An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice
BMC Health Services Research, vol. 23, pp. 1455
Abstract
BACKGROUND: The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined. METHODS: We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3). RESULTS: The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders' input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy. CONCLUSION: This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.
Authors 9
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Renée V H IJzerman corresponding Aachen Health Medical and Neuropsychology Unit Faculty of Social and Behavioural Sciences
Affiliation as printed
Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands. r.v.h.ijzerman@fsw.leidenuniv.nl
Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
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The Hague University of Applied Sciences
Affiliation as printed
Centre of expertise Health Innovation, The Hague University of Applied Sciences, Den Haag, the Netherlands
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Linda D. Breeman Aachen Health Medical and Neuropsychology Unit Faculty of Social and Behavioural Sciences
Affiliation as printed
Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
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Affiliation as printed
Department of Cardiology, Tergooi MC, Blaricum and Hilversum, the Netherlands
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Mike Keesman Aachen Health Medical and Neuropsychology Unit Faculty of Social and Behavioural Sciences
Affiliation as printed
Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
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Affiliation as printed
Vital10, Amsterdam, the Netherlands
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Andrea W.M. Evers Aachen Health Medical and Neuropsychology Unit Faculty of Social and Behavioural Sciences
Affiliation as printed
Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
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Amsterdam University Medical Centers · University of Amsterdam
Affiliation as printed
Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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