Why did we do the study?
Health TAPESTRY was implemented in six communities across Ontario, Canada. Each community differed in many aspects (e.g., size, rural vs. urban, etc). The primary care teams involved in Health TAPESTRY were also vastly different (e.g., number and type of providers, in-clinic programs, etc). We wanted to explore these contextual differences between sites, and how context may have impacted implementation at each site. This was especially important as we found the positive effectiveness seen in the first study was maintained at the original site in this second implementation but was not when looking at all sites.
What did we do?
We conducted interviews and focus groups and considered facts and details in the communities and settings. The interviews and focus group data used in this study included 135 people total, with clients, volunteers, volunteer coordinators, health care providers and other primary care team members, as well as administrative data from program staff.
What did we find?
We focused on three areas of the program that had the most distinct differences between sites: the work of the interprofessional teams, the volunteer program, and the client experience.
The sections describe main differences between sites which impacted implementation.
1. The Work of Interprofessional Teams
- Characteristics of the TAP-Huddle lead
- For example, was the leader in a clinical role? Were they new to the team or an existing member? What activities did they do in and out of the TAP-Huddle?
- Involvement of physicians
- For example, was there physician buy-in or investment into the program?
- Involvement of the volunteer coordinator
- For example, was the coordinator at the TAP-Huddle discussions or not? How did the volunteer coordinator communicate with the TAP-Huddle?
2. The Volunteer Program Coordination
- Relationships and connections between the volunteers and the primary care practices
- Volunteer coordinator characteristics
- For example, were the volunteer coordinators in the community or in a neighboring community? How did people see the role of the volunteer coordinator in that community and what tasks they do?
- Volunteer training
- For example, were continuing education sessions offered? How often and what topics were presented? Were there gaps in the training material?
- Connections with the community
- For example, were volunteers expected to make client referrals to community-based health and social services in that community? Did only the interprofessional care team focus on these referrals?
3. The Client Experience
- Different approaches to implementation
- For example, different communities recruited clients using different methods such as mailing out letters or phone calls
- Reaching the right group of patients
- For example, did respondents feel that the clients in Health TAPESTRY were the ones who would really benefit?
What do our findings mean?
We suggest that future programs consider local context in these key areas when planning implementation of similar programs and their impact on the implementation of key elements. Providing clear roles for all stakeholders is important and considering this along with both the size of the primary care practice and community prior to implementing a primary care-based program is very important for successful program implementation.
The full article can be found here:
Gaber J, Datta J, Clark R, Lamarche L, Parascandalo F, Di Pelino S, Forsyth P, Oliver D, Mangin D, and Price D. Understanding how context and culture in six communities can shape implementation of a complex intervention: a comparative case study. BMC Health Serv Res 22, 221 (2022). https://doi.org/10.1186/s12913-022-07615-0