Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Facilitating practice change: lessons from the STEP-UP clinical trial.

Mary C Ruhe1, Sharon M Weyer, Sue Zronek

  • 1Department of Family Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106-7136, USA. mary.ruhe@case.edu

Preventive Medicine
|April 27, 2005
PubMed
Summary

Understanding primary care practice change requires identifying "malleable moments" and aligning interventions with existing motivations. Tailored approaches, even with unpredictable change, can foster sustainable improvements in preventive service delivery.

Related Concept Videos

You might also read

Related Articles

Articles linked to this work by shared authors, journal, and citation graph.

Sort by
Same author

The effect of recent changes in federal preventive guidance on patients and primary care practice.

American journal of preventive medicine·2026
Same author

Systemic path to global health 2050.

Bulletin of the World Health Organization·2026
Same author

Integrated care-The way of the generalist.

Families, systems & health : the journal of collaborative family healthcare·2026
Same author

Care Coordination and Hospitalization in Older Adults With or at Risk for Cardiovascular Disease: A Randomized Clinical Trial.

JAMA network open·2026
Same author

Factors Influencing Quality Improvement Success in Primary Care: A Comparative Case Study of High- and Low-Performing Sites in Patient Hypertension Outcomes.

Journal of the American Heart Association·2026
Same author

Continuity of Primary Care in Community Health Centers.

Annals of family medicine·2026

Area of Science:

  • Health Services Research
  • Primary Care Medicine
  • Organizational Change Management

Background:

  • The Study To Enhance Prevention by Understanding Practice (STEP-UP) trial demonstrated sustainable increases in preventive service delivery in primary care.
  • The facilitators of practice change within primary care settings remain incompletely described.

Purpose of the Study:

  • To describe the process of facilitating practice change in primary care.
  • To identify pragmatic lessons for improving primary care practice.

Main Methods:

  • Comparative case studies of eight high-impact and seven low-impact STEP-UP practices.
  • Multidisciplinary team utilized editing analysis and immersion-crystallization approaches.
  • Lessons were validated with participating practices and facilitators.

Related Experiment Videos

Main Results:

  • Predicting practice change based on initial conditions is difficult; "malleable moments" are key opportunities for change.
  • Motivation is crucial and can be fostered by challenging self-image, aligning with values, or addressing pressures.
  • Instrumental interventions are effective when motivation exists or when they address perceived needs; disruption can promote openness to change.

Conclusions:

  • Individualized approaches, informed by understanding practice evolution, can facilitate positive change.
  • Despite unpredictability, opportunities for positive change can be identified and leveraged.