Exploring the implementation of a long COVID rehabilitation intervention: a mixed-methods process evaluation

Area of Science:

• Healthcare Delivery
• Rehabilitation Medicine
• Public Health

Background:

• Long COVID presents a global health challenge, increasing the need for effective rehabilitation services.
• Limited knowledge on the implementation of long COVID rehabilitation hinders its adaptation and transfer across healthcare settings.
• A previous study refined the program theory for a Danish community-based long COVID rehabilitation intervention, but implementation uncertainties persisted.

Purpose of the Study:

• To explore the delivery and implementation processes of a specific Danish community-based long COVID rehabilitation intervention.
• To identify key contextual factors influencing the implementation and adaptation of the long COVID rehabilitation program.

Main Methods:

• Convergent mixed-methods process evaluation examining intervention reach, fidelity, dose, and delivery processes.
• Quantitative data from patient questionnaires and records; qualitative data from health professional focus groups and manager interviews.
• Descriptive analysis for quantitative data, content analysis for qualitative data, with narrative integration of findings.

Main Results:

• 336 patients were included, with 321 initiating the program; most were female with higher education.
• Median rehabilitation length was 183 days with 13 sessions, primarily individual and group-based energy management.
• Intervention delivery was consistent, with variations in length and sessions reflecting adaptations influenced by flexible structure, knowledge, reflection, and organizational legitimacy.

Conclusions:

• The study details the implementation and delivery of the long COVID rehabilitation intervention, identifying crucial contextual conditions.
• Findings can guide the adaptation and transfer of similar rehabilitation interventions to diverse healthcare settings.
• Future long COVID rehabilitation development must prioritize equity in access for varied patient groups.