Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

Abstract

Purpose Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. Methods A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation and exploratory measures of program adoption and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interviews. We evaluated elements of the RE-AIM model (reach, adoption) to assess staff barriers to success for future scalability. Findings There were 27 patients and 8 staff completing measures. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. Conclusions The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity. Trial registration Clinicaltrials.gov NCT03309787. Registered on 16 October 2017.

Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members

“…To our knowledge, this is the first study to apply CFIR to identify facilitators and barriers of telehealth implementation within the CF community. It adds to a growing literature using CFIR to explore telehealth implementation in chronic conditions [ 17 , 21 , 22 ]. Our findings align with recent CF program surveys of telehealth implementation [ 13 , 23 ], and provide a narrative on providing high quality telehealth and navigating reimbursement.…”

“…The Consolidated Framework for Implementation Research (CFIR) is an established framework that can be used to evaluate implementation of health care delivery interventions [16] . It has been used to evaluate implementation of telemedicine-based interventions [17] , and in CF to analyze barriers and facilitators of mental health screening and treatment [18] . This paper used CFIR and thematic analysis to qualitatively identify facilitators and barriers to (a) providing high-quality telehealth care for CF, and (b) navigating telehealth reimbursement.…”

A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States

“…In more recent years, the Consolidated Framework for Implementation Research (CFIR) has been leveraged to guide telehealth service implementation initiatives [40][41][42][43]. Since its introduction in 2009, the CFIR has gained considerable popularity and recognition as an influential theoretical framework to inform both 'implementation science' and 'implementation strategy' [40].…”

Clinician Perspectives on Barriers and Facilitators to Implementing e-Health Technology in Substance Use Disorder (SUD) Treatment Facilities

“…Studies attempting to increase the use of telehealth and shared patient-provider decision-making found the use of the CFIR to be especially effective as a framework for their implementation projects. 25 - 27 Some of the most cited constructs that impacted implementation include complexity and source of the intervention, patient need for the intervention and access to the technology required, available resources to successfully implement the intervention, and compatibility of the intervention with the work and structure of the organization. 25 , 26 , 28 , 29 Organizations that assessed the alignment of their organizational characteristics with the CFIR constructs and used strategies presented by the CFIR for overcoming these barriers had more success with implementation.…”