Skip to main content
Top
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

A qualitative study examining healthcare managers and providers’ perspectives on participating in primary care implementation research

Authors: Lisa A. Wozniak, Allison Soprovich, Sandra Rees, Steven T. Johnson, Sumit R. Majumdar, Jeffrey A. Johnson

Published in: BMC Health Services Research | Issue 1/2016

Login to get access

Abstract

Background

Primary care reforms should be supported by high-quality evidence across the entire life cycle of research. Front-line healthcare providers play an increasing role in implementation research. We recently evaluated two interventions for people with type 2 diabetes (T2D) in partnership with four Primary Care Networks (PCNs) in Alberta, Canada. Here, we report healthcare professionals perspectives on participating in primary care implementation research.

Methods

Guided by the RE-AIM framework, we collected qualitative data before, during, and after both interventions. We conducted 34 in-person or telephone interviews with 17 individual PCN professionals. We used content analysis to identify emerging codes and concepts.

Results

Two major themes emerged from the data. First, healthcare managers were eager to conduct implementation research in a primary care setting. Second, regardless of willingness to conduct research, there were challenges to implementing experimental study designs for both interventions. PCN professionals presumed the interventions were better than usual care, expressed role conflict, and reported administrative burdens related to research participation. Perceptions of patient vulnerability and an obligation to intervene exacerbated these issues.

