Fidelity evaluation of the compared procedures for conducting the PVS-PREDIAPS implementation strategy to optimize diabetes prevention in primary care

Alvaro Sánchez, Heather L Rogers, Susana Pablo, Esther García, Inmaculada Rodríguez, Mª Antonia Flores, Olga Galarza, Ana B Gaztañaga, Pedro A Martínez, Eider Alberdi, Elena Resines, Ana I Llarena, Gonzalo Grandes, PREDIAPS Group, Amaia Bengoetxea, Olga Galarza, Elsa Martínez, Itziar Zalduegi, Dorothea Chausson, Agurtzane Gorroño, Alicia Pollán, Marisol Bernabéu, Mª Yolanda Calvo, Ander Artiagoitia, Nerea Zaramillo, Lidia Gonzalez, Asier Aurrekoetexea, Jon Azkarate, María Muñoa, Mar Bilbao, Vicki Camineiro, Gonzalo Gómez de Iturriaga, Fernando Gago, Iciar Ochoa de Retana, Ana Zorrilla, Mª Luisa Gutiérrez, Jone Capetillo Serra, Mª Nieves Lopez, Nekane Iguerregui, Dolores López, Maite Gastañaga, Antonia Flores, Marcos Pereda, Amaya González, Ana Castresana, Laura Saiz, Nerea Regulez, Estibaliz Peciña, Jasone De la Plaza, Lucía Irastoza, Jose Contreras, Idoia Etxebarria, Begoña Oleaga, Cristina Herrero, Nora Cabezón, Fátima Calvo, J Manuel Llamazares, Mª Ángeles Gutierrez, Monica Prieto, Concepción Estébanez, María José Cordovilla, Alicia Domínguez, Isabel Lázaro, Elena Resines, Yolanda Villalba, Begoña Ayerdi, Florencia Martín, Magdalena Presmanes, Floreal Crespo, Araceli Benito, Mª Belén Molina, Mª Mar García, Mª Gracia Díaz, Mª Luisa Rodriguez Ortiz de Zarate, Rebeca San Cristóbal, M Zugazaga Prieto, Pedro Martínez, Mercedes Crespo, Estíbaliz Albitre, Adelina García-Roldán, Amaia García, Maite Castro, Iñaki Gorospe, Amelia V Hernández, Maite López, Mirian Sainz, Irene Marín, María Jesús Aragón, Leire Ulayar, Encarnación Santamaría, Carmen Sánchez, Javier Bayo, Begoña Urkullu, Ana Inés Pereda, Mercedes Garcia, Pilar Blanco, Silvia Soler Valverde, Jose I Atela, Hiart Trespalacios, Anabel Llarena, Verónica Ruiz, Begoña Cabieces, Concepción Ugarte, Guadalupe Icaza, Edurne Zubeldia, Idoia González, Ángeles Gayo, Itxaso Arévalo, Gloria Intxausti, Esther García, Teresa Sánchez, Igone Lobato, Noelia Fuente, Naiara Ortolachipi, Edelweiss Sánchez, Victoria Cosgaya, Ángeles Gayo, Arantza Azazeta, Patricia Zaballa, Ana Isabel Ramila, Teresa Rodeño, Inmaculada Rodríguez, Teresa Vázquez, Raquel Ruíz, Rosa Herrero, María Valvanera, Saioa Setién, Begoña Ruíz, Juan José Casas, Joana Clemente, Javier Amiama, Javier Angulo, Belén Aramendia, Soledad Asenjo, Mª Sonia Mayoral, Remedios Oyarzun, Bergoi Calvar, Belinda Zulueta, Edurne Elola, Josu Egaña, Gemma Díaz, Mª Ángeles Sola, Laura Balague, Mª Ángeles Ganzarain, Arantxa Aramburu, Ana Mª Guinea, Edurne Lizarazu, Inma Valverde, Nekane Arenas, Susana Alonso, Rosa Salaberria, Javier Merino, Mercedes Álvarez, Ester Lázaro, Juncal Izcara, Leire González, Ainhoa García Leunda, Idoia Sánchez, Esther Usandiaga, Eluska Yetano, Jaione Larrea, Inés Mendinueta, Asún Uria, Ana Belén Gaztañaga, Eva Mayo, Onintza Aranzadi, Eulalia Medina, Rosa González, Ione Gutiérrez, Arantxa Perez, Mª Ángeles Izquierdo, Alejandro García, Ainhoa Ugarte, Mª Teresa Zubeldia, Bingen Uriondo, Mª Carmen Aranegui, Arantxa Mendiguren, Yolanda Fernández, Maite Zapirain, Mª Jose Garín, Aitziber Ayerbe, Jon Urkia, Alvaro Sánchez, Josep Cortada, Susana Pablo, Heather Lynn Rogers, Arturo García-Alvarez, Gonzalo Grandes, Alicia Cortazar, Patxi Ezkurra, Rafa Rotaetxe, Alvaro Sánchez, Heather L Rogers, Susana Pablo, Esther García, Inmaculada Rodríguez, Mª Antonia Flores, Olga Galarza, Ana B Gaztañaga, Pedro A Martínez, Eider Alberdi, Elena Resines, Ana I Llarena, Gonzalo Grandes, PREDIAPS Group, Amaia Bengoetxea, Olga Galarza, Elsa Martínez, Itziar Zalduegi, Dorothea Chausson, Agurtzane Gorroño, Alicia Pollán, Marisol Bernabéu, Mª Yolanda Calvo, Ander Artiagoitia, Nerea Zaramillo, Lidia Gonzalez, Asier Aurrekoetexea, Jon Azkarate, María Muñoa, Mar Bilbao, Vicki