79 Implementation strategies of fall prevention interventions in hospitals: A systematic review 3 Within the domain ‘train and educate stakeholders’, the most utilized individual strategy was ‘conduct educational meetings’ (n=39), followed by ‘develop educational materials’ (n=19). Two studies did not use any educational strategies [41, 56]. For example, Kwok et al. focused their only strategy on the domain ‘developing stakeholder interrelationships’, which was the second-most used domain. The most utilized strategies within the domain ‘developing stakeholder interrelationships’ were ‘use advisory boards and work groups’ (n=27) and ‘identify and prepare champions’ (n=18). Strategies from the domains ‘engaging consumers’ and ‘utilizing financial strategies’ were both used four times. Operationalization of implementation strategies according to Proctors’ prerequisites None of the studies provided all seven prerequisites for each specific strategy suggested by Proctor et al. [13], the median number of reported prerequisites per strategy was 2 (IQR 1-3). The action was never missing, since this was how the implementation strategies were determined. The actor was described in 47% of the implementation strategies. Often the actor was a work group, research group, or quality improvement team (46%) or management (25%). The least described prerequisite (18 out of 350) was ‘implementation outcome affected’. There was no significant difference in the reported prerequisites before and after the publication of the reporting guideline of Proctor (p=0.55). Table 3 shows an overview of the number of prerequisites for all unique strategies (n=350). In additional file V a detailed overview of all the mentioned details for each unique strategy is provided. Implementation theories, models, and frameworks Twenty-one studies (44%) used an implementation theory, model or framework to guide their implementation. Two studies [43, 61] employed an implementation theory, seventeen utilized a process model [24, 31, 32, 34, 35, 41, 43, 47, 49, 52, 56, 59-61, 64, 69, 71], three used an evaluation framework [30, 52, 54], and two used a determinant framework [52, 53]. Leone et al., Mordiffi et al., Ploeg et al. and Titler et al. used a combination of theories, models or frameworks [43, 49, 52, 61]. Most studies did not elaborate on how the implementation theory, model or framework was operationalized.
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