Interactive and Participatory Audit and Feedback (IPAF): theory-based development and multi-site implementation...

Area of Science:

• Implementation Science
• Healthcare Quality Improvement
• Behavioral Science

Background:

• Audit and Feedback (A&F) is a theory-based strategy to improve evidence-based practice adoption.
• Specialty clinics require tailored A&F strategies, particularly for frontline staff executing cardiovascular disease (CVD) risk reduction protocols.
• Existing A&F strategies are not well-examined for supporting frontline staff in specialty settings.

Purpose of the Study:

• To develop and evaluate a theory-based approach, Interactive and Participatory A&F (IPAF), for specialty clinics.
• To assess IPAF's feasibility, appropriateness, acceptability, fidelity, and adoption in improving CVD risk reduction behaviors.
• To extend A&F research beyond primary care settings.

Main Methods:

• Developed IPAF using Self-Regulation Theory (SRT) and Self-Determination Theory (SDT) to guide content and interaction.
• Utilized a semi-structured guide to facilitate staff discussions on behaviors, barriers, goals, and action plans.
• Employed a hybrid type 2 effectiveness-implementation design with mixed-methods data (EHR, team records, questionnaires) across eight specialty clinics.

Main Results:

• High staff attendance (90-93%) and engagement in 99 monthly IPAF sessions over 6 months.
• Positive staff ratings on IPAF acceptability and demonstrated fidelity in delivery and receipt.
• Significant increases in target behavior adoption (P < 0.05), maintained for over 24 months.

Conclusions:

• IPAF is a feasible, appropriate, acceptable, and fidelity-promoting theory-based A&F strategy for specialty clinics.
• IPAF effectively supports frontline staff in adopting and maintaining evidence-based behaviors.
• This multi-site evaluation extends A&F research to specialty care settings and frontline staff.