Study characteristics of qualitative studies (n = 14) | |||||||
Author/ Country | Methodology and Methods | Sample | Aim | Setting | Technology | Role | Main results |
Bee et al. [35], UK | Qualitative design, semi-structured interviews. Descriptive implementation study | N = 18 18 therapists | To explore cognitive behavioral therapists’ narratives around T- CBT, with a view to identifying current and potential influences on its uptake and implementation in statutory mental health services. | Primary health care | Telemedicine | T-CBT-Champions | The local practice-based champion had the potential to influence other health professionals with enthusiasm and experiential knowledge. |
Bennett-Levy et al. [41], Australia | Qualitative design, semi- structured interviews and reports. Program Evaluation study | N = 26 26 health professionals | To provide a qualitative evaluation of the impact of e-MH training plus follow-up consultation sessions with Aboriginal health providers. | Primary health care | Telemedicine | Tech-savvy champions | Tech savvy champions suggested ideas for practicing on the Stay Strong app. |
Buckingham et al. [44], England | Qualitative design, guided discussions (individual and group). Program evaluation Study | N = 53 2 carers 7 patients 21 individuals practitioners 23 practitioners in group | To inform an online toolkit and training package (the Telerehab Toolkit) to assist the current and future health and social care workforce in conducting safe and effective remote physical assessments and consultations. | Mixed settings | Rehabilitation technologies | Digital champion | Digital champions are recommended to lead telerehabilitation and provide support to other staff members. |
Chung et al. [45], Australia | Qualitative design, semi-structured interviews. Descriptive implementation study | N = 19 14 Cross-disciplinary clinicians and 5 service managers | The study sought to explore the perspectives of clinicians and service managers working in private mental healthcare regarding VR use, including potential implementation barriers and facilitators. | Hospital | Rehabilitation technologies | Opinion leader | Local opinion leaders are important for promoting, establishing credibility, and maintaining quality during the implementation period. |
Fontaine et al. [36], USA | Qualitative design, semi-structured interviews. Descriptive implementation study | N = 31 31 administrative or clinical leaders | To identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve PCMH certification in Minnesota. | Home based care | Client Health records | Physician champions | Salary coverage for physicians and staff time that was devoted to PCMH development. |
Gui et al. [29], USA | Qualitative design, email interviews. Descriptive implementation study | N = 45 45 Physician champions | To understand what strategies Physician champions must tackle challenges in their practices during the implementation and adoption processes of a EHR to be able to cultivate the best practices. | Mixed setting | Client Health records | Physician champion | Physician champions faced challenges, including inadequate training before start-up, insufficient elbow support after start-up, challenges in communication between the builders and suppliers’ company, and system design errors after start-up. |
Hogan-Murphy et al. [46], Ireland | Qualitative design, semi-structured interviews. Descriptive implementation study | N = 23 23 Key stakeholders | To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing, robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings. | Hospital | Prescription and Medication management | Clinical champions | Clinical champions at ward level promoted engagement. They are involved in planning and discussions, as well as discussing what will be functional in the ward. |
Kolltveit et al. [37], Norway | Interpretive description, Qualitative design, focus group interviews. Descriptive implementation study | N = 34 24 registered nurses 5 clinical leaders 1 nurse assistant 2 podiatrists 2 physicians | To identify what health care professionals in distinct staff groups perceived as essential conditions for effective implementation of telemedicine as a new health care technology in diabetes foot care. | Mixed settings | Telemedicine | Telemedicine champion | A telemedicine champion was one of four key conditions for success. Those champions were described by the health personnel in the outpatient clinics as professional, updated, and engaged, and able to use the technology. |
Moss et al. [47], USA | Qualitative design, semi-structured interviews. Descriptive implementation study | N = 17 17 participants. Fourteen providers, three site champions | To understand provider perspectives on VTE prophylaxis and facilitators and barriers to using the risk calculator. | Hospitals | Health care provider decision support | Physician champions and Site champions | Physician champions promoted the use of calculators. Site champions experienced larger facilities and private physicians were a barrier to calculator use. |
