An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice | JoVE Visualize

Area of Science:

Health Informatics
Digital Health Implementation Science
Cardiac Patient Care Technology

Background:

Complex eHealth interventions are increasing, but practical implementation and sustainability remain challenging.
Existing implementation theories often fall short in guiding sustainable adoption within clinical practice.
Bridging the gap between theory and practice is crucial for developing effective implementation strategies.

Purpose of the Study:

To outline and evaluate an iterative approach for developing a multifaceted implementation strategy for a complex eHealth intervention.
To refine the strategy through alternating cycles of theory application and practical testing in clinical settings.
To enhance the sustainability of eHealth interventions by integrating theory-based development with practice-based findings.

Main Methods:

A six-phase iterative approach was employed, alternating between theoretical development and practical evaluation.
The BENEFIT program, an eHealth platform for cardiac patients, was implemented using this strategy.
Initial strategy development utilized the Implementation model and RE-AIM, refined through stakeholder engagement and pilot testing (phases 1-3).
Subsequent phases involved identifying practical challenges, linking them to the Consolidated Framework for Implementation Research (CFIR), and formulating practice recommendations (phases 4-6).

Main Results:

The iterative process successfully developed a multifaceted, theory-informed, and practice-based implementation strategy.
Key context-specific challenges in implementing the eHealth intervention were identified during pilot testing.
The strategy was refined by integrating practical findings with CFIR theory and stakeholder feedback, leading to actionable recommendations.

Conclusions:

This case study demonstrates an effective iterative methodology for creating evidence-based, tailored implementation strategies for complex eHealth interventions.
The described approach provides a valuable blueprint for researchers aiming for sustainable implementation of eHealth solutions in clinical practice, particularly in cardiac care.
Successful implementation hinges on a cyclical process of theory application, practical testing, and continuous refinement informed by real-world challenges.