The implementation and sustainability of a combined lifestyle intervention in primary care: mixed method process evaluation

Berendsen, Brenda A J; Kremers, Stef; Savelberg, Hans; Schaper, Nicolaas C.; Hendriks, Marc

doi:10.1186/s12875-015-0254-5

Cited by 40 publications

(97 citation statements)

References 30 publications

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“…These findings align with the findings of this study that lack of coherence and cognitive participation were important barriers to implementation, and therefore may be important targets for intervention 25. Likewise, Berendsen et al 26 found the BeweegKuur (combined lifestyle intervention) was not implemented according to protocol and had poor sustainability because patient's expectations of the intervention were not met and tailoring to general practice and patient contexts was required. Moore et al 27 have also shown how implementation of an exercise intervention varied by patient characteristics and context.…”

Section: Discussionsupporting

confidence: 87%

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

2017

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ObjectiveTo explore how different practices responded to the Data-driven Quality Improvement in Primary Care (DQIP) intervention in terms of their adoption of the work, reorganisation to deliver the intended change in care to patients, and whether implementation was sustained over time.DesignMixed-methods parallel process evaluation of a cluster trial, reporting the comparative case study of purposively selected practices.SettingTen (30%) primary care practices participating in the trial from Scotland, UK.ResultsFour practices were sampled because they had large rapid reductions in targeted prescribing. They all had internal agreement that the topic mattered, made early plans to implement including assigning responsibility for work and regularly evaluated progress. However, how they internally organised the work varied. Six practices were sampled because they had initial implementation failure. Implementation failure occurred at different stages depending on practice context, including internal disagreement about whether the work was worthwhile, and intention but lack of capacity to implement or sustain implementation due to unfilled posts or sickness. Practice context was not fixed, and most practices with initial failed implementation adapted to deliver at least some elements. All interviewed participants valued the intervention because it was an innovative way to address on an important aspect of safety (although one of the non-interviewed general practitioners in one practice disagreed with this). Participants felt that reviewing existing prescribing did influence their future initiation of targeted drugs, but raised concerns about sustainability.ConclusionsVariation in implementation and effectiveness was associated with differences in how practices valued, engaged with and sustained the work required. Initial implementation failure varied with practice context, but was not static, with most practices at least partially implementing by the end of the trial. Practices organised their delivery of changed care to patients in ways which suited their context, emphasising the importance of flexibility in any future widespread implementation.Trial registration numberNCT01425502.

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Section: Discussionsupporting

confidence: 87%

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

2017

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“…22,27 Of note is the range of commitment and planning for SDT practices which are more consistent in the Scandinavian ERS literature. 28,29 Moreover, the holistic view of primary care practice for lifestyle behaviors compared to singular behaviors is more evident in these countries compared to the UK. This may provide a partial explanation for the diversity of findings in the literature.…”

Section: Introductionmentioning

confidence: 99%

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

Eynon

Foad

Downey

et al. 2019

Scandinavian Med Sci Sports

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This paper aimed to systematically review the evidence base to uncover the key psychosocial factors that underpin adherence to an exercise referral scheme (ERS).Databases PsycINFO, MEDLINE, SPORTDiscus, Web of Science, PubMed, PsycARTICLES, Open Grey, and PsycEXTRA were systematically searched. A parallel results-based convergent synthesis was performed by identifying key themes from quantitative and qualitative studies separately. After applying inclusion and exclusion criteria, the review included 24 eligible studies. Key findings showed intrinsic motivation, psychological need satisfaction, social support, and self-efficacy to be the prominent psychosocial factors associated with ERS adherence. In addition, lower expectations for change when entering the scheme was associated with ERS adherence. This review should serve as a catalyst to provide evidence-based ERS and as such ERS providers should seek to place an emphasis on participants' expectations and beliefs when entering the scheme. Moreover, targeting the key factors of intrinsic motivation, psychological need satisfaction, social support, and self-efficacy throughout the duration of an ERS should serve to facilitate adherence. K E Y W O R D Scorrelates, exercise maintenance, exercise prescription, GP referral, physical activity SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article.

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“…A significant effect was found, but the results must be carefully interpreted, because of the missing values and lack of power. Previous intervention programs also showed decreased fatigue in cancer survivors, therefore the effect of this program on fatigue should be further examined [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a lifestyle intervention program in primary care on physical and mental health and quality of life of cancer survivors: A pilot study

Beumeler

Waarsenburg²,

Booij

et al. 2018

European Journal of Integrative Medicine

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Introduction: Cancer survivors often suffer from fatigue and (mental) health impairments. Despite evidence for effectiveness, lifestyle interventions are seldom applied in their aftercare. The aim of this study was to assess feasibility of a lifestyle intervention program on physical and mental wellbeing and quality of life (QoL) of cancer survivors, and to get a first impression of effectiveness, by means of a pilot study. Methods: Nine subjects were enrolled in a 12-month lifestyle intervention pilot study without a control group, conducted in a Dutch primary care centre. The intervention consisted of individual and group lifestyle training focusing on diet, exercise and mind-body interaction. The main outcomes were physical and mental health and QoL. Results: All 9 subjects completed the 12-month lifestyle intervention program. We found a large positive effect on fatigue (r=-0.9), stress (r=-0.8) and anxiety (r=-0.9). With respect to quality of life, large improvements in vitality (r=0.7), role limitations due to physical health (r=-0.7), role limitations due to emotional problems (r=-0.8) and personal health experience (r=0.8) were found. Subjects' arm strength increased (r=0.9), but there were no significant changes in other physical parameters, depressive symptoms, social optimism and autonomy. Contradictory results were found for pain. Conclusion: Implementation of this lifestyle intervention program seems feasible in this small uncontrolled pilot study. The reduced QoL that is typical for cancer survivors was positively influenced by this program. Most prominent results were retrieved for fatigue and mental functioning, whereas little effects were found for physical health.

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The implementation and sustainability of a combined lifestyle intervention in primary care: mixed method process evaluation

Cited by 40 publications

References 30 publications

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing

Assessing the psychosocial factors associated with adherence to exercise referral schemes: A systematic review

Evaluation of a lifestyle intervention program in primary care on physical and mental health and quality of life of cancer survivors: A pilot study

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