Conclusions

Healthcare professionals with limited practical research experience might not foresee the challenges in implementing experimental study designs in primary care settings to generate high-quality evidence. These issues are intensified when healthcare professionals perceive target patient populations as vulnerable and in need of intervention based on the presenting illness. Possible solutions include further research training, involving healthcare professionals in study design development, and using non-clinical staff to conduct research activities, particularly among acutely unwell patient populations.
Literature
2.
go back to reference Donovan JL, Paramasivan S, de Salis I, Toerien M. Clear obstacles and hidden challenges: understanding recruiter perspectives in six pragmatic randomised controlled trials. Trials. 2014;15:5–17.CrossRefPubMedPubMedCentral Donovan JL, Paramasivan S, de Salis I, Toerien M. Clear obstacles and hidden challenges: understanding recruiter perspectives in six pragmatic randomised controlled trials. Trials. 2014;15:5–17.CrossRefPubMedPubMedCentral
3.
go back to reference Spilsbury K, Petherick E, Cullum N, Nelson A, Nixon J, Mason S. The role and potential contribution of clinical research nurses to clinical trials. J Clin Nurs. 2008;17:549–57.PubMed Spilsbury K, Petherick E, Cullum N, Nelson A, Nixon J, Mason S. The role and potential contribution of clinical research nurses to clinical trials. J Clin Nurs. 2008;17:549–57.PubMed
4.
go back to reference Lawton J, Jenkins N, Darbyshire J, Farmer A, Holman R, Hallowell N. Understanding the outcomes of multi-centre clinical trials: A qualitative study of health professional experiences and views. Soc Sci Med. 2012;74:574–81.CrossRefPubMed Lawton J, Jenkins N, Darbyshire J, Farmer A, Holman R, Hallowell N. Understanding the outcomes of multi-centre clinical trials: A qualitative study of health professional experiences and views. Soc Sci Med. 2012;74:574–81.CrossRefPubMed
5.
go back to reference Oberle K, Allen M. Ethical considerations for nurses in clinical trials. Nurs Ethics. 2006;13:180–6.CrossRefPubMed Oberle K, Allen M. Ethical considerations for nurses in clinical trials. Nurs Ethics. 2006;13:180–6.CrossRefPubMed
6.
go back to reference Tomlin Z, deSalis I, Toerien M, Donovan JL. Patient advocacy and patient centredness in participant recruitment to randomized-controlled trials: implications for informed consent. Health Expect. 2014;17:670–82.CrossRefPubMed Tomlin Z, deSalis I, Toerien M, Donovan JL. Patient advocacy and patient centredness in participant recruitment to randomized-controlled trials: implications for informed consent. Health Expect. 2014;17:670–82.CrossRefPubMed
7.
go back to reference Wilkes L, Cert R, Beale B. Role conflict: appropriateness of a nurse researcher’s actions in the clinical field. Nurse Res. 2005;12:57–70.CrossRefPubMed Wilkes L, Cert R, Beale B. Role conflict: appropriateness of a nurse researcher’s actions in the clinical field. Nurse Res. 2005;12:57–70.CrossRefPubMed
8.
go back to reference Beale B, Wilkes L. Nurse researcher: always a researcher, sometimes a nurse. Collegian. 2001;8:33–9.CrossRefPubMed Beale B, Wilkes L. Nurse researcher: always a researcher, sometimes a nurse. Collegian. 2001;8:33–9.CrossRefPubMed
9.
go back to reference Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA. 2009;301:2038–40.CrossRefPubMed Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform? JAMA. 2009;301:2038–40.CrossRefPubMed
10.
go back to reference Reid RJ, Coleman K, Johnson EA, Fishman PA, Hsu C, Soman MP, Trescott CE, Erikson M, Larson EB. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29:835–43.CrossRef Reid RJ, Coleman K, Johnson EA, Fishman PA, Hsu C, Soman MP, Trescott CE, Erikson M, Larson EB. The Group Health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Aff (Millwood). 2010;29:835–43.CrossRef
12.
go back to reference Johnson ST, Mundt C, Soprovich A, Wozniak L, Plotnikoff RC, Johnson JA. Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes. BMC Public Health. 2012;12:455–64.CrossRefPubMedPubMedCentral Johnson ST, Mundt C, Soprovich A, Wozniak L, Plotnikoff RC, Johnson JA. Healthy eating and active living for diabetes in primary care networks (HEALD-PCN): rationale, design, and evaluation of a pragmatic controlled trial for adults with type 2 diabetes. BMC Public Health. 2012;12:455–64.CrossRefPubMedPubMedCentral
13.
go back to reference Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, et al. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation. BMC Health Serv Res. 2012;12:258.CrossRefPubMedPubMedCentral Johnson JA, Al Sayah F, Wozniak L, Rees S, Soprovich A, Chik CL, Chue P, Florence P, Jacquier J, Lysak P, et al. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Rationale and design for a comprehensive evaluation. BMC Health Serv Res. 2012;12:258.CrossRefPubMedPubMedCentral
14.
go back to reference Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC. Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Diabetes Obes Metab. 2009;11:836–43.CrossRefPubMed Johnson ST, Bell GJ, McCargar LJ, Welsh RS, Bell RC. Improved cardiovascular health following a progressive walking and dietary intervention for type 2 diabetes. Diabetes Obes Metab. 2009;11:836–43.CrossRefPubMed
15.
go back to reference Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363:2611–20.CrossRefPubMedPubMedCentral Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, Peterson D, Rutter CM, McGregor M, McCulloch D. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363:2611–20.CrossRefPubMedPubMedCentral
16.
go back to reference Katon WJ, Von Korff M, Lin EHB, Simon G, Ludman E, Russo J, Ciechanowski P, Walker W, Bush T. The pathways study - A randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.CrossRefPubMed Katon WJ, Von Korff M, Lin EHB, Simon G, Ludman E, Russo J, Ciechanowski P, Walker W, Bush T. The pathways study - A randomized trial of collaborative care in patients with diabetes and depression. Arch Gen Psychiatry. 2004;61:1042–9.CrossRefPubMed
17.
go back to reference Johnson ST, Mundt C, Qiu W, Soprovich A, Wozniak L, Plotnikoff R, Johnson JA. Increase in daily steps after an exercise specialist led lifestyle intervention for adults with type 2 diabetes in primary care: a controlled implementation trial. J Phys Act Health. 2015;12:1492–9.CrossRefPubMed Johnson ST, Mundt C, Qiu W, Soprovich A, Wozniak L, Plotnikoff R, Johnson JA. Increase in daily steps after an exercise specialist led lifestyle intervention for adults with type 2 diabetes in primary care: a controlled implementation trial. J Phys Act Health. 2015;12:1492–9.CrossRefPubMed
