Factors influencing the implementation of a lifestyle counseling program in patients with venous leg ulcers: a multiple case study

Abstract

BackgroundImplementation of lifestyle interventions in patient care is a major challenge. Understanding factors that influence implementation is a first step in programs to enhance uptake of these interventions. A lifestyle-counseling intervention, Lively Legs, delivered by trained nurses, can effectively improve the lifestyle in patients with venous leg ulcers. The aim of this study was to identify factors that hindered or facilitated implementation of this intervention in outpatient dermatology clinics and in home care.MethodsA mixed-methods multiple case study in five purposefully selected healthcare settings in the Netherlands was conducted. Measurements to identify influencing factors before and after implementation of Lively Legs included interviews, focus groups, questionnaires, and nurses’ registration. Analyses focused on qualitative data as the main data source. All data were compared across multiple cases to draw conclusions from the study as a whole.ResultsA total of 53 patients enrolled in the Lively Legs program, which was delivered by 12 trained nurses. Barriers for implementation were mainly organizational. It was difficult to effectively organize reaching and recruiting patients for the program, especially in home care. Main barriers were a lack of a standardized healthcare delivery process, insufficient nursing time, and a lack of motivated nurses to deliver the program. Facilitating factors were nurse-driven coordination of care and a standardized care process to tie Lively Legs into, as this resulted in better patient recruitment and better program implementation.ConclusionsThis study identified a range of factors influencing the implementation of a lifestyle-counseling program, mainly related to the organization of healthcare. Using a case study method proved valuable in obtaining insight into influencing factors for implementation. This study also shed light on a more general issue, which is that leg ulcer care is often fragmented, indicating that quality improvement is needed.

Evaluation of an occupation-based sleep programme for people with Insomnia

“…During the workshops, patients could learn from experience of each other, and the group interaction reinforced the engagement and motivation for change. This is consistent with research on coaching strategies in health care, which supported that it is an effective way to manage lifestyle health problems including obesity, diabetes, chronic ulcer, and chronic pain (Prah et al, 2017; van de Glind et al, 2012). Further studies could further examine how occupational coaching strategies could be systematically integrated into programmes for insomnia (Kessler & Graham, 2015).…”

Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study

“…The selection of these regions was based on regional spread of health promotion research institutes and on contact through related previous research performed by Van de Glind and Heinen et al (2012) [30]. Purposive sampling was used to include at least three GPs (preferably one in a solo practice, one in an healthcare centre and one in a general practice) and one PN (in a general practice or health care centre) in every region.…”

Exploring the Range of Lifestyle Interventions Used in Dutch Health Care Practice

“…Cardiology, (vascular) surgery, internal medicine, and pulmonary medicine were selected because of the high prevalence of lifestyle-related diseases among patients treated at these settings. We selected dermatology because of a previous collaboration in the development of a lifestyle program for patients with venous leg ulcers (van de Glind, Heinen, Evers, Wensing, & van Achterberg, 2012).…”