Act in Time -Implementation of Health Promotive Work-way in