Table 3.
Additional examples of data for contextual factors influencing implementation of CBPHC innovations by theme
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| 1a. Cross-jurisdictional nature of the work |
| “I think what we found in our program is that we’re doing it across 7 provinces with 11 communities, with the limited amount of resources that they have, and also the amount of resources that we can put in based on our funding constraints, so we tried to come up with some creative ways to make sure that the program was as participatory…” (T01 interview) |
| “…the pieces there that were again difficult were the ethics approvals we had to get in the four jurisdictions and then not only within the four universities but also within health authorities, within education regions within the four [jurisdiction] province.” (T09 interview) |
| 1b. International partners |
| “So the international collaborators, there’s…two people from the [country], two people from [country] and one person from [country]… So I will say that one of the things that facilitated the development of the protocol, linking as a group, and connecting with these international liaisons is an organization called [name] which is an international organization focusing on primary care, researchers and practitioners who are interested specifically in [chronic disease]…There were maybe 3 people in the world that were doing this.” (T12 interview) |
| “…he [research member] is also working with children and youth in [country] in the work that he is doing and often [country] and [country] are ahead of the curve in mental health issues. So, he’s been very much sending us things and bringing back ideas. Again, he’s always on our meetings every second week.” (T09 interview) |
| 1c. Multiple languages |
| “Language issues give rise to other problems, such as over-reliance on relatives and ethnic staff with the right language capacities, inconsistencies in deciding which services require interpretation and the patience of the staff in dealing with a non-English speaker. There are also culturally sensitive issues that may affect immigrants, regardless of their language capacity.” (T07 interview) |
| “…we’re the only bilingual team. We’re the only team that started at the beginning with a philosophy that was we are working on the things that we have in common. We can express those things in either language because someone will translate if needed…” (T11 interview) |
|
| 2a. Establishing and maintaining relationships |
| “…in every project I’ve ever worked on involving government people is the change of personnel and the inconsistency of who you deal with. It’s very hard to build relationships when you build a relationship with someone and they leave. And that turnover is such a huge issue.” (T08 interview) |
| “People’s position within the [health care network] changed, they might still be employees but they moved from a clinical role to an administrative role or…went back to school to upgrade their education.” (T06 interview) |
| “I think the point about overcoming conflict has to do with establishing those relationships [with providers] …” (T11 interview) |
| “…other researchers that just left because they took positions in other universities and institutions and didn’t feel it was relevant to stay involved in the project.” (T05 interview) |
| 2b. Complexity of being part of the CBPHC 12 teams |
| “At different meetings we would have as a research team it would be reflected on well we need to keep you aware that there are 12 teams… I think it’s nice to think that you’re part of something bigger and I think that to learn things across 12 teams definitely has the potential to have some powerful outcomes.” (T06 interview) |
| “So I think it’s kind of an opportunity to spawn, among the 12 teams, relationships and other working connections beyond just at the 12 team level, but a little bit closer with regards to what the work is of the intervention we’re planning.” (T12 interview) |
| “I have always maintained the 12 teams are very different, and that although there are some cross-cutting things….I can participate in that, but a lot of other things is not that relevant…on a personal level, knowing the other teams is important. In terms of impact on the research design, the research was designed before the teams were formed.” (T04 interview) |
| 2c. Level of engagement with stakeholders |
| “The status and buy-in of the leaders of the three case organizations here, at least in [province] were also impressive. The leaders of these organizations thought this was an important project, and at least a few of them are considered thought leaders in the broader health care community….” (T10 questionnaire) |
| “We had identified policy makers at the beginning of the grant but, had minimal involvement throughout. We struggled with knowing which policy makers to reach out to, along with what organizations should be involved” (T08 questionnaire). |
| 2d. Leadership |
| “…leadership can come from a variety of different levels…it could be community members who are really pushing for change and improvement…it’s an organization like a tribal council or regional health authorities who recognize that they want to do things differently than what has been done…” (T01 interview) |
| “…if you’re going to do a large-scale study across multiple jurisdictions and promise a lot of high-quality work, it’s just always a lot more money and time and waiting…If you have good people in leadership, like our group it’s do-able.” (T02 interview) |
| 2e. Working with Indigenous Peoples |
| “…because of our governance model and our being a First Nations organization involved in the collaboration, we had a responsibility to communities to respect their right to not share their data…And that has a lot to do with individual communities’ rights to have governance over their own data.” (T05 interview) |
| “So all of these are sort of contextual factors, having locally placed researchers. In the past, we rely on local people just to get the catering, you know, get the transportation and we want to move beyond that. So the people there [First Nation people] are actually playing a major role in planning research and implementing research.” (T04 interview) |
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| 3a. Differences in provincial health care systems |
| “There are provincial mandates about how much you can link at one time and how many people…you know system level and bureaucratic challenges but with that each of those provinces sort of have their own primary interests.” (T08 interview) |
| “…trying to understand how primary care physicians are organized and governed in groups…in the three different provinces…very challenging…” (T02 interview) |
| “Some [networks] are situated such that all services and providers are physically located in one building or site. Other are decentralized where a single [network] may have some centralized resources that service more than 35 clinics over a large geographical area. As such, providers are spread out over a large area, and this was a barrier to forming an intervention team…” (T06 questionnaire) |
| 3b. Funding models |
| “ None of it would have happened without the ability to…have a team grant and stable funding over time.” (T12 interview) |
| “Having a line in the budget of a region of the province which says, ok, these are the funds devoted to running this program. So as long as this is essentially run on research money, I think the real challenge for implementation, because it does require some additional resources, the challenge is that we want to see results within the same fiscal year, and within the same department.” (T07 interview) |
| 3c. Changes in legislation and health care priorities |
| “…there will be change facilitators introduced into academic family practices, there are more allied health professionals that are going to get integrated into those teams…part of the challenge is that we are in the context of a system that is constantly trying to evolve.” (T07 interview) |
| “…that was the change in the responsibility for the [service provider]; to have to take on this home and community care, and so that meant less engagement, you were less well-informed, less well-integrated.” (T03 interview) |
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| 4a. The fragmented structure of PHC |
| “Another weakness is a very low penetration of information technology (IT) to support health care delivery and improved performance. This is a major barrier to the coordination and continuity of care, especially for Canadians with chronic diseases” (T07 questionnaire). |
| “We need to really seriously start to look at technology. Technology does not replace cultural sensitive human contact, but on the other hand, if you try reaching continuity using technology vs. lack of continuity using short term people.” (T04 interview) |
| “I’m always saying that I don’t think that we need a lot of new resources in our health care system, we probably have enough, we just have to start using what we have in a much smarter way. The big issue is integration and organization of these services.” (T07 interview) |
| 4b. Competing priorities |
| “…we are not realistic…when we ask busy people to do research there seems to be an assumption that this is their only piece of research that they’re doing but it isn’t.” (T09 interview) |
| “So we had this really key partner who we were working with, and they were probably the number one stakeholder for that group who was most engaged, but then with the influx with refugees, that person was so busy on refugee health care for those people that they pretty well just left the project entirely.” (T02 interview) |