{
  "abstract": "Background Supported self-management reduces asthma hospital admissions and unscheduled consultations, and improves asthma control (Pinnock 2017), but its implementation in routine clinical practice remains poor. IMP 2ART is a theoretically-based, whole system primary care intervention designed to improve asthma outcomes. It is being evaluated in a UK-wide, cluster randomized trial (144 practices) with co-primary outcomes (unscheduled asthma care and possession of a personalised asthma action plan) at two years’ follow up. Trial results will be available in Summer 2025. Intervention arm practices were supported for 12-months by a nurse facilitator. The implementation strategy included facilitated formation of a practice plan, a template for asthma reviews, regular audit and feedback, team/professional education, and a ‘Living-with-Asthma’ website for patients and professionals. Here we report the findings of a nested process evaluation designed to understand how the strategy was delivered and what influenced practice engagement and change.Methods We analysed data over the two-year trial period on delivery of, and response to, the IMP 2ART strategy in implementation practices. Quantitative data were obtained from practice surveys, publicly available sources on practice populations, researcher and facilitator logs and educational module analytics. Interviews were undertaken with clinical and non-clinical staff involved in asthma care (n=28) in 16 practices to understand practice context, expectations and experiences of IMP2ART, using a topic guide informed by the iPARIHS framework (Harvey & Kitson, 2015). Qualitative and quantitative data were analysed separately by data source, then selected interim findings across data sources were triangulated.Results Of the 73 practices randomised to implementation, 69 (95%) remained in the trial. Facilitation workshops were delivered to 66 (90%) practices. Most practices engaged with team (84%) and individual (75%) education modules. On average practices received 21 (SD 3) monthly audit reports (range 10–25), though discrepancies with their own audit data highlighted issues with clinical coding in some practices. The asthma review template was the least used resource, with staff preferring their current templates. There was, however, variation across practices in which implementation strategies were used and valued. Qualitative data suggested that engagement was strongest in practices which started with scope to improve and readiness to change. Change appeared more sustainable in practices with aligned perspectives and processes across the whole practice team.Conclusion The process evaluation provides insights into the variability of delivery and response to the implementation of the IMP 2ART strategy and supports the whole systems approach.Funding NIHR RP-PG-1016–20008 ( ISRCTN 15448074).",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Steph Taylor"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Catherine MacLeod"
    },
    {
      "affiliations": [
        "Department of Applied Health Research, University College London, London, UK"
      ],
      "name": "Jessica Sheringham"
    },
    {
      "affiliations": [
        "School of Health and Related Research, The University of Sheffield, Sheffield, UK"
      ],
      "name": "Brigitte Delaney"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Viv Marsh"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Victoria Hammersley"
    },
    {
      "affiliations": [
        "University of Dundee, Dundee, UK"
      ],
      "name": "Kirstie McClatchey"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Liz Steed"
    },
    {
      "affiliations": [
        "Usher Institute, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Hilary Pinnock"
    }
  ],
  "title": "OP46 Delivery and response to implementation strategies in primary care: findings of a mixed-methods process evaluation within the IMP2ART cluster randomised controlled trial",
  "uid": "0dd5aaaf-7e0a-5acc-9222-2f381b8a66d8"
}