Act in Time -Implementation of Health Promotive Work-way in Primary Care Setting (AcTi)

Study Overview
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Brief Summary
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The study will support implementation of a health promotive work-way in primary care setting by using external and internal facilitators, with the aim to identify effective implementation strategies and to evaluate intervention uptake. Data will be collected from multiple perspecitves.

Detailed Description
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Insufficient physical activity, hazardous use of alcohol, tobacco use and unhealthy eating habits increase the risk of cardiovascular diseases, cancer and type 2-diabetes. Health-promoting work reduces the disease risk and mortality and should thus be integrated in clinical care processes. Despite support by the National guideline for prevention and treatment of unhealthy life-style habits, there is a chasm to bridge when integrating evidence into clinical practise. Prerequisites for changing work-ways are often underestimated and left to the individual co-workers to full fill on their own. Too few patients are asked about life-style habits and too few receive evidence-based measures. The measures taken may also depend on sex, language, residence and caregiver's profession. The investigators strive to support the implementation of a health-promoting way of working that includes self-reporting of life-style habits before a visit and that takes measures for those with at least one unhealthy lifestyle habit. The aim is to identify effective implementation strategies for health-promoting efforts in the primary care. The perceptions of barriers and opportunities when changing way of working from the target groups (leaders, co-workers, patients) will be used to enhance the possibility of successful implementation. Strategies are enhanced by theories of leading change. External and internal facilitators support the implementation. The study will evaluate the effects and the implementation process at the level of leaders, patients, co-workers and organisation. The project provides generalizable knowledge on strategies to overcome the gap between evidence and praxis, contributing to utilize an existing synthesized knowledgebase regarding health-promoting and preventative workways in a Swedish primary care setting. It is central for the health care system to identify successful implementation strategies in order to manage their future mission.

Official Title
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Act in Time- Implementation of Health Promotive Work-way in Primary Care Setting - Evaluation of Effect- and Implementation Process (AcTi)

Conditions
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Health Knowledge, Attitudes, Practice

Intervention / Treatment
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* Behavioral: health promotive work-way


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria for co-workers: being a caregiver meeting patients and/or being assigned a role as internal facilitator in the project Inclusion criteria for patients filling in the study specific questionnaire: 18 years or older visiting primary care units a specific time pre- or post implementation support Inclusion criteria for personcentered processmapping: * : having one or more unhealthy life-style habit 18 years or older

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: A pre-post-intervention design with control group will be used to evaluate intervention uptake and implementation process effectiveness from the perspective of managers, primary care professionals, patients, and organisation. Primary care settings in central Sweden will be supported in implementing a guideline-based health-promoting way of working including screening of life-style habits, measures taken according to evidence based recommendations and documentation. Strategies will include interactive education sessions, external and internal facilitators, audit and feedback, and tools from theories of leading change; tailored according to contextual and participant needs.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: health promotive work-way<br>Six primary care units that voluntarily enrolls as experimental units. The units will receive implementation support based on previous research and tailored to the specific prerequisits and context for each unit. Strategies includes involvement of target groups; informationa and interactive education;use of external and internal facilitators tarined for the purpose; systematic feedback and learning dialogs during the project. The implementation support will take approximately 12 months. | Behavioral: health promotive work-way<br>* Clinical intervention: The patient is asked to fill in a screening form with life-style related questions. The caregiver takes adequate measures according to the recommendations of the national guideline and the filled in screeing form. The caregiver documents the measures taken. Implementation intervention as described previously: using tailored strategies to support implementation of the gudieline-based recommendations<br>|
| No Intervention: Control<br>Six primary care centers of similar size and socioeconomic background in the population listed to each center. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change and trend from baseline documented codes in medical records | specific codes are used for measures related to the guideline recommendations for grade of advice for insufficient physical activity, unhealthy eating habits, hazardous use of alcohol and tobacco use and prescribed physical activity | Change from baseline, through study completion up to 4 to 6 months after end of implementation support | 
| Change in S-NoMAD score (Swedish translation of NoMAD | 23-item questionnaire covering the constructs coherence, cognitive participation, collective action and reflexive monitoring | Change from baseline S-Nomad score up to 4 to 6 months after end of study completion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in perceived clincial intervention by a study specific questionnaire | Questions related to the patients' perception on receiving the clinical intervention or not | Change from baseline up to 4 to 6 months after end of implementation support | 
| Change in perceived appropriateness (AIM), feasability (FIM) and acceptability (IAM) of the clinical intevention. | Appropriateness, feasability, acceptability of the clinical intervention is rated on a 5-graded scale with 4 items per construct | Change from baseline in AIM,IAM and FIM up to 4 to 6 months after end of implementation support | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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implementation, primary care, process evaluation