title: Adapting community based participatory research (CBPR) methods to the implementation of an asthma shared decision making intervention in ambulatory practices.
abstract: OBJECTIVE
  Translating research findings into clinical practice is a major challenge to improve the quality of healthcare delivery. Shared decision making (SDM) has been shown to be effective and has not yet been widely adopted by health providers. This paper describes the participatory approach used to adapt and implement an evidence-based asthma SDM intervention into primary care practices.
  
  
  METHODS
  A participatory research approach was initiated through partnership development between practice staff and researchers. The collaborative team worked together to adapt and implement a SDM toolkit. Using the RE-AIM framework and qualitative analysis, we evaluated both the implementation of the intervention into clinical practice, and the level of partnership that was established. Analysis included the number of adopting clinics and providers, the patients' perception of the SDM approach, and the number of clinics willing to sustain the intervention delivery after 1 year.
  
  
  RESULTS
  All six clinics and physician champions implemented the intervention using half-day dedicated asthma clinics while 16% of all providers within the practices have participated in the intervention. Themes from the focus groups included the importance of being part the development process, belief that the intervention would benefit patients, and concerns around sustainability and productivity. One year after initiation, 100% of clinics have sustained the intervention, and 90% of participating patients reported a shared decision experience.
  
  
  CONCLUSIONS
  Use of a participatory research process was central to the successful implementation of a SDM intervention in multiple practices with diverse patient populations.
authors.affiliation: Department of Family Medicine, Carolinas Healthcare System , Charlotte, NC , USA and.
authors.forename: Hazel
authors.initials: H
authors.lastname: Tapp
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kuhn
authors.forename: Thamara
authors.initials: T
authors.lastname: Alkhazraji
authors.forename: Mark
authors.initials: M
authors.lastname: Steuerwald
authors.forename: Tom
authors.initials: T
authors.lastname: Ludden
authors.forename: Sandra
authors.initials: S
authors.lastname: Wilson
authors.forename: Lauren
authors.initials: L
authors.lastname: Mowrer
authors.forename: Sveta
authors.initials: S
authors.lastname: Mohanan
authors.forename: Michael F
authors.initials: MF
authors.lastname: Dulin
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D055812:Community-Based Participatory Research / Q000379:methods*; D003657:Decision Making; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010817:Physician-Patient Relations; D018570:Risk Assessment; D012720:Severity of Illness Index; D014481:United States; D035862:Vulnerable Populations; D055815:Young Adult