title: Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation.
abstract: BACKGROUND
  Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, context and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care.
  
  
  METHODS
  A descriptive study of 2-year implementation indicators for the PVS clinical intervention was conducted in four primary health care centers. A multifaceted collaborative modeling implementation strategy was developed to enhance the integration of a clinical intervention to promote healthy lifestyles into clinical practice. Process indicators were assessed for intervention reach, adoption, implementation, sustainability and their variability at center, practice, and patient levels.
  
  
  RESULTS
  Mean rates of adoption by means of active collaboration among the three main professional categories (family physicians, nurses and administrative personnel) were 75% in all centers. Just over half of the patients that attended (n = 11650; 51.9%) were reached in terms of having their lifestyle habits assessed, while more than a third (33.7%; n = 7433) and almost 10% (n = 2175) received advice or a printed prescription for at least one lifestyle change, respectively. Only 3.7% of the target population received a repeat prescription. These process indicators significantly (p < 0.001) varied by center, lifestyle habit and patient characteristics. Sustainability of intervention components changed thorough the implementation period within centers.
  
  
  CONCLUSIONS
  The implementation strategy used showed moderate-to-good performance on process indicators related to adoption, reach, and implementation of the evidence-based healthy lifestyle promotion intervention in the context of routine primary care. Sources of heterogeneity and instability in these indicators may improve our understanding of factors required to attain adequate program adoption and implementation through improved implementation strategies.
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014, Bilbao, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014, Bilbao, Spain. gonzalo.grandes@osakidetza.eus.
authors.forename: Gonzalo
authors.identifier: http://orcid.org/0000-0002-5217-6628
authors.initials: G
authors.lastname: Grandes
authors.affiliation: Deusto Primary Health Care Center, Bilbao-Basurto Integrated Care Organization- Osakidetza, BioCruces Health Research Institute, Luis Power 18, E48014, Bilbao, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Cortada
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014, Bilbao, Spain.
authors.forename: Haizea
authors.initials: H
authors.lastname: Pombo
authors.affiliation: Primary Care Research Unit of Bizkaia, Basque Healthcare Service - Osakidetza, BioCruces Health Research Institute, Luis Power 18, 4ª planta, E48014, Bilbao, Spain.
authors.forename: Catalina
authors.initials: C
authors.lastname: Martinez
authors.affiliation: La Merced Primary Health Care Center, Bilbao-Basurto Integrated Care Organization - Osakidetza, Luis Iraurrizaga 1, 48003, Bilbao, Spain.
authors.forename: Mary Helen
authors.initials: MH
authors.lastname: Corrales
authors.affiliation: Sondika Primary Health Care Center, Uribe Integrated Care Organization - Osakidetza, Lehendakari Agirre 41, 48160, Sondika, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: de la Peña
authors.affiliation: Beasain Primary Health Care Center, Goieri-Alto Urola Integrated Care Organization - Osakidetza, Bernedo s/n, 20200, Beasain, Spain.
authors.forename: Justo
authors.initials: J
authors.lastname: Mugica
authors.affiliation: Matiena Primary Health Care Center, Barrualde-Galdakao Integrated Care Organization - Osakidetza, BioCruces Health Research Institute, Trañabarren 13-Bajo, 48220, Abadiño, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Gorostiza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D019033:Delivery of Health Care, Integrated; D005240:Feasibility Studies; D005260:Female; D017408:Guidelines as Topic; D006293:Health Promotion / Q000592:standards*; D006301:Health Services Needs and Demand / Q000592:standards*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000592:standards*; D013030:Spain; D055815:Young Adult
keywords: Health promotion; Implementation; Primary Health Care; Process evaluation