JMIR Publications

ABSTRACT

Background:

There is growing evidence that non-communicable diseases (NCDs) can be attributable to unhealthy lifestyle habits. However, there has been little application of this confirmation in primary health care (PHC).

Objective:

This study aims to evaluate the process and outcomes of a multifaceted implementation strategy for a health-promoting working approach in a PHC setting. This working practise is based on national guidelines targeting unhealthy lifestyle habits with a potential risk for NCDs.

Methods:

A pre-post implementation study design with a control group is used in a PHC setting in central Sweden. The Medical Research Council guidance for process evaluations of complex interventions will be applied. The implementation process and outcomes will be assessed using a mix of qualitative and quantitative methods. A strategic sample of up to six PHC centres will be included as intervention centres, which will receive a 12-month multifaceted implementation strategy. Six matched PHC centres will serve as controls. Core components in the implementation strategy are external and internal facilitators in line with the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and a model for leading change. Data will be collected at baseline, during the implementation phase and 4-6 months after the implementation strategy. Questionnaires will be sent to roughly 500 patients/PHC centres and 200 health care professionals before and after implementation. In addition, purposeful sampling will be employed for interviews and focus group discussions with managers, health care professionals, patient representatives and internal and external facilitators. Use of data from medical records and activity logs will be an additional data source.

Results:

Recruitment of PHC centres began in Spring 2021 and is ongoing. Based on the planned timeline with the 12-month implementation strategy and 4-6-month follow-up, we expect to collect the last data in Summer 2023.

Conclusions:

This study will explain implementation process and outcomes using a multifaceted implementation strategy for a health-promoting working approach in a real-world PHC context. The study should also provide new knowledge about the role of facilitators and their contribution to implementation outcomes. These findings can guide policymakers, managers and PHC staff to integrate health promotion and disease prevention in PHC and provide methodological support to facilitators. Clinical Trial: This project is registered in ClinicalTrials.gov with number NCT04799860. Registred 03 March 2021, https://clinicaltrials.gov/ct2/show/NCT04799860