Olsen et al. [42], USA | Qualitative design, open-ended questions in electronic survey format. Program evaluation study | N=? | To describe barriers and best practices learned when implementing EHR-based NDPP referral programs (National Diabetes Prevention Program) in two rural health care organizations. | Mixed setting | Client health records | Provider champions | Start small with one provider champion, and make sure to not exceed resources, the providers need time to master the new technology and the providers wants to be involved in the discussions and decisions. |
Owens and Charles [32], England | Qualitative design, individual interviews and focus group interviews. Descriptive implementation study | N = 23 Focus groups with 14 team members, individual interviews with 7 clinicians and 2 service managers | To test and refine the intervention in situ, before proceeding to a full trial. | Primary health care | Behavior change technology (mHealth) | Committed participants, Product champions and Clinical champions | Early clinical champions may overestimate the clinician’s readiness for the intervention. |
Salbach et al. [38], Canada | Qualitative design, individual interviews and focus group interviews. Descriptive implementation study | N = 40 33 Physical Therapists, 4 Professional Practice Leaders, 3 Professional Leaders. Program evaluation study | To examine how the contextual circumstances of acute care and of inpatient and outpatient rehabilitation practice settings influenced participants’ engagement with the toolkit and implementation strategy to effect practice change. | Hospital | Rehabilitation technology | Facilitators | Every site was asked to identify a facilitator. However, not all places had a facilitator, which resulted in no use of the strategy. |
Yang et al. [43], USA | Qualitative design, Individual interviews. Descriptive implementation study | Reflections after 1000 video visits for 4 weeks. N =? | To describe Stanford Neurology Department’s transition of all subspecialty and general neurology patient consultations to stay at home video visits. | Hospital | Telemedicine | Physician champion | Physician champion (also named as key drivers) conducted 1:1 training session to approximately 50% of providers that was a significant factor for successful deployment. Physician champion gave virtually training to schedulers, including templates and checklists. Physician champion participated in daily huddles and answering emails and were available. |
Yusof [48], Malaysia | Qualitative design, semi structured interviews, observation and document analysis. Program Evaluation study | N = 193 193 system users; 134 ICU nurses, 24 anesthetists, 23 perfusionists, 10 OT technicians, and 2 surgeons. | The purposes of the study are to (1) assess CCIS (Critical Care Information System) adoption level and issues in achieving its desired outcomes which subsequently affect healthcare delivery; (2) examine current CCIS implementation status; and (3) identify lessons from influential adoption factors to inform decision making. | Hospital | Client health records | IT nurse, super user, and IT savvy clinicians | Super users received inadequate training and were trained at the same time, as they were required to perform clinical tasks. Management’s support for a champion was lacking. Super users did not find evidence that the system made a significant difference. The super user experienced their own work, and the system created more IT-savvy employees. |
Study characteristics of quantitative studies (n = 4) | |||||||
Author/ Country | Design | Sample | Aim | Setting | Technology | Role | Main results |
Bullard [30], USA | Quantitative design, descriptive study, case study. Cost-effective study | 150+ recent graduated nurses | To explore the costs of EHR implementation with the nursing super-user role in a metropolitan, not-for-profit health care system. | Hospitals | Client Health records | Super-user | Reduced labor costs were associated with super-user staffing by 31.8%. |
Dugstad et al. [49], Norway | Quantitative, cross-sectional descriptive design. Program Evaluation study | N = 98 79 Care providers 19 superusers | To explore healthcare providers’ evaluation of facilitators and barriers during implementation of WNCSs in residential care settings. | Home based care | Assistive technology | WNCS super user Digital transformation facilitator | The care providers could provide feedback regarding WNCS to their manager or a super user in a confident way (82%). There was a high degree of management engagement, and care providers reported feeling social support from the management and their colleagues (80%). |
Rea et al. [50], USA | Quantitative descriptive design, electronic survey. Descriptive Implementation Study | N = 14 14 nurse champions | To investigate if use of a QI cloud-based software technology accessible on mobile devices causes differences in rates, causes differences in compliance with evidence-based CAUTI prevention practices, level of nurse champion satisfaction and identification of benefits and barriers and perceptions of adopting the technology. | Hospital | Health care provider decision support | Nurse champion | The nurse champion was responsible for quality improvement. |
