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Green Book

Approaches to implementation - Chapter 3.1

Introduction

Guidelines for the implementation of prevention in the general practice setting
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  1. Figures and tables
  2. Green book resources
  3. Provided under licence

Key points

  • Using a framework can make implementing preventive care activities easier and more successful.
  • Which of the relevant frameworks you choose will depend on your situation and goals.
  • Understanding behaviour and behaviour change is a component of many frameworks and a key part of successful implementation.

The Green Book brings together two main themes: prevention and implementation.

Both of these sit within QI and are inherently associated with behaviour change.

When you decide to improve preventive care in your practice, having a framework to help you plan and implement strategies and interventions can be beneficial. There are several frameworks (and theories) that are relevant to preventive care implementation in general practice, and it can be challenging to select the ‘right’ one.1

It’s important to note that:

  • many strategies and interventions have been shown to be effective when implemented individually or collectively2–56
  • there is no one framework that is more effective for implementing strategies and interventions than the others across all situations20,22,23,57–64
  • many of the theories and frameworks help us understand behaviours and identify techniques to change both patient and practice behaviours.65
  1. Bhattacharyya O, Reeves S, Garfinkel S, Zwarenstein M. Designing theoretically-informed implementation interventions: Fine in theory, but evidence of effectiveness in practice is needed. Implement Sci 2006;1:5.
  2. Walling EB, Benzoni N, Dornfeld J, et al. Interventions to improve HPV vaccine uptake: A systematic review. Pediatrics 2016;138(1).
  3. Tansil KA, Esser MB, Sandhu P, et al. Alcohol electronic screening and brief intervention: A community guide systematic review. Am J Prev Med 2016;51(5):801–11.
  4. Syrowatka A, Krömker D, Meguerditchian AN, Tamblyn R. Features of computer-based decision aids: Systematic review, thematic synthesis, and meta-analyses. J Med Internet Res 2016;18(1):e20.
  5. Pearce G, Parke HL, Pinnock H, et al. The PRISMS taxonomy of self-management support: Derivation of a novel taxonomy and initial testing of its utility. J Health Serv Res Policy 2016;21(2):73–82.
  6. McLean SM, Booth A, Gee M, et al. Appointment reminder systems are effective but not optimal: Results of a systematic review and evidence synthesis employing realist principles. Patient Prefer Adherence 2016;10:479–99.
  7. McElwaine KM, Freund M, Campbell EM, Bartlem KM, Wye PM, Wiggers JH. Systematic review of interventions to increase the delivery of preventive care by primary care nurses and allied health clinicians. Implement Sci 2016;11:50.
  8. Liddy C, Drosinis P, Keely E. Electronic consultation systems: Worldwide prevalence and their impact on patient care – A systematic review. Fam Pract 2016;33(3):274–85.
  9. Lau R, Stevenson F, Ong BN, et al. Achieving change in primary care – Causes of the evidence to practice gap: Systematic reviews of reviews. Implement Sci 2016;11:40.
  10. Khan MS, Guan BY, Audimulam J, Cervero Liceras F, Coker RJ, Yoong J. Economic interventions to improve population health: A scoping study of systematic reviews. BMC Public Health 2016;16:528.
  11. Jacob V, Chattopadhyay SK, Hopkins DP, et al.
  12. Increasing coverage of appropriate vaccinations:
  13. A community guide systematic economic review. Am J Prev Med 2016;50(6):797–808.
  14. Herrmann A, Mansfield E, Hall AE, Sanson-Fisher R, Zdenkowski N. Wilfully out of sight? A literature review on the effectiveness of cancer-related decision aids and implementation strategies. BMC Med Inform Decis Mak 2016;16:36.
  15. Escribà-Agüir V, Rodríguez-Gómez M, Ruiz-Pérez I. Effectiveness of patient-targeted interventions to promote cancer screening among ethnic minorities: A systematic review. Cancer Epidemiol 2016;44:22–39.
  16. Clayman ML, Bylund CL, Chewning B, Makoul G. The impact of patient participation in health decisions within medical encounters: A systematic review. Med Decis Making 2016;36(4):427–52.
  17. Brown BB, Patel C, McInnes E, Mays N, Young J, Haines M. The effectiveness of clinical networks in improving quality of care and patient outcomes: A systematic review of quantitative and qualitative studies. BMC Health Serv Res 2016;16:360.
