Developing and tailoring a complex intervention for the primary prevention of cardiovascular disease prior to its implementation in general practices in Belgium

Naomi Aerts, Sibyl Anthierens, Kathleen Van Royen, Lieve Peremans, Peter Van Bogaert, Hilde Bastiaens

Keywords: implementation, intervention development, general practice, primary care

Cardiovascular diseases (CVDs) are the world’s leading cause of mortality. CVD and risk factors can be prevented by addressing unhealthy lifestyle behaviors. In Belgium, contextual factors pose a burden on primary health care and despite national guidelines, systematic implementation of prevention is lacking. This work is part of Horizon 2020 project ‘SPICES’, which aims to implement risk profiling and communication, and behavior change counseling.

Research questions:
Our aim was to design and tailor an evidence based complex intervention for the primary prevention of CVD, prior to its implementation in general practices in vulnerable city districts in Belgium.

Development of the intervention was based on a systematic review of international guidelines and a contextual analysis with stakeholder interviews. Acceptability, adoption and appropriateness were assessed through interviews and implementation strategies were tailored to the resources, needs and preferences of the implementers at general practice level. Our participatory action research design allows ongoing process evaluation throughout the implementation to adapt the intervention or strategies where needed.

The intervention is designed to support awareness of CVD risk and modification and maintenance of healthy lifestyle behaviors to decrease individual CVD risk. We developed a guidebook to communicate the individual CVD risk as a result. The behavior change counseling component consists of ten lifestyle coaching sessions with set intervals, delivered by a practice nurse over one year, in interaction with the available community resources. Given the implementers’ concerns around intervention complexity and competence gap, one of the most important implementation strategies applied is training of all providers of one or more components of the intervention, prior to the implementation.

This study provides a practical example of translating evidence into practice, outlining the development and tailoring of an evidence based intervention designed in co-creation with multi-level stakeholders to reduce the risk of CVD.

Points for discussion:
Used methodology and approach.

The process of implementing evidence-based interventions GP practices in other contexts.