Implementation of the SMART MOVE intervention in primary care: a qualitative study using normalisation process theory

Abstract

BackgroundProblematic translational gaps continue to exist between demonstrating the positive impact of healthcare interventions in research settings and their implementation into routine daily practice. The aim of this qualitative evaluation of the SMART MOVE trial was to conduct a theoretically informed analysis, using normalisation process theory, of the potential barriers and levers to the implementation of a mhealth intervention to promote physical activity in primary care.MethodsThe study took place in the West of Ireland with recruitment in the community from the Clare Primary Care Network. SMART MOVE trial participants and the staff from four primary care centres were invited to take part and all agreed to do so. A qualitative methodology with a combination of focus groups (general practitioners, practice nurses and non-clinical staff from four separate primary care centres, n = 14) and individual semi-structured interviews (intervention and control SMART MOVE trial participants, n = 4) with purposeful sampling utilising the principles of Framework Analysis was utilised. The Normalisation Process Theory was used to develop the topic guide for the interviews and also informed the data analysis process.ResultsFour themes emerged from the analysis: personal and professional exercise strategies; roles and responsibilities to support active engagement; utilisation challenges; and evaluation, adoption and adherence. It was evident that introducing a new healthcare intervention demands a comprehensive evaluation of the intervention itself and also the environment in which it is to operate. Despite certain obstacles, the opportunity exists for the successful implementation of a novel healthcare intervention that addresses a hitherto unresolved healthcare need, provided that the intervention has strong usability attributes for both disseminators and target users and coheres strongly with the core objectives and culture of the health care environment in which it is to operate.ConclusionWe carried out a theoretical analysis of stakeholder informed barriers and levers to the implementation of a novel exercise promotion tool in the Irish primary care setting. We believe that this process amplifies the implementation potential of such an intervention in primary care. The SMART MOVE trial is registered at Current Controlled Trials (ISRCTN99944116; Date of registration: 1st August 2012).

Usability and utility of eHealth for physical activity counselling in primary health care: a scoping review

“…Ten out of 30 articles focused on a stand-alone PA domain [ 18 , 21 , 28 , 30 , 31 , 34 , 35 , 37 – 39 ]. The rest of the articles embedded other components of health behaviours or counselling domains.…”

“…Of 17 articles published from 2014 to 2019, more than half ( n = 10) obviously presented the use of mobile technologies (e.g. smartphone, tablet) [ 21 , 28 , 30 , 31 , 34 , 39 , 40 , 42 , 51 , 52 ], while some programmes were potential to access by mobile devices (Table 2 and Additional file 2 ) [ 20 , 32 ].…”

“…Parekh et al investigated the short-term and long-term effects of eHealth at 3 months and 12 months [ 49 , 50 ]. An intervention, SMART MOVE, conducted in Ireland were published in different occasions, including qualitative studies and a randomised controlled trial [ 21 , 28 , 30 ]. The research group in the Netherlands produced ‘It’s LiFe!’ as an intervention for promoting PA in PHC [ 31 , 34 , 39 ].…”

“…While some eHealth tools were used in a combination of multiple face-to-face consultations [ 31 , 34 , 39 ]. Some articles presented the use of a mobile app, as part of the intervention, to provide PA tracking and tailored feedback [ 21 , 28 , 30 ].…”

“…easiness) and dissatisfaction in diverse factors (e.g. time consumption, phone battery consumption, technological issues) [ 18 , 28 , 30 , 51 ]. An article (7.69%) published in 2004 noted that the internet based programme was complicated for patients [ 36 ].…”