Background
Methods
Conceptual framework
Intervention overview
Setting
Design
Organizational situation
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Organizational readiness to change
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Degree to which organization members perceive that the organization, as opposed to the individual, is prepared to implement a specific intervention. | |||
Positive factors | Negative factors | ||
+ | Buy-in from administration | - | Nurse commitment hard to gauge |
+ | Buy-in from providers | - | Nurses may be reluctant because of other job tasks |
+ | Clinic accustomed to innovation | - | Clinic leaders don’t know what to expect |
+ | Dovetails with priorities | - | Implementation has taken a back seat |
+ | Clinic is committed b/c benefits are understood in terms of research, medical understanding and telehealth | ||
+ | Core team is committed and communicating that, and wouldn't do if it wasn’t important | ||
Change valence
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Value that organizational members attribute to a proposed change. | |||
Positive factors | |||
+ | Research is part of culture | ||
+ | Self-management behavioral interventions viewed positively | ||
+ | Increased access to care | ||
+ | Clinicians view program will be beneficial for patients | ||
+ | Extremely important to control BP | ||
RN scope of practice
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+ | Better job satisfaction | ||
+ | Active in patient panel | ||
+ | Active in population management | ||
+ | Using more skills as nurses | ||
+ | Better job satisfaction | ||
Change valence is temporary (these are both positive &
negative factors)
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+/− | Buy-in from patients needed | ||
+/− | Patient perspective is needed in implementation and evaluation | ||
+/− | Belief in program will depend on seeing evidence; thinks maybe the key is in not letting patients fall through the cracks | ||
+/− | Feedback from patients on satisfaction with program is important | ||
+/− | Interested to see if Motivational Interviewing affects HTN patient self-management | ||
+/− | Success depends on seeing patient data measurements (BP control; smoking; weight) | ||
+/− | Wait and see attitude | ||
+/− | Qualitative and quantitative evidence is important for continued success | ||
Situational factors
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Organizational contextual situations that affect the confidence and commitment of organizational members to implement the intervention | |||
Positive factors | Negative factors | ||
Timing of change effort
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+ | Aligns with clinic workflow and External Peer Review Program (EPRP) | - | Length of time to implementation is a barrier |
+ | Aligns with values of PACT (patient-centered care & care teams) | - | Can’t remember what HTN Improve is |
+ | Other programs will support HTNI (e.g., telehealth, MOVE, Pact, HTN clinic) | - | Don’t know what happened to HTN Improve |
+ | Will be better or add to current programs/patient contact frequency | - | Eager to start |
Technology
| - | Long time ago | |
+ | Will be added to existing technology infrastructure | - | Many existing BP interventions |
- | Need to make PCP aware of program | ||
Time available
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- | Clinic visit time is limited to introduce patients to the intervention | ||
- | Nurses are concerned about time available | ||
Technology
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- | Security challenges with access to software | ||
- | Interoperability issues | ||
Task demands
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Knowledge about the tasks that need to be performed, resources that are needed, and the time and effort that are needed to implement the intervention | |||
Positive factors | Negative factors | ||
+ | Behavioral self-management intervention | - | Coordinating outreach to patient could be a burden |
+ | RN delivered calls | - | Implementation will be seen as adding one more thing to a nurse’s full plate |
- | Another clinical reminder | ||
- | Contacting patients is challenging | ||
- | Integration into existing workflow with minimal steps is needed | ||
Resource perceptions
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Access to financial, material, or human assets to support implementation and ongoing use of the intervention | |||
+ | Have office space | - | Need a dedicated research staff |
+ | Have staffing for HTNI | - | Staffing is an issue |
+ | Use existing equipment | ||
+ | Have IT support | ||
+ | Fairly knowledgeable about intervention | ||
Contextual factors
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Broader contextual conditions that affect organizational readiness for change | |||
+ | Clinic accustomed to innovation | - | No dedicated research staff |
+ | Research is part of the culture | - | IT is undergoing infrastructure change |
+ | Past experience with implementing research | ||
+ | Other programs will support HTNI (e.g., telehealth, MOVE, Pact, HTN clinic) | ||
+ | Telemedicine is part of the VA culture and delivered by RNs |
Qualitative analysis
N | Mean | Standard deviation | Fairly/very confident | Not at all/A little confident | Don’t know | |
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Efficacy (Imp. Group)
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Use resources effectively | 71 | 3.28 | 0.70 | 82% | 8% | 10% |
Encourage clinicians to try program | 74 | 3.20 | 0.72 | 80% | 14% | 6% |
Coordinate implementation efforts | 72 | 3.25 | 0.62 | 82% | 9% | 9% |
Support clinicians as they adjust | 71 | 3.15 | 0.71 | 74% | 17% | 9% |
Solve implementation problems | 72 | 3.19 | 0.74 | 78% | 13% | 9% |
Fairly/Very Committed | Not At All/A Little Committed | Don’t Know | ||||
Commitment (Imp. Group)
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Committed | 56 | 3.45 | 0.69 | 64% | 8% | 28% |
Motivated | 58 | 3.41 | 0.73 | 64% | 10% | 26% |
Willing | 59 | 3.53 | 0.65 | 69% | 6% | 25% |
Somewhat/Very Much | Not At All/A Little | Don’t Know | ||||
Want to | 53 | 3.68 | 0.51 | 67% | 1% | 32% |
Fairly/Very Committed | Not At All/A Little Committed | Don’t Know | ||||
Commitment (User Group)
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Committed | 61 | 2.84 | 0.80 | 56% | 25% | 19% |
Motivated | 61 | 2.80 | 0.87 | 49% | 32% | 19% |
Willing | 61 | 2.82 | 0.85 | 55% | 26% | 19% |
Somewhat/Very Much | Not At All/A Little | Don’t Know | ||||
Want to | 51 | 3.16 | 0.86 | 56% | 12% | 32% |
Change Valence
| Strongly Agree/Agree | Strongly Disagree/Disagree | Don’t Know | |||
Need for change | 74 | 3.55 | 0.53 | 97% | 1% | 1% |
Relative advantage | 57 | 3.26 | 0.67 | 67% | 9% | 24% |
Perceived fit | 68 | 3.34 | 0.66 | 84% | 7% | 9% |
Informational Assessment
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Knowledge of task requirements | 56 | 2.91 | 0.82 | 52% | 23% | 25% |
Resources availability | 57 | 2.75 | 0.87 | 51% | 27% | 22% |
Timing | 57 | 3.02 | 0.79 | 64% | 15% | 21% |
Competing priorities | 60 | 2.47 | 0.85 | 32% | 48% | 20% |
Time availability | 60 | 2.73 | 0.78 | 51% | 29% | 20% |
Yes | No | Don’t Know | ||||
Presentation attendance | 74 | 0.25 | 0.46 | 24% | 73% | 3% |