Barriers and facilitators to implementation of cognitive adaptation training in long-term inpatient facilities for people diagnosed with severe mental illness: A nursing perspective

Accessible Summary What is known on the subject? To date, the majority of the research regarding innovative psychosocial interventions in psychiatry focuses upon the development and effectiveness of the interventions. Despite the fact that these are important clinical and scientific contributions, only a small percentage of the evidence-based interventions reach clinical practice. Cognitive Adaptation Training (CAT) is an effective psychosocial intervention to increase daily functioning and cognitive functioning in people diagnosed with severe mental illness (SMI) in inpatient and outpatient psychiatric care. Despite knowledge on the intervention's effectiveness, systematic use of CAT in the daily routine of mental health nurses is insufficient. What the paper adds to existing knowledge? To date, no research is available that describes the factors associated to the implementation of CAT from a nursing perspective. This research also adds to the literature on rehabilitation in people diagnosed with SMI in an inpatient setting. The results contribute to the science of implementing interventions in long-term psychiatric care and may help future interventions in their implementation process. What are the implications for practice? This study highlights that multiple factors need to be considered when implementing an intervention in routine care and that it is a complicated process. Future implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers. Without acknowledging the presence of barriers to implementation and considering strategies to overcome these barriers, sustainable implementation is likely to be unsuccessful. Introduction Evidence-based interventions in psychiatry often fail to reach clinical practice. Cognitive Adaptation Training (CAT) is an evidence-based psychosocial intervention that aims to improve daily functioning of people diagnosed with a severe mental illness. Implementation of CAT remains challenging, despite demonstrated effectiveness. Aim Identifying facilitators and barriers of CAT on the intervention, nursing, and organizational levels, and investigating relationships between capability, opportunity, motivation, and appraisal using the COM-B model. Method The Measurement Instrument for Determinants of Innovations and CAT-specific questions were administered to 46 nurses. The relationship among capability, opportunity, motivation and appraisal was calculated using the Pearson's r correlation coefficient. Results Nine barriers (mostly organizational level) and 13 facilitators (mostly intervention and nursing level) were identified. Significant moderate correlations were found between capability and opportunity, capability and motivation, capability and appraisal and a strong correlation between motivation and appraisal. Discussion The results suggest that barriers at the organizational level should be removed and facilitators at intervention and nursing levels may be exploited to improve implementation. Implications for practice Future implementation initiatives require ongoing training and supervision of CAT specialists, appointment of local champions to increase commitment among nursing staff and inclusion and commitment of management to overcome organizational barriers.