Tailoring intervention procedures to routine primary health care practice; an ethnographic process evaluation
Yvonne J F M Jansen1, Antoinette de Bont, Marleen Foets
1Institute of Health Policy and Management, Erasmus MC Rotterdam, Rotterdam, The Netherlands. y.jansen@erasmusmc.nl
BMC Health Services Research
|August 9, 2007
Summary
Tailor-made interventions for cardiovascular disease prevention in primary care were explored. While guidelines facilitated tailoring and organizational change, pragmatic trial flexibility in routine practice was overestimated.
Area of Science:
- Public Health
- Health Services Research
- Implementation Science
Background:
- Tailor-made interventions are crucial for integrating new practices into routine healthcare by respecting local knowledge and professional relationships.
- The Quattro project, a cardiovascular disease prevention program for high-risk patients in deprived areas, was implemented as a pragmatic trial.
- The project emphasized local knowledge and internally developed guidelines for primary care settings.
Purpose of the Study:
- To demonstrate the implementation process of a tailor-made prevention program within routine primary care.
- To evaluate the effectiveness of tailoring interventions in a pragmatic trial setting.
Main Methods:
- An ethnographic design was employed, involving observations and interviews with researchers and practice nurses.
- Thematic analysis was conducted on research documents, observations, and transcribed interviews.
Main Results:
- Despite the intention for tailoring, the pragmatic trial did not achieve a well-organized intervention due to a lack of standard protocols.
- A guideline was developed, which, while not initially intended, facilitated tailoring and organizational change.
- The guideline served as a tool for professionals to achieve organizational change and transform interprofessional relations.
Conclusions:
- Guidelines can act as crucial tools to facilitate the tailoring of interventions and enable organizational change in routine practice.
- While pragmatic trials offer flexibility, their ability to accommodate local practice variations in implementation may be overestimated.
- Tailor-made approaches, supported by tools like guidelines, are essential for successful intervention uptake in healthcare settings.
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