Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework

• Published in: Canadian journal of diabetes 2015-10, Vol.39, p.S92-S99
• Main Authors: Wozniak, Lisa, MA, Soprovich, Allison, MPH, Mundt, Clark, MSc, Johnson, Jeffrey A., PhD, Johnson, Steven T., PhD
• Format: Article
• Language: English
• Subjects: activité physique; Diabetes Mellitus, Type 2 - therapy; diabète de type 2; Endocrinology & Metabolism; Exercise; health program evaluation; Health Promotion - methods; Health Promotion - standards; Humans; Life Style; Other; physical activity; primary care; Primary Health Care - methods; Primary Health Care - standards; Program Evaluation; RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance); RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance, soit la portée, l’efficacité, l’adoption, la mise en œuvre et le maintien); soins primaires; type 2 diabetes; évaluation des programmes sanitaires
• ISSN: 1499-2671; 2352-3840
• DOI: 10.1016/j.jcjd.2015.05.003

Abstract Objective The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff’s perceptions of its success in improving diabetes management. Methods We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10. Results HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention “dose” inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process. Conclusions Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.