Schwarz et al. [39], Australia | Quantitative descriptive design, cross-sectional survey. Descriptive Implementation Study | N = 104 104 AHPs | To provide an overview of AHPs’ perceptions of EMR implementation across three sites (both regional and metropolitan), with a focus on identifying perceptions before, during, and after implementation in relation to subjective perceptions, barriers and facilitators and overall satisfaction. | Hospital | Client health records | Clinician change champion | The presence of a profession-specific clinician “change champion” was the most important factor in facilitating the implementation of electronic medical records among allied health personnel. The champion could provide practical and cultural support if needed. Additionally, 62% of respondents agreed that they received enough support during the implementation, while 8% disagreed. |
Study characteristics of mixed methods studies (n = 5) | |||||||
Author/ Country | Design | Sample | Aim | Setting | Technology | Role | Main results |
Bail et al. [51], Australia | Mixed-methods case study, observations, individual interviews, surveys, focus group interviews and hospital admission data analysis. Descriptive Implementation Study | N = 152 20 patient interviews 33 patient surveys 48 clinician interviews 51 clinician surveys Admission data analysis | To investigate the implementation of a novel electronic bedside nursing chart in an acute hospital setting. | Hospital | Client Health records, electronic bedside nursing chart | Super-user | Six of eight trained nurse super-users were moved from the ward during the implementation period of four weeks, which was inconsistent with a trial implementation. |
Helmer-Smith et al. [33], Canada | Multi-method approach, cross-sectional study, use data, close-out survey and focus group interviews. Program Evaluation study | N = 16 10 PCPs, 4 administrations, 2 nurse champions. | To explore the perceptions of key stakeholders towards the facilitators and barriers to implementing electronic prescribing (ePrescribing), robotic pharmacy systems, and automated medication storage and retrieval systems in public hospital settings. | Home based care | Telemedicine | Clinician champion | Clinical champions at the ward level promoted engagement. They are involved in planning and discussions, as well as discussing what will be functional in the ward. |
Orchard et al. [34], Australia | Mixed Methods study. Cross sectional pilot study. Semi-structured interviews. Program Evaluation study | N = 989 972 patients screening, 17 health personnel interviews | To determine the feasibility of practice nurse screening in Australia during the flu-vaccination period. | Primary health care | Health care provider decision support | Practice manager | A practice champion was important for the success of the implementation since he/she led and enhanced it. The practice champion suggested that it is necessary to finance the setup and filing, as well as the expenses for the time spent by nurses during the screening process. |
Stewart et al. [40], UK | Mixed-methods evaluation, online questionnaire, semi structured interviews and focus group interviews. Program Evaluation study | N = 63 63 General practice staff | To evaluate the rapid and reactive implementation of RAC in general practice in response to the COVID-19 pandemic, through the lens of eNPT, to identify factors that promoted or inhibited implementation, and identify the ‘work’ that is required for ‘normalization’ into routine clinical care. | Primary health care | Telemedicine | Practice champion | Identify a practice champion to lead the implementation, since no one usually takes the responsibility. A practice champion is often a GP who plays a strategic role in providing adaptive care. A practice champion was important for engaging other personnel. |
Yuan et al. [31], USA | Mixed method design, comparative case study, observation, in-depth interviews and pre-/follow up surveys. Descriptive implementation study | N = 67 24 In-depth interviews superuser/non-superuser 43 pre-/follow up surveys | To provide insight that may help health care organizations better select, prepare, and support super users so that they can realize their potential for positive influence on the implementation of EHRs, and health information technology broadly. | Hospital | Client health records | Superuser | Volunteered superusers were proactive, explained through practical use and the logic behind it, used positive frameworks when discussing implementation procedure, and shared information about EHR. Department heads identified superusers who were tech-savvy; Designated superusers supported their employees on demand; they practically showed how the technology worked but did not explain the logic behind it. Designated superusers spoke neutrally about EHR and provided limited information. |