Exploring the barriers and enablers to the implementation and adoption of recovery-orientated practice by community mental health provider organizations in England

Figures & data

Table 1. Consolidated framework for implementation research (Damschroder et al., 2009)

Domain	Underlying construct
Characteristics of the intervention	Intervention source Evidence strength and quality Relative advantage Adaptability Trialability Complexity Design quality and packaging Cost
Outer setting	Patient needs and resources Cosmopolitanism Peer pressure External policies and incentives
Inner setting	Structural characteristics Networks and communications Culture Implementation climate Available resources Access to knowledge and information Leadership engagement Compatibility Goals and feedback Tension for change Relative priority Organizational incentives and rewards
Characteristics of the individuals involved	Knowledge and beliefs about the intervention Self‐efficacy Individual stage of change Individual identification with the organization Other personal attributes
Process of implementation	Planning Engaging Executing Reflecting and evaluating Champion External change agent Formally appointed internal implementation Opinion leaders

Table 2. Summary of barriers and enablers to RO practice

Barriers	Enablers
Characteristics of the intervention
RO practice is labor intensive RO practice is a skilled activity Difficulties reviewing outcomes associated with RO practice	Application of Recovery Star
Outer setting
Commissioner funding thresholds Limited access to culturally appropriate care Mental health stigma and discrimination Lack of secure housing Poverty	Flexible commissioner funding thresholds Local authority commissioning standards
Inner setting
High staff turnover Risk averse provider organizations	Staff training for skills acquisition Staff supervision and mentorship Organizational commitment to RO practice
Characteristics of individuals involved
Misaligned service-user and family member goals and aspirations	Motivational interviewing skills Family involvement in care planning
Process of implementation
	Registered managers championing RO practice

Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(50). doi:10.1186/1748-5908-4-50

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