This study was performed in accordance with the Declaration of Helsinki and approved by the appropriate ethics committee. Ethics approval was obtained from Nova Scotia Health (NSH), Research Ethics Board (Approval #1026183). For the survey portion of the study, consent was implied by opening and completing the survey, which was described in the information provided to potential participants. For the knowledge sharing event, the need for informed consent was waived by the ethics board as the nature of the event involved mutual sharing of information and co-development of implementation strategies. All methods were carried out in accordance with relevant guidelines and regulations.
Aim I: Validating and prioritizing barriers and enablers
Survey Development
Barriers and enablers to IPCT implementation were identified via a literature review (43) using the CFIR (44), which the research team used to create the survey (Appendix A). Survey items were identified through a three-step process of item reduction, consolidation, and transformation (Figure 1). The survey focused on items within Domain III – Inner setting or Characteristics of the Team to detect strategies that could be enacted at the practice level.
The barriers and enablers identified in the literature review were combined into shared concepts and consolidated into opposing barrier and enabler statements (n=21) to prompt respondents to identify whether they had experienced each item as a barrier, enabler, or neither. In the second stage of the survey, respondents rated selected items on a 5-point Likert scale (1 = no impact to 5 = significant impact). The survey also contained an open-ended question on barriers and enablers to IPCT implementation. Demographic information (e.g., role, time with team) was also collected.
Survey Recruitment
The survey was administered using REDCapTM (45,46). Members of IPCTs (n=85 teams at the time of the survey) in Nova Scotia including HCPs, managers, administrative staff, and health service leads (for role definitions see: https://cfpt.nshealth.ca/team-members) were invited to participate via email from the Director of each of the four Primary Health Care health service management zones. Three reminder emails were sent at two-week intervals (47). Targeted recruitment from Directors was used when there was a low response rate within a zone or from specific professions to maximize the number of respondents. Respondents were also offered a chance to win one of five $100 gift cards.
Survey Data Analysis
Data were analyzed using SPSSV26.0 (48). Demographic information and questionnaire responses were summarized using descriptive statistics. For each potential barrier and facilitator, a sum score was generated from the product of its frequency (number of respondents who indicated they had experienced the item) and its impact (response item selected on the 5-point Likert scale). The summed scores for each statement were compared across participant roles and other demographics, and combined scores were used to determine prioritization rankings. Responses to the open-ended question was analyzed deductively to the CFIR domains by one team member (SA) and inductively using content analysis to identify overarching themes (49). Results are reported in accordance with the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) (50).
Part II: Co-creating strategies
A two-hour, virtual knowledge sharing event was held on October 20, 2022 to: 1) share survey findings and 2) co-create strategies to mitigate and/or enhance priority barriers and enablers.
Recruitment for Knowledge Sharing Event
Recruitment was purposive to attract participation from IPCT HCPs and staff, Primary Health Care Leads and Managers, patients and caregivers, and government representatives. Invitations were emailed by Zone Directors to Zone Health Service Managers to IPCTs. Existing Patient and Family Advisors and MSSU Patient Public Partners were also emailed invitations by Patient Engagement Advisors. Participants completed an online registration that collected information about their roles and where they work to help assign individuals to breakout groups. Prior to the event, participants were sent the event objectives, agenda, and discussion topics.
Event structure
Following an overview of the literature review and survey results, participants were split into pre-assigned groups, with a mix of participants based on role and practice location, for world café-style discussions (51). Experienced interprofessional facilitators were each assigned one topic: team organization and coordination supports; communication tools and technology; role clarity and relationships; goals and feedback; or availability of resources and leadership engagement. Each topic was associated with priority barriers and enablers, and a set of prompt questions (Appendix B). Each facilitator met with two breakout groups, such that each breakout group had the opportunity to discuss two topics. Following the event, participants were invited to complete an online event evaluation survey using Select Survey v5.0 (52). Participants responded to statements about the event objectives and possible applications on 5-point Likert scale ranging from strongly agree to strongly disagree or very likely to very unlikely. Responses were collapsed into agree (i.e., strongly agree, agree), neutral, or disagree (i.e., disagree, strongly disagree).
Knowledge Sharing Event Analysis
A content analysis of audio/video recordings of breakout group discussions identified overarching themes, strategies, and actions to address the barriers and enablers discussed (49). Five team members independently coded breakout group discussions for one topic (AG, AB, AMir, RG, EL), and met to compare their analyses, and to revise and agree on the coding. Two team members (AB, AMir) independently coded the next recording, and then again met to compare results and discuss with the coding team. The remaining topics were double-coded (AB, AMir). Discrepancies were resolved by group consensus. Findings were consolidated into strategies and actions by one team member (AB) and were reviewed by the full study team.