Barriers and Facilitators to the Implementation of Injury Prevention Programs: A Qualitative Exploration and Model Development.
Anna B Newcomb, Mary Zadnik, Anthony R Carlini, Molly M Francis, Katherine P Frey, Sara E Heins, Leslie McNamara, Elena D Staguhn, Renan C Castillo
Author Information
Anna B Newcomb: Trauma Services, Inova Fairfax Medical Campus, Falls Church, Virginia (Dr Newcomb); Department of Occupational Therapy, University of St. Augustine, Austin, Texas (Dr Zadnik); Center for Injury Research and Policy, Johns Hopkins University, Baltimore, Maryland (Mr Carlini, Mss Francis and Staguhn, and Drs Frey and Castillo); RAND Corporation, Pittsburgh, Pennsylvania (Dr Heins); and U.S. Government Accountability Office, Washington, District of Columbia (Ms McNamara).
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.
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