Barriers and supports to implementation of MDI/spacer use in nine Canadian pediatric emergency departments: a qualitative study

Scott, Shannon D; Osmond, Martin H; O'Leary, Kathy A; Graham, Ian D; Grimshaw, Jeremy; Klassen, Terry

The findings from our case study suggest how barriers and facilitators interact with each other in complex ways ( Table 2) to produce different outcomes in each of the study EDs. In fact, there was not a clear pattern with respect to the barriers and facilitators in terms of stage of MDI/spacer adoption by EDs. Noteworthy is that the early adopter sites reported having many of the same barriers that sites that had yet to adopt the innovation had, however, early adopter sites were motivated to find ways to overcome these barriers. The identified barriers and facilitators related to: attributes of the innovation (MDI/ spacer), such as perceived ease of use, clear advantages of MDI/spacers and cost; attributes of the practice environment including both structural (e.g., staffing issues, organizational bureaucracy) and social factors (e.g., presence of a research champion, autonomy); and attributes of the individual clinicians working within the EDs including elements such as entrenched ideas and scepticism. This complex array of factors at multiple levels shaping the adoption process mirrors the findings of Denis and colleagues [19] . They suggested that adoption processes followed different paths and factors that facilitated adoption at one site may hinder adoption in another site given the complex interplay of individual, contextual, and historical factors.