Early mobility to improVE health outcomes following cardiac surgery (EVE) clinical feasibility trial development

Abstract

There is a know-do gap between the generation of research knowledge and its use in clinical healthcare. Implementation science research focuses on closing the know-do gap by investigating interventions that support the uptake of research knowledge into clinical practice. When practices, such as early mobility in the cardiac surgery intensive care unit (CSIUC) are shown to be effective and efficacious, research should shift to focus on how these practices can be implemented into clinical practice. One approach to implementation science is intervention mapping, a multi-step, theory-informed process for co-developing an intervention, an implementation plan, and an evaluation plan. There are six steps in intervention mapping: 1) a needs assessment exploring the behaviour targeted for change through a review of the literature and contextually through qualitative and quantitative means, 2) identifying performance objectives, 3) selecting theory-based methods for behaviour change, 4) creating an intervention, 5) planning for intervention implementation, and 6) evaluating the intervention. This dissertation shares the process of intervention mapping applied to early mobility in the CSICU. First, an overview of implementation science, integrated knowledge translation, intervention mapping, my guiding worldview and positionality, patient engagement in research, arts-based research methods, and the current state of early mobility literature are shared to provide context for the dissertation. Chapters 2-7 describe the research that formed the needs assessment, the first step of intervention mapping. The needs assessment includes a review of the literature (Chapter 2), a quantitative exploration of the current state of early mobility in the CSICU using behaviour mapping (Chapter 3), a qualitative exploration of clinicians’ perspectives of early mobility through interpretive description (Chapter 4), and then the lived experience of early mobility in the CSICU is explored with patients and care partners through body mapping and virtual engagement works (Chapters 5-7). The findings of the needs assessment generated performance objectives which were aligned with two theoretical methods for behaviour change to support intervention development (Chapter 8). An implementation and an evaluation plan were developed (Chapter 8). The intervention was implemented and evaluated through repeated behaviour mapping (Chapter 9). Finally, the work is synthesized, discussed in the context of existing literature, and its impact explored (Chapter 10). Overall, this dissertation makes a novel contribution to implementation science literature. It provides an example of how an implementation science approach of early mobility in the CSICU can be used to move research findings into practice. The thesis also demonstrates that novel approaches to research, such as patient engagement and arts-based research methods, uncover important knowledge that can be used to inform early mobility intervention development for the CSICU. Finally, this dissertation shares that implementation science research guided by a pragmatist worldview can engage people with lived experience and clinicians and use the literature to develop an educational intervention to support clinicians in engaging in early mobility behaviours to change patient early mobility in the CSICU.