A Longitudinal Mixed-Methods Examination of Positive Health Check: Implementation Results From a Type 1 Effectiveness-Implementation Hybrid Trial

Abstract

Background: Positive Health Check is an evidence-based video doctor intervention developed for improving the medication adherence, retention in care, and viral load suppression of people with HIV receiving clinical care.Setting: Four HIV primary care clinics within the United States. Methods:As part of a type 1 hybrid trial, a mixed-methods approach was used to longitudinally assess the following 3 key implementation constructs over a 23-month period: innovationvalues fit (ie, the extent to which staff perceive innovation use will foster the fulfillment of their values), organizational readiness for change (ie, the extent to which organizational members are psychologically and behaviorally prepared to implement organizational change), and implementation climate (ie, the extent to which implementation is expected, supported, and rewarded). Quantitative mixed-effects regression analyses were conducted to assess changes over time in these constructs. Qualitative analyses were integrated to help provide validation and understanding.Results: Innovation-values fit and organizational readiness for change were found to be high and relatively stable. However, significant curvilinear change over time was found for implementation climate. Based on the qualitative data, implementation climate declined toward the end of implementation because of decreased engagement from clinic champions and differences in priorities between research and clinic staff. Conclusions:The Positive Health Check intervention was found to fit within HIV primary care service settings, but there were some logistical challenges that needed to be addressed. Additionally, even within the context of an effectiveness trial, significant and nonlinear change in implementation climate should be expected over time.

From innovative applications of the effectiveness-implementation hybrid trial design to the dissemination, implementation, effectiveness, sustainment, economics, and level-of-scaling hybrid trial design

“…More specifically, both quantitative surveys and qualitative interviews were conducted at baseline and then every 3 months over a 23-month period to collect the eight data time points used to test for statistically significant changes over time in an innovation-values fit measure developed for the PHC intervention (12), a measure of organizational readiness for implementation change developed by Shea et al ( 17) and a measure of implementation climate developed by Jacob et al (18). As recently reported by Garner et al (19) there were not a significant changes over time found for innovation-values fit or organizational readiness for implementing change, but there was significant change over time for implementation climate.…”

Perioperative mental health intervention for depression and anxiety symptoms in older adults study protocol: design and methods for three linked randomised controlled trials

“…Similar to other hybrid effectiveness-implementation RCTs,98–101 the qualitative assessments will be used to help provide context to the quantitative findings in order to draw conclusions about reach, implementation, acceptability, feasibility and appropriateness of the intervention.…”

Effectiveness of an Interactive, Highly Tailored “Video Doctor” Intervention to Suppress Viral Load and Retain Patients With HIV in Clinical Care: A Randomized Clinical Trial

“…This article presents the effectiveness outcomes. The companion article by Garner et al 17 examines the implementation outcomes that were assessed in this trial.…”