Exploratory study to identify facilitators and barriers for implementing a multiplatform communication app for prehospital screening and transfer follow-up in acute stroke

Introduction: Early-stage stroke management is a complex, time-sensitive healthcare process requiring coordinated action and prompt decision-making. JOIN is a multiplatform communication application that streamlines and facilitates healthcare coordination. The objective of the study was to explore the process of implementing and using JOIN across a network of hospitals within the South-East Metropolitan Health Service to identify facilitators, barriers, and perceptions of its impact. Methods: A multiple-case study design was conducted based on a qualitative research framework. The process evaluation used purposive sampling to capture relevant experiences across diverse hospital contexts. Semi-structured interviews were conducted with individuals involved in implementing and using JOIN. Coding was performed using ATLAS.ti software, based on thematic analysis and an iterative procedure. The analysis was based on the components of process normalization theory and focused on evaluating key implementation outcomes. Results: During the interviews (n = 8), some of the facilitators identified ongoing training and the presence of a leader as factors in the use of JOIN. Overload of the emergency care system, resistance to change, and difficulties with technology use were among the barriers identified. Although the application's benefits (user-friendly and intuitive) were recognized, the implementation process posed significant challenges. Fidelity and feasibility were the most difficult implementation outcomes to achieve. Conclusions: The process evaluation highlights the importance of ongoing training and leadership for implementing new interventions within emergency healthcare settings. Furthermore, it emphasized the importance of achieving a comprehensive understanding of the context to improve implementation.