Contextualizing the proven effectiveness of a lifestyle intervention for type 2 diabetes in primary care: A qualitative assessment using re-aim


Objective: The Healthy Eating and Active Living for Diabetes in Primary Care Networks (HEALD) intervention proved effective in increasing daily physical activity among people with type 2 diabetes in four community-based Primary Care Networks (PCNs) in Alberta. Here, we contextualize its effectiveness by describing implementation fidelity and PCN staff's perceptions of its success in improving diabetes management. Methods: We used the RE-AIM framework to evaluate HEALD. Qualitative methods used to collect data related to the RE-AIM dimensions of Implementation and Effectiveness included interviews with PCN staff (n=24), research team reflections (n=4) and systematic documentation. We used content analysis, and data were imported into and managed using Nvivo 10. Results: HEALD was implemented as intended with adequate fidelity across all four PCNs. Identified implementation facilitators included appropriate human resources, training provided, ongoing support, provision of space and simplicity of the intervention. However, PCN staff reported varying opinions regarding its potential for improving diabetes management among patients. Rationales for their views included: intervention "dose" inadequacy, quality of usual care for people with diabetes was already good, patients were already managing their diabetes well and potential for co-intervention. Recommended improvements to HEALD included increasing the dose of the intervention, expanding it to other modes of exercise and incorporating a medical clearance process. Conclusions: Based on the high degree of fidelity, the demonstrated effectiveness of HEALD in improving physical activity among patients was a result of sound implementation of an efficacious intervention. Increasing the dose of HEALD could result in additional improvements for patients.

Acknowledgments: This work was supported in part by a contract from Alberta Health, a grant from the Lawson Foundation and a Canadian Institutes for Health Research (CIHR) Team Grant to the Alliance for Canadian Health Outcomes Research in Diabetes sponsored by the CIHR Institute of Nutrition, Metabolism and Diabetes.