Page 185 - Demo

General discussion1837perspectives might be difficult for care professionals because of the limited ability of people with intellectual disabilities to express themselves (Dalton & Sweeney, 2013; Smith et al., 2020), paying attention to the needs and wishes of clients motivated care teams to reduce involuntary care. Hence, when implementing methods that aim to phase out involuntary care practices, useful implementation strategies and interventions might be setting a clear vision by care organisations and articulating commitment to improving quality of care with the chosen innovation. Furthermore, consensus processes with care professionals, clients, and other stakeholders about the innovation to align goals and discuss possible barriers might help. Moreover, the use of local opinion leaders, possibly in a role as implementation champion, might be a useful implementation intervention. Furthermore, the study in Chapter 4 investigated how these implementation interventions appear to activate social mechanisms in implementation processes as proposed by Normalisation Process Theory (NPT). The adapted NPT-EPOC framework suggests that implementation interventions such as Consensus Processes, Local Opinion Leaders and Client-related Interventions could activate all four social mechanisms of Normalisation Process Theory (NPT). Other implementation interventions, such as Educational Outreach, Distribution of Informational Materials and Audit and Feedback also activated social mechanisms described by NPT. For example, to pursue Coherence, which is about sense-making, care professionals can build a shared understanding of the aims and benefits of an innovation by exploring their individual and collective tasks and responsibilities in consensus processes. They can also add value to an innovation by connecting their clients%u2019 care needs to the aims of the innovation. To pursue Collective Action, educational outreach and discussions among care professionals to reach consensus and operationalise their actions might be helpful. Cognitive Participation of care professionals in implementation processes was also initiated through consensus processes and local opinion leaders, for example in explaining to care staff why it was important to be involved. Audit and feedback as implementation intervention can be used to pursue Reflexive Monitoring. Hence, intellectual disability care