How does mentoring occupational therapists improve intervention fidelity in a randomised controlled trial? A realist evaluation

De Dios Pérez, Blanca; Merchán-Baeza, Jose Antonio; Powers, Katie; Craven, Kristelle; Holmes, Jain; Phillips, Julie; Tyerman, Ruth; Radford, Kate

Abstract

Background: Integrating complex interventions within healthcare settings can be challenging. Mentoring can be embedded within a randomised controlled trial (RCT) to upskill and support those delivering the intervention. This study aimed to understand, from a realist perspective, how mentoring worked to support implementation fidelity for occupational therapists (OTs) delivering a vocational rehabilitation (VR) intervention within the context of an RCT. Methods: A realist evaluation using secondary data (emails, mentoring record forms, interviews) collected as part of an RCT. Three researchers coded the data following content analysis, focused on refining or refuting an initial programme theory by exploring the interactions between context, mechanisms, and outcomes. The research team met to further refine the programme theories. Results: Data from 584 emails, 184 mentoring record forms, and 25 interviews were analysed following a realist approach. We developed a programme theory consisting of two contexts (trial set-up, ongoing mentoring), nine mechanisms (collective understanding, monitoring, timely support, positive reinforcement, reflective practice, support data completeness, facilitation strategy, shared learning experience, management of research and clinical duties), and three outcomes (improved confidence, improved fidelity, reduced contamination). Conclusions: Offering mentoring support to OTs delivering a VR intervention as part of an RCT improves intervention fidelity and reduces the risk of contamination. It improves OTs’ understanding of the differences between their clinical and research roles and increases their confidence and competence in trial paperwork completion and identification of potential contamination issues.

Citation

De Dios Pérez, B., Merchán-Baeza, J. A., Powers, K., Craven, K., Holmes, J., Phillips, J., Tyerman, R., & Radford, K. (2024). How does mentoring occupational therapists improve intervention fidelity in a randomised controlled trial? A realist evaluation. BMC Medical Research Methodology, 24(1), Article 142. https://doi.org/10.1186/s12874-024-02269-4

• Journal Article Type: Article
• Acceptance Date: Jun 24, 2024
• Online Publication Date: Jul 1, 2024
• Publication Date: Jul 1, 2024
• Deposit Date: Jul 9, 2024
• Publicly Available Date: Jul 9, 2024
• Journal: BMC Medical Research Methodology
• Electronic ISSN: 1471-2288
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 24
• Issue: 1
• Article Number: 142
• DOI: https://doi.org/10.1186/s12874-024-02269-4
• Keywords: Vocational rehabilitation, Realist evaluation, Mentoring, Occupational therapy
• Public URL: https://nottingham-repository.worktribe.com/output/37140667
• Publisher URL: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-024-02269-4
• Additional Information: Received: 11 December 2023; Accepted: 24 June 2024; First Online: 1 July 2024; : ; : The RETAKE Trial received full Ethical approval through the East Midlands–Nottingham 2 Research Ethics Committee on the 5th February 2018 (Ref: 18/EM/0019) and the NHS Health Research Authority. The study involved secondary data analysis, and participants consented to participate in the research.; : Not applicable.; : The authors declare no competing interests.; : K.R, B.D.P, J.M and K.P conceived the study and designed the protocol for the realist evaluation. B.D.P developed the data extraction forms. B.D.P, J.M, and K.P conducted the data analysis and synthesis. All authors (K.R, B.D.P, J.M, K.P, K.C, J.H, J.P, R.T) engaged in group discussions to develop the initial programme theory, met to synthesise the research findings, and read and approved the final version.