Table 2. Summary of Elements of the Eight Methods
MethodMain ElementsSubcategories
Centralized training1. Select an attractive city
  1. Link to another meeting

  2. Choose a “vacation” city

2. Brief and focused presentations
3. All central team members make presentations
4. Introduce all site champion teams and announce randomization
  1. Celebrate with both groups

  2. Extra support for usual care initial disappointment

5. Introduce site champions to the central site liaison
6. Introduce the topic of the protocol and reasons for the study
7. Provide detailed information in the slides and handbooks
  1. Continually refer to the handbook when champions return home

  2. Use the handbook to reinvigorate, remind, and refresh

8. Introduce the intervention to appropriate sites
  1. Use practical examples based on patient care

  2. Let the group brainstorm anticipated problems and solutions

  3. Introduce the concept of implementation flexibility

9. Provide time for each set of site champions to discuss their local implementation strategies while central team members are present to answer questions.
10. Take and share pictures of site champions and central teams
  1. It may be harder to ignore calls from someone whose picture is right over the phone

  2. Helps central team to remember more details about each champion

11. Provide time to complete human subjects training with central team mentors
  1. Reinforce that support is readily available

  2. Helps when the champions may have to repeat training in 2 to 3 years

12. Provide concise slide set for site champions to use to train practices when they go home
13. Use humor and interactive, supportive sessions to model behavior for interactions for the rest of the study period
Liaisons1. Assign to specific practices for the entire study
2. Serve as primary contact for practices to the central team
3. Include in all study meetings
4. Become an early warning system for practice problems and “voltage drop”
FAQs1. Develop and use a consistent format with study logo at top
2. Send to sites on a consistent day of the week
3. Share by fax or E-mail as sites request
4. Use for continuing education, maintaining same style as central training
5. Reinforce complex or apparently confusing steps in implementation
6. Recognize accomplishments such as enrollment numbers
7. Share local sites' stories
  1. Successes

  2. New strategies or tools developed by sites

  3. Occurrence and burden of natural disasters

  1. Floods, earthquakes, fires, hurricanes, tornadoes

  2. Share interpractice support given

8. Use humor and cartoons to illustrate issues and celebrations
9. Develop and use mini crossword puzzles or other study-related “contests”
10. Share case reviews and questions
11. Celebrate holidays
Incentives1. Foster recognition and acknowledgement
  1. Press releases for local media

  2. Framed certificates of participation for display in the local office

2. Set achievable goals and recognize them when they are met
3. Provide small but fun rewards, eg, boxes of microwave popcorn
4. Use variety to continue encouraging participation
5. Increase the frequency at lulls in enrollment or other dips in activity
6. Provide larger rewards for major achievements like meeting total enrollment goals
  1. Pizza party

  2. Ice cream social

7. Provide personalized thank you from the PI for special recognition
Case reviews1. Assume sites have important insight to offer and expect to learn from sites
2. Highlight positive aspects of care
3. Ask what could be done to make care even better
4. Relate the care questions to the intervention
5. Allow site attendees to teach each other
6. Present alternatives from other sites or the PI's experience or expertise
7. Guide problem solving
8. End by setting up the next review and perhaps follow up on the cases presented
Appreciation1. Respect is mainstay
2. Acknowledge all members of the practice
3. Praise the work of the site champions during case reviews and in FAQs
4. Schedule interactions at the convenience of the sites
5. Consider using emails for some interactions—especially PI to site physician champions
6. Give site champions study shirts or mugs
7. Give modest holiday gifts for all practice members
  1. Candy or fruit for winter holidays

  2. Cookies or gift card for an ice cream party in summer

IRB support1. Offer to do initial submission
2. Provide support for all IRB interactions
  1. Serious adverse events reporting

  2. Annual reports

3. Copy and mail new consent forms required annually
4. Offer to provide telephone support for all site-required IRB interactions
5. As requested, teach sites to do its own IRB submissions with oversight and support
  • FAQ, frequently asked question; IRB, institutional review board; PI, primary investigator.