Organisational Factors Associated With Readiness to Implement a Preventive Intervention for Overweight and Obese Patients in Australian General Practice: a Mixed Methods Exploration From the HELP GP Trial.

Abstract Background: Australian rates of obesity are increasing. General practice has a definite role to play in addressing obesity and preventing further chronic disease but relatively few encounters focus primarily on weight management. The HeLP GP trial assisted overweight and obese patients to make positive lifestyle changes to diet and physical activity and increase the capacity of practice nurses to deliver comprehensive weight management. The nurse led intervention comprised a health check and access to a lifestyle app and/or telephone coaching. Within this paper we describe the experience of implementing this intervention through the lens of organisational readiness with specific emphasis on the role of the practice nurse. Methods: Routinely collected research data, quantitative practice surveys, and qualitative field notes from research officers and facilitators were mapped against a recognised organisational readiness framework. Motivation to implement, general capacity and intervention-specific capacity were assessed. Results: The level of organisational readiness within the participating practices was observed to vary considerably, particularly the domain of intervention specific capacity. The level of practice nurse turnover negatively impacted the implementation of the intervention, affecting half of the intervention practices. Within this study we observed a general lack of practice-based support for the practice nurse regarding intervention delivery and varying levels of interest, skill, and confidence in delivering the program to patients. Nurses struggled to complete the health checks and subsequently to conduct timely follow up appointments. Risk assessment and referral to telephone coaching were generally not problematic, although we noted lower confidence with the setup of the lifestyle app and with instructing patients to use it.Conclusions: Using an organisational readiness checklist is valuable for determining specific capacity issues prior to commencing research but should also assess the capacity of those individuals responsible for the intervention. We found a lack of general ‘readiness’ inherent in the practice nurse role. If they are to fulfil their potential in supporting patients to reduce risk and adopt healthier life choices, our study indicates that more could be done to improve their workforce positioning and remuneration, which may, in turn, improve continuity of care, retention, and individual motivation.Trial registration:The HeLP GP trial is registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR - ACTRN12617001508369). The trial was registered 26/10/2017 http://www.ANZCTR.org.au/ACTRN12617001508369.aspx