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Developing an implementation strategy for a digital health intervention: An example in routine healthcare 11 Medical and Health Sciences 1117 Public Health and Health Services

Developing an implementation strategy for a digital health intervention: An example in routine healthcare 11 Medical and Health Sciences 1117 Public Health and Health Services
Developing an implementation strategy for a digital health intervention: An example in routine healthcare 11 Medical and Health Sciences 1117 Public Health and Health Services

Background: Evidence on how to implement new interventions into complex healthcare environments is often poorly reported and indexed, reducing its potential to inform initiatives to improve healthcare services. Using the implementation of a digital intervention within routine National Health Service (NHS) practice, we provide an example of how to develop a theoretically based implementation plan and how to report it transparently. In doing so we also highlight some of the challenges to implementation in routine healthcare. Methods: The implemented intervention was HeLP-Diabetes, a digital self-management programme for people with Type 2 Diabetes, which was effective in improving diabetes control. The target setting for the implementation was an inner city London Clinical Commissioning Group in the NHS comprised of 34 general practices. HeLP-Diabetes was designed to be offered to patients as part of routine diabetes care across England. Evidence synthesis, engagement of local stakeholders, a theory of implementation (Normalization Process Theory), feedback, qualitative interviews and usage data were used to develop an implementation plan. Results: A new implementation plan was developed to implement HeLP-Diabetes within routine practice. Individual component strategies were selected and developed informed by Normalization Process Theory. These strategies included: engagement of local opinion leaders, provision of educational materials, educational visits, educational meetings, audit and feedback and reminders. Additional strategies were introduced iteratively to address barriers that arose during the implementation. Barriers largely related to difficulties in allocating resources to implement the intervention within routine care. Conclusion: This paper provides a worked example of implementing a digital health intervention. The learning from this work can inform others undertaking the work of planning and executing implementation activities in routine healthcare. Of particular importance is: the selection of appropriate theory to guide the implementation process and selection of strategies; ensuring that enough attention is paid to planning implementation; and a flexible approach that allows response to emerging barriers.

Delivery of health care, Diabetes mellitus, Digital health, Health plan implementation, Healthcare, Implementation, Implementation planning, Implementation strategy, Implementation theories, Routine practice, Type 2
1472-6963
Ross, Jamie
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Stevenson, Fiona
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Dack, Charlotte
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Pal, Kingshuk
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May, Carl
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Michie, Susan
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Barnard, Maria
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Murray, Elizabeth
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Ross, Jamie
55b300ae-4a06-418d-b0b7-fdbab91e9970
Stevenson, Fiona
881eb2a9-d7a8-449d-be50-ead6fda5cd3e
Dack, Charlotte
d3b4f40f-0c5d-4117-9aaa-e500976d4af5
Pal, Kingshuk
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May, Carl
17697f8d-98f6-40d3-9cc0-022f04009ae4
Michie, Susan
47e0a907-79cb-47d5-b5a9-82d2afe1747a
Barnard, Maria
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Murray, Elizabeth
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Ross, Jamie, Stevenson, Fiona, Dack, Charlotte, Pal, Kingshuk, May, Carl, Michie, Susan, Barnard, Maria and Murray, Elizabeth (2018) Developing an implementation strategy for a digital health intervention: An example in routine healthcare 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Health Services Research, 18 (1), [794]. (doi:10.1186/s12913-018-3615-7).

Record type: Article

Abstract

Background: Evidence on how to implement new interventions into complex healthcare environments is often poorly reported and indexed, reducing its potential to inform initiatives to improve healthcare services. Using the implementation of a digital intervention within routine National Health Service (NHS) practice, we provide an example of how to develop a theoretically based implementation plan and how to report it transparently. In doing so we also highlight some of the challenges to implementation in routine healthcare. Methods: The implemented intervention was HeLP-Diabetes, a digital self-management programme for people with Type 2 Diabetes, which was effective in improving diabetes control. The target setting for the implementation was an inner city London Clinical Commissioning Group in the NHS comprised of 34 general practices. HeLP-Diabetes was designed to be offered to patients as part of routine diabetes care across England. Evidence synthesis, engagement of local stakeholders, a theory of implementation (Normalization Process Theory), feedback, qualitative interviews and usage data were used to develop an implementation plan. Results: A new implementation plan was developed to implement HeLP-Diabetes within routine practice. Individual component strategies were selected and developed informed by Normalization Process Theory. These strategies included: engagement of local opinion leaders, provision of educational materials, educational visits, educational meetings, audit and feedback and reminders. Additional strategies were introduced iteratively to address barriers that arose during the implementation. Barriers largely related to difficulties in allocating resources to implement the intervention within routine care. Conclusion: This paper provides a worked example of implementing a digital health intervention. The learning from this work can inform others undertaking the work of planning and executing implementation activities in routine healthcare. Of particular importance is: the selection of appropriate theory to guide the implementation process and selection of strategies; ensuring that enough attention is paid to planning implementation; and a flexible approach that allows response to emerging barriers.

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Accepted/In Press date: 9 October 2018
e-pub ahead of print date: 19 October 2018
Keywords: Delivery of health care, Diabetes mellitus, Digital health, Health plan implementation, Healthcare, Implementation, Implementation planning, Implementation strategy, Implementation theories, Routine practice, Type 2

Identifiers

Local EPrints ID: 425657
URI: http://eprints.soton.ac.uk/id/eprint/425657
ISSN: 1472-6963
PURE UUID: dab0cc03-a964-4146-9dc9-cd0c741e3a75
ORCID for Carl May: ORCID iD orcid.org/0000-0002-0451-2690

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Date deposited: 31 Oct 2018 17:30
Last modified: 07 Oct 2020 01:58

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