Abstract
This study looks at how to successfully use a program called Identity Development Evolution and Sharing (IDEAS) in occupational therapy settings.
The profession of occupational therapy is committed to promoting diversity, equity, inclusion (DEI), access, and justice for all people. The American Occupational Therapy Association (AOTA; 2021) offers tools and resources as well as a practice framework to empower occupational therapy practitioners to enact these principles to support those they serve. Although occupational therapy practitioners have readily embraced these ideals through advocacy and education, few interventions within the field exist to directly target health care inequity. As Johnson et al. (2024) pointed out, “Although State of the Science columns have historically taken stock of specific evidence in occupational therapy, there is yet no consensus on DEI approaches” (p. 1). Moreover, resistance to change may limit the application of potentially promising approaches to increase justice and equity in occupational therapy practice. For example, Gündemir et al. (2024) identified several drivers of resistance to DEI initiatives, including a desire to maintain the status quo, perceived threat by groups that have historically benefited from the status quo, ambivalence, personal prejudices, and verbal endorsement of DEI initiatives paired with reluctance to take concrete actions to engender change. As prior studies have suggested, programs that promote ideals such as justice, equity, diversity, and inclusion “may require that we disrupt some current practices” (Suarez-Balcazar et al., 2023, p. 2) that perpetuate systemic injustices. Johnson et al. (2024) echoed this claim, noting that “the profession has not fully interrogated the legacy of white supremacy and its influences on our research traditions and approaches” (p. 2.)
Johnson et al. (2024) urged occupational therapists to “establish DEI as a novel approach to occupational therapy service provision” (p. 3). Perhaps the most prevalent area of practice currently implementing DEI practices is occupational therapy education. A scoping review of antiracist educational practices suggested that occupational therapy educators can use collaborative, anti-racist teaching strategies throughout the curriculum; engage in reflexivity[,] including how intersecting identities impact occupational engagement; decolonize curricula through including Indigenous content and non-Western practice frameworks; increase representation of Black, Indigenous, and other People of Color students and faculty; and strengthen educators’ capacity to engage in anti-racist actions. (Sterman et al., 2022, para. 1)
Echoing this claim, Banks (2020) examined barriers to and facilitators of creating a diverse environment within occupational therapy educational programs, noting barriers to recruiting and adequately supporting Black and Hispanic occupational therapy students. Banks (2020) also noted that these students were not sufficiently supported with respect to leadership roles.
Beyond applying DEI in educational settings, an additional and critically important way occupational therapy practitioners can establish DEI-inspired service provision is by targeting implicit provider biases that impede health equity. Implicit provider biases perpetuate health disparities and poor health care decision making (Davis et al., 2022; Vela et al., 2022), thus making bias a key factor to address if health care equity is to be advanced (Mateo and Williams, 2020). However, disruption of practices rooted in bias requires not only interventions to decrease that bias but also an investigation of the situational and contextual factors surrounding inequitable practices. In this study, we examined a novel intervention for reducing provider bias—Identity Development Evolution and Sharing (IDEAS)—and the ways in which the implementation and effectiveness of this intervention are influenced by surrounding contextual factors, such as the implementation climate. Analysis of the context that is present during the implementation of IDEAS can inform decisions with respect to whether and how clinicians transfer to their everyday practices the knowledge or perspectives they gain from this intervention.
IDEAS is an evidence-supported narrative intervention that shares stories of people who have been harmed by stigma in health care through filmed monologues. Researchers have examined the effectiveness of IDEAS films that have focused on the harms experienced by three populations: (1) Black women, (2) transgender and gender-diverse individuals, and (3) people with substance use disorders (Wasmuth et al., 2023, 2024). Immediately after viewing the film providers complete a pre–post survey that evaluates stigma-related beliefs and engage in a reflective conversation with panel speakers from the population of focus. This approach has been shown to consistently reduce health care provider stigma (Wasmuth et al., 2021, 2023, 2024), thereby increasing the likelihood of positive patient/client experiences.
