Table 5 Empirical support for within-site and between-site implementation themes
From: Between and within-site variation in qualitative implementation research
Site | Within-site theme | Support for within-site theme | Support for between-site theme |
|---|---|---|---|
Alpha | Coordination processes between services rather than structural factors required for implementation | · Co-located structure present, but limited cross-service collaboration | · Space and preexisting consultation-liaison agreements are structural barriers |
· POD and PC/MHI viewed as separate mechanisms for mental health access | · Neither barrier resolved by collaboration; space resolved through PCMH innovation | ||
· Local tailoring of processes addressed structural space barrier | |||
Bravo | Communication and collaboration facilitated PC/MHI implementation | · Inter-service collaboration resolved differences | · Mutual awareness of concerns between services |
· Open communication facilitates patient access and process improvement | · Similar barriers to Site Alpha, but in Site Bravo, barriers were resolved through negotiation | ||
Yankee | Poor collaboration between primary care and mental health caused implementation problems | · Space conflict | · Space and ER coverage agreements are structural barriers |
· ER referral procedure conflict | · Lack of collaboration appears to lead to conflicts over structural differences | ||
· Different definitions of intervention success | |||
Zulu | Prior failure implementing co-located care influenced decision to physically separate services | · MH leader report of prior failure | · Prior space limitation influenced implementation |
· No divergent perspectives of shared phenomena, possibly due to physical separation between PC and MH | · PC/MHI adapted to preexisting space barrier |