Online Program

Addressing implementation of a patient-activation and self-management intervention within the context of an effectiveness trial – a hybrid-implementation study

Tuesday, November 5, 2013 : 11:30 a.m. - 11:50 a.m.

Andrea Ault-Brutus, PhD, MPA, Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA
Catherine Lee, MD, Department of Psychiatry & Human Behavior, Brown Alpert Medical School, Providence, RI
Margarita Alegria, PhD, Psychiatry--Center for Multicultural MH Research, Harvard Medical School, Somerville, MA
Objective: This hybrid-implementation study examines contextual factors important for delivering a patient-activation/self-management intervention in 13 mental health clinics within the context of an effectiveness trial in order to inform understanding of what could happen when implementing the intervention in a real-world context. Methods: Eighteen key personnel addressed the following contextual factors in interviews: intervention linkage to organization values/ patient needs; leadership, provider, and administrative buy-in/support; leadership and key personnel roles; and organizational resources. Data were qualitatively analyzed using the constant comparative method. Results: All four contextual factors were relevant in facilitating the delivery of the intervention. However, challenges in delivering the intervention existed as well. Notably, organizational constraints within the clinic and resource constraints of some patients served as barriers to delivering the intervention to patients. Although buy-in for the intervention was achieved at all levels of the clinic (leadership, most providers, and administrative staff), buy-in was weaker among providers with a psychodynamic orientation and among providers who may have misunderstood the intent of questions asked by activated patients; thus, impacting the delivery of the intervention. Discussion: In order to expedite the research-to-practice process, contextual factors that play a role in the implementation of an intervention could be examined in the intervention's effectiveness trial. Findings from this study could aid in the development of an implementation strategy for this intervention by addressing clinic and patient constraints and ensuring buy-in from leadership, providers, and administrative staff. Such an implementation strategy could, in turn, be tested in a future full-scale implementation study.

Learning Areas:

Implementation of health education strategies, interventions and programs

Learning Objectives:
Explain effectiveness-implementation hybrid designs. Describe the hybrid effectiveness-implementation study and discuss findings. Discuss how hybrid effectiveness-implementation studies can advance the improvement of quality mental health care by expediting the research-to-practice process.

Keyword(s): Mental Health Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a mental health services researcher with expertise in examining racial/ethnic disparities in mental health care. I am now utilizing my previous background in management consulting and implementation science theory to conduct research investigating how to move quality improvement interventions into health care practices more quickly.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.