A recent study (Wasmuth et al., 2024) detailed the use of external facilitation to implement IDEAS in 10 occupational therapy clinical settings in five states across the United States. External facilitation is an implementation strategy that involves someone external to the clinical setting providing training and consultation to support internal members at the site in implementing the intervention (Penney et al., 2021). In this study, an external facilitator (EF) trained an internal occupational therapist facilitator to lead IDEAS at each clinical setting using a shared fidelity checklist. Wasmuth et al. (2024) found external facilitation to be an effective strategy for expanding the implementation of IDEAS in occupational therapy settings. Their study demonstrated that IDEAS continued to produce significant reductions in stigma among occupational therapy practitioners, and feedback on the intervention and the implementation strategy were overwhelmingly positive. However, despite fidelity to external facilitation and IDEAS implementation, sites differed with respect to the success of the IDEAS implementation and the degree to which IDEAS was effective. Wasmuth et al. (2024) described how site-specific differences in the implementation conditions affected implementation success. For example, some sites had much larger groups participating in IDEAS, which made discussions less intimate and more difficult to facilitate. Some sites had trouble with technology, which affected their ability to play the IDEAS film.
In the current study, we moved beyond description, using coincidence analysis (CNA; Whitaker et al., 2020) to determine whether and how differences in implementation conditions were related to the effectiveness of IDEAS (its ability to reduce provider stigma), with the intent of maximizing its future success and effectiveness. This study is important for occupational therapy practitioners because it identifies the conditions that make a difference in the effectiveness of IDEAS for reducing provider stigma. Staff at occupational therapy settings who wish to implement IDEAS can use this information to maximize its effectiveness. In other words, by attending to factors that were shown to have a large impact on effectiveness, occupational therapy practitioners can facilitate the successful implementation of IDEAS at their setting and thereby produce greater reductions in provider stigma.
The need for this type of hybrid implementation-and-effectiveness research has been emphasized recently in the occupational therapy literature as a means of supporting the profession’s ability to enact change and produce desired outcomes (Juckett et al., 2019). This research addresses a gap in the literature and maximizes the occupational therapy profession’s ability to reduce provider stigma and thus support health care equity for clients. This is a critical step in promoting occupational justice within health care and thus is central to the vision of occupational therapy (AOTA, 2021).
Method
Design and Procedures
This study is part of a larger hybrid Type III trial that is examining IDEAS implementation and effectiveness (Wasmuth et al., 2024). In the current study, we expanded on findings from the original study by using CNA to identify implementation conditions that make a difference in IDEAS effectiveness.
CNA is a case-based approach that identifies necessary and sufficient conditions to produce a desired outcome, such as intervention effectiveness. In this study, we used CNA to identify combinations of conditions that produced a large decrease in provider stigma, which we measured by noting pre–post changes on the Acceptance and Action Questionnaire– Stigma (AAQ–S; Levin et al., 2014). We refer to these combinations of conditions as bundles. Table 1 defines each of the conditions included in analysis. An example of a bundle might be an IDEAS feasibility rating of 5/5 and a relative priority rating of strong positive (+2) combined together as necessary conditions to produce a large change in provider stigma.
Implementation and Effectiveness Variables
Note. AAQ–S = Acceptance and Action Questionnaire–Stigma; AIM = Acceptability of Intervention Measure; CFIR = Consolidated Framework for Implementation Research; FIM = Feasibility of Intervention Measure; IAM = Intervention Appropriateness Measure; IDEAS = Identity Development Evolution and Sharing; OT = occupational therapist/therapy.
In addition to determining what conditions make a difference with respect to effectiveness (decreased provider stigma), CNA modeling can demonstrate equifinality, which is when multiple pathways lead to the same outcome (Roczniewska et al., 2024; Whitaker et al., 2020; Yakovchenko et al., 2020). CNA can also identify causal chains, which occur when certain bundles of conditions yield an intermediate outcome and the intermediate outcome then merges with additional conditions to yield a final outcome (Baumgartner & Epple, 2014; Cragun et al., 2024).
Participants
Participating sites included 10 occupational therapy clinical settings in five states across the United States. Each site had an internal facilitator: a lead occupational therapist who was the recipient of external facilitation. External facilitation involved a virtual training from the EF on how to lead an IDEAS training with staff clinicians. The EF also provided virtual support to the internal facilitator as needed to answer questions and troubleshoot problems.
Participants also included staff occupational therapists at each site who attended the IDEAS training provided by the internal facilitator. All occupational therapy staff were invited to attend IDEAS trainings at the site and received a study information sheet. Additional participants included site managers and other key stakeholders who participated in interviews about the site and their perceptions of IDEAS and its fit within their site (N = 58).
Measures
Data included in this study stem from three sources: (1) pre–post effectiveness ratings of IDEAS’ impact on provider bias; (2) a set of Likert scales that measured feasibility, acceptability, and appropriateness; and (3) a list of implementation conditions relevant to this study, obtained via systematic procedures for the rating of qualitative interview data.
