Table 1.

Description of Research Strategies Used to Increase Generalizability in the IDEALL Study

Recommended StrategyAnticipated Impact on GeneralizabilityIDEALL StrategyChallenges and Trade-offs
Patient sample reflects population diversity
    Minimize exclusionsResults apply to broad range of patients since a broad range was included in the studyFew clinical exclusion criteria applied and intervention offered in 3 languagesIRB 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 settingsResults apply to broad range of patients irrespective of practice level conditions that may affect the delivery or quality of careInclusion of as many CHNSF clinics as possible using a targeted recruitment of clinics with the largest number of eligible patientsLogistics: 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 realitiesImplementation and adoption likely smoother and higher overall at the patient, clinician, and health care systems levelInclude patient, clinician, and clinic level input into the nature and design of interventionsAdjunctive 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 alternativesRandomized design did not allow patients to select interventions, affecting acceptability to patients and clinics