Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research
Abstract 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 primar...
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| Veröffentlicht in: | Translational behavioral medicine 2022-02, Vol.12 (2), p.214-224 |
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| creator | Espel-Huynh, Hallie M Goldstein, Carly M Stephens, Michael L Finnegan, Olivia L Elwy, A Rani Wing, Rena R Thomas, J Graham |
| description | Abstract
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.
Clinicians implementing online obesity treatment in primary care described many factors related to implementation success, most notably fit between the intervention and existing clinical practice |
| doi_str_mv | 10.1093/tbm/ibab160 |
| format | Article |
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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.
Clinicians implementing online obesity treatment in primary care described many factors related to implementation success, most notably fit between the intervention and existing clinical practice</description><identifier>ISSN: 1869-6716</identifier><identifier>EISSN: 1613-9860</identifier><identifier>DOI: 10.1093/tbm/ibab160</identifier><identifier>PMID: 34971381</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Behavior Therapy ; Care and treatment ; Humans ; Methods ; Obesity ; Obesity - therapy ; Physical Activity ; Primary Health Care ; Qualitative Research ; Telemedicine</subject><ispartof>Translational behavioral medicine, 2022-02, Vol.12 (2), p.214-224</ispartof><rights>Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. 2021</rights><rights>Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2022 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c479t-8772696d863308eb8decbd89a891eb23c5418fd98d6b654e79aa76d1767e1e83</citedby><cites>FETCH-LOGICAL-c479t-8772696d863308eb8decbd89a891eb23c5418fd98d6b654e79aa76d1767e1e83</cites><orcidid>0000-0001-8456-3465</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,778,782,883,1581,27907,27908</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34971381$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Espel-Huynh, Hallie M</creatorcontrib><creatorcontrib>Goldstein, Carly M</creatorcontrib><creatorcontrib>Stephens, Michael L</creatorcontrib><creatorcontrib>Finnegan, Olivia L</creatorcontrib><creatorcontrib>Elwy, A Rani</creatorcontrib><creatorcontrib>Wing, Rena R</creatorcontrib><creatorcontrib>Thomas, J Graham</creatorcontrib><title>Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research</title><title>Translational behavioral medicine</title><addtitle>Transl Behav Med</addtitle><description>Abstract
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.
Clinicians implementing online obesity treatment in primary care described many factors related to implementation success, most notably fit between the intervention and existing clinical practice</description><subject>Behavior Therapy</subject><subject>Care and treatment</subject><subject>Humans</subject><subject>Methods</subject><subject>Obesity</subject><subject>Obesity - therapy</subject><subject>Physical Activity</subject><subject>Primary Health Care</subject><subject>Qualitative Research</subject><subject>Telemedicine</subject><issn>1869-6716</issn><issn>1613-9860</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk2LFDEQhhtR3GXdk3cJCF6kd5Pp3nx4EJbBL1jwsveQj-qZaKczJOlZ94f5_6yhx8UVMTkkqTzvS1VRTfOS0QtGVXdZbbwM1ljG6ZPmlHHWtUpy-hTvkquWC8ZPmvNSvlFcPV8xwZ43J12vBOskO21-rtNU4UedzUjCNIwzTA4KSRMJcTdChKmaGvCZBgyOYQJiYWv2IWVUJAsl1HtSM5h6YNGD7HKIJt8TZzK8I0PKER32QGBvxnkx28zBgycWlVsgLk0ljcGbirEhmwh3KX8_KP9OIkMBk932RfNsMGOB8-N51tx-_HC7_tzefP30ZX1907peqNpKIVZccS9511EJVnpw1ktlpGJgV5276pkcvJKeW37Vg1DGCO6Z4AIYyO6seb_Y7mYbwTvMA6vWxwJ1MkE__pnCVm_SXkvZK0oZGrxeDDZmBI39TYi5GIrT14IqueKMUaQu_kHh9hADNgeGgPFHgreLwOVUSobhISVG9WEsNI6FPo4F0q_-rOKB_T0ECLxZgDTv_uv0C22cx5U</recordid><startdate>20220216</startdate><enddate>20220216</enddate><creator>Espel-Huynh, Hallie M</creator><creator>Goldstein, Carly M</creator><creator>Stephens, Michael L</creator><creator>Finnegan, Olivia L</creator><creator>Elwy, A Rani</creator><creator>Wing, Rena R</creator><creator>Thomas, J Graham</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8456-3465</orcidid></search><sort><creationdate>20220216</creationdate><title>Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research</title><author>Espel-Huynh, Hallie M ; Goldstein, Carly M ; Stephens, Michael L ; Finnegan, Olivia L ; Elwy, A Rani ; Wing, Rena R ; Thomas, J Graham</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-8772696d863308eb8decbd89a891eb23c5418fd98d6b654e79aa76d1767e1e83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Behavior Therapy</topic><topic>Care and treatment</topic><topic>Humans</topic><topic>Methods</topic><topic>Obesity</topic><topic>Obesity - therapy</topic><topic>Physical Activity</topic><topic>Primary Health Care</topic><topic>Qualitative Research</topic><topic>Telemedicine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Espel-Huynh, Hallie M</creatorcontrib><creatorcontrib>Goldstein, Carly M</creatorcontrib><creatorcontrib>Stephens, Michael L</creatorcontrib><creatorcontrib>Finnegan, Olivia L</creatorcontrib><creatorcontrib>Elwy, A Rani</creatorcontrib><creatorcontrib>Wing, Rena R</creatorcontrib><creatorcontrib>Thomas, J Graham</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Translational behavioral medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Espel-Huynh, Hallie M</au><au>Goldstein, Carly M</au><au>Stephens, Michael L</au><au>Finnegan, Olivia L</au><au>Elwy, A Rani</au><au>Wing, Rena R</au><au>Thomas, J Graham</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research</atitle><jtitle>Translational behavioral medicine</jtitle><addtitle>Transl Behav Med</addtitle><date>2022-02-16</date><risdate>2022</risdate><volume>12</volume><issue>2</issue><spage>214</spage><epage>224</epage><pages>214-224</pages><issn>1869-6716</issn><eissn>1613-9860</eissn><abstract>Abstract
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.
Clinicians implementing online obesity treatment in primary care described many factors related to implementation success, most notably fit between the intervention and existing clinical practice</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>34971381</pmid><doi>10.1093/tbm/ibab160</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-8456-3465</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Translational behavioral medicine, 2022-02, Vol.12 (2), p.214-224 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current) |
| subjects | Behavior Therapy Care and treatment Humans Methods Obesity Obesity - therapy Physical Activity Primary Health Care Qualitative Research Telemedicine |
| title | Contextual influences on implementation of online behavioral obesity treatment in primary care: formative evaluation guided by the consolidated framework for implementation research |
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