Page 191 - Demo

General discussion1897The third study (Chapter 4) used data that were not originally generated with the intention to conduct a qualitative analysis. For this study data of MDET consultation plans and processes from 19 care homes were used to identify implementation interventions. The fact that not all care homes went through all phases of MDET may have affected the study findings. Another limitation in this study may have been that a first edition of the taxonomy of the Cochrane EPOC review group was used (Cochrane Epoc, 2002), instead of the updated taxonomy (Cochrane Epoc, 2015). The first edition was used to compare the results of the adapted NPT-EPOC framework in this study with the findings of Johnson and May%u2019s NPT-EPOC framework (Johnson & May, 2015). Because NPT seemed to be an implementation theory that is appropriate for explaining and understanding implementation processes in intellectual disability care, using this theoretical framework in other studies may enhance academic insights. A limitation of the fourth study (Chapter 5) was that the response rate to questionnaires administered to care staff was low. The study was conducted in the aftermath of COVID-19 pandemic measures, when direct care staff were recovering from a highly stressful period and demands for extra work needed to be made in moderation. Instead of following the implementation process by repeated measures with the NoMAD questionnaire for Level of Implementation and the questionnaire for Awareness for considering clients%u2019 perspectives on involuntary care, only a before and after measurement could be conducted for 54 participants (experimental condition n = 37, control condition n = 17). The nuances of change in implementation could therefore not be detected in the data, leaving the effect of the three tailored implementation interventions that were executed within the four organisations uncertain. A second limitation was that mean scores on both questionnaires were relatively high at the first measurement (time-point 0) for both the experimental and control groups, which might indicate a possible ceiling effect leaving no room for improvement. With regard to the CoP, described in the fourth study, a limitation was that the three overarching implementation strategies for all organisations participating in the CoP were chosen to be similar. The rationale for this was that it would facilitate discussion and enhance mutual learning, while