The 5As Team (5AsT) Implementation Strategies, Methods, and Actors Structured According to the Interactive Process Framework (Figure 2)
| 5AsT Strategy | Methods | Team Members and Actors |
|---|---|---|
| Flexible Intervention with Fixed Core Elements and Adaptable Periphery | ||
| Needs assessment | Participants self-identified learning needs | Research team and clinical champion |
| Expert speaker | Interdisciplinary experts addressed learning gaps | Research team arranged expert speakers |
| Up to date research and practice implications | ||
| Learning collaboratives | Sharing of experiences, ideas, discussing needs, group activities, interactive activities | Coordinated by clinical champion, facilitated by clinical champion, and PCN clinician trained in practice facilitation |
| Co-creation of tools | In response to identified needs search for existing tools, creation of tools, iterative with providers and graphic designers | Facilitated research team and graphic designer, and cocreated by participants |
| Supporting learning resources | Podcasts, tools online, and emailed one week after session | Compiled by research team, topic experts, with input from clinicians and participants |
| Summaries of session materials emailed after session | ||
| Flexible Intervention Adaptation | Change of session topics | Clinical champion and research team |
| Change of learning collaborative groups | ||
| Addition of team relationship–enhancing activities | ||
| Iterative Qualitative Evaluation | ||
| Clinical champion and researchers | Ongoing feedback between participants, PCN management, and research team. Clinical champion kept logbook of encounters with researchers and detailed record of all project materials and communications | Clinical champion and research team |
| Qualitative evaluation | Guided field notes on intervention sessions, interviews parallel to ongoing intervention, evaluation workshops [at 6 and 12 months] | Researchers and clinical champion |
| Collective Sense-Making | ||
| Learning collaboratives | Sharing of experiences, ideas, discussing needs | Coordinated by clinical champion, facilitated by clinical champion, and PCN clinician trained in practice facilitation |
| Group activities, interactive activities | ||
| Team meetings | Troubleshooting emerging barriers | Research team, feedback from clinical champion |
| Goal setting in learning collaboratives | Making explicit the implications of knowledge for practice and practicable strategies for putting them into action | Learning collaborative facilitators and clinician participants |
| Engagement | ||
| Research partnership | PCN management as co-investigator, collaborative grant writing and intervention design, PCN in-kind contributions [dedicated time of clinical champion] | PCN administrative and senior clinical leadership |
| Practice facilitators | Clinical champion and anthropologist from the research team keep logs of their encounters and detailed record of all project materials and communications | 5AsT practice facilitators were the clinical champion and research team anthropologist |
| Clinical champion | Research team meetings, logistics, communication. Consulted on interviews, tools, problem solving, and review of codes and themes | Clinical champion (a frontline PCN dietician) |
| Team meetings | Implementation evaluation update, interview and analysis update, peer coding, troubleshooting emerging barriers, reviewing results papers [dissemination] | Research team, clinical champion, and PCN administrative and senior clinical leadership |
| Transparency | Open communication about intervention intent, encouragement of participant input | Research team, clinical champion, and PCN administrative and senior clinical leadership |
| Organizational Context | ||
| Partnership | 5AsT as part of PCN business plan, PCN in-kind contributions [dedicated time of clinical champion] | Research team and PCN administrative and senior clinical management |
| Clinical champion | Navigated logistics, recruitment, arranged for spaces, time, food; introduced team to organizational culture | Clinical champion (a frontline PCN dietician) |
| Research and Theory | ||
| Knowledge synthesis and transformation | Expertise on 5As of obesity management and on obesity topics, snowball sampling of existing tools, and cocreation and publishing of new and adapted tools | Research team, topic experts, participants, graphic designer |
| Implementation framework/theory | Selection of framework for project design based on focus on context, after project revision of lessons learned, and refinement of theoretical approach | Research team |
| Policy and Funding | ||
| PCN partnership | Using the PCN structure and autonomy to partner in research | PCN leadership |
| Grant application | Leveraging grant funding with PCN in-kind contributions | Research team and PCN administrative and clinical management |
PCN, Primary Care Network.