Description of Research Strategies Used to Increase Generalizability in the IDEALL Study
| Recommended Strategy | Anticipated Impact on Generalizability | IDEALL Strategy | Challenges and Trade-offs |
|---|---|---|---|
| Patient sample reflects population diversity | |||
| Minimize exclusions | Results apply to broad range of patients since a broad range was included in the study | Few clinical exclusion criteria applied and intervention offered in 3 languages | IRB restrictions for direct patient contact led to a change in study design and recruitment strategy |
| Some exclusion criteria, such as requiring patients to come to the clinic or to be in the area for 12 months may have restricted diversity | |||
| Recruit patients from diverse clinic settings | Results apply to broad range of patients irrespective of practice level conditions that may affect the delivery or quality of care | Inclusion of as many CHNSF clinics as possible using a targeted recruitment of clinics with the largest number of eligible patients | Logistics: needing to recruit patients over a short time period and setting up GMV at each clinic limited the number of clinics to 4 |
| Balance of neighborhood and hospital-based clinics | |||
| Interventions are relevant across patient groups and across settings | |||
| Develop interventions that reflect primary care realities | Implementation and adoption likely smoother and higher overall at the patient, clinician, and health care systems level | Include patient, clinician, and clinic level input into the nature and design of interventions | Adjunctive care model does not address the importance of having clinics independently integrate patient self-management supports into primary care settings and may not be sustainable |
| Adjunctive care model chosen to provide extra care to patients without burdening clinics | |||
| Compare clinically relevant alternatives | Randomized design did not allow patients to select interventions, affecting acceptability to patients and clinics | ||