provided in the HTML burden of trauma (Brockamp et al., 2018; Cirone, Bendix, and PDF versions of this article on the journal{\textquoteright}s Web site (WWW. & An, 2020; Cornwell, Chang, Phillips, & Campbell, 2003; JOURNALOFTRAUMANURSING.COM). Shackford et al., 1987; Stewart et al., 2019). Policy, Johns Hopkins Bloomberg School of Public Health, 415 NorthCorrespondence:Renan C. Castillo, PhD, Center for Injury Research and Models of trauma center-based injury prevention Washington Street, Baltimore, MD 21231 (rcastil1@jhu.edu). (IP) programs have been developed to address this important public health problem, and trauma-specific Funding Information: The IP coordinators{\textquoteright} work was influenced by the support from direct managers and senior leadership. The IPCs described the hospital leadership perspective of the IP program on a continuum between an “afterthought” and “the hospital{\textquoteright}s pride and joy.” Few IPCs experienced high levels of support from the leadership. One center stood out as distinctive, with the IPC conveying a feeling of being fully integrated into the organization. At this Level II center, all interviewed subjects expressed great pride over their IP program, using the words “robust” and “innovative” to characterize their program. Hospital staff and medical team members, including registrars, researchers, surgeons, marketing, administrative assistants, and nurse educators, were described as having a stake in the programs and were dependable participants. Administration and clinical team members were involved in the development, implementation, evaluation, and reworking of the programs; the IPC felt they all “want to be a part of it” and that their IP participation was a benefit of employment rather than an added burden. When asking for help, the IPC encountered little resistance: So we work together to make [the program] happen, and … when I say, “Okay, Dr. M, I need you Funding Information: Although not explicitly discussed in our developing model, several stakeholders are inferred, including IPPs, trauma program managers, hospital leadership, IP trainers, the ACSCOT, and the injury prevention community as a whole. When considering the factors relevant for program success, each stakeholder would focus on different areas. IPPs tasked with leadership of the prevention efforts would focus on program selection and program success. Day-to-day activities would be defined by data regarding local burdens of injury, as well as building and maintaining community and program champion partnerships. Hospital leadership, including the trauma program manager, contributes to successful efforts by ensuring the IPC position is funded, the coordinator is well-trained, and funding is available for programmatic activities. The professional community, focusing on “external factors,” contributes by developing evidence-based IP programs and providing opportunities for program leaders to learn and share best practices. Publisher Copyright: {\textcopyright} 2020 Lippincott Williams and Wilkins. All rights reserved.",
year = "2020",
month = nov,
doi = "10.1097/JTN.0000000000000540",
language = "English (US)",
volume = "27",
pages = "335--345",
journal = "Journal of Trauma Nursing",
issn = "1078-7496",
publisher = "Lippincott Williams and Wilkins",
number = "6",
}