Keywords: Implementation strategy; Fidelity; Health promotion; Diabetes prevention

Background:

Assessing implementation strategy fidelity is important to understand why and how the strategy influences the uptake of evidence-based interventions.

Research questions:

What is the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC?

Method:

Nine PC centers from the Basque Health Service were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts. One group used a Global procedure, promoting the cooperation of all healthcare professionals from the beginning. The other group used a Sequential procedure, centered first on nurses who then engaged physicians. Process indicators of the delivery and receipt of implementation strategy actions, documented modifications to the planned implementation strategy, and a structured group interview with centers' leaders were conducted to assess adherence, dose, quality of delivery, professionals' responsiveness and program differentiation.

Results:

Generally, the procedures compared for engagement and deployment were carried out with the planned differentiation although some between-group differences were observed. Initial collaboration rate of nurses was higher in the Sequential vs Global group (93% vs. 67%). Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies' perceived usefulness was overwhelmingly positive, with few differences between groups.

Conclusions:

The implementation strategy was implemented with high fidelity and minor unplanned reactive modifications. Professionals' exposure to the implementation strategy was high in both groups. The centers' organizational context (i.e., work overload) led to small mismatches between groups in participation and professionals' exposure to implementation actions.

Points for discussion:

What role do primary care nurses play on primary care teams in your practice, especially regarding care for chronic conditions?

In your own research, are unplanned reactive modifications to interventions and/or implementation strategies common? How do you manage them?

In your own research, how do you measure fidelity of an intervention and/or implementation strategy?