TY - JOUR
T1 - Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care
T2 - A Qualitative Assessment Based on the RE-AIM Framework
AU - Wozniak, Lisa
AU - Soprovich, Allison
AU - Mundt, Clark
AU - Johnson, Jeffrey A.
AU - Johnson, Steven T.
N1 - Funding Information:
This work was supported in part by a contract from Alberta Health , a grant from the Lawson Foundation and a Canadian Institutes for Health Research (CIHR) Team Grant to the Alliance for Canadian Health Outcomes Research in Diabetes (reference # OTG-88588), sponsored by the CIHR Institute of Nutrition, Metabolism and Diabetes . JAJ is a Senior Scholar with Alberta Innovates-Health Solutions (AIHS) and a Centennial Professor at the University of Alberta. The authors thank Ana Mladenovic for reviewing and editing an earlier draft of this manuscript.
Publisher Copyright:
© 2015 Canadian Diabetes Association.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Objective: The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management. Methods: We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10. Results: HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention "dose" inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process. Conclusions: Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.
AB - Objective: The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management. Methods: We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10. Results: HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention "dose" inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process. Conclusions: Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.
KW - Health program evaluation
KW - Physical activity
KW - Primary care
KW - RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance)
KW - Type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=84941875049&partnerID=8YFLogxK
U2 - 10.1016/j.jcjd.2015.05.003
DO - 10.1016/j.jcjd.2015.05.003
M3 - Journal Article
C2 - 26277222
AN - SCOPUS:84941875049
SN - 1499-2671
VL - 39
SP - S92-S99
JO - Canadian Journal of Diabetes
JF - Canadian Journal of Diabetes
IS - 3
ER -
