Factors affecting the implementation of a comprehensive intervention program for prevention of cardiovascular diseases in community settings in Belgium

Kathleen Van Royen, Naomi Aerts, Hamid Hassen, Hilde Bastiaens

Keywords: CVD prevention, local community settings, participatory action research, socio economically disadvantaged groups

Background:

Involving accessible community welfare organizations provide an opportunity to reach people living in vulnerable conditions who are often most at risk for cardiovascular diseases (CVD). In order to amplify systematic implementation of primary prevention of CVD in these settings, insight is needed in factors that determine successful implementation.

Research questions:

Which factors influence reach, adoption, implementation and maintenance of a comprehensive evidence-based prevention program for CVD in local community settings

Method:

A qualitative study with participatory action research approach was used to evaluate the implementation process of a comprehensive CVD intervention program in local community organizations. The program consisted of risk assessment of adults (40-75 yrs) and lifestyle coaching. Semi-structured interviews (N=22), comprising both individual and group interviews, were conducted with stakeholders, including implementers, coaches and volunteers.
With the aid of NVivo 1.5.1, an adaptive framework analysis was used according to the RE-AIM and CFIR frameworks.

Results:

Most significant identified facilitators included structural characteristics of local welfare organizations (e.g., trusted organizations); the adaptability of the intervention to the local needs of the organization and the target group; the compatibility with existing workflows; the ownership and engagement of the implementers; and organizational priority for prevention. Significant barriers included the complexity of the intervention; low compatibility for some settings; competition for other priorities/projects in a scattered healthcare landscape; and lack of resources such as time.

Conclusions:

Co-development and adaptability of the intervention to the local organizational needs, is a relevant strategy to enhance adoption, fidelity and maintenance of an evidence-based intervention program in the community. To tackle barriers such as lack of time and competition for other projects, it will be important to enhance collaboration between smaller local organizations. Emphasizing the added value and the quality of the intervention program, is crucial to support more leadership engagement which is key to a successful, adoption, implementation and maintenance.

Points for discussion:

How to further enhance the link between community welfare organizations and the primary care for primary CVD prevention

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