18.
go back to reference Johnson JA, Al Sayah F, Rees S, Qiu W, Chik C, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, et al. Collaborative Care vs Screening and Follow-up for Patients with Depression and Diabetes: Results of a Primary-Care Based Comparative Effectiveness Trial. Diabetes Care. 2014;37:3220–6.CrossRefPubMed Johnson JA, Al Sayah F, Rees S, Qiu W, Chik C, Chue P, Florence P, Jacquier J, Lysak P, Opgenorth A, et al. Collaborative Care vs Screening and Follow-up for Patients with Depression and Diabetes: Results of a Primary-Care Based Comparative Effectiveness Trial. Diabetes Care. 2014;37:3220–6.CrossRefPubMed
19.
go back to reference Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.CrossRefPubMedPubMedCentral Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.CrossRefPubMedPubMedCentral
20.
go back to reference Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–27.CrossRefPubMed Glasgow RE, McKay HG, Piette JD, Reynolds KD. The RE-AIM framework for evaluating interventions: what can it tell us about approaches to chronic illness management? Patient Educ Couns. 2001;44:119–27.CrossRefPubMed
21.
go back to reference Glasgow RE. Translating research to practice - Lessons learned, areas for improvement, and future directions. Diabetes Care. 2003;26:2451–6.CrossRefPubMed Glasgow RE. Translating research to practice - Lessons learned, areas for improvement, and future directions. Diabetes Care. 2003;26:2451–6.CrossRefPubMed
22.
go back to reference Wozniak L, Rees S, Soprovich A, Al Sayah F, Johnson ST, Majumdar SR, Johnson JA. Applying the RE-AIM framework to the Alberta's Caring for Diabetes Project: a protocol for a comprehensive evaluation of primary care quality improvement interventions. BMJ Open. 2012;2:e002099-e002109. Wozniak L, Rees S, Soprovich A, Al Sayah F, Johnson ST, Majumdar SR, Johnson JA. Applying the RE-AIM framework to the Alberta's Caring for Diabetes Project: a protocol for a comprehensive evaluation of primary care quality improvement interventions. BMJ Open. 2012;2:e002099-e002109.
23.
go back to reference Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13:87–108.CrossRefPubMed Shediac-Rizkallah MC, Bone LR. Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy. Health Educ Res. 1998;13:87–108.CrossRefPubMed
24.
go back to reference Garfield SA, Malozowski S, Chin MH, Narayan KM, Glasgow RE, Green LW, Hiss RG, Krumholz HM. Considerations for diabetes translational research in real-world settings. Diabetes Care. 2003;26:2670–4.CrossRefPubMed Garfield SA, Malozowski S, Chin MH, Narayan KM, Glasgow RE, Green LW, Hiss RG, Krumholz HM. Considerations for diabetes translational research in real-world settings. Diabetes Care. 2003;26:2670–4.CrossRefPubMed
25.
go back to reference Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38:65–76.CrossRefPubMed Proctor E, Silmere H, Raghavan R, Hovmand P, Aarons G, Bunger A, Griffey R, Hensley M. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38:65–76.CrossRefPubMed
26.
go back to reference Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, et al. A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med. 2004;141:366–73.CrossRefPubMed Majumdar SR, Rowe BH, Folk D, Johnson JA, Holroyd BH, Morrish DW, Maksymowych WP, Steiner IP, Harley CH, Wirzba BJ, et al. A controlled trial to increase detection and treatment of osteoporosis in older patients with a wrist fracture. Ann Intern Med. 2004;141:366–73.CrossRefPubMed
27.
go back to reference Mathe N, Johnson ST, Wozniak L, Majumdar SR, Johnson JA. Alternation as a form of allocation for quality improvement studies in primary health care settings: the on-off study design. Trials. 2015;16:375–85.CrossRefPubMedPubMedCentral Mathe N, Johnson ST, Wozniak L, Majumdar SR, Johnson JA. Alternation as a form of allocation for quality improvement studies in primary health care settings: the on-off study design. Trials. 2015;16:375–85.CrossRefPubMedPubMedCentral
28.
go back to reference Morse JM, Field PA. Qualitative Research Methods for Health Professionals. 2nd ed. Thousand Oaks: Sage Publications; 1995. Morse JM, Field PA. Qualitative Research Methods for Health Professionals. 2nd ed. Thousand Oaks: Sage Publications; 1995.
29.
go back to reference Mayan MJ. Essentials of qualitative inquiry. Walnut Creek: Left Coast Press; 2009. Mayan MJ. Essentials of qualitative inquiry. Walnut Creek: Left Coast Press; 2009.
30.
go back to reference Morse JM, Barret M, Mayan M, Olson K, Spier J. Verification Strategies for Establishing Reliability and Validity in Qualitative Research. Int J Qual Methods. 2002;1:13–22.CrossRef Morse JM, Barret M, Mayan M, Olson K, Spier J. Verification Strategies for Establishing Reliability and Validity in Qualitative Research. Int J Qual Methods. 2002;1:13–22.CrossRef
31.
go back to reference Guba EG, Lincoln YS. Fourth Generation Evaluation. Newbury Park: Sage; 1989. Guba EG, Lincoln YS. Fourth Generation Evaluation. Newbury Park: Sage; 1989.
33.
go back to reference Jones A, Burgess TA, Farmer EA, Fuller J, Stocks NP, Taylor JE, Waters RL. Building research capacity. An exploratory model of GPs’ training needs and barriers to research involvement. Aust Fam Physician. 2003;32:957–60.PubMed Jones A, Burgess TA, Farmer EA, Fuller J, Stocks NP, Taylor JE, Waters RL. Building research capacity. An exploratory model of GPs’ training needs and barriers to research involvement. Aust Fam Physician. 2003;32:957–60.PubMed
34.
go back to reference Wozniak L, Soprovich A, Rees S, Johnson ST, Majumdar SR, Johnson JA. Challenges in identifying patients with type 2 diabetes for quality-improvement interventions in primary care settings and the importance of valid disease registries. Can J Diabetes. 2015;39:S77–82.CrossRefPubMed Wozniak L, Soprovich A, Rees S, Johnson ST, Majumdar SR, Johnson JA. Challenges in identifying patients with type 2 diabetes for quality-improvement interventions in primary care settings and the importance of valid disease registries. Can J Diabetes. 2015;39:S77–82.CrossRefPubMed
Metadata
Title
A qualitative study examining healthcare managers and providers’ perspectives on participating in primary care implementation research
Authors
Lisa A. Wozniak
Allison Soprovich
Sandra Rees
Steven T. Johnson
Sumit R. Majumdar
Jeffrey A. Johnson
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1577-1

Other articles of this Issue 1/2016

BMC Health Services Research 1/2016 Go to the issue