Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study

Emma Nilsing Strid, Lars Wallin, Ylva Nilsagård, Emma Nilsing Strid, Lars Wallin, Ylva Nilsagård

Abstract

Background: There is growing evidence that noncommunicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this knowledge in primary health care (PHC).

Objective: This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a PHC setting. This practice is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs.

Methods: A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidelines for process evaluation of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to 6 PHC centers will be included as intervention centers, which will receive a 12-month multifaceted implementation strategy. Up to 6 matched PHC centers will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and the Astrakan change leadership model. Data will be collected at baseline, during the implementation phase, and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients in every PHC center and 200 health care professionals (HCPs) before and after implementation. In addition, purposeful sampling will be used for interviews and focus group discussions with managers, HCPs, patient representatives, and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source.

Results: Recruitment of PHC centers began in March 2021 and ended in Spring 2022. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the final data in Summer 2023.

Conclusions: This study will explain implementation process and outcomes using a multifaceted implementation strategy for a healthy lifestyle-promoting practice in a real-world PHC context. The study is expected to provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policy makers, managers, and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators.

Trial registration: ClinicalTrials.gov NCT04799860; https://ichgcp.net/clinical-trials-registry/NCT04799860.

International registered report identifier (irrid): DERR1-10.2196/37634.

Keywords: facilitation; health personnel; health promotion; implementation science; lifestyle; practice guideline; primary health care; qualitative research; quality improvement.

Conflict of interest statement

Conflicts of Interest: None declared.

©Emma Nilsing Strid, Lars Wallin, Ylva Nilsagård. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.08.2022.

Figures

Figure 1
Figure 1
Critical functions of process evaluation and their relations (blue boxes are key components of a process evaluation). Adapted from Moore et al [45] and modified for process evaluation of the Act in Time study.
Figure 2
Figure 2
Overview of the Act in Time study’s process evaluation components, research questions, and data sources. EF: external facilitator; IF: internal facilitator; PHC: primary health care. Adapted from Saarijärvi et al [58].
Figure 3
Figure 3
An overview of data collection including the timeline, target group, and methodology. FGD: focus group discussion; HCP: health care professional; PHC: primary health care.

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Source: PubMed

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