BACKGROUND In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. METHODS An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. RESULTS The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. CONCLUSIONS The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.

中文翻译：

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物理疗法中行为医学方法的实施：简化方法的过程评估。

背景技术在一项准实验研究中，便利化被用来支持在物理疗法中实施行为医学方法。便利包括个人量身定制的多方面干预措施，包括外展访问，同伴指导，教育材料，个人目标设定，视频反馈，日记中的自我监控，经理支持以及向患者提供的信息传单。行为医学方法意味着关注与健康相关的行为改变。临床行为改变已开始，但参与的物理治疗师并未维持。为了解释这些发现，有必要对实施过程有更深入的了解。因此，目的是通过检查剂量，范围，和参与者的经验。方法探索性混合方法设计被用作准实验性试验的一部分。准实验性试验中包括二十四位在初级卫生保健中工作的物理治疗师，而本研究中还包括了实验组中的所有物理治疗师（n = 15）。在六个月的时间内对主要基于社会认知理论的促进干预进行了测试。在实施期间和实施之后，通过时间分配的自我报告收集有关参与不同实施方法，个人目标的文档，最重要的实施方法的排名以及半结构化访谈的数据。使用描述性统计方法和归纳含量分析。结果物理治疗师最常参加以下实施方法：外展访问，同伴指导，教育材料和个人目标设定。他们还认为这些方法是最重要的实施方法，有助于支持学习，练习，记忆，情绪，自我管理和时间管理。但是，缺少经理的时间管理支持。结论研究结果表明，不同的机制控制着临床行为改变的发生和维持。启动临床行为改变的影响机制是指使用外部启动的多种方法，例如对实践，时间管理和外部动机的反馈。缺乏自我调节能力，内在动力，