Evaluating the Implementation of a Mobile Phone–Based Telemonitoring Program: Longitudinal Study Guided by the Consolidated Framework for Implementation Research

Abstract

BackgroundTelemonitoring has shown promise for alleviating the burden of heart failure on individuals and health systems. However, real-world implementation of sustained programs is rare.ObjectiveThe objective of this study was to evaluate the implementation of a mobile phone–based telemonitoring program, which has been implemented as part of standard care in a specialty heart function clinic by answering two research questions: (1) To what extent was the telemonitoring program successfully implemented? (2) What were the barriers and facilitators to implementing the telemonitoring program?MethodsWe conducted a longitudinal single case study. The implementation success was evaluated using the following four implementation outcomes: adoption, penetration, feasibility, and fidelity. Semistructured interviews based on the Consolidated Framework for Implementation Research (CFIR) were conducted at 0, 4, and 12 months with 12 program staff members to identify the barriers and facilitators of the implementation.ResultsOne year after the implementation, 98 patients and 8 clinicians were enrolled in the program. Despite minor technical issues, the intervention was used as intended. We obtained qualitative data from clinicians (n=8) and implementation staff members (n=4) for 24 CFIR constructs. A total of 12 constructs were facilitators clustered in the CFIR domains of inner setting (culture, tension for change, compatibility, relative priority, learning climate, leadership engagement, and available resources), characteristics of individuals (knowledge and beliefs about the intervention and self-efficacy), and process (engaging and reflecting and evaluating). In addition, we identified other notable facilitators from the characteristics of the intervention domain (relative advantage and adaptability) and the outer setting (patient needs and resources). Four constructs were perceived as minor barriers— the complexity of the intervention, cost, inadequate communication among high-level stakeholders, and the absence of a formal implementation plan. The remaining CFIR constructs had a neutral impact on the overall implementation.ConclusionsThis is the first comprehensive evaluation of the implementation of a mobile phone–based telemonitoring program. Although the acceptability of the telemonitoring system was high, the strongest facilitators to the implementation success were related to the implementation context. By identifying what works and what does not in a real-world clinical context using a framework-guided approach, this work will inform the design of telemonitoring services and implementation strategies of similar telemonitoring interventions.

Defining and assessing context in healthcare implementation studies: a systematic review

“…Articles provide a rich definition of an aspect of context or provide a comprehensive definition of sub-elements of a framework that includes context "Organisational climate is conceptualised as individual and group perceptions of how the work environment affects the well-being of the organisations members while organisational culture is conceptualised as how the work is done in the organisation based on worker expectations" [28]. [36,48,60,82], at district level [50,68,74] or at a national level within health systems [40]. For some articles, it was unclear which care setting the research was conducted [44,46,51,54,71,77,83,86].…”

User-Centered Adaptation of an Existing Heart Failure Telemonitoring Program to Ensure Sustainability and Scalability: Qualitative Study (Preprint)

“…A previous study concluded the initial implementation to be a success based on the degree of integration within the clinic, patient adoption, and fidelity of program delivery as part of the standard of care [16]. However, this study also identified important barriers related to the cost of the equipment and supporting human resources which could hinder the sustainability and scalability of this program [16].…”

“…A previous study concluded the initial implementation to be a success based on the degree of integration within the clinic, patient adoption, and fidelity of program delivery as part of the standard of care [16]. However, this study also identified important barriers related to the cost of the equipment and supporting human resources which could hinder the sustainability and scalability of this program [16]. The objectives of this paper are (1) to understand which components of the TM program could be modified to reduce costs and adapted to other local contexts while maintaining program fidelity; and (2) to describe the changes made to the TM program to enable its sustainability within the initial implementation site and scalability to other health organizations.…”

“…In addition, the THA role includes the management of inventory and onsite face-to-face training for each new user. Further details of the program have been published elsewhere [16,17].…”

Exploring perspectives, preferences and needs of a telemonitoring program for women at high risk for preeclampsia in a tertiary health facility of Karachi: a qualitative study protocol

“…The aim of this study is to explore the perspectives, preferences and needs of TM for pregnant women at HRPE in Karachi, to inform a potential future implementation. In particular, a smartphone-based TM platform developed in Canada is being considered as a possible system for TM of pregnant women at HRPE in Karachi [35][36][37][38][39][40][41][42][43][44]. The TM platform includes a smartphone app that automatically transfers blood pressure readings wirelessly from a blood pressure home monitor and sends automated alerts to providers and self-care instructions to the patient based on their readings.…”