Universität zu Köln

Söling, Sara ORCID: 0000-0002-0752-358X (2024). Adoption of a Digital Intervention for Clinical Decision Making in Polypharmacy - Implementation Science Perspective on Pathways to Advance the Adoption. PhD thesis, Universität zu Köln.

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Abstract

Exploring implementation pathways and mechanisms in the adoption of a digital intervention for clinical decision-making in polypharmacy requires the conduction of theory-driven and context-focused process evaluation studies at the intersection with implementation science (ImpSci) methodology. Therefore, this thesis gives an overview of formative and process evaluation approaches used in health services research (HSR) and describes rationales and differences compared to ImpSci methodology. Furthermore it is discussed, how the digital transformation challenges clinical decision-making in polypharmacy and the generation of evidence in HSR and how ImpSci methodology can be used to facilitate the understanding of complex change processes. In the empirical studies, contextual evidence in implementation processes at three different levels of abstraction were analyzed. 1) The role of physician habitus in simple and complex implementation pathways toward adoption, 2) the latent construct of individual-level implementation leadership of physicians and its associations with innovation climate, social capital, and organizational readiness to implement change at the meso level, and 3) mediating contextual factors in the form of clinician beliefs about the effectiveness of the digital intervention, were the key contextual factors inherent in the implementation mechanisms, and explained how they served as barriers and facilitators for the adoption behavior of participating clinicians. The ImpSci methodology proved to be particularly relevant to the generation of contextual evidence and its adaption to the development of tailored implementation strategies to advance adoption pathways.

Item Type:	Thesis (PhD thesis)
Creators:	Creators Email ORCID ORCID Put Code Söling, Sara sara.soeling@uk-koeln.de orcid.org/0000-0002-0752-358X UNSPECIFIED
URN:	urn:nbn:de:hbz:38-752467
Date:	2024
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft > Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR)
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language Implementation Science English Digital Transformation English Clinical Decision Making English Polypharmacy English Process Evaluation English Clinical Decision Support Systems UNSPECIFIED Evidence-based medicine UNSPECIFIED
Date of oral exam:	11 February 2025
Referee:	Name Academic Title Stock, Stephanie Prof. Dr. Polidori, Cristina M. Prof. Dr. Dr.
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/75246