Skip to main content

Table 4 Overview of all adaptations to intervention components

From: Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark

Intervention Component

Department X/Y

Number of Adaptations

Content or Context Adaptation

Descriptions of the Adaptations

When Did the Adaptation Occur?

WALK-plans

X

1

Content

Patients who have not been assigned a WALK-plan are marked with a minus sign on the board in the staff room. This is to ensure that all health professionals are made aware that a decision has been made about WALK-plans for the patient in question

Implementation

 

X

2

Content

A rack for WALK-plans is installed

Pre-implementation

 

X

3

Content

Changes in time and timing of board meetings, where WALK-plans are discussed

Implementation

 

X

4

Content

Changes in the interprofessional collaboration in relation to WALK-plans by which the physicians did not have a part in the intervention

Implementation

 

X

5

Content

It is discussed whether WALK-plans should be described in the care plan or in the discharge report/rehabilitation plan, and it is agreed that the WALK-plans should be described in the discharge report/rehabilitation plan

Implementation

 

X

6

Content

Changing signature on the WALK-plans, so the nurses and physiotherapists become responsible for signing the WALK-plans

Implementation

 

X

7

Content

Changes in the responsibility for handing out WALK-plans with shifts from physicians to nurses and physiotherapists

Implementation

 

X

8

Content

WALK-plans (home) are not handed out to patients

Implementation

 

X

9

Content

In-hospital WALK-plans and WALK-plans (home) are merged into one WALK-plan

Implementation

 

X

10

Content

Sticker with WALK-Cph logo is attached to envelope with welcome folder

Implementation

 

Y

11

Content

Patients who have not been assigned a WALK-plan are marked with a minus sign on the board in the staff room. This is to ensure that all health professionals are made aware that a decision has been made about WALK-plans for the patient in question

Implementation

 

Y

12

Content

The WALK-plans are placed behind the patient’s bed, so it becomes visible for both patients and health professionals

Implementation

 

Y

13

Content

The establishment of a whiteboard with clips and coloured magnets for WALK-plans located in the staff’s room. This is done to create greater visibility and systematization of the WALK-plan practice

Implementation

 

Y

14

Content

Changes in the responsibility for signing and handing out WALK-plans shifting from physicians to physiotherapists

Implementation

 

X

1

Context

Implementation champions become responsible for board meetings when frontline managers are unavailable

Implementation

 

X

2

Context

The WALK-plans are placed behind the patient’s bed, so it becomes visible for both patients and health professionals

Implementation

 

X

3

Context

WALK-plans are expanded in the rehabilitation department so all patients, and not only patients enrolled in the WALK-trial, receive a WALK-plan

Implementation

WALK-path

X

1

Content

A sign indicating the length of the WALK-path in metres is placed on the wall in the department

Implementation

 

X

2

Content

Posters are placed on the walls in the patient rooms

Implementation

 

X

1

Context

The WALK-path is moved into the new building when the department moves

Scale up

 

X

2

Context

Two therapists help mobilize patients at lunch time

Implementation

 

X

1

Content

The green chairs disappear

Implementation

 

Y

1

Content

The blue chairs disappear. The chairs were similar to the other chairs in the ward and were not marked as WALK-chairs

Implementation

 

Y

2

Content

Marking of blue chairs to ensure that they do not disappear from their location by the posters

Implementation

 

X

1

Content

Small whiteboards are used periodically by health professionals and patients

Implementation

 

X

2

Content

The small whiteboards are brought back to life; the physiotherapists start counting the daily number of rounds that patients have walked

Implementation

Independent collection of clothes

X

1

Content

Signs with sizes and descriptions of clothes are placed on the shelves in the closet. The placement of clothes in the closet is changed, so smaller garments are placed at the bottom of the closet so that patients of smaller stature can reach their sizes

Implementation

 

X

2

Content

Stickers are placed on the outside of the closets to indicate contents

Implementation

Welcome folder

X

1

Content

Information about the project is not given when handing out welcome material and therefore a WALK-logo is added as a reminder

Implementation

Independent collection of beverages

X

1

Content

The refrigerator is moved due to fire hazard. Patients can no longer access the refrigerator and collect beverages

Implementation

 

Y

1

Content

No one is responsible for ensuring that fresh coffee and other beverages are placed on a table in the ward for self-service

Pre-implementation

Others

X

1

Content

Reward in the form of cake for staff and patients when the patients in the department had walked 10 km in total

Implementation

 

X

2

Content

The board of directors are informed about the project and how many kilometres patients have walked in total

Implementation

 

Y

1

Content

Magnets are placed on the overview board to indicate which patients have a WALK-plan

Implementation

 

Y

2

Content

The whiteboards to mark rounds are abandoned due to formal rules for this hospital

Pre-implementation

 

Y

3

Content

Posters with research findings are placed on the wall along the WALK-path to motivate health professionals

Pre-implementation

 

Y

4

Content

Posters with research findings are removed, so that they are no longer visible

Implementation

 

Y

1

Context

Due to an organizational change in the Danish health care system, where smaller hospitals are merged with larger ones, Department Y closes

Implementation

Implementation strategies

X

1

Content

Written material placed by the computers as reminders are forgotten

Pre-implementation

 

X

2

Content

The physicians talk about the project at physicians’ conferences and at board meetings

Implementation

 

X

3

Content

Increased communication efforts (at staff and morning meetings) about the WALK-intervention to spread the message about WALK

Implementation

 

X

4

Content

The operational target board is not used in relation to Walk-plans; no operational target has been set for Walk-plans

Implementation

 

X

5

Content

The frontline manager nurse receives coaching in relation to the management of the project

Implementation

 

Y

1

Content

Increased communication efforts about the WALK-intervention in the group of nursing staff to spread the message of WALK

Implementation