Effectiveness
We collected effectiveness data (related to pre–post provider stigma) using the AAQ–S.
Feasibility, Acceptability, and Appropriateness Scales
Scores from the Feasibility of Intervention Measure (Weiner et al., 2017), the Acceptability of Intervention Measure (AIM; Weiner et al., 2017), and the Intervention Appropriateness Measure (Weiner et al., 2017) were included as implementation conditions (Table 1). Each measure consists of four questions, which are rated on a 5-point Likert scale. These measures were used to collect perceptions among occupational therapists and stakeholders at each site with respect to both IDEAS and the EF strategy.
Implementation Conditions
Additional implementation conditions emerged from interviews with occupational therapists and site managers. Our interview guide was generated using the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2022a) to examine factors that could affect IDEAS implementation, including relative advantage, design quality and packaging, implementation climate, compatibility, impact on internal facilitator, impact on site, and relative priority. We used deductive coding to identify qualitative data related to each construct on the basis of interview transcripts, and we used a rating scale to quantify the data for each construct with respect to its impact on implementation (range = –2 [strong negative impact] to +2 [strong positive impact]). These constructs are defined in Table 1 alongside their associated interview questions and quantitative rating outcomes. This method of quantitatively rating qualitative data is widely accepted when applied to the CFIR conceptual model that guided our methods. Detailed procedures related to the collection and analyses of these data were described in Wasmuth et al.’s (2024) article.
Analysis
In this study, quantitative data from each of the measures described in Table 1 were included as conditions in the CNA to determine which ones made a difference in IDEAS effectiveness. CNA, which draws on Boolean algebra and set theory, can be applied across a wide spectrum of sample sizes, including small ones. CNA has an established and growing evidence base in the health care literature, with more than 60 peer-reviewed articles published since 2020.
We conducted an exploratory analysis using the MSC (minimally sufficient conditions) function within the CNA software package in R (Version 3.5; Ambühl et al., 2025) to inductively analyze the original dataset to identify configurations of conditions with particularly strong connections to IDEAS effectiveness outcomes.
As part of the exploratory data analysis, we converted conditions with a continuous scale into dichotomous values around a threshold. This was achieved by considering both the mathematical output from the MSC function along with the project team members’ subject matter knowledge (Miech et al., 2022; Roczniewska et al., 2024). For example, a factor called Implementation Climate had five possible outcomes: –2, –1, 0, +1, and +2, indicating a range from strong negative impact on implementation to strong positive impact on implementation. If the MSC function output revealed that what made a difference to the outcome was whether the factor was at value +2 (i.e., strong positive impact), and this cutoff point aligned with theory and background knowledge, that condition was recategorized as dichotomous; either Implementation Climate = +2 (classified as 1) or Implementation Climate <+2 (classified as 0). This conversion of values from multifactor to dichotomous reduced dimensionality with the overall dataset to work within an analytic search space that was commensurate with the sample size (Roczniewska et al., 2024).
This configurational approach to data reduction has been described in detail in earlier studies (Miech et al., 2022; Yakovchenko et al., 2020). It exhaustively considers all one-, two-, and three-condition configurations that met predesignated thresholds for consistency and coverage. Consistency indicates how reliably a model yields an outcome, whereas coverage relates to explanatory power. During this exploratory data analysis, the MSC function was run multiple times at different consistency levels (95%, 90%, 85%, 80%, and 75%) to compare output at different thresholds (Roczniewska et al., 2024). Using this approach, we identified a subset of conditions that had a strong connection to IDEAS effectiveness to use in the model-developing phase of the analysis.
In the modeling phase, we developed models by iteratively using model-building functions within the CNA software package. We assessed models on the basis of their overall consistency and coverage as well as potential model ambiguity (i.e., when competing models explain the outcome equally well on the basis of consistency and coverage scores). After a preliminary model was identified, we optimized coverage by reviewing the condition table to consider additional configurations that met consistency and coverage thresholds for occupational therapy sites with the outcome of interest (high IDEAS effectiveness) that had not yet been explained by the preliminary models developed thus far. Our final model met an overall consistency threshold of ≥80% and a coverage threshold of ≥80% and had no model ambiguity. In addition to the CNA package, Microsoft Excel was used in the analyses.
