Peels Denise A, Boekhout Janet M, van Nassau Femke, Lechner Lilian, Bolman Catherine A W, Berendsen Brenda A J
Department of Psychology, Open University of the Netherlands, Heerlen, P.O. Box 2960, Heerlen, 6401 DL, The Netherlands.
Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
Implement Sci Commun. 2024 Aug 19;5(1):90. doi: 10.1186/s43058-024-00622-8.
Although there are many proven effective physical activity (PA) interventions for older adults, implementation in a real world setting is often limited. This study describes the systematic development of a multifaceted implementation intervention targeting the implementation of an evidence-based computer-tailored PA intervention and evaluates its use and feasibility.
The implementation intervention was developed following the Intervention Mapping (IM) protocol, supplemented with insights from implementation science literature. The implementation intervention targets the municipal healthcare policy advisors, as an important implementation stakeholder in Dutch healthcare system. The feasibility of the implementation intervention was studied among these stakeholders using a pretest-posttest design within 8 municipal healthcare settings. Quantitative questionnaires were used to assess task performance (i.e. achievement of performance objectives), and utilization of implementation strategies (as part of the intervention). Furthermore, changes in implementation determinants were studied by gathering quantitative data before, during and after applying the implementation intervention within a one-year period. Additionally, semi-structured interviews with stakeholders assessed their considerations regarding the feasibility of the implementation intervention.
A multi-faceted implementation intervention was developed in which implementation strategies (e.g. funding, educational materials, meetings, building a coalition) were selected to target the most relevant identified implementation determinants. Most implementation strategies were used as intended. Execution of performance objectives for adoption and implementation was relatively high (75-100%). Maintenance objectives were executed to a lesser degree (13-63%). No positive changes in implementation determinants were found. None of the stakeholders decided to continue implementation of the PA intervention further, mainly due to the unforeseen amount of labour and the disappointing reach of end-users.
The current study highlights the importance of a thorough feasibility study in addition to the use of IM. Although feasibility results may have demonstrated that stakeholders broadly accepted the implementation intervention, implementation determinants did not change favorably, and stakeholders had no plans to continue the PA intervention. Yet, choices made during the development of the implementation intervention (i.e. the operationalization of Implementation Mapping) might not have been optimal. The current study describes important lessons learned when developing an implementation intervention, and provides recommendations for developers of future implementation interventions.
尽管有许多已证实对老年人有效的体育活动（PA）干预措施，但在现实环境中的实施往往受到限制。本研究描述了针对基于证据的计算机定制PA干预措施实施的多方面实施干预措施的系统开发，并评估了其使用情况和可行性。
实施干预措施是按照干预映射（IM）协议开发的，并辅以实施科学文献中的见解。实施干预措施的目标是市政医疗保健政策顾问，他们是荷兰医疗保健系统中重要的实施利益相关者。在8个市政医疗保健环境中，采用前测-后测设计，在这些利益相关者中研究实施干预措施的可行性。定量问卷用于评估任务绩效（即绩效目标的达成情况）和实施策略的使用情况（作为干预措施的一部分）。此外，通过在一年时间内收集应用实施干预措施之前、期间和之后的定量数据，研究实施决定因素的变化。此外，对利益相关者进行半结构化访谈，评估他们对实施干预措施可行性的考虑。
开发了一种多方面的实施干预措施，其中选择了实施策略（如资金、教育材料、会议、建立联盟）来针对最相关的已确定实施决定因素。大多数实施策略按预期使用。采用和实施的绩效目标执行率相对较高（75-100%）。维持目标的执行程度较低（13-63%）。未发现实施决定因素有积极变化。没有一个利益相关者决定进一步继续实施PA干预措施，主要原因是劳动力数量意外以及最终用户的覆盖面令人失望。
本研究强调了除使用IM之外进行全面可行性研究的重要性。尽管可行性结果可能表明利益相关者广泛接受了实施干预措施，但实施决定因素并未产生有利变化，且利益相关者没有继续实施PA干预措施的计划。然而，在实施干预措施开发过程中做出的选择（即干预映射的操作化）可能并非最佳。本研究描述了开发实施干预措施时吸取的重要经验教训，并为未来实施干预措施的开发者提供了建议。