  18. Zimbudzi E, Lo C, Misso M, Ranasinha S, Zoungas S. Effectiveness of management models for facilitating self-management and patient outcomes in adults with diabetes and chronic kidney disease. Syst Rev 2015;4:81.
  19. Yamada J, Shorkey A, Barwick M, Widger K, Stevens BJ. The effectiveness of toolkits as knowledge translation strategies for integrating evidence into clinical care: A systematic review. BMJ Open 2015;5(4):e006808.
  20. Sinclair P, Kable A, Levett-Jones T. The effectiveness of internet-based e-learning on clinician behavior and patient outcomes: A systematic review protocol. JBI Database System Rev Implement Rep 2015;13(1):52–64.
  21. Oliveira VC, Ferreira ML, Pinto RZ, Filho RF, Refshauge K, Ferreira PH. Effectiveness of training clinicians’ communication skills on patients’ clinical outcomes: A systematic review. J Manipulative Physiol Ther 2015;38(8):601–16.
  22. Mostofian F, Ruban C, Simunovic N, Bhandari M. Changing physician behavior: What works? Am J Manag Care 2015;21(1):75–84.
  23. Morton K, Beauchamp M, Prothero A, et al. The effectiveness of motivational interviewing for health behaviour change in primary care settings: A systematic review. Health Psychol Rev 2015;9(2):205–23.
  24. Leeman J, Calancie L, Hartman MA, et al. What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: A systematic review. Implement Sci 2015;10:80.
  25. Johnson MJ, May CR. Promoting professional behaviour change in healthcare: What interventions work, and why? A theory-led overview of systematic reviews. BMJ Open 2015;5(9):e008592.
  26. Irwin R, Stokes T, Marshall T. Practice-level quality improvement interventions in primary care: A review of systematic reviews. Prim Health Care Res Dev 2015;16(6):556–77.
  27. Harden SM, Gaglio B, Shoup JA, et al. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: A systematic review. Syst Rev 2015;4:155.
  28. Grudniewicz A, Kealy R, Rodseth RN, Hamid J, Rudoler D, Straus SE. What is the effectiveness of printed educational materials on primary care physician knowledge, behaviour, and patient outcomes: A systematic review and meta-analyses. Implement Sci 2015;10:164.
  29. Davy C, Bleasel J, Liu H, Tchan M, Ponniah S, Brown A. Effectiveness of chronic care models: Opportunities for improving healthcare practice and health outcomes: A systematic review. BMC Health Serv Res 2015;15:194.
  30. Bambra CL, Hillier FC, Cairns JM, Kasim A, Moore HJ, Summerbell CD. How effective are interventions at reducing socioeconomic inequalities in obesity among children and adults? Two systematic reviews. Public Health Research. Southampton, UK: NIHR Journals Library, 2015.
  31. Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B. A systematic review of real-world diabetes prevention programs: Learnings from the last 15 years. Implement Sci 2015;10:172.
  32. Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev 2014;(7):CD005188.
  33. Thepwongsa I, Kirby CN, Schattner P, Piterman L.
  34. Online continuing medical education (CME) for GPs: Does it work? A systematic review. Aust Fam Physician 2014;43(10):717–21.
  35. Thepwongsa I, Kirby C, Schattner P, Shaw J, Piterman L. Type 2 diabetes continuing medical education for general practitioners: What works? A systematic review. Diabet Med 2014;31(12):1488–97.
  36. Taylor SJC, Pinnock H, Epiphaniou E, et al. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic Review of SelfManagement Support for long-term conditions. Health Services and Delivery Research. Southampton, UK: NIHR Journals Library, 2014.
  37. Stacey D, Légaré F, Col NF, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014;(1):CD001431.
  38. McLean S, Gee M, Booth A, et al. Targeting the use of reminders and notifications for uptake by populations (TURNUP): A systematic review and evidence synthesis. Health Services and Delivery Research. Southampton, UK: NIHR Journals Library, 2014.
  39. Martínez-González NA, Djalali S, Tandjung R, et al.
  40. Substitution of physicians by nurses in primary care: A systematic review and meta-analysis. BMC Health Serv Res 2014;14:214.
  41. Légaré F, Stacey D, Turcotte S, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2014;(9):CD006732.
  42. Jones KR, Lekhak N, Kaewluang N. Using mobile phones and short message service to deliver selfmanagement interventions for chronic conditions: A meta-review. Worldviews Evid Based Nurs 2014;11(2):81–88.