To examine whether causal chains were present, we also modeled as outcomes the explanatory factors identified as strongly connected to intervention effectiveness, examining whether an initial set of conditions merged to yield these factors as intermediate outcomes, which then in turn merged with additional conditions to yield the final intervention effectiveness outcomes. Models for an intermediate outcome were held to the same evaluation criteria, that is, a consistency threshold of ≥80%, a coverage threshold of ≥80%, and no model ambiguity.
Results
Table 2 describes characteristics and IDEAS effectiveness outcomes of nine participating occupational therapy sites. One site (Site 9) was dropped from the analysis because it was missing values for multiple factors, including the intervention effectiveness outcome. IDEAS effectiveness data across the nine implementation sites was described in detail in Wasmuth et al.’s (2024) article. Overall, participants demonstrated significantly lower AAQ–S scores after the IDEAS intervention (presurvey: M = 75.5, SD = 11.1; postsurvey: M = 62.6, SD = 11.4; p < .001), indicating decreased stigma. The average difference across sites was −13.03 (SD = 8.3). In this study, high IDEAS effectiveness refers to sites where the average AAQ–S difference was greater than the mean change across all sites, and low effectiveness refers to sites where the average difference was less than the mean change across sites.
Site Characteristics and Effectiveness Measure: Means
Note. Site 9 was dropped from the study analysis because of notable missing data. A = acute care; EC = East Coast; ECF = extended-care facility; H = hospital; I = inpatient; IR = inpatient rehabilitation; M = missing; MW = Midwest; N/A = not applicable; OP = outpatient; Ortho = orthopedic; Ped = pediatric.
The exploratory CNA data analysis of conditions connected to intervention effectiveness identified two variables to carry forward into the modeling phase: (1) design quality and packaging, and (2) impact of external facilitation. A rating of +2 (strong positive impact on implementation) for design quality and packaging was strongly connected to high IDEAS effectiveness. A rating of +1 (weak to moderate positive impact on implementation) was connected to high IDEAS effectiveness only if it was paired with a +2 rating of impact of external facilitation. The model is depicted in Figure 1. Consistency and coverage for this model were both .80, meaning the model reliably yields high IDEAS effectiveness 80% (4/5) of the time (consistency) and explains 80% (4/5) of the instances of high IDEAS effectiveness, suggesting reasonable explanatory power (coverage).
Two difference-making pathways for intervention success.
Design quality and packaging and impact of external facilitation were then modeled as outcomes themselves to determine whether bundles of conditions were connected to a +2 value of these intermediary constructs. The CNA analysis revealed two separate models linked together by a common factor in a causal chain (Figure 2). We found that a value of +2 for relative advantage combined with a value of 5 (completely agree) with the item “The external facilitation approach is appealing to me” consistently led to a value of high for the impact of external facilitation. Furthermore, a high value for the impact of external facilitation, combined with either a value of +2 for implementation climate or a value of high for impact on site, consistently indicated a high level of effectiveness of IDEAS. These findings illustrate that certain conditions became difference-makers only when they jointly appeared with other specific conditions, showing how particular factors work together in important ways to yield outcomes.
Intermediary difference-making causal chains leading to intervention success.
Discussion
Individual Difference-Makers
Design quality and packaging refers to how well the intervention is “bundled, presented, and assembled” (Consolidated Framework for Implementation Research [CFIR], 2025). IDEAS implementation involved the dissemination of a handout with “shared agreements and assumptions” (Wasmuth et al., 2024) to be read at the start of the IDEAS session, a link to the IDEAS film, and a check-off list for the internal facilitator. Interview data coded as design quality and packaging reflected a site’s ability to play the film, which varied because of technology differences. These data also reflected challenges using the “shared agreements and assumptions” handout, which was influenced by the size of the group (Wasmuth et al., 2024). One common practice to engage people in the IDEAS program was to have each attendee read one of the bulleted items on the handout. In larger groups not everyone had a chance to read, and it was difficult to hear one another.
Given that the IDEAS program consisted mainly of these components, it makes sense that the construct of design quality and packaging would be a key difference- maker in terms of intervention effectiveness. If, for example, the film would not play, or was difficult to hear, or had to be stopped and started several times, this would understandably detract from its impact on its viewers. Likewise, if the group was not able to hear or engage with one another and thus did not establish shared assumptions and agreements for the postfilm dialogue, this could significantly detract from the climate and culture of the program, in which open, safe sharing is essential.
