Table 5 Regional Variation of Program Implementation by Implementation Domain
From: Implementation of a group-based diabetes prevention program within a healthcare delivery system
Domain | Consistent across all regions | Variable across regions |
|---|---|---|
Adoption | • Promoted as a weight management program • Exclusively offered in English | • Branded name • Number of sites offering the program • Frequency of program offerings |
Penetration | • Physician referrals as a recruitment method | • Visibility of program to patients • Consistency of physician referrals |
Acceptabilitya | + Evidence base of program + Easy-to-follow curriculum − Focus on calories and fat counting − Visual appeal of materials | • Program’s focus on behavior change • Group-based nature of program • Quality and level of physical activity and nutrition information in curriculum |
Appropriateness | • No consistencies in views of appropriateness | • Suitability of curriculum’s educational level • Relevance of program material example stories and problems • Compatibility of program’s goal-setting guidelines |
Feasibility | • Difficulties with recruitment and retention • Patient attrition as a reason for discontinuation at site | • Site also discontinued program due to other reasons (e.g. LC availability) |
Fidelity | • Intensive core phase • Self-monitoring of food choices and weight • Content of post-core maintenance | • Type of training LC received • Eligibility criteria of participants • Variation in program structure (see Table 4 for details) • Supplementation of core curriculum with additional information for specific patient groups |
Program Cost | • No consistencies in cost of program | • Cost of the program for participants • Insurance coverage • Perceived program affordability |
Sustainability | • Patient attrition as a challenge | • Specific strategies to increase recruitment and stakeholder’s buy-in • Specific strategies to increase retention |