Process Evaluation of an Intensified Preventive Intervention to Reduce Cardiovascular Risk in General Practices in Deprived Neighbourhoods

• Published in: European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2008-12, Vol.7 (4), p.296-302
• Main Authors: El Fakiri, Fatima, Hoes, Arno W., Uitewaal, Paul J.M., Frenken, Rianne A.A., Bruijnzeels, Marc A.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Cardiovascular Diseases - ethnology; Cardiovascular Diseases - prevention & control; Chi-Square Distribution; Community Health Workers - organization & administration; Cooperative Behavior; Family Practice - organization & administration; Female; Health Education - organization & administration; Humans; Male; Middle Aged; Multicenter Studies as Topic; Netherlands - epidemiology; Nurse Practitioners - organization & administration; Nursing Evaluation Research; Outcome and Process Assessment, Health Care; Poverty Areas; Primary Health Care - organization & administration; Primary Prevention - organization & administration; Program Evaluation; Randomized Controlled Trials as Topic; Risk Assessment - organization & administration; Risk Reduction Behavior
• ISSN: 1474-5151; 1873-1953
• DOI: 10.1016/j.ejcnurse.2008.01.002

Background: A RCT, conducted to examine the effectiveness of a structured collaboration in general practice to provide intensified preventive care in patients at high cardiovascular risk yielded no effect in the total group but differences across healthcare centres and ethnic groups become apparent. We conducted a process evaluation to explain these differences. Methods: We assessed the reach of the target group and whether key intervention components (individual educational sessions, structured team meetings, and risk assessments) were performed as planned (maximum score for protocol completion is 11). Results: The reach was initially 91%, but only a minority of patients completed the intervention activities as planned. The average score of the number of intervention components was low (5.66 out of 11 (sd 2.8)) and varied between centres (4.84 to 7.40) and ethnic groups (4.89 to 7.38), with team meetings as the least implemented activity conform plan. Conclusion: This study indicates that adding a practice nurse and a peer health educator to the general practice did not seem to result in the desired collaboration between the healthcare personnel. Further research is needed to investigate the reasons behind the low participation rate of the patients in the intervention.