Process evaluation of a cluster randomised controlled trial to improve bronchiolitis management - a PREDICT...

Area of Science:

• Pediatrics
• Health Services Research
• Implementation Science

Background:

• Bronchiolitis is a leading cause of infant hospitalization, often managed with supportive care.
• Significant variation exists in clinical practice, with some infants receiving non-evidence-based therapies.
• Developed and tested targeted, theory-informed interventions to improve bronchiolitis management.

Purpose of the Study:

• To evaluate the implementation fidelity and end-user perceptions of interventions aimed at reducing non-evidence-based care for bronchiolitis.
• To correlate intervention fidelity with outcomes from a cluster randomized controlled trial (cRCT).

Main Methods:

• A mixed-methods process evaluation was conducted alongside a cRCT.
• Quantitative data on intervention fidelity, dose, and reach were collected from 13 hospitals.
• Qualitative data on perceptions and acceptability were gathered from 42 clinical leads via thematic analysis.

Main Results:

• The cRCT demonstrated a 14.1% improvement in bronchiolitis management with the interventions.
• Intervention fidelity varied across hospitals, with scores ranging from 55% to 98% (mean 78%).
• Clinical leads perceived interventions positively, but time constraints were a significant barrier.

Conclusions:

• Targeted interventions for bronchiolitis were implemented with moderate fidelity and were well-received.
• Intervention fidelity positively impacted the de-implementation of non-evidence-based care.
• Findings will guide the broader rollout of bronchiolitis interventions and future practice change initiatives.