PDF(Pubmed)
Abstract：
BACKGROUND: Providing supported self-management for people with asthma can reduce the burden on patients, health services and wider society. Implementation, however, remains poor in routine clinical practice. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a UK-wide cluster randomised implementation trial that aims to test the impact of a whole-systems implementation strategy, embedding supported asthma self-management in primary care compared with usual care. To maximise opportunities for sustainable implementation beyond the trial, it is necessary to understand how and why the IMP2ART trial achieved its clinical and implementation outcomes.
METHODS: A mixed-methods process evaluation nested within the IMP2ART trial will be undertaken to understand how supported self-management was implemented (or not) by primary care practices, to aid interpretation of trial findings and to inform scaling up and sustainability. Data and analysis strategies have been informed by mid-range and programme-level theory. Quantitative data will be collected across all practices to describe practice context, IMP2ART delivery (including fidelity and adaption) and practice response. Case studies undertaken in three to six sites, supplemented by additional interviews with practice staff and stakeholders, will be undertaken to gain an in-depth understanding of the interaction of practice context, delivery, and response. Synthesis, informed by theory, will combine analyses of both qualitative and quantitative data. Finally, implications for the scale up of asthma self-management implementation strategies to other practices in the UK will be explored through workshops with stakeholders.
CONCLUSIONS: This mixed-methods, theoretically informed, process evaluation seeks to provide insights into the delivery and response to a whole-systems approach to the implementation of supported self-management in asthma care in primary care. It is underway at a time of significant change in primary care in the UK. The methods have, therefore, been developed to be adaptable to this changing context and to capture the impact of these changes on the delivery and response to research and implementation processes.
METHODS: A mixed-methods process evaluation nested within the IMP2ART trial will be undertaken to understand how supported self-management was implemented (or not) by primary care practices, to aid interpretation of trial findings and to inform scaling up and sustainability. Data and analysis strategies have been informed by mid-range and programme-level theory. Quantitative data will be collected across all practices to describe practice context, IMP2ART delivery (including fidelity and adaption) and practice response. Case studies undertaken in three to six sites, supplemented by additional interviews with practice staff and stakeholders, will be undertaken to gain an in-depth understanding of the interaction of practice context, delivery, and response. Synthesis, informed by theory, will combine analyses of both qualitative and quantitative data. Finally, implications for the scale up of asthma self-management implementation strategies to other practices in the UK will be explored through workshops with stakeholders.
CONCLUSIONS: This mixed-methods, theoretically informed, process evaluation seeks to provide insights into the delivery and response to a whole-systems approach to the implementation of supported self-management in asthma care in primary care. It is underway at a time of significant change in primary care in the UK. The methods have, therefore, been developed to be adaptable to this changing context and to capture the impact of these changes on the delivery and response to research and implementation processes.
摘要：
背景：为哮喘患者提供支持的自我管理可以减轻患者的负担，卫生服务和更广泛的社会。实施,然而,在常规临床实践中仍然很差。IMP2ART是一项英国范围的集群随机实施试验，旨在测试整个系统实施策略的影响。与常规护理相比，嵌入支持哮喘在初级保健中的自我管理。为了最大限度地增加审判后可持续实施的机会，有必要了解IMP2ART试验如何以及为何取得其临床和实施结果.
方法：将在IMP2ART试验中进行混合方法过程评估，以了解初级保健实践如何实施（或不实施）支持的自我管理，帮助解释试验结果，并告知扩大规模和可持续性。数据和分析策略已由中期和计划级别的理论提供信息。将在所有实践中收集定量数据，以描述实践背景，IMP2ART交付（包括保真度和适应性）和实践反应。在三到六个地点进行的案例研究，补充了与实践人员和利益相关者的额外访谈，将致力于深入了解实践背景的相互作用，delivery,和回应。合成,以理论为基础，将结合定性和定量数据的分析。最后,将通过与利益相关方的研讨会探讨在英国推广哮喘自我管理实施策略对其他实践的影响.
结论：这种混合方法，从理论上讲，过程评估旨在为初级保健哮喘护理中实施支持性自我管理的全系统方法的实施和反应提供见解.这是在英国初级保健发生重大变化的时候进行的。这些方法有，因此,适应这种不断变化的环境，并捕捉这些变化对交付和响应研究和实施过程的影响。
方法：将在IMP2ART试验中进行混合方法过程评估，以了解初级保健实践如何实施（或不实施）支持的自我管理，帮助解释试验结果，并告知扩大规模和可持续性。数据和分析策略已由中期和计划级别的理论提供信息。将在所有实践中收集定量数据，以描述实践背景，IMP2ART交付（包括保真度和适应性）和实践反应。在三到六个地点进行的案例研究，补充了与实践人员和利益相关者的额外访谈，将致力于深入了解实践背景的相互作用，delivery,和回应。合成,以理论为基础，将结合定性和定量数据的分析。最后,将通过与利益相关方的研讨会探讨在英国推广哮喘自我管理实施策略对其他实践的影响.
结论：这种混合方法，从理论上讲，过程评估旨在为初级保健哮喘护理中实施支持性自我管理的全系统方法的实施和反应提供见解.这是在英国初级保健发生重大变化的时候进行的。这些方法有，因此,适应这种不断变化的环境，并捕捉这些变化对交付和响应研究和实施过程的影响。
