Table 2.

Supporting Data on 5As Team Implementation Process from Participant Interviews and Field Notes

FindingRepresentative Quotes, Field Notes, and Examples
Knowledge (synthesis and transformation)A2: I really liked it. It was really just kind of asking us what we want to learn and what we find we can use to help patients so it's really, I like that it's focused on us and what we want to learn.
A11: I like that you guys ask us what our needs are and, and, and that kind of helps bring in what, what's relevant to us
Practice support (team and individual capacity building)C6: I was feeling positive about my knowledge and my beliefs in it but I wasn't very good at sharing them to other people so there's been a little bit more of that since I've done it, I can talk more comfortably and not be so afraid to kind of challenge some of the physician's statements and opinions so that's been helpful to feel a little bit more, more assertive I guess in that and have something to back it up with so.
A3: I was really excited. I'm going, actually the first morning back I went around to all the doctors and gave them a copy of each of the, the tear offs saying you know this is, you know this is finally actually on one piece of paper, the approach we've been using with weight.
A14: I will see someone and then or X will see somebody, our dietician and say you know what, you need to go see X, … , you know you're not ready to deal with any of these, we have to deal with this first and so I think we've really been more conscious and doing that more even since we were all involved with this research so and we work together, you know … will meet with some patients together and come from two perspectives and then say you know what, I think you need to see X.
Field notes from learning collaboratives:
∙ Laughter and joking were not uncommon and they increased as the sessions went on. This is evidence of a friendly atmosphere.
∙ Likewise discussion around tools, particularly the physical activity guidelines tool, which was critiqued quite a bit, is evidence of an open and sharing atmosphere.
Practice deliveryB4: Just collaborating at the end, having an open discussion, getting perspectives from different health care professionals is always good too and like even for today, we identified gaps in terms of the classes that we were offering for nutrition so it brought to light something like change right that can happen so it's good. I've, I've really enjoyed it.
A11: It's really good. One thing that I have addressed is that in the waiting room we don't have any bariatric chairs, which can be a little bit uncomfortable so I have ordered those through the PCN for the clinic and for my office as well.
B2: Yeah, well the one clinic where the scale was in the front entrance, I moved it to the back room into the clinic or in the office where I was and it was fine so.
Interactional findings:
Collective sense-makingB2: Yeah I really like that. I like doing that because then you can learn something, then you talk with everybody about certain things and then you could try it in their clinic if you can so.
B6: I like the breakout sessions so we get a chance to talk about and how it applies to our settings and to patients, I like that part of it.
A5: I thought it was very good. I especially enjoyed today. I think it gives us new ways to look at things and I think we need each other's ideas because lots of times there's just one little thing that somebody else does that you never thought of and if we, if we work in isolation, you know if we never have meetings then and we always do the same thing with patients, we don't get any new ideas and I think that's important in learning, you know trying different things. Maybe it won't work but at least you've tried or, or it gives you another idea.
Field notes from learning collaboratives:
∙ There are many examples of provider troubleshooting what they are learning with the realities of its application in clinics. Example: how to ask with very sensitive patients, or how to deal with weight bias when the doctor is the problem?
∙ There are examples of providers sharing ideas, little tricks, and often, specific wording of issues or questions that work well for them with patients.
There was often rich discussion around topics wherein providers clarified any misunderstandings and found a common understanding of topics/facts/ideas that were brought up during the talk.
Dynamic intervention and evaluation designExample of feedback that led to project adjustment
A10: I think the facilitator should rotate or I don't think you're going, I think the group altogether is too big so I think they should try to rematch the groups a bit because there's certain, like the group I'm in is a very quiet group
Field notes
Deliberate introductions between participants are necessary and should be planned.
Deliberate planning and strong facilitation of learning collaboratives: using quiet time before goal setting, trying different approach to encourage responses.
Print-outs of materials and providing binders work well.
Group activities and interactive methods (writing on charts, using sticky dots) were well received and could be used more often.
Intervention focus and design was reached through collaboration with the organization. Open communication was maintained by all involved. Study length, focus, and intensity were agreed upon through detailed discussion with the organization management and staff.
  • A = Nurse

  • B = Dietician

  • C = Mental Health Consultant.