Purpose
The examination of implementation process in translation research can inform other interventions’ modifications for different socio-cultural contexts. The purpose of this paper is to answer key implementation questions of a primary-care based, nurse-community health worker (CHW) team intervention to support type 2 diabetes self-management, as part of a randomized trial: 1) How was the evidence-based model adapted? 2) How were CHWs trained and supervised? 3) What was fidelity to protocols? 4) What were intervention costs? Lessons learned during implementation are also discussed.
Methods
Descriptive data are given on intervention delivery, CHW visit content, patient safety and intervention costs, along with statistical analyses to examine participant characteristics of higher attendance at visits.
Results
In the intervention sample (n=104), 74% (SD 16) of planned intervention visits occurred, guided by an algorithm-based protocol. Higher risk participants had a significantly lower dose of their weekly assigned visits (66%), than those at moderate (74%) and lower risk (90%). Twenty-eight percent of participants moved to a lower risk group over the year. Estimated intervention cost was $656 per person. Participants with less education were more likely to attend optimal percent of visits.
Conclusions
A nurse-CHW team can deliver a culturally adapted diabetes self-management support intervention with excellent fidelity to the algorithm-based protocols. The team accommodated participants’ needs by meeting them whenever and wherever they could. This study provides an example of adaptation of an evidence-based model to the Samoan cultural context and its resource-poor setting.