Camineiro, Gonzalo Gómez de Iturriaga, Fernando Gago, Iciar Ochoa de Retana, Ana Zorrilla, Mª Luisa Gutiérrez, Jone Capetillo Serra, Mª Nieves Lopez, Nekane Iguerregui, Dolores López, Maite Gastañaga, Antonia Flores, Marcos Pereda, Amaya González, Ana Castresana, Laura Saiz, Nerea Regulez, Estibaliz Peciña, Jasone De la Plaza, Lucía Irastoza, Jose Contreras, Idoia Etxebarria, Begoña Oleaga, Cristina Herrero, Nora Cabezón, Fátima Calvo, J Manuel Llamazares, Mª Ángeles Gutierrez, Monica Prieto, Concepción Estébanez, María José Cordovilla, Alicia Domínguez, Isabel Lázaro, Elena Resines, Yolanda Villalba, Begoña Ayerdi, Florencia Martín, Magdalena Presmanes, Floreal Crespo, Araceli Benito, Mª Belén Molina, Mª Mar García, Mª Gracia Díaz, Mª Luisa Rodriguez Ortiz de Zarate, Rebeca San Cristóbal, M Zugazaga Prieto, Pedro Martínez, Mercedes Crespo, Estíbaliz Albitre, Adelina García-Roldán, Amaia García, Maite Castro, Iñaki Gorospe, Amelia V Hernández, Maite López, Mirian Sainz, Irene Marín, María Jesús Aragón, Leire Ulayar, Encarnación Santamaría, Carmen Sánchez, Javier Bayo, Begoña Urkullu, Ana Inés Pereda, Mercedes Garcia, Pilar Blanco, Silvia Soler Valverde, Jose I Atela, Hiart Trespalacios, Anabel Llarena, Verónica Ruiz, Begoña Cabieces, Concepción Ugarte, Guadalupe Icaza, Edurne Zubeldia, Idoia González, Ángeles Gayo, Itxaso Arévalo, Gloria Intxausti, Esther García, Teresa Sánchez, Igone Lobato, Noelia Fuente, Naiara Ortolachipi, Edelweiss Sánchez, Victoria Cosgaya, Ángeles Gayo, Arantza Azazeta, Patricia Zaballa, Ana Isabel Ramila, Teresa Rodeño, Inmaculada Rodríguez, Teresa Vázquez, Raquel Ruíz, Rosa Herrero, María Valvanera, Saioa Setién, Begoña Ruíz, Juan José Casas, Joana Clemente, Javier Amiama, Javier Angulo, Belén Aramendia, Soledad Asenjo, Mª Sonia Mayoral, Remedios Oyarzun, Bergoi Calvar, Belinda Zulueta, Edurne Elola, Josu Egaña, Gemma Díaz, Mª Ángeles Sola, Laura Balague, Mª Ángeles Ganzarain, Arantxa Aramburu, Ana Mª Guinea, Edurne Lizarazu, Inma Valverde, Nekane Arenas, Susana Alonso, Rosa Salaberria, Javier Merino, Mercedes Álvarez, Ester Lázaro, Juncal Izcara, Leire González, Ainhoa García Leunda, Idoia Sánchez, Esther Usandiaga, Eluska Yetano, Jaione Larrea, Inés Mendinueta, Asún Uria, Ana Belén Gaztañaga, Eva Mayo, Onintza Aranzadi, Eulalia Medina, Rosa González, Ione Gutiérrez, Arantxa Perez, Mª Ángeles Izquierdo, Alejandro García, Ainhoa Ugarte, Mª Teresa Zubeldia, Bingen Uriondo, Mª Carmen Aranegui, Arantxa Mendiguren, Yolanda Fernández, Maite Zapirain, Mª Jose Garín, Aitziber Ayerbe, Jon Urkia, Alvaro Sánchez, Josep Cortada, Susana Pablo, Heather Lynn Rogers, Arturo García-Alvarez, Gonzalo Grandes, Alicia Cortazar, Patxi Ezkurra, Rafa Rotaetxe

Abstract

Background: Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial.

Method: We conducted a mixed-method fidelity evaluation study of the PVS-PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers' leaders were all used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals' responsiveness and program differentiation.

Results: Generally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies' perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers.

Conclusions: The PVS-PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals' exposure to the implementation strategy was high in both groups. The centers' organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions.

Trial registration: Clinicaltrials.gov identifier: NCT03254979 . Registered 16 August 2017.

Keywords: Diabetes prevention; Fidelity; Implementation strategy; Primary healthcare.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1.
Fig. 1.
Participation of PC professionals in the PREDIAPS strategy in the planned implementation sessions (n = 10)

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Source: PubMed

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