Process evaluations of primary care interventions addressing chronic disease: a systematic review

Liu, Hueiming; Alim, Mohammed; Shanthosh, Janani; Laba, Tracey‐Lea; Hackett, Maree L.; Peiris, David; Jan, Stephen

doi:10.1136/bmjopen-2018-025127

Cited by 33 publications

(51 citation statements)

References 70 publications

(120 reference statements)

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“…For these reasons, there is an urgent need for approaches that address complex problems related to access and quality of health care [10]. However, a recent systematic review of process evaluation studies of complex interventions focused on chronic diseases found a lack of alignment between local needs expressed by stakeholders and the interventions implemented [13]. It was also found that limited knowledge of the health system could affect the implementation of interventions.…”

Section: Introductionmentioning

confidence: 99%

Lessons learned about co-creation: developing a complex intervention in rural Peru

Lazo-Porras

Perez-Leon

Cárdenas

et al. 2020

Global Health Action

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Background: Co-creation is the process of involving stakeholders in the development of interventions. Although co-creation is becoming more widespread, reports of the process and lessons learned are scarce. Objective: To describe the process and lessons learned from using the COHESION manual, a co-creation methodology to develop interventions aimed at the improvement of diagnosis and/or management of chronic diseases at the primary healthcare level in a low-resource setting in Peru. Methods: Observational study to describe the use of the COHESION manual 'Moving from Research to Interventions: The COHESION Model' developed for a multi-country project in low-and middle-income countries for co-creation and the adaptations needed to customize it to the local context of rural communities in northern Peru. Results: The actual process of co-creation in Peru included co-creation-related questions in the formative research; an initial consultation with stakeholders at the micro, meso, and macro levels (e.g. community members, health workers, and policy-makers); the analysis of the collected data; a second consultation with each stakeholder group; the prioritization of intervention options; and finally the design of a theory of change for all activities included in the complex intervention. The complex intervention included: 1) offer training in specific diseases and soft skills to health workers, 2) create radio programs that promote chronic disease prevention and management plus empower patients to ask questions during their visits to primary health care (PHC) facilities, and 3) provide a small grant to the PHC for infrastructure improvement. Small adaptations to the COHESION manual were necessary for this co-creation process. Conclusion: This study provides a practical example of the process of co-creating complex interventions to increase access and quality of health care in a low-resource setting. The process, components, challenges and opportunities identified could be useful for other researchers who want to co-create interventions with beneficiaries in similar settings.

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Section: Introductionmentioning

confidence: 99%

Lessons learned about co-creation: developing a complex intervention in rural Peru

Lazo-Porras

Perez-Leon

Cárdenas

et al. 2020

Global Health Action

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“…The major strengths of this study lie in the application of existing theoretical frameworks – MRC guidelines and CFIR – that enabled a more systematic approach to data collection and analysis and also increases the replicability and generalizability of study findings [ 7 , 39 ]. Additionally, triangulation of qualitative and quantitative data provides different perspectives on aspects of program implementation.…”

Section: Discussionmentioning

confidence: 99%

Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation

et al. 2021

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Background Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation. Methods Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase. Results Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity. Conclusion These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD. Trial registration ClinicalTrials.gov, NCT02727478, registered 30 march, 2016 − Retrospectively registered.

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“…As in many other process evaluations, we will use maximum variation sampling on sociodemographic characteristics and baseline adherence, alongside triangulation, to minimise the risk of bias. 102 Additionally, readers should be aware that small-scale feasibility work does not generalise in every regard when scaled up in larger scale studies. 103 104 Finally, early health economic modelling of the cost-effectiveness, 105 was not updated as part of this feasibility work, but will be revisited in 2021 as part of the full-scale evaluation.…”

Section: Discussionmentioning

confidence: 99%

Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation

et al. 2020

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ObjectivesTo undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.SettingTwo UK cystic fibrosis (CF) units.ParticipantsFourteen adult PWCF; three professionals delivering adherence support (‘interventionists’); five multi-disciplinary CF team members.InterventionsNebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).Primary and secondary measuresFeasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.ResultsInterventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%–92%, respectively, indicating that interventionists needed to focus more on intervention ‘active ingredients’ during sessions.ConclusionsThe process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.Trial registration numberISRCTN13076797; Results.

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Process evaluations of primary care interventions addressing chronic disease: a systematic review

Cited by 33 publications

References 70 publications

Lessons learned about co-creation: developing a complex intervention in rural Peru

Lessons learned about co-creation: developing a complex intervention in rural Peru

Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation

Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation

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