JMIR Publications

ABSTRACT

Background:

Background:

Given the rapid growth of digital healthcare, greater transparency in engaging end-users in developing implementation plans is needed to improve the sustained delivery and effectiveness of digital healthcare. PREVENT is a patient-centered digital health tool designed to engage patients with overweight or obesity in conversations about behavior change to lower their cardiovascular disease (CVD) risk. We are implementing PREVENT in a rural federally qualified health center with eight clinics in Southeast Missouri.

Objective:

Objective:

The objective of this paper is to present a multi-method approach used to engage clinic teams, including healthcare team members and administrators, to co-develop an implementation plan for the clinical trial of the PREVENT digital health tool.

Methods:

Methods:

Over one year (9/1/2023- 8/30/2024), healthcare team members (e.g., clinicians, community health workers) and administrators (e.g., informatics professionals, clinic managers, CEO) were recruited via email and engaged through qualitative interviews, advisory board meetings, and site visits to develop an implementation plan prior to implementation. Qualitative interviews were analyzed using rapid qualitative analysis using the Consolidated Framework for Implementation Research to identify potential barriers and facilitators of implementing PREVENT. Findings were paired with learnings from previous trials of PREVENT to inform the selection and tailoring of implementation strategies. Direct clinic observations generated clinic workflow maps, roles and responsibilities of team members, clinic resources (e.g., technology, space), and an understanding of the clinic and community context. An evaluation plan was developed using validated measures, input from the advisory board, and implementation research logic models.

Results:

Results:

Potential facilitators of future PREVENT implementation were a positive clinic culture, alignment with chronic disease priorities, an easy-to-use and adaptable design with EHR integration, and CHWs’ experience addressing social needs. Potential barriers included limited technology infrastructure, variable staffing across clinics, patients’ digital access and literacy challenges, and the need for additional training and support for care team members. An implementation plan that includes thirteen strategies across six implementation strategy clusters was created to leverage facilitators and address barriers. A multi-modal evaluation plan was created to examine implementation and effectiveness.

Conclusions:

Conclusions:

This paper provides an example of how to engage stakeholders in the development of implementation and evaluation plans tailored to the healthcare context prior to implementation, in hopes to increase successful use and achieve the intended impact of the digital health intervention. This work may be replicated to support the successful implementation planning for other digital health tools, particularly in under-resourced, complex healthcare contexts such as rural clinics where context specific implementation is critical.