Table 3.
Reporting modifications of the PVS-PREDIAPS implementation strategy
| 1. Added actions | |||
| Modification/Description | Additional training session in the recommended clinical intervention and in the ICT tool (M1) | Additional session for physicians’ involvement in the Sequential Group (M2) | Additional training session in the recommended clinical intervention and in the ICT for new professionals (M3) |
| When did the modification occur? | Month 1 of the implementation phase | Month 11 of the implementation phase | Month 20–21 of the implementation phase |
| Were modifications planned? | Unplanned and reactive | Unplanned and reactive | Unplanned and reactive |
| Who participated in the decision to modify? Who made the ultimate decision? | Implementation team, formed by healthcare professionals of the center and the external facilitator | Local leader and the external facilitator | Implementation team, formed by healthcare professionals of the center and the external facilitator |
| What was modified? | The dose of the training component by repeating the former planned action/session | The dose and the actors involved, as the session for “involvement of physicians” (PDSA session #3) was repeated adding the presence of the integrated healthcare organization management staff | An additional training session was to newly incorporated professionals was offered, scheduled and performed |
| At what level of delivery (for whom/what is the modification made)? | Healthcare professionals of one PC of the Sequential group (Sv) | One PC of the Sequential group (Sv) | Few new professionals from 4 centers: 1 from the Global (A, n = 3); 3 from the Sequential (Sv, n = 1; Z, n = 2; So, n = 1) |
| What is the nature of the content modification? | An additional 90-min session was performed on the recommended clinical health promotion intervention and the ICT healthy lifestyle promotion tool | An additional 90-min session with all PC professionals with the participation of representatives of the management of the integrated healthcare organization | An additional 90-min session was performed on the recommended clinical health promotion intervention and the ICT healthy lifestyle promotion tool |
| Relationship fidelity/core elements? | Fidelity consistent/core elements or functions preserved | Fidelity consistent/core elements or functions preserved | Unknown |
| What was the goal? | Increase healthcare professional’s knowledge and skills to provide the recommended clinical intervention | Maximize number of physicians engaged | Train newly incorporated professionals to provide the recommended clinical intervention |
| What are the reasons for the modifications? | Perceived difficulty of the providing the recommended intervention through the ICT healthy lifestyle promotion tool | Lack of attendance to the planned session | Staff turnover |
| 2. Actions not or only partially delivered | |||
| Modification/Description | Failed to organize and conduct the planned ongoing supportive training session (M5) | Failed to attend to regular audits and ongoing facilitation sessions (M4) | Failed to organize and conduct the planned number of regular audits and ongoing facilitation sessions (M6) |
| When did the modification occur? | Month 20 in the post-implementation phase | Months 15, 22 and 24 in the post-implementation phase | Post-implementation phase |
| Were adaptations planned? | Unplanned and reactive | Unplanned and reactive | Unplanned and reactive |
| Who participated in the decision to modify? Who made the ultimate decision? | Local leader and healthcare professionals of the center | Local leader and healthcare professionals of the center | Implementation team, formed by healthcare professionals of the center and the external facilitator |
| What was modified? | Planned training session suspended | Planned and scheduled sessions suspended | Planned sessions suspended |
| At what level of delivery (for whom/what is the modification made)? | 2 centers in the Sequential group (Eg, So) and 2 in the Global group (A, Z) failed | 2 PC in the Sequential group (Eg, Z) and one in the Global group (I) failed once; 1 PC in the Sequential group (Er) failed twice | All centers |
| What is the nature of the content modification? | No modification required | No modification required | No modification required |
| Relationship fidelity/core elements? | Fidelity inconsistent as this was a core element within the planned strategy | Fidelity inconsistent as this was a core element within the planned strategy | Fidelity inconsistent as this was a core element within the planned strategy |
| What was the goal? | Increase healthcare professionals’ knowledge and skills to provide the recommended clinical intervention | Provide ongoing support and assess progress in the implementation process | Provide ongoing support and assess progress in the implementation process |
| What are the reasons for the modifications? | Difficulty for scheduling meetings due to work overload or other competing priorities | Difficulty for scheduling meetings due to work overload or other competing priorities | Difficulty for scheduling meetings due to work overload or other competing priorities |