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Table 2 The HeLP-Diabetes implementation plan

From: Developing an implementation strategy for a digital health intervention: an example in routine healthcare

Strategy Strategies operationalised for HeLP-Diabetes
To target coherence:
 Local opinion leaders • Key people within the CCG were identified at a CCG local policy meeting. • All practice managers and lead GPs for diabetes were informed about HeLP-Diabetes by email
 Educational materials • Information email sent to all practice managers and leads emphasised that HeLP-Diabetes was an online programme thus different from other self-management programmes, that it was free to use and had been developed by a university. • Flyers, posters and other advertising materials were developed and circulated throughout the CCG.
 Educational outreach visits, or academic detailing Meetings were arranged between practices and the research team to provide health care professionals (HCPs) with information about HeLP-Diabetes and discuss the implications for their working practice, in order to allow them to decide whether or not to adopt it. Informed by the need to promote coherence (sense-making), during these meetings we emphasised the online nature of the programme, its evidence-base, theoretical underpinning and participatory design, and the potential benefits to patients, practices and the healthcare system.
To target cognitive participation:
 Educational meetings We promoted cognitive participation during meetings at practices by emphasising the benefits to patients, practices and healthcare system (coherence), while ensuring minimum workload and optimal fit with interactional workability, skill set workability, contextual integration and relational integration (Collective Action).
 Inter-professional education HCPs were provided with a training session which provided the opportunity for staff to understand the actions and procedures needed to sustain HeLP-Diabetes in practice and see that HeLP-Diabetes could deliver the anticipated advantages.
 Local consensus processes Training was with groups of staff which allowed the opportunity for them to discuss and decide how the work of implementing would be shared within the practice and how HeLP-Diabetes would be offered to patients.
To target collective action:
 Educational meetings Staff were provided with login details which allowed them to try out HeLP-Diabetes. This allowed staff to see how HeLP-Diabetes fitted with the skill sets of the HCPs in the practice (skill set workability), what resources were needed to make it part of routine practice (contextual integration), what knowledge was needed to be confident with HeLP-Diabetes as a new way of working (relational integration), and the impact that HeLP-Diabetes would have on interaction with colleagues and patients (relational integration).
 Educational materials Training booklets were developed and provided to staff at the training sessions containing information on how to access HeLP-Diabetes, how to create a login, and how to sign patients up and provided summaries of the different parts of the intervention and how to use them with patients.
To target reflexive monitoring:
 Continuous quality improvement • Ongoing support and communication was provided to each service who adopted HeLP-Diabetes to allow problem solving and maintain awareness of HeLP-Diabetes. • Data on the number of patients being registered at each practice was collected • Informal discussions and interviews with staff were conducted in order to identify barriers to the implementation and to develop solutions.
 Audit and feedback Feedback that included number of patients using HeLP-Diabetes, how each service was performing and feedback from patients using HeLP-Diabetes was provided to services via email regularly to promote positive reflexive monitoring.
 Reminders Regular emails and newsletters were sent from the research team and the CCG to practices to remind them about HeLP-Diabetes and to encourage those who had already adopted it to keep referring patients to use it.