The study aimed to explore demand for the new intervention within a specialist service and examine its acceptability, practicability, and appropriateness.
The six clinicians who had delivered the new Neuromuscular Bridges intervention as part of a larger hybrid, mixed methods study (ADAPT-NMD) were invited to participate in semi-structured interviews. The topic guide was informed by Normalisation Process Theory (NPT), with questions mapped to its core constructs. The analysis of the data utilised a hybrid, multi-phased approach, drawing on the two primary opposing philosophical approaches to reasoning: a deductive, top-down, theoretical method and an inductive, bottom-up, data-driven method. Phase one employed a flexible, iterative, recursive approach, and in phase two, the data were re-interrogated deductively using the recently developed NPT coding manual. All six clinicians who delivered the intervention participated in the semi-structured interviews.
The findings suggest there is demand for interventions like Neuromuscular Bridges at the specialist centre, and indicate its acceptability, practicability, and appropriateness as a technique to support self-management for people living with neuromuscular disorders (NMDs). Data reveal a promising shift towards a more person-centred, flexible, and adaptable approach to healthcare at the specialist centre, and the intervention's implementation was driven by its alignment with the core professional values of the clinical team. Participants' appreciation of the intervention dovetailing with their existing practice reflects the coherence component of NPT. The initiative shown by clinicians to embed Neuromuscular Bridges into their practice is a strong indicator of cognitive participation. Clinicians were generally proactive in their approach to integrating the intervention, finding innovative ways to drive implementation momentum. Collective action was demonstrated in the way that Neuromuscular Bridges was operationalised. Clinicians embraced the intervention's language modification techniques and appreciated its potential to drive a cultural shift towards a more person-centred approach to patient care. Finally, the reflexive monitoring construct of NPT was evidenced through the clinicians' descriptions of collaborative experimentation and experiential learning. A gradual communal shift was facilitated by an iterative cycle of observation, dialogic reflection, and the repeated application of self-management support techniques.
The findings reveal key facilitators to implementation, such as strong clinician engagement, adaptability to patient needs, collaborative learning environments, and supportive leadership. Challenges such as role identity conflicts, selective patient inclusion, questions of long-term sustainability, and variable interdisciplinary adoption suggest areas requiring further attention and improvement.
The findings support the use of a stakeholder-engaged approach for implementing self-management support in this clinical context, highlighting the value of mapping implementation strategies to context-specific barriers and facilitators using Normalisation Process Theory. Overall, data provide further evidence of the feasibility of a new co-designed self-management support programme for people living with NMDs, indicating its acceptability to clinicians and practicability for use in a specialist neuromuscular service.
Neuromuscular Disorders
Implementation Science
