Embedding mentoring to support trial processes and implementation fidelity in a randomised controlled trial of vocational rehabilitation for stroke survivors

Craven, Kristelle; Holmes, Jain; Powers, Katie; Clarke, Sara; Cripps, Rachel L.; Lindley, Rebecca; Phillips, Julie; Tyerman, Ruth; McKevitt, Christopher; Clarke, David; Radford, Kathryn

Abstract

Background: Little guidance exists regarding how best to upskill and support those delivering complex healthcare
interventions to ensure robust trial outcomes and implementation fidelity. Mentoring was provided to occupational
therapists (OTs) delivering a complex vocational rehabilitation (VR) intervention to stroke survivors. This study aimed
to explore mentors’ roles in supporting OTs with intervention delivery and fidelity, and to describe factors affecting
the mentoring process and intervention delivery.

Methods: Quantitative data (duration, mode and total time of mentoring support) was extracted from mentoring
records and emails between mentors and OTs, alongside qualitative data on barriers and facilitators to intervention
delivery. Semi-structured interviews with mentors (n = 6) and OTs (n = 19) explored experiences and perceptions of
intervention training, delivery and the mentoring process. Mean total and monthly time spent mentoring were
calculated per trial site. Qualitative data were analysed thematically.

Results: Forty-one OTs across 16 sites were mentored between March 2018 and April 2020. Most mentoring was
provided by phone or Microsoft Teams (range: 88.6–100%), with the remainder via email and SMS (Short Message
Service) text messages. Mentors suggested strategies to enhance trial recruitment, improved OTs’ understanding ofand
adherence to trial processes, intervention delivery and fidelity, and facilitated independent problem-solving.
Barriers to mentoring included OT non-attendance at mentoring sessions and mentors struggling to balance
mentoring with clinical roles. Facilitators included support from the trial team and mentors having protected time
for mentoring.

Conclusions: Mentoring supported mentee OTs in various ways, but it remains unclear to what extent the OTS
would have been able to deliver the intervention without mentoring support, or how this might have impacted
fidelity. Successful implementation of mentoring alongside new complex interventions may increase the likelihood
of intervention effectiveness being observed and sustained in real-life contexts. Further research is needed to
investigate how mentors could be selected, upskilled, funded and mentoring provided to maximise impact. The
clinical- and cost-effectiveness of mentoring as an implementation strategy and its impact on fidelity also requires
testing in a future trial.

• Journal Article Type: Article
• Acceptance Date: Aug 28, 2021
• Online Publication Date: Oct 3, 2021
• Publication Date: 2021-12
• Deposit Date: Oct 7, 2021
• Publicly Available Date: Oct 15, 2021
• Journal: BMC Medical Research Methodology
• Electronic ISSN: 1471-2288
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Article Number: 203
• DOI: https://doi.org/10.1186/s12874-021-01382-y
• Keywords: Mentoring, Occupational therapy, Stroke, Vocational rehabilitation, Randomised controlled trial, Trial processes, Adherence, Implementation fidelity, Process evaluation
• Public URL: https://nottingham-repository.worktribe.com/output/6396418
• Publisher URL: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-021-01382-y