Contextual factors associated with successful implementation of the evidence-based health promotion intervention Prescibe Vida Saludable

Heather L Rogers, Susana Pablo Harnando, Silvia Nunez-Fernandez, Alvaro Sanchez, Carlos Martos, Maribel Moreno, Gonzalo Grandes

Keywords: health promotion, implementation science, primary care

Background:
The benefits of primary care health promotion are well-documented, yet primary prevention lifestyle advice is not typical routine clinical practice in primary care.

Research questions:
This study aims to elucidate the contextual factors associated with the implementation effectiveness of an evidence-based health promotion intervention in primary care centers in Basque Country, Spain.

Method:
Seven primary care centers participated in the 'Prescribe Vida Saludable' (PVS) phase III intervention-implementation effectiveness trial. After 18 months of participation, centers were classified as having high, medium, or low implementation effectiveness based on the proportion of their population who received the 5A’s intervention . In this qualitative study, seven focus groups with the participating staff of six primary care centers were conducted. Three trained researchers coded the transcripts using The Consolidated Framework for Implementation Research (CFIR) codebook available here: https://cfirguide.org/constructs/.

Results:
Of the 36 CFIR constructs, 14 were associated with implementation performance: 2 intervention characteristics (relative advantage, adaptability), 1 outer setting construct (needs & resources), 4 inner setting constructs (structural characteristics, networks & communication, culture, implementation climate), 2 characteristics of individuals (self-efficacy, individual stage of change), and 5 process constructs (engaging, engaging champions, engaging external change agents, executing, reflecting & evaluating). Of these, three of the inner setting constructs and two of the process constructs (engaging champions, executing) were positively related with implementation effectiveness. In contrast, smaller centers had higher implementation effectiveness, indicating a negative relationship.

Conclusions:
Inner setting and process factors are especially important to effective implementation of health promotion interventions in primary care. In those centers with smaller size, strong existing communication networks among staff (e.g., regular meetings), a culture of teamwork, a favorable implementation climate, champions who promote the intervention and motivate colleagues, and the capacity to execute their planned strategy reached higher percentages of their assigned populations than those without these characteristics.

Points for discussion:
To what extent do you think that these factors, especially those related to inner setting, are modifiable?

Do you use implementation science frameworks in your own research? Why or why not?