Table 3 Refined programme theories for facilitators to the implementation of prehabilitation for frail patients into routine health care
CMOC | Context | + Mechanism | = Outcome | References |
|---|---|---|---|---|
1 Well-timed and appropriate information provision | If information about the prehabilitation intervention is provided • in an understandable, “intuitive and user-friendly”([58], p. 7) way, • in a way that emphasises the “value of physical activity and the need to exercise”([33], p. 5) and stresses how prehabilitation helps “perform ADLs [activities of daily living]”([31], p. 449) • at an early time point, “since it helps demystify the reason for the intervention”([39], p. 324) | then this enacts • an understanding of the benefits • facilitation of exercise • increased willingness and interest in active participation | resulting in • patient empowerment • increased adherence and motivation • awareness and understanding of one’s own active role in improvement • maintenance of a healthy lifestyle | |
2 Patient-centred individualisation | If prehabilitation programmes can be • developed with “patient-centered approaches”([37], p. 580) • “easily accessible and take personal preferences, needs and abilities into account”([33], p. 1) • home-based or centre-based, supervised or unsupervised, depending on the patients’ needs, and • “goal-directed, with individualized targets”([51], p. 21) | then this enacts • a feeling of attainability/manageability • patients feeling comfortable with the intervention • stress-free participation • confidence among the patients | resulting in • increased participation • increased adherence and motivation • facilitating implementation in various patient groups | [31,32,33, 37,38,39, 41, 43, 44, 46, 48, 51, 52, 54, 56, 58,59,60,61,62,63] |
3 Guidance and (social) support | If the prehabilitation intervention • includes adequate guidance and monitoring by healthcare professionals (digitally and in person), • incorporates goal setting, gamification aspects, and/or rewards, and • integrates the patients’ social environment (family, friends, peers) | then this enacts • enjoyment of the intervention • a feeling of accountability and security with the intervention • emotional and psychological well-being | resulting in • increased adherence • increased participation • self-affirmation by the patients | |
4 Integration into and adaption of the setting | If prehabilitation programmes can be • “integrated in the perioperative trajectory and performed in the patient’s preexistent living context”([36], p. 896), • “administered within the scope of multidisciplinary collaboration and as an integrated concept”([26], p. 112), and • diffused by an ambassador | then this enacts access to and acceptance of the programme by patients and providers alike | resulting in • more opportunities and motivation to implement prehabilitation interventions into a given setting • increased participation • increased adherence | |
5 Multidisciplinary team approach | If, in a multidisciplinary team, • prehabilitation is “understood as an appeal to cooperation between all professions involved”([26], p. 112), • leadership and responsibilities are clear, and • a “shift in the current health care paradigm”([46], p. 6) can be achieved | then this enacts • a new understanding of a common purpose, • an understanding of roles, • mutual respect and support | resulting in • more integrated care, • more cooperation and teamwork • maximised benefit for the patient | |
6 Clear patient pathway | If there are • specific and early entry points, • clear referral guidelines, and • possibilities “to lengthen the time interval between operation indication and surgery”([44], p. 11) | then this enacts • smooth referral of patients between disciplines, • shared accountability, • sufficient time for the intervention | resulting in • maximisation of the benefits of prehabilitation, • care integration, • optimal use of resources |