Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals' evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.

Background Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline health care providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine frontline provider and middle-level manager individual readiness for change in the context of primary care program integration. Methods Using a qualitative case study approach, we examined how individuals in frontline provider and middle manager positions experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Primary data consisted of semi-structured interviews with frontline providers and middle managers involved in the change, and meeting observation notes. Data were analyzed using first-cycle descriptive coding followed by second-cycle coding. Results The findings show that lack of clear lines of authority and communication have a cascading influence across the levels in the organization, and can hinder readiness for change at the middle manager and frontline provider levels. The findings also show that the notion of valence should be expanded to consider individuals’ evaluation of benefits not only to themselves but also to patients and the health system; that efficacy applies to both content and process of change; that both fairness and trust in management need to be more centrally incorporated in models of readiness for change. Conclusions Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the importance of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout various levels of the organization.

Background Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors that affect patients’ use behavior. Objective The aim of this study was to explore the social and behavioral factors contributing to patients’ use behavior of an mHealth app called the electronic Patient-Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. Methods A descriptive qualitative study was used to analyze interview data collected for a larger mixed methods pragmatic trial. The original 15-month trial was conducted in 6 primary care teams across Ontario, Canada, between 2018 and 2019. The eligibility criteria for patients were being aged ≥60 years with ≥10 visits within the previous 12 months of study enrollment. For this analysis, patients were classified as long-term or short-term users based on their length of use of the ePRO app during the trial. The Social Cognitive Theory by Bandura was used to categorize social-behavioral factors that contributed to patients’ decision to continue or discontinue using the app. Results The patient-provider relationship emerged as a key factor that shaped patients’ experiences with the app and subsequent decision to continue using the app. Other factors that contributed to patients’ decision to continue using the app were personal and social circumstances, perceived usefulness, patients’ previous experience with goal-related behaviors, and confidence in one’s capability. There was an overlap of experience between long- and short-term app users but, in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term app users. This observation was complicated by the fact that patient health-related goals were dynamic and changed over time. Conclusions Complex patients’ use behavior of a goal-supporting mHealth app is shaped by an array of sociobehavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. Trial Registration ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954

Background Virtual models of health service delivery are being offered to patients diagnosed and recovering from COVID-19 as a key strategy to minimize the spread of the variants. Although evidence is growing in this area, more is needed to understand the experiences and perceptions of patients and their care partners associated with virtual and telehealth care to inform future care delivery efforts beyond our current pandemic. In this context, a study was undertaken to explore a virtual primary home care program led by a nurse practitioner developed for acute and post-acute COVID-19 patients and their care partners. Methods The study employed a mixed methods design that included a cross-sectional patient survey and semi-structured interviews with a sample of COVID-19 patients. Results The CC@H program was reported by study participants to have several positive benefits including needs being met and better able to manage their care at home. Qualitative results further elucidated three key themes easing anxiety by providing emotional support and checking in; 2) providing holistic compassionate care to enable self-management; and 3) viewing virtual care as efficient and convenient. Conclusions Our study provides interesting insights into the experiences and perceptions of COVID-19 patients receiving care through a primary health care nurse practitioner-lead virtual care program that may be useful to other organizational efforts.

BACKGROUND Although mobile health (mHealth) applications are increasingly being used to support patients with multiple chronic conditions (multimorbidity), the majority of mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, it is important to understand social-behavioral factors that impact patients’ usage behavior when developing a mHealth program. OBJECTIVE This study aims to explore the social and behavioral factors contributing to the patients’ usage behavior of a mHealth app called the electronic Patient Reported Outcome (ePRO). The ePRO app supports goal-oriented care delivery in interdisciplinary primary care models. METHODS A descriptive qualitative study was used to analyze interview data collected for a larger mixed-method pragmatic trial. The original 15-month trial was conducted in six primary care teams across Ontario between 2018 and 2019. For this analysis, patients were classified as long-term or short-term users based on their length of usage of the ePRO app during the trial. Bandura’s Social Cognitive Theory (SCT) was used to categorize social-behavioral factors that contributed to patients' decisions to continue/discontinue the app. RESULTS The patient-provider relationship emerged as a key factor that shaped patients’ experiences with the app and subsequent decisions to continue using the app. Other factors that contributed to the patients’ decisions to continue using the app were: personal and social circumstances, perceived usefulness, patients’ prior experience in goal-related behaviors, and confidence in one’s capability to achieve goals and/or use technology. There was an overlap of experience between long-term and short-term app users but in general, long-term users perceived the app to be more useful and their goals to be more meaningful than short-term users. This observation was complicated by the fact that patient health-related goals are dynamic and changed over time. CONCLUSIONS Multimorbid patients’ usage behavior of a goal-supporting mHealth is shaped by an array of socio-behavioral factors that can evolve. To tackle this dynamism, there should be an emphasis on creating adaptable health technologies that are easily customizable by patients and able to respond to their changing contexts and needs. CLINICALTRIAL ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954