  43. Donoghue K, Patton R, Phillips T, Deluca P, Drummond C. The effectiveness of electronic screening and brief intervention for reducing levels of alcohol consumption: A systematic review and meta-analysis. J Med Internet Res 2014;16(6):e142.
  44. Schichtel M, Rose PW, Sellers C. Educational interventions for primary healthcare professionals to promote the early diagnosis of cancer: A systematic review. Educ Prim Care 2013;24(4):274–90.
  45. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: Effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013;(3):CD002213.
  46. O’Mara-Eves A, Brunton G, McDaid D, et al. Community engagement to reduce inequalities in health: A systematic review, meta-analysis and economic analysis. Public Health Research. Southampton, UK: NIHR Journals Library, 2013.
  47. McDermott MS, While AE. Maximizing the healthcare environment: A systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings. Patient Educ Couns 2013;92(1):13–22.
  48. Jackson GL, Powers BJ, Chatterjee R, et al. Improving patient care. The patient centered medical home. A systematic review. Ann Intern Med 2013;158(3):169–78.
  49. Housden L, Wong ST, Dawes M. Effectiveness of group medical visits for improving diabetes care: A systematic review and meta-analysis. CMAJ 2013;185(13):E635–44.
  50. Colquhoun HL, Brehaut JC, Sales A, et al. A systematic review of the use of theory in randomized controlled trials of audit and feedback. Implement Sci 2013;8:66.
  51. Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev 2012;12:CD007457.
  52. Pereira JA, Quach S, Heidebrecht CL, et al. Barriers to the use of reminder/recall interventions for immunizations: A systematic review. BMC Med Inform Decis Mak 2012;12:145.
  53. Lau D, Hu J, Majumdar SR, Storie DA, Rees SE, Johnson JA. Interventions to improve influenza and pneumococcal vaccination rates among communitydwelling adults: A systematic review and meta-analysis. Ann Fam Med 2012;10(6):538–46.
  54. Giguère A, Légaré F, Grimshaw J, et al. Printed educational materials: Effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012;10:CD004398.
  55. Deneckere S, Euwema M, Van Herck P, et al. Care pathways lead to better teamwork: Results of a systematic review. Soc Sci Med 2012;75(2):264–68.
  56. Cunningham FC, Ranmuthugala G, Plumb J, Georgiou A, Westbrook JI, Braithwaite J. Health professional networks as a vector for improving healthcare quality and safety: A systematic review. BMJ Qual Saf 2012;21(3):239–49.
  57. Chung VC, Ma PH, Hong LC, Griffiths SM. Organizational determinants of interprofessional collaboration in integrative health care: Systematic review of qualitative studies. PLoS One 2012;7(11):e50022.
  58. Cheung A, Weir M, Mayhew A, Kozloff N, Brown K, Grimshaw J. Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev 2012;1:36.
  59. Waldron CA, van der Weijden T, Ludt S, Gallacher J, Elwyn G. What are effective strategies to communicate cardiovascular risk information to patients? A systematic review. Patient Educ Couns 2011;82(2):169–81.
  60. van Achterberg T, Huisman-de Waal GG, Ketelaar NA, Oostendorp RA, Jacobs JE, Wollersheim HC. How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques. Health Promot Int 2011;26(2):148–62.
  61. Lorenc T, Pearson M, Jamal F, Cooper C, Garside R. The role of systematic reviews of qualitative evidence in evaluating interventions: A case study. Res Synth Methods 2012;3(1):1–10.
  62. Baskerville NB, Liddy C, Hogg W. Systematic review and meta-analysis of practice facilitation within primary care settings. Ann Fam Med 2012;10(1):63–74.
  63. Flodgren G, Parmelli E, Doumit G, et al. Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2011;(8):CD000125.
  64. Christl B, Lloyd J, Krastev Y, Litt J, Harris M. Preventing vascular disease: Effective strategies for implementing guidelines in general practice. Aust Fam Physician 2011;40(10):825–28.
  65. Tugwell P, Robinson V, Grimshaw J, Santesso N. Systematic reviews and knowledge translation. Bull World Health Organ 2006;84(8):643–51.
  66. Foy R, Eccles MP, Jamtvedt G, Young J, Grimshaw JM, Baker R. What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Serv Res 2005;5:50.
  67. Grimshaw J, Thomas R, MacLennan G, et al.
  68. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004;8(6):1–72.
  69. Glasgow R, Goldstein M, Ockene J, Pronk N. Translating what we have learned into practice. Principles and hypotheses for interventions addressing multiple behaviors in primary care. Am J Prev Med 2004;27(2 Suppl):88–101.