Impact of external facilitation refers to the change in self-efficacy of the internal facilitator, that is, their belief in their own capabilities to execute the IDEAS training after external facilitation (CFIR, 2025). This was measured through an analysis of interview questions about the occupational therapist’s confidence to lead the IDEAS program (Table 1). It makes sense that this affected the intervention’s effectiveness. For example, an internal facilitator at one site rated high with respect to the impact of external facilitation noted that the EF “did a really good job of going through it all with me, making sure I understood it in the moment, almost like a universal accessibility.” Another noted there was “flexibility to allow me to make my own choices and go with the flow,” which helped with confident delivery of the intervention. Sites that were rated low on this construct had internal facilitators who thought they understood how to lead IDEAS but ran into last-minute uncertainties and questions for which they didn’t have answers, leaving them feeling less able to implement the intervention with confidence. The notion that internal facilitator self-efficacy influences intervention effectiveness is consistent with the existing literature (Smith, 2017).
When design quality and packaging was rated only +1, a + 2 rating of the EF’s impact indicated a high level of IDEAS effectiveness. In other words, a confident, self-efficacious internal facilitator could navigate the difficulties posed by limitations such as technology difficulties. One internal facilitator was easily able to pivot to leading a conversation during moments when the film stopped working, whereas another internal facilitator was distressed and distracted by the technology challenges. This finding indicates the importance of ensuring effective external facilitation that inspires confidence in internal facilitators and illustrates the need to equip internal facilitators with strategies to overcome challenges during IDEAS implementation. Thus, a key finding of this study is that well-trained internal facilitators who can navigate challenges to implementation can support program effectiveness. Future research is needed to examine factors that contribute to or hinder self-efficacy among lead occupational therapists. An additional key finding is that care should be taken to ensure a good fit between the intervention technology needs and the resources available at the site.
Causal Chain
High impact of external facilitation served as an intermediate factor in a causal chain. We found that two factors combined to consistently produce s high impact of external facilitation: (1) a maximum rating on one item of the AIM, “the external facilitation approach is appealing to me” and (2) a +2 rating of perceived relative advantage. In other words, if the internal facilitator believed that IDEAS was advantageous to implement compared with other, similar programs, and found the external facilitation approach to be appealing, the result was a confident internal facilitator able to successfully roll out the IDEAS program and overcome mild to moderate technological challenges. This finding is consistent with literature illustrating how relative advantage, alongside self- efficacy, positively affects implementation success (Young et al., 2022).
As part of a causal chain, a high impact of external facilitation, combined with a +2 rating of implementation climate or a high rating of impact on site, resulted in high effectiveness irrespective of design and quality packaging.
Implementation Climate
Implementation climate refers to the culture, attitudes, beliefs, and receptivity of an organization to implement an innovation (CFIR, 2025). Sites where practitioners did not feel the need for implicit-bias training or did not feel they possessed harmful stigma beliefs experienced limited effectiveness. In contrast, sites with an implementation climate that reflected openness to new ways of thinking and an awareness of the need to target and reduce implicit bias demonstrated high IDEAS effectiveness.
Impact on Site
It is intuitive that sites with a high impact on site also had a high level of IDEAS effectiveness. Impact on site refers to the degree to which the occupational therapy practitioners implemented actionable change at their site. For example, a site that used an IDEAS training that illuminated the experiences of transgender and gender-diverse clients immediately ordered new gender-neutral signs for their restrooms, illustrating a concrete change in that setting to support inclusivity at the site. The alignment between IDEAS effectiveness and impact on site is encouraging because it suggests that the effectiveness outcome measure also aligned with concrete positive clinical changes.
Implicit Bias
Several factors, such as socioeconomic status, geographic location, disparate access to quality health care, and other social determinants of health, contribute to health care inequity (Wilkerson et al., 2024). In this study, we focused on the role of implicit bias in health care inequities because it has yielded unfavorable health care encounters that can deter people from seeking needed services (Davis et al., 2022). It also has influenced care decisions in ways that compromise patient safety (Ross, 2021). As such, provider implicit biases infringe on occupational justice in health care.
It is important to note, however, that the literature on the effectiveness of implicit bias interventions is limited, which calls into question whether bias is the best intervention target to improve health care equity and occupational justice. For example, a recent rapid review of implicit-bias intervention effectiveness studies yielded inconclusive evidence for implicit-bias training and education (Fricke et al., 2024).
