A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery

Anaïs Tuepker, Christine Elnitsky, Summer Newell, Tara Zaugg, James Henry

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Tinnitus is a common condition, especially prevalent among military Veterans. Progressive Tinnitus Management (PTM) is an interdisciplinary, structured, stepped-care approach to providing clinical services, including teaching coping skills, to people bothered by tinnitus. PTM has been shown to be effective at reducing functional distress, but implementation of the intervention outside of a research setting has not been studied, even though dissemination is underway within the Veterans Health Administration (VHA) system in the United States. This study was designed to address a gap in knowledge of PTM clinical implementation to date, with a focus on factors facilitating or hindering implementation in VHA audiology and mental health clinic contexts, and whether implementing sites had developed intervention adaptations. Methods Qualitative interviews were conducted with 21 audiology and mental health clinicians and service chiefs across a regional service network. Interviews were transcribed and coded using a hybrid inductive-deductive analytic approach guided by existing implementation research frameworks and then iteratively developed for emergent themes. Results PTM prioritization was rare overall, with providers across disciplines challenged by lack of capacity for implementation, but with differences by discipline in challenges to prioritization. Where PTM was prioritized and delivered, this was facilitated by perception of unique value, provider’s own experience of tinnitus, observation/experience with PTM delivery, intervention fit with provider’s skills, and an environment with supportive leadership and adaptive reserve. PTM was frequently adapted to local contexts to address delivery challenges and diversify patient options. Adaptations included shifting from group to individual formats, reducing or combining sessions, and employing novel therapeutic approaches. Conclusions Existing adaptations highlight the need to better understand mechanisms underlying PTM’s effectiveness, and research on the impact of adaptations on patient outcomes is an important next step. Prioritization of PTM is a key barrier to the scale up and spread of this evidence-based intervention. Developing clinician champions may facilitate dissemination, especially if accompanied by signals of systemic prioritization. Novel approaches exposing clinicians and administrators to PTM may identify and develop clinical champions. Acknowledging the potential for PTM adaptations may make delivery more feasible in the context of existing system constraints and priorities.

Original languageEnglish (US)
Article numbere0196105
JournalPLoS One
Volume13
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Tinnitus
prioritization
veterans
mental health
Health
Audiology
Veterans Health
United States Department of Veterans Affairs
interviews
coping strategies
Pulse time modulation
leadership
Research
Interviews
qualitative analysis
distress
Psychological Adaptation
Mental Health Services
Veterans
Administrative Personnel

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery. / Tuepker, Anaïs; Elnitsky, Christine; Newell, Summer; Zaugg, Tara; Henry, James.

In: PLoS One, Vol. 13, No. 5, e0196105, 01.05.2018.

Research output: Contribution to journalArticle

Tuepker, Anaïs ; Elnitsky, Christine ; Newell, Summer ; Zaugg, Tara ; Henry, James. / A qualitative study of implementation and adaptations to Progressive Tinnitus Management (PTM) delivery. In: PLoS One. 2018 ; Vol. 13, No. 5.
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