Contextualizing the Proven Effectiveness of a Lifestyle Intervention for Type 2 Diabetes in Primary Care: A Qualitative Assessment Based on the RE-AIM Framework.
OBJECTIVE
The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in 4 community-based primary care networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management.


METHODS
We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the HEALD intervention. Qualitative methods used to collect data related to the RE-AIM dimensions of implementation and effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10.


RESULTS
HEALD was implemented as intended with adequate fidelity across all 4 PCNs. Identified implementation facilitators included appropriate human resources, the training provided, ongoing support, the provision of space and the simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included intervention "dose" inadequacy; that the quality of usual care for people with diabetes was already good; patients were already managing their diabetes well; and the potential for cointervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process.


CONCLUSIONS
Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.
Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
Lisa
L
Wozniak
Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
Allison
A
Soprovich
Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada.
Clark
C
Mundt
Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada; Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
Jeffrey A
JA
Johnson
Alliance of Canadian Health Outcomes Research in Diabetes, University of Alberta, Edmonton, Alberta, Canada; Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada. Electronic address: sjohnson@athabascau.ca.
Steven T
ST
Johnson
D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D015444:Exercise; D006293:Health Promotion / Q000379:methods* / Q000592:standards; D006801:Humans; D008019:Life Style; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D015397:Program Evaluation
RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance); RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance, soit la portée, l’efficacité, l’adoption, la mise en œuvre et le maintien); activité physique; diabète de type 2; health program evaluation; physical activity; primary care; soins primaires; type 2 diabetes; évaluation des programmes sanitaires