An implementation strategy bundle targeting knowledge and costs to implement the combined lifestyle intervention ProMuscle for community-dwelling older adults: a mixed-methods pilot study

Abstract

Background ProMuscle is an evidence-based lifestyle intervention for community-dwelling older adults, combining exercise and nutrition. This pilot study investigated the feasibility, acceptability, and fidelity of a recently developed Implementation Strategy Bundle to implement ProMuscle in seven community settings in the Netherlands. Method This mixed-methods study followed an exploratory sequential approach. Eight physical therapists and three dieticians received a digital implementation toolbox in which the Implementation Strategy Bundle was further specified into chronologically described activities targeting the two main barriers ‘knowledge’ and ‘costs’. Quantitative data were collected through surveys at baseline, 3 months and 8 months post-implementation. A process evaluation consisted of monthly project meetings and a 90-minute focusgroup 8 months post-implementation. Quantitative data were statistically analyzed and informed the interview guide of the focusgroup. Field notes, memos and transcript of the focus group were thematically analyzed. Results Quantitative results showed the implementation strategy bundle was acceptable (mean = 4.31 ± 0.54, 5-point Likert scale) and feasible (mean = 4.61 ± 0.42). Most activities were executed as proposed, indicating good fidelity. The process evaluation indicated the strategy bundle as helpful and easy to use, with suggestions for improvement. Low recruitment rates and a long start-up resulted in two of the 16 practices delivering ProMuscle. Extra activities to enhance collaboration seems needed to overcome these barriers. Conclusion This mixed-methods pilot study showed that the implementation strategy bundle addressing barriers on knowledge and costs is feasible and acceptable for implementing ProMuscle in multiple community care settings. Suggestions from this pilot should be considered before investigating the effectiveness in a larger trail.