Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

Download Full-text

Choosing Healthy Eating for Infant Health (CHErIsH) study: protocol for a feasibility study

BMJ Open ◽

10.1136/bmjopen-2019-029607 ◽

2019 ◽

Vol 9 (8) ◽

pp. e029607

Author(s):

Karen Matvienko-Sikar ◽

Elaine Toomey ◽

Michelle Queally ◽

Caragh Flannery ◽

Kate O Neill ◽

...

Keyword(s):

Primary Care ◽

Childhood Obesity ◽

Infant Feeding ◽

Process Evaluation ◽

Feasibility Study ◽

Healthy Eating ◽

Implementation Strategy ◽

Infant Health ◽

Intervention Delivery ◽

Electronic Delivery

IntroductionChildhood obesity is a public health challenge. There is evidence for associations between parents’ feeding behaviours and childhood obesity risk. Primary care provides a unique opportunity for delivery of infant feeding interventions for childhood obesity prevention. Implementation strategies are needed to support infant feeding intervention delivery. The Choosing Healthy Eating for Infant Health (CHErIsH) intervention is a complex infant feeding intervention delivered at infant vaccination visits, alongside a healthcare professional (HCP)-level implementation strategy to support delivery.Methods and analysisThis protocol provides a description of a non-randomised feasibility study of an infant feeding intervention and implementation strategy, with an embedded process evaluation and economic evaluation. Intervention participants will be parents of infants aged ≤6 weeks at recruitment, attending a participating HCP in a primary care practice. The intervention will be delivered at the infant’s 2, 4, 6, 12 and 13 month vaccination visits and involves brief verbal infant feeding messages and additional resources, including a leaflet, magnet, infant bib and sign-posting to an information website. The implementation strategy encompasses a local opinion leader, HCP training delivered prior to intervention delivery, electronic delivery prompts and additional resources, including a training manual, poster and support from the research team. An embedded mixed-methods process evaluation will examine the acceptability and feasibility of the intervention, the implementation strategy and study processes including data collection. Qualitative interviews will explore parent and HCP experiences and perspectives of delivery and receipt of the intervention and implementation strategy. Self-report surveys will examine fidelity of delivery and receipt, and acceptability, suitability and comprehensiveness of the intervention, implementation strategy and study processes. Data from electronic delivery prompts will also be collected to examine implementation of the intervention. A cost–outcome description will be conducted to measure costs of the intervention and the implementation strategy.Ethics and disseminationThis study received approval from the Clinical Research Ethics Committee of the Cork Teaching Hospitals. Study findings will be disseminated via peer-reviewed publications and conference presentations.

Download Full-text

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

10.21203/rs.3.rs-59646/v1 ◽

2020 ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Melanie Krüger ◽

Anna Gabriel ◽

Joachim Hermsdörfer ◽

...

Keyword(s):

Primary Care ◽

Data Collection ◽

Older People ◽

Process Evaluation ◽

Feasibility Study ◽

Health Professionals ◽

Implementation Strategy ◽

Care Pathway ◽

Balance Disorders ◽

Telephone Helpline

Abstract BackgroundCommunity-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a Care Pathway (CPW) to improve their mobility and participation by offering standardised approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.MethodsThis 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s guidance for developing and evaluating complex interventions. Patients with VDB (≥ 65 years), GPs and PTs in primary care were included. Intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. Implementation strategy contained specific educational trainings and a telephone helpline. Data for mixed-method process evaluation was collected via standardised questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data via content analysis.ResultsA total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rate GP practices: 27,8%; PT practices: 38,5%). 91% of patients and all health professionals completed the study. The health professionals responded well to the educational trainings, the utilization of the telephone helpline was low (one call each from GPs and PTs). Routine in the intervention’s application and positive attitudes were emphasised as facilitators for the interventions’ implementation, whereas lack of time was mentioned as a barrier. Despite of difficulties in GPs’ adherence to intervention protocol, GPs, PTs and patients benefited from the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.ConclusionAlthough the process evaluation provides good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need of improvement in recruitment, the GPs’ intervention part and data collection procedures. Findings will inform the main trial to prove the interventions effectiveness in a cluster RCT.Trial registrationDeutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered); Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017

Download Full-text

Health promotion in basque local primary care centers: results from implementation strategy optimization and evaluation

International Journal of Integrated Care ◽

10.5334/ijic.s3609 ◽

2019 ◽

Vol 19 (4) ◽

pp. 609

Author(s):

Heather L. Rogers ◽

Alvaro Sanchez ◽

Susana Pablo ◽

Maite Espinosa ◽

Arturo Garcia ◽

...

