Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research.

Autor:	Espel-Huynh HM; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA., Goldstein CM; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA., Stephens ML; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA., Finnegan OL; Department of Kinesiology, University of Rhode Island, Kingston, RI, USA., Elwy AR; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.; Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA., Wing RR; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA., Thomas JG; Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA.; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
Jazyk:	angličtina
Zdroj:	Translational behavioral medicine [Transl Behav Med] 2022 Feb 16; Vol. 12 (2), pp. 214-224.
DOI:	10.1093/tbm/ibab160
Abstrakt:	Online behavioral obesity treatment is a promising first-line approach to weight management in primary care. However, little is known about contextual influences on implementation. Understand qualitative contextual factors that affect the implementation process, as experienced by key primary care stakeholders implementing the program. Online behavioral obesity treatment was implemented across a 60-clinic primary care practice network. Patients were enrolled by nurse care managers (NCMs; N = 14), each serving 2-5 practices. NCMs were randomized to one of two implementation conditions-"Basic" (standard implementation) or "Enhanced" (i.e., with added patient tracking features and more implementation strategies employed). NCMs completed qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed and analyzed via directed content analysis. Emergent categories were summarized by implementation condition and assigned a valence according to positive/negative influence. Individuals in the Enhanced condition viewed two aspects of the intervention as more positively influencing than Basic NCMs: Design Quality & Packaging (i.e., online program aesthetics), and Cost (i.e., no-cost program, clinician time savings). In both conditions, strongly facilitating factors included: Compatibility between intervention and clinical context; Intervention Source (from a trusted local university); and Evidence Strength & Quality supporting effectiveness. Findings highlight the importance of considering stakeholders' perspectives on the most valued types of evidence when introducing a new intervention, ensuring the program aligns with organizational priorities, and considering how training resources and feedback on patient progress can improve implementation success for online behavioral obesity treatment in primary care. (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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