CONSULT
Overview
Consulting with stakeholders before you start will help you identify perceived barriers and facilitators to implementation, and what needs to change. The steps outlined below are guided by the Behaviour Change Wheel.
In the PREPARE phase, you created a list of your stakeholders, and positioned them on a matrix to understand how you will need to involve them. A group’s position on the matrix depends on their level of interest in, and influence on, PREP2 implementation. If you haven’t done this step already, return to the PREPARE page.
Once you have identified your stakeholders, you will first need to give them some information about PREP2. You could ask them to look at the Introduction to PREP2 page as a good starting point, prior to discussions.
Then your aims will be to:
- Discuss general facilitators and barriers to PREP2 implementation.
- Identify 2 – 3 target behaviours the stakeholder group needs to perform for PREP2.
- Identify specific facilitators and barriers for each target behaviour and what needs to change for each behaviour to occur.
Several discussions might be needed, in an iterative process. Then you can complete a Behavioural Analysis, to understand the Capabilities, Opportunities, and Motivations of your stakeholders.
It is recommended that the consultation process is repeated before starting Phase 2, as new behaviours are added with the inclusion of TMS testing, NIHSS scoring, and the ability to make all four possible predictions.
Discuss facilitators and barriers
Some of the general barriers and facilitators to PREP2 implementation have been identified and form a good starting point for discussion (Connell et al. 2018).
Here’s a PREP2 One Page Summary that you can use during your discussions with stakeholders.
Target what needs to be done
There are a number of things that have to be done (behaviours) for PREP2 to be used in everyday practice. Each stakeholder group will be involved in performing a different combination of behaviours.
Some example target behaviours are listed below:
- Identifies suitable patients for PREP2 in a timely manner (before day 3 post-stroke), and accurately obtains the SAFE score in a timely manner (up to day 3 post-stroke) and interprets the results
- Accurately determines eligibility for TMS
- Accurately performs TMS assessment in a timely fashion (day 3 – 7 post-stroke) and interprets the results
- Accurately completes the NIHSS in a timely fashion (day 3 post-stroke) and interprets the results
- Communicates the potential for UL recovery to the patient (and their family)
- Communicates the predicted UL functional outcome to the clinical team, and to relevant subsequent rehabilitation services, such as inpatient, outpatient, or community teams
- Documents UL prediction accurately and in a timely fashion
- Develops appropriate UL goals, and delivers focused UL rehabilitation based on the UL prediction
- Answers questions and supports patients who have been given a UL prediction
- Identify the behaviours that are relevant for each stakeholder group, adding any that haven’t been listed.
Select 2-3 behaviours to be targeted first. Choose ones that are most relevant and are amenable to change. The remaining behaviours not chosen can be reviewed at a later stage.
Here is a worksheet you can use to identify the target behaviours for your stakeholder groups.
Identify specific facilitators and barriers
With each stakeholder group, discuss and record the specific facilitators and barriers for each target behaviour, and what needs to happen for the target behaviour to occur.
You can do this on the same worksheet you used to identify the target behaviours, which can be found here.
Here’s an example of target behaviours for acute stroke physical therapists for Phase 1.
Behavioural analysis
The last step in the Consult phase is to carry out a behavioural analysis for each target behaviour. This analysis will identify:
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- Capability: do people have the knowledge and skills needed for the target behaviour?
- Opportunity: do people have the time, resources and social support needed to do the behaviour?
- Motivation: do people think it’s a good idea, part of their role, and worth doing?
Completing this analysis provides a systematic way to select effective strategies for helping stakeholders to change their behaviour.
Here’s a behavioural analysis template you can use for each target behaviour you have identified for each stakeholder group.
Here’s an example for acute stroke physical therapists for Phase 1.
The TRAIN page provides guidance on what interventions could be chosen to influence staff capability, opportunity and motivation for the identified behaviours.