  70. Eccles MP, Hrisos S, Francis JJ, et al. Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study. Implement Sci 2011;6:61.
  71. Kastner M, Bhattacharyya O, Hayden L, et al. Guideline uptake is influenced by six implementability domains for creating and communicating guidelines: A realist review. J Clin Epidemiol 2015;68(5):498–509.
  72. Braithwaite J, Marks D, Taylor N. Harnessing implementation science to improve care quality and patient safety: A systematic review of targeted literature. Int J Qual Health Care 2014;26(3):321–29.
  73. May C. Towards a general theory of implementation. Implement Sci 2013;8:18.
  74. Grimshaw JM, Eccles MP, Lavis JN, Hill SJ, Squires JE. Knowledge translation of research findings. Implement Sci 2012;7:50.
  75. Crabtree BF, Nutting PA, Miller WL, et al. Primary care practice transformation is hard work: Insights from a 15-year developmental program of research. Med Care 2011;49 Suppl:S28–35.
  76. Thomson A, Robinson K, Vallée-Tourangeau G. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine 2016;34(8):1018–24.
  77. The Royal Australian College of General Practitioners. Smoking, nutrition, alcohol, physical activity (SNAP): A population health guide to behavioural risk factors in general practice. 2nd edn. East Melbourne, Vic: RACGP, 2015.
  78. Campbell-Scherer DL, Asselin J, Osunlana AM, et al. Implementation and evaluation of the 5As framework of obesity management in primary care: Design of the 5As Team (5AsT) randomized control trial. Implement Sci 2014;9:78.
  79. Dosh SA, Holtrop JS, Torres T, Arnold AK, Baumann J, White LL. Changing organizational constructs into functional tools: An assessment of the 5As in primary care practices. Ann Fam Med 2005;3 Suppl 2:S50–52.
  80. Alperstein D, Sharpe L. The efficacy of motivational interviewing in adults with chronic pain: A meta-analysis and systematic review. J Pain 2016;17(4):393–403.
  81. Ekong G, Kavookjian J. Motivational interviewing and outcomes in adults with type 2 diabetes: A systematic review. Patient Educ Couns 2016;99(6):944–52.
  82. Barnes RD, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev 2015;16(4):304–18.
  83. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: A systematic review and meta-analysis. J Behav Med 2014;37(4):768–80.
  84. Foxcroft DR, Coombes L, Wood S, Allen D, Almeida Santimano NM. Motivational interviewing for alcohol misuse in young adults. Cochrane Database Syst Rev 2014;(8):CD007025.
  85. Lundahl B, Moleni T, Burke BL, et al. Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Educ Couns 2013;93(2):157–68.
  86. Smedslund G, Berg RC, Hammerstrøm KT, et al. Motivational interviewing for substance abuse.
  87. Cochrane Database Syst Rev 2011;(5):CD008063.
  88. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010;(1):CD006936.
  89. Thompson-Leduc P, Clayman ML, Turcotte S, Légaré F. Shared decision-making behaviours in health professionals: A systematic review of studies based on the Theory of Planned Behaviour. Health Expect 2015;18(5):754–74.
  90. Perez R, Brehaut JC, Taljaard M, Stiell IG, Clement CM, Grimshaw J. Theory of planned behaviour can help understand processes underlying the use of two emergency medicine diagnostic imaging rules. Implement Sci 2014;9:88.
  91. Myers LB, Goodwin R. Determinants of adults’ intention to vaccinate against pandemic swine flu. BMC Public Health 2011;11(1):15.
  92. Ramsay CR, Thomas RE, Croal BL, Grimshaw JM, Eccles MP. Using the theory of planned behaviour as a process evaluation tool in randomised trials of knowledge translation strategies: A case study from UK primary care. Implement Sci 2010;5:71.
  93. Hagger MS, Chatzisarantis NL. Integrating the theory of planned behaviour and self-determination theory in health behaviour: A meta-analysis. Br J Health Psychol 2009;14(Pt 2):275–302.
  94. Michie S, Atkins L, West R. The behaviour change wheel: A guide to designing interventions. 1st edn. London: Silverback, 2014.
  95. Jones S, Babiker N, Gardner E, et al. Promoting adherence to nebulized therapy in cystic fibrosis: Poster development and a qualitative exploration of adherence. Patient Prefer Adherence 2015;9:1109–20.
  96. Janamian T, Upham SJ, Crossland L, Jackson CL. Quality tools and resources to support organisational improvement integral to high-quality primary care:
  97. A systematic review of published and grey literature. Med J Aust 2016;204(7 Suppl):S22–28.
  98. Kuwaiti AA, Subbarayalu AV. Reducing patients’ falls rate in an Academic Medical Center (AMC) using Six Sigma 'DMAIC' approach. Int J Health Care Qual Assur 2017;30(4):373–84.
  99. Leaphart CL, Gonwa TA, Mai ML, et al. Formal quality improvement curriculum and DMAIC method results in interdisciplinary collaboration and process improvement in renal transplant patients. J Surg Res 2012;177(1):7–13.
  100. American Society for Quality. What is Six Sigma? Milwaukee, WI: ASQ Quality Press, 2009 overview.html [Accessed 2 March 2018].
  101. Straus SE, Tetroe J, Graham I. Defining knowledge translation. CMAJ 2009;181(3–4):165–68. [Accessed 2 March 2018].
  102. Field B, Booth A, Ilott I, Gerrish K. Using the Knowledge to Action Framework in practice: A citation analysis and systematic review. Implement Sci 2014;9:172. [Accessed 2 March 2018].
  103. Registered Nurses’ Association of Ontario. Toolkit: [Accessed 2 March 2018].
  104. Implementation of best practice guidelines. 2nd edn. Toronto, ON: RNAO, 2012. [Accessed 2 March 2018].
  105. Tierney E, McEvoy R, O’Reilly-de Brún M, et al. A critical analysis of the implementation of service user involvement in primary care research and health service development using normalization process theory. Health Expect 2016;19(3):501–15. [Accessed 2 March 2018].
  106. O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: A systematic review of qualitative studies. BMC Med Inform Decis Mak 2016;16(1):120. [Accessed 2 March 2018].
  107. Holtrop JS, Potworowski G, Fitzpatrick L, Kowalk A, Green LA. Effect of care management program structure on implementation: A normalization process theory analysis. BMC Health Serv Res 2016;16(a):386. [Accessed 2 March 2018].
  108. McEvoy R, Ballini L, Maltoni S, O’Donnell CA, Mair FS, Macfarlane A. A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implement Sci 2014;9:2. [Accessed 2 March 2018].
  109. Mair FS, May C, O’Donnell C, Finch T, Sullivan F, Murray E. Factors that promote or inhibit the implementation of e-health systems: An explanatory systematic review. Bull World Health Organ 2012;90(5):357–64. [Accessed 2 March 2018].
  110. Litt J, Weingarten M. Putting prevention into practice: [Accessed 2 March 2018].
  111. How can you do it ethically, effectively and efficiently. PrimaryCare (Switzerland) 2010;10(14):266–67. [Accessed 2 March 2018].
  112. Litt JC. Exploration of the delivery of prevention in the general practice setting [PhD]. Adelaide: Flinders, 2007. [Accessed 2 March 2018].
  113. Shoup JA, Gaglio B, Varda D, Glasgow RE. Network analysis of RE-AIM framework: Chronology of the field and the connectivity of its contributors. Transl Behav Med 2015;5(2):216–32. [Accessed 2 March 2018].
  114. Loef M, Walach H. How applicable are results of systematic reviews and meta-analyses of health behaviour maintenance? A critical evaluation. Public Health 2015;129(4):377–84. [Accessed 2 March 2018].
  115. Horodyska K, Luszczynska A, Hayes CB, et al. Implementation conditions for diet and physical activity interventions and policies: An umbrella review. BMC Public Health 2015;15:1250. [Accessed 2 March 2018].
  116. Compernolle S, De Cocker K, Lakerveld J, et al. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: A systematic review (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2014;11:147. [Accessed 2 March 2018].
  117. Antikainen I, Ellis R. A RE-AIM evaluation of theory-based physical activity interventions. J Sport Exerc Psychol 2011;33(2):198–214. [Accessed 2 March 2018].
  118. Glasgow R, McKay H, Piette J, Reynolds K. The RE-AIM framework for evaluating interventions: What can it tell us about approaches to chronic illness management? Patient Educ Couns 2001;44(2):119–27. [Accessed 2 March 2018].
  119. Glasgow R, Vogt T, Boles S. Evaluating the public health impact of health promotion interventions: The RE-AIM framework. Am J Public Health 1999;89(9):1322–27. [Accessed 2 March 2018].
  120. Litt J, Brotons C, Bulc M, et al. Putting prevention into practice – Case studies from four countries. Swiss Primary Care 2011;11(4):63–65. [Accessed 2 March 2018].
  121. The Royal Australian College of General Practitioners. Putting Prevention into Practice. Guidelines for the implementation of prevention in the general practice setting. 2nd edn. East Melbourne, Vic: RACGP, 2006. [Accessed 2 March 2018].
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