Nonetheless, some recent studies suggest promising results. For example, Svetkey et al. (2024) pilot-tested REACHing Equity, a 9-wk educational intervention designed to provide skills clinicians can use to mitigate implicit bias toward Black patients among health care providers. This study of 37 health care providers found the intervention to be feasible and acceptable, and providers reported significant increases in self-efficacy for mitigating the harms of implicit biases affecting Black patients. Like IDEAS, the intervention used video testimonials from patients and group discussions.
Interventions targeting implicit biases often involve assessment and feedback about one’s own implicit biases. However, Howell et al. (2024) suggest this feedback can work against the goal of positive behavior change. They explored when feedback facilitated (as opposed to worked against) behavior change and found that when feedback about one’s own implicit biases was different from and less socially acceptable than self-reported attitudes, it unsurprisingly produced psychological discomfort. Taking this a step further, Howell et al. suggested that in such cases, when a person accepts personal responsibility for the feedback this leads to direct efforts toward positive behavior and attitude changes. In contrast, study participants who rejected personal responsibility for feedback about implicit biases responded defensively, attempting to prove the feedback to be inaccurate. Such efforts stood in the way of making positive attitude and behavior changes. IDEAS and other testimonial interventions that target implicit bias allow providers to attend to stories and internally reflect on their own biases. Some studies have suggested that this method is superior to trainings that contain more overt, persuasive messaging to change specific attitudes, which can trigger cognitive resistance (Fransen et al., 2015). By viewing stories that detail the lived experiences of harms resulting from implicit bias, providers can reflect and learn without becoming defensive.
Limitations
This study was limited to the nine occupational therapy sites included in the analyses and the three populations on which IDEAS interventions focused. Its use in additional types of occupational therapy settings may reveal new considerations for implementation among occupational therapists. Likewise, expanding IDEAS interventions to a broader range of populations harmed by implicit bias will undoubtedly reveal new considerations related to implementation and effectiveness. As demonstrated in this study and in Wasmuth et al.’s (2024) study, the implementation climate of occupational therapy settings may limit IDEAS effectiveness. Unfortunately, it is perhaps the people who do not prioritize intervening with implicit biases who are most in need of such interventions (Cooper et al., 2022). The future success of this program will therefore rely on studies aimed at addressing this limitation.
An additional limitation is the possibility that the effectiveness of IDEAS may have been overestimated; provider stigma was measured by the AAQ–S, which consists of “I” statements that respondents may have answered on the basis of the social desirability of certain traits rather than actual beliefs or qualities. Scales (van de Mortel, 2008) intended to identify and control for social desirability response bias can address this limitation and strengthen future IDEAS research.
At the start of this study, the revised CFIR guidelines (Damschroder et al., 2022b) were not yet available; therefore, in this study we used the 2009 CFIR constructs, which limits its generalizability to implementation research databases. However, these 2009 constructs were mapped to the new CFIR guidelines, providing an opportunity to translate our findings in the most current terminology.
Future Directions
CNA is a case-based approach that allowed us to examine which differences in implementation outcomes were strongly connected with the effectiveness of IDEAS. The findings from this study will be used to maximize its effectiveness in future implementation efforts by tailoring the implementation conditions that were difference-makers with respect to IDEAS’ impact on providers’ implicit bias. Additional research is underway that is exploring the impact that decreased provider stigma has on the experiences of people receiving health care in an effort to understand IDEAS’ impact on experiences of occupational justice.
Implications for Occupational Therapy Practice
This study illustrates that it is critical for occupational therapy practitioners to not only explore effective, evidence-based interventions to improve clinical practice but to also examine and become familiar with implementation science, which can influence whether and how evidence-based practices affect clients. In this study, we introduced both a novel, evidence-supported occupational therapy intervention (IDEAS) and an innovative methodology (CNA) that allowed us to examine the implementation factors that make a difference in whether an intervention is successfully implemented or effective. This work is important for occupational therapy practitioners to consider when attempting to reduce implicit biases and provider stigma to improve occupational justice for their clients.
Conclusion
This study identified key difference-making conditions that influenced the successful implementation and effectiveness of the IDEAS intervention in occupational therapy settings. Using CNA, we found that design quality and packaging and the impact of external facilitation were critical to IDEAS’ impact on reducing provider stigma. By attending to these difference-makers, occupational therapy practitioners can enhance the likelihood that IDEAS will be implemented effectively, thereby promoting more equitable care. The study met its objective of identifying implementation conditions that contribute to IDEAS’ success, offering practical guidance for future implementation efforts. These insights contribute to the broader goal of increasing occupational justice by addressing provider stigma, which can pose a barrier to equitable health care.