Research location and research reach: The My Own Health Report (MOHR) study

Background:  Beyond geographic location, “Healthography” can be interpreted as health research sites’ locations in organizational, financial and cultural systems.   Research location influences a study’s reach, validity, and outcomes.  The aims of this study are to: (1) describe variation in research location; and (2) discuss how location influenced reach in the My Own Health Report (MOHR) study.  MOHR is an evidence-based patient-reported behavioral health assessment tool that includes physician-led counseling and goal-setting.

Methods:  MOHR was federally funded as a cluster-randomized pragmatic implementation trial.  Nine pairs of diverse primary care practices (either FQHC or PBRN sites) were randomized to field MOHR in 6 states across the U.S.  Reach, % of eligible patients that were offered and completed the MOHR tool, was computed for each practice.  Location was measured qualitatively at three time points, via practice-based observation and key informant interviews.  Data were coded by four independent coders using qualitative analysis software. Content analysis was performed to identify salient practice characteristics by which each location differed.

Results: Overall reach for the nine practices was 40.0%, ranging from 27.0%-89.5% across sites.  Variation in reach can be explained by five practice characteristics that differed by location:  (1) clinician and staff attitudes and motivations towards MOHR, (2) mode of MOHR administration (3) impact of the research process on the practice, (4) patient populations and (5) staffing constraints.  The motivation of practice leaders and autonomy of MOHR champions aided efforts to administer MOHR.  Mode of administration (e.g., via web, paper and pencil, or telephone) based upon patient/practice preference and capacity resulted in significant differences in reach.  Practice resources such as staff time and access to technology, and patient literacy differed by location and influenced reach. Although clinicians found MOHR valuable to initiate health behavior discussions, aspects of location limited MOHR's sustainability in routine practice.

Conclusion.  Understanding how and why implementation trials reach their target population requires knowledge of location, since implementation happens in diverse, real-world settings.  Implementation success of evidence-based interventions depends largely on the location of research sites.