Keyword(s):

Primary Care ◽

Health Promotion ◽

Implementation Strategy ◽

Local Primary Care

Download Full-text

A Collaborative Approach to Health Promotion Targeting People with Mental Illness at Risk of Diabetes—A Process Evaluation

Diabetes ◽

10.2337/db18-2261-pub ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 2261-PUB

Author(s):

NANA F. HEMPLER ◽

VINIE H. LEVISEN ◽

REGITZE S. PALS ◽

NAJA RAMSKOV KROGH ◽

RIKKE H. LAURSEN

Keyword(s):

At Risk ◽

Health Promotion ◽

Mental Illness ◽

Process Evaluation ◽

Collaborative Approach ◽

People With Mental Illness

Download Full-text

Effectiveness of two procedures for deploying a facilitated collaborative modeling implementation strategy—the PVS-PREDIAPS strategy—to optimize type 2 diabetes prevention in primary care: the PREDIAPS cluster randomized hybrid type II implementation trial

Implementation Science ◽

10.1186/s13012-021-01127-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alvaro Sanchez ◽

◽

Susana Pablo ◽

Arturo Garcia-Alvarez ◽

Silvia Dominguez ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Diabetes Prevention ◽

Implementation Strategy ◽

Type Ii ◽

Collaborative Process ◽

Type 2 Diabetes Prevention ◽

Cluster Randomized ◽

Implementation Trial

Abstract Background The most efficient procedures to engage and guide healthcare professionals in collaborative processes that seek to optimize practice are unknown. The PREDIAPS project aims to assess the effectiveness and feasibility of different procedures to perform a facilitated interprofessional collaborative process to optimize type 2 diabetes prevention in routine primary care. Methods A type II hybrid cluster randomized implementation trial was conducted in nine primary care centers of the Basque Health Service. All centers received training on effective healthy lifestyle promotion. Headed by a local leader and an external facilitator, centers conducted a collaborative structured process—the PVS-PREDIAPS implementation strategy—to adapt the intervention and its implementation to their specific context. The centers were randomly allocated to one of two groups: one group applied the implementation strategy globally, promoting the cooperation of all health professionals from the beginning, and the other performed it sequentially, centered first on nurses, who later sought the pragmatic cooperation of physicians. The following patients were eligible for inclusion: all those aged ≥ 30 years old with at least one known cardiovascular risk factor and an impaired fasting glucose level (≥ 110-125 mg/dl) but without diabetes who attended centers during the study period. The main outcome measures concerned changes in type 2 diabetes prevention practice indicators after 12 months. Results After 12 months, 3273 eligible patients at risk of type 2 diabetes had attended their family physician at least once, and of these, 490 (15%) have been addressed by assessing their healthy lifestyles in both comparison groups. The proportion of at-risk patients receiving a personalized prescription of lifestyle change was slightly higher (8.6%; range 13.5-5.9% vs 6.8%; range 7.2-5.8%) and 2.3 times more likely (95% CI for adjusted hazard ratio, 1.38-3.94) in the sequential than in the global centers, after 8 months of the intervention program implementation period. The probability of meeting the recommended levels of physical activity and fruit and vegetable intake were four- and threefold higher after the prescription of lifestyle change than only assessment and provision of advice. The procedure of engagement in and execution of the implementation strategy does not modify the effect of prescribing healthy habits (p interaction component of intervention by group, p > 0.05). Discussion Our results show that the PVS-PREDIAPS implementation strategy manages to integrate interventions with proven efficacy in the prevention of type 2 diabetes in clinical practice in primary care. Further, they suggest that implementation outcomes were somewhat better with a sequential facilitated collaborative process focused on enhancing the autonomy and responsibility of nurses who subsequently seek a pragmatic cooperation of GPs. Trial registration Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017—retrospectively registered.

Download Full-text

Pilot Testing the Theoretical Framework of Acceptability in a Process Evaluation of a Community Pharmacy–Based Men’s Mental Health Promotion Program

SAGE Open ◽

10.1177/2158244019885129 ◽

2019 ◽

Vol 9 (4) ◽

pp. 215824401988512

Author(s):

Andrea Lynn Murphy ◽

David Martin Gardner

Keyword(s):

Mental Health ◽

Health Promotion ◽

Process Evaluation ◽

Theoretical Framework ◽

Mental Health Promotion ◽

Health Promotion Program ◽

Perceived Effectiveness ◽

Pilot Testing ◽

Promotion Program ◽

Affective Attitude

The objective of this study was to assess men’s acceptability of a men’s mental health promotion program in community pharmacies through pilot testing the theoretical framework of acceptability (TFA) as part of the process evaluation. Five men were interviewed about their experiences with the Headstrong program to learn about the acceptability of the program. The TFA was used as the deductive coding scheme and consists of seven constructs including affective attitude, burden, intervention coherence, ethicality, opportunity costs, perceived effectiveness, and self-efficacy. Three constructs, affective attitude, perceived effectiveness, and intervention coherence, from the TFA were coded in all five transcripts. The most frequently coded constructs were affective attitude and perceived effectiveness, coded 19 and 17 times, respectively. Interviewees all reported good relationships with their pharmacists, which influenced their willingness, attitude, and low burden for participation in Headstrong. Each of the men expressed comments reflecting anticipated effectiveness of the program outside of their own experience and how it could impact other men. Use of the TFA as part of a process evaluation of men’s experiences in a men’s mental health program was useful in identifying men’s perceptions of the program’s acceptability. Further research regarding how the quality of existing relationships with clinicians and patients impacts the TFA constructs of affective attitudes, perceived effectiveness, and burden would be useful.

Download Full-text