title: Sustained use of a tool for lifestyle intervention implemented in primary health care: a 2-year follow-up.
abstract: OBJECTIVE
  Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability.
  
  
  METHODS
  A computer-based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4-week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE-AIM framework was applied to assess and compare outcome according to strategy.
  
  
  RESULTS
  A more positive outcome regarding reach, effectiveness, adoption and implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible.
  
  
  CONCLUSIONS
  After 24 months, the most positive outcomes regarding all RE-AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.
authors.affiliation: Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden. siw.carlfjord@liu.se
authors.forename: Siw
authors.initials: S
authors.lastname: Carlfjord
authors.forename: Malou
authors.initials: M
authors.lastname: Lindberg
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson
mesh_terms: D000328:Adult; D000368:Aged; D003376:Counseling / Q000379:methods*; D004059:Diffusion of Innovation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D013548:Sweden; D014584:User-Computer Interface