Table 4.
Additional examples of data for strategies to address contextual factors in CBPHC
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1. Conducting an environmental scan at the beginning
“Environmental scans are contextual portraits of [project] communities, that include collating the existing data related to health needs, key healthcare indicators, organization of healthcare services, and available resources and partnerships.” (T07 questionnaire) |
| “…An environmental scan is really sort of the basic part of the design of the program. The first thing that we do, we want to know what’s available. We want to know who are the primary care providers, we want to know about community pharmacies, we want to know about different organizations, different programs, different initiatives that exist within the region because ultimately these are our partners…We don’t create new programs ourselves, but we want to make sure that the existing programs are better utilized.” (T07 interview) |
| 2. Maintaining engagement among partners and stakeholders by encouraging open and inclusive communication |
| “We found it necessary to devote significant time engaging stakeholders. Feedback through this engagement influenced our study processes.” (T02 questionnaire) |
| “We committed our partners to be involved and communities to be involved in every aspect of the program and they have been involved in every aspect of the program…it’s not as ideal as we would have hoped for and that is one of the reasons that we are having an October workshop is because we want to ensure that the [First Nation] communities have a full say in the evaluation and knowledge translation phase.” (T01 interview) |
| “We favour open discussions where all [project] investigators and staff are welcome to contribute. As such, we hold weekly teleconferences to provide progress reports, and discuss common opportunities and challenges and higher levels discussion of [project] orientation and strategic planning.” (T07 questionnaire) |
| 3. Contextualizing the innovation for different settings |
| “We’re also interested to see if we can go beyond cardiovascular risk factors…In some projects we were also looking at screening for atrial fibrillation because the automated blood pressure devices that we utilize allow us to do that as well. We also looked at the issue of patients who don’t have family physicians…So the interest was to see how the program needs to be again, modified, adapted, and how do we integrate the program with larger primary care?” (T07 interview) |
| “Maybe an important lesson for us is you know the more integration we are trying to do into existing structures, the more changes in context can be a threat. Because you know, we’re relying on more and more things that are outside our control.” (T03 interview) |
| “The idea was that you could demonstrate that it works very well [jurisdiction], we would take it over to [jurisdiction] and say look, your remote system is pretty much the same, why don’t you move to something that is more centralized…” (T04 interview) |
| 4. Anticipating and addressing changes, delays, and needing additional resources |
| “So workload, so I was anticipating a certain staffing complement to do these tasks and we pretty much had to double. We pretty much had to have many more staff to do the task to make sure all the patients were being approached in the right way, and that the providers were in the loop and everybody had their responsibility of who they were communicating with.” (T11 interview) |
| “I’m speaking just for the patients’ journey piece right now because you have referenced the people we interviewed and we did some training of students we did sort of a boot-camp to train up students to how to do interviews with children, parents, service provider, policy-makers. So that was another piece that we felt was very important to the project but was very time consuming.” (T09 interview) |
| “…it’s a lot of extra work to be part of the 12 teams and work together….” (T02 interview) |
| 5. Fostering a culture of research and innovation among partners and stakeholders |
| “So that is something that I think that unfortunately, research is something that the government says ‘It’s not our job to support research, we will promote it, we will help you facilitate, and write letters of support, but don’t expect us to spend money on’” (T04 interview) |
| “So there is little interest on the part of decision makers who collect any meaningful data. They are usually interested in sort of head count, they are not necessarily interested in sort of the impact, very frequently there is no before data or after data. There is no research culture.” (T07 interview) |
| 6. Ensuring information about the innovation is widely available |
| “In the third phase, we aim to translate our research into practice by identifying emerging models of Integrated CBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction.” (T10 questionnaire) |
| “We’re trying to develop a newsletter, [study member] has been leading that. We have a website, we let people know about publications…” (T12 interview) |
| “…At the mid-way through where we started not just involving our people that’ve experienced any organizations that sort of higher-level discussion. But actually bringing our research outwards to them [organizations], having different kinds of presentations and taking more time to understand their perspectives at each stage of the research process.” (T08 interview) |