Implementation salvage experiences from the Melbourne diabetes prevention study

BMC Public Health

Correspondence

Rob Carter¹  Amy Timoshanko²  Greg Johnson²  Dino Asproloupos³  Catherine M Bennett³  Elizabeth Stewart³  Sharleen O’Reilly³  Nathalie Davis-Lameloise⁴  Andrea Hernan⁴  Edward Janus⁵  James Dunbar⁶ 

[1] Deakin Health Economics, Deakin Strategic Research Centre - Population Health, Faculty of Health, Deakin University, 221 Burwood Highway, 3125, Burwood, VIC, Australia;Diabetes Australia – Victoria, 570 Elizabeth Street, 3000, Melbourne, VIC, Australia;Faculty of Health, Deakin University, 221 Burwood Highway, 3125, Burwood, VIC, Australia;Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, 3280, Warrnambool, VIC, Australia;Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, 3280, Warrnambool, VIC, Australia;Department of Medicine, North West Academic Centre, The University of Melbourne, Western Hospital, 3011, Footscray, VIC, Australia;Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, 3280, Warrnambool, VIC, Australia;the Melbourne Diabetes Prevention Study research group, Australia;

关键词: Implementation;    Salvage strategy;    Type 2 diabetes;    Prevention;    Effectiveness;    Randomised controlled trial;   

DOI  :  10.1186/1471-2458-12-806

 received in 2012-04-24, accepted in 2012-09-17,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundMany public health interventions based on apparently sound evidence from randomised controlled trials encounter difficulties when being scaled up within health systems. Even under the best of circumstances, implementation is exceedingly difficult. In this paper we will describe the implementation salvage experiences from the Melbourne Diabetes Prevention Study, which is a randomised controlled trial of the effectiveness and cost-effectiveness nested in the state-wide Life! Taking Action on Diabetes program in Victoria, Australia.DiscussionThe Melbourne Diabetes Prevention Study sits within an evolving larger scale implementation project, the Life! program. Changes that occurred during the roll-out of that program had a direct impact on the process of conducting this trial. The issues and methods of recovery the study team encountered were conceptualised using an implementation salvage strategies framework. The specific issues the study team came across included continuity of the state funding for Life! program and structural changes to the Life! program which consisted of adjustments to eligibility criteria, referral processes, structure and content, as well as alternative program delivery for different population groups. Staff turnover, recruitment problems, setting and venue concerns, availability of potential participants and participant characteristics were also identified as evaluation roadblocks. Each issue and corresponding salvage strategy is presented.SummaryThe experiences of conducting such a novel trial as the preliminary Melbourne Diabetes Prevention Study have been invaluable. The lessons learnt and knowledge gained will inform the future execution of this trial in the coming years. We anticipate that these results will also be beneficial to other researchers conducting similar trials in the public health field. We recommend that researchers openly share their experiences, barriers and challenges when conducting randomised controlled trials and implementation research. We encourage them to describe the factors that may have inhibited or enhanced the desired outcomes so that the academic community can learn and expand the research foundation of implementation salvage.

【 授权许可】

CC BY   
© Dunbar et al.; licensee BioMed Central Ltd. 2012