Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a...

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Kentucky has high type 2 diabetes (T2D) prevalence, with underutilization of free Diabetes Self-Management Education and Support (DSMES).
• Learning collaboratives offer a promising strategy to improve DSMES referrals by facilitating small tests of change.
• Understanding implementation determinants is crucial for optimizing DSMES utilization.

Purpose of the Study:

• To identify determinants of successful learning collaborative implementation for improving DSMES referrals.
• To explore perceived progress on implementation outcomes among collaborative participants.

Main Methods:

• Semi-structured interviews were conducted with 26 participants across three groups: clinic staff, health department educators, and regional extension center staff.
• Interviews were guided by the Practical, Robust Implementation and Sustainability Model (PRISM) domains.
• Verbatim transcripts were coded using a matrix-based approach to identify overarching themes within PRISM domains.

Main Results:

• Facilitators and barriers were most commonly identified within PRISM domains related to organizational perspectives, patient characteristics, and implementation infrastructure.
• Participants employed various strategies and adaptations to leverage strengths and mitigate barriers during implementation.
• Clinic staff addressed infrastructure barriers like competing priorities by using morning huddles to meet collaborative goals.

Conclusions:

• The study provides context on determinants impacting learning collaborative implementation and strategies used to address them.
• Findings will inform refinements to the collaborative and implementation strategies for future cohorts.
• This framework aims to increase DSMES referrals and engagement among T2D patients in Appalachian Kentucky.