Strid Emma Nilsing, Wallin Lars, Nilsagård Ylva
University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Health and Welfare, Dalarna University, Falun, Sweden.
JMIR Res Protoc. 2022 Aug 19;11(8):e37634. doi: 10.2196/37634.
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).
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.
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.
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.
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.
ClinicalTrials.gov NCT04799860; https://clinicaltrials.gov/ct2/show/NCT04799860.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37634.
越来越多的证据表明，非传染性疾病（NCDs）可归因于不健康的生活方式习惯。然而，这一知识在初级卫生保健（PHC）中的应用却很少。
本研究旨在评估在初级卫生保健环境中促进健康生活方式实践的多方面实施策略的过程和结果。这种实践基于针对具有非传染性疾病潜在风险的不健康生活方式习惯的国家指南。
在瑞典中部的一个初级卫生保健机构中采用带有对照组的实施前-后研究设计。将应用医学研究理事会关于复杂干预措施过程评估的指南。将使用定性和定量方法相结合的方式评估实施过程和结果。最多6个初级卫生保健中心的策略性样本将被纳入作为干预中心，这些中心将接受为期12个月的多方面实施策略。最多6个匹配的初级卫生保健中心将作为对照。实施策略的核心组成部分是符合卫生服务研究实施综合促进行动（i-PARIHS）框架和阿斯特拉坎变革领导模型的内部和外部促进因素。数据将在基线、实施阶段以及实施策略后的4 - 6个月收集。在实施前后，将向每个初级卫生保健中心的大约500名患者和200名医疗保健专业人员（HCPs）发送问卷。此外，将采用目的抽样法对管理人员、医疗保健专业人员、患者代表以及内部和外部促进因素进行访谈和焦点小组讨论。使用病历和活动日志中的数据将作为额外的数据来源。
初级卫生保健中心的招募于2021年3月开始，并于2022年春季结束。根据为期12个月的实施策略和4 - 6个月随访的计划时间表，我们预计在2023年夏季收集最终数据。
本研究将在真实世界的初级卫生保健背景下，使用多方面实施策略来解释促进健康生活方式实践的实施过程和结果。该研究有望提供关于促进因素的作用及其对实施结果贡献的新知识。这些发现可以指导政策制定者、管理人员和初级卫生保健工作人员在初级卫生保健中整合健康促进和疾病预防，并为促进因素提供方法学支持。
ClinicalTrials.gov NCT04799860；https://clinicaltrials.gov/ct2/show/NCT
国际注册报告标识符（IRRID）：DERR1-10.2196/37634。
