# Using context mapping for planning implementation of movement behavior change in physiotherapy

## TL;DR

This paper presents an implementation plan to help physiotherapists adopt a tool for promoting physical activity in patients with chronic conditions.

## Contribution

The study introduces a structured implementation plan for integrating the Keep Moving Support Tool into physiotherapy clinics.

## Key findings

- Barriers and facilitators for implementing the KMST were identified through expert interviews and context mapping.
- An implementation plan was developed with strategies like e-learning, communication materials, and a learning community.
- Five key themes were identified to guide successful KMST adoption in physiotherapy practice.

## Abstract

Physiotherapists often lack a comprehensive understanding of self-management and encounter challenges in providing self-management support. The Keep Moving Support Tool (KMST) was developed to support physiotherapists in their role as health promotors and to stimulate physical activity in patients with (risk of) chronic conditions. The KMST requires a change in workflow and behaviour of professionals, therefore it is crucial to meticulously identify barriers and facilitators during the pre-implementation stage to address them before the actual implementation. The aim of this study was to develop an implementation plan directed at the integration of the KMST within everyday practice in multiple physiotherapy clinics.

A two-step research approach was applied using the Consolidated Framework for Implementation Research. First, a needs assessment was performed to identify barriers and facilitators for the implementation of the KMST. This process involved semi-structured interviews with four implementation experts with scientific knowledge and experience in the physiotherapeutic field and three context mapping sessions with four physiotherapists. Second, implementation strategies were selected and combined with their proposed operationalization (materials and actions) to address the barriers and facilitators.

The inventory of barriers and facilitators was grouped into five themes; (1) the KMST needs to be understood and appreciated, (2) physiotherapists need to feel and be competent to work with the KMST, (3) the KMST needs to be applied in physiotherapy clinics and implementation needs to be monitored, (4) several interest holders need to be involved, and (5) resources are necessary to facilitate implementation. Each theme included both barriers and facilitators. The developed implementation plan consists of various implementation strategies and practical materials and actions: develop communication materials and an e-learning to train physiotherapists how to apply the KMST, compose a core team of early adoptors and a learning community, align the KMST with the electronic patient file, monitor and evaluate application of the KMST.

The combined data from the interviews and context mapping sessions helped to identify key factors that need to be addressed to enhance successful implementation of the KMST in daily practice of physiotherapy clinics. A future effect study should assess whether the implementation materials and actions effectively support physiotherapists in applying the KMST, and whether this leads to sustained physical activity among their patients.

The online version contains supplementary material available at 10.1186/s12913-025-13897-x.