Development of an implementation intervention to integrate the use of health innovations in routine practice: an insulin patient decision aid as an exemplar

Abstract

Abstract Background Implementation, which is defined as the process of getting evidence-based innovation to be utilised is critical in ensuring innovation is being integrated into real-world practice. The way an implementation intervention (i.e., a bundle of strategies to facilitate implementation) is developed has an impact on the types of strategies chosen, and whether they are relevant to the implementation setting to exert their effects. However, literature pertaining to development of intervention or detailed descriptions of implementation processes are scarce. This study aims to report the development of an implementation intervention to integrate the use of an evidence-based innovation in routine practice, using a Malaysian insulin patient decision aid (PDA) as an exemplar. Methods The development of the insulin PDA implementation intervention was divided into two phases, incorporating step 3 and 4 of the Action Cycle in the Knowledge to Action framework. In Phase 1, barriers to the insulin PDA implementation was explored through qualitative interviews using an interview guide developed based on the Theoretical Domains Framework. In Phase 2, prioritisation of the barriers was conducted using the multivoting technique. Next, potential strategies that can address the barriers were identified based on understanding the clinic context, and evidence from literature. Then, the selected strategies were operationalised by providing full descriptions in terms of its actor, action, action target, temporality, dose, implementation outcome affected, before they were embedded into the patient care pathway in the clinic. The implementation intervention was finalised through a clinic stakeholders meeting. Results Through a systematic implementation intervention development process, a tailored implementation intervention was developed comprising 11 strategies selected to address 13 barriers to the implementation of the insulin patient decision aid. Conclusion This study adds to the dearth body of literature on the implementation intervention development process for PDA implementation, and for implementation of health innovations in general. Future implementers can adapt, or replicate the steps described when developing implementation intervention. The processes described can be compared with other intervention development methods in order to advance the field of implementation of evidence-based innovations.