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

While this study sheds light on the factors that shaped the adoption process of the MDI/spacer, the results must be interpreted cautiously because individual responses were used to developed thick descriptions of a unit-level phenomenon (adoption of the MDI/spacer). Although focus group interviews are an effective technique to acquire data on unit-level phenomenon, and much effort was exerted to ensure a broader representation in the composition of the focus group participants, readers must be mindful that individual perspectives were acquired. While we were able to identify the barriers and supports to implementation of the MDI/spacers, we collected data on several important contextual factors, such as ED census, and decision-making structure; however, in order to protect anonymity, specific data on these elements cannot be shared at the individual ED level. We did not interview parents to explore their perspective of MDI/spacer use. While they could have been considered adopters of the innovation because they must give consent for medical intervention, we limited our focus to how they influenced clinician behaviour. The final limitation of our study is a temporal one. It must be noted that we were not intervening and studying the effects of various strategies to facilitate MDI/ spacer adoption, rather, we were retrospectively exploring the adoption processes for EDs that had either already adopted or were adopting the MDI/spacer, or exploring potential factors for sites that had not yet adopted the MDI/spacers. Thus, limitations arise when asking participants to reflect upon events that happened, in some cases, several years ago. For example, participants in sites where adoption had taken place may have unintentionally justified their present practice by 'glossing over' the main barriers they had experienced in the past. Having already adopted the practice, adopters could have been 'convincing themselves' that the path chosen was the correct one. However, through the use of focus groups, we believe that this limitation is minimized through the garnering of multiple perspectives on the process.