Addressing implementation of a patient-activation and self-management intervention within the context of an effectiveness trial – a hybrid-implementation study

Objective: This hybrid-implementation study examines contextual factors important for delivering a patient-activation/self-management intervention in 13 mental health clinics within the context of an effectiveness trial in order to inform understanding of what could happen when implementing the intervention in a real-world context. Methods: Eighteen key personnel addressed the following contextual factors in interviews: intervention linkage to organization values/ patient needs; leadership, provider, and administrative buy-in/support; leadership and key personnel roles; and organizational resources. Data were qualitatively analyzed using the constant comparative method. Results: All four contextual factors were relevant in facilitating the delivery of the intervention. However, challenges in delivering the intervention existed as well. Notably, organizational constraints within the clinic and resource constraints of some patients served as barriers to delivering the intervention to patients. Although buy-in for the intervention was achieved at all levels of the clinic (leadership, most providers, and administrative staff), buy-in was weaker among providers with a psychodynamic orientation and among providers who may have misunderstood the intent of questions asked by activated patients; thus, impacting the delivery of the intervention. Discussion: In order to expedite the research-to-practice process, contextual factors that play a role in the implementation of an intervention could be examined in the intervention's effectiveness trial. Findings from this study could aid in the development of an implementation strategy for this intervention by addressing clinic and patient constraints and ensuring buy-in from leadership, providers, and administrative staff. Such an implementation strategy could, in turn, be tested in a future full-scale implementation study.