Ann Arbor VA Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, USA.
BMC Health Serv Res. 2011 Sep 30;11:248. doi: 10.1186/1472-6963-11-248.
In January 2006, Veterans Affairs (VA) disseminated the MOVE!® Weight Management Program to VA medical centers to address the high prevalence of overweight/obesity. In its second year, MOVE! implementation varied widely across facilities. The objective of this study was to understand contextual factors that facilitated or impeded implementation of MOVE! in VA medical centers in the second year after its dissemination.
We used an embedded mixed methods cross-sectional study design. Qualitative and quantitative data were collected simultaneously with the primary purpose to explore contextual factors most likely to influence MOVE! implementation effectiveness at five purposively selected facilities. Facilities were selected to maximize variation with respect to participation in MOVE! by candidate Veterans. Semi-structured phone interviews were conducted with 24 staff across the five facilities. Quantitative responses were elicited followed by open-ended questions. The quantitative measures were adapted from a published implementation model. Qualitative analysis was conducted using rigorous content analysis methods.
Qualitative and quantitative data converged to strengthen findings that point to several recommendations. Management support can help increase visibility of the program, commit needed resources, and communicate the importance of implementation efforts. Establishing a receptive implementation climate can be accomplished by emphasizing the important role that weight management may have in reducing incidence and severity of obesity-related chronic conditions. Coalescing highly functioning multi-disciplinary teams was an essential step for more effective implementation of MOVE!. In some situations, local champions can overcome challenging barriers in facilities that lack sufficient management support.
Key organizational factors at local VA medical centers were strongly associated with MOVE! implementation. Results pointed to recommendations that can help accelerate large-scale dissemination of complex weight management programs.
2006 年 1 月，退伍军人事务部（VA）向退伍军人事务医疗中心传播 MOVE！®体重管理计划，以解决超重/肥胖的高患病率。在第二年，MOVE！在设施之间的实施差异很大。本研究的目的是了解促进或阻碍 MOVE！在传播后的第二年在退伍军人事务医疗中心实施的环境因素。
我们使用了嵌入式混合方法的横断面研究设计。定性和定量数据同时收集，主要目的是探索在五个有目的选择的设施中最有可能影响 MOVE！实施效果的环境因素。这些设施是为了最大限度地增加有资格参加 MOVE！的退伍军人的参与度而选择的。对五个设施中的 24 名工作人员进行了半结构式电话访谈。定量反应后提出了开放式问题。定量测量方法改编自已发表的实施模型。定性分析采用严格的内容分析方法。
定性和定量数据的融合加强了研究结果，这些结果指出了一些建议。管理层的支持可以帮助提高项目的可见度，承诺所需的资源，并传达实施工作的重要性。通过强调体重管理在减少肥胖相关慢性病的发病率和严重程度方面可能发挥的重要作用，可以建立一个乐于接受的实施环境。形成高效的多学科团队是 MOVE！更有效实施的关键步骤。在某些情况下，当地的拥护者可以克服缺乏足够管理支持的设施中的挑战性障碍。
退伍军人事务医疗中心的关键组织因素与 MOVE！的实施密切相关。结果指出了一些建议，可以帮助加速复杂的体重管理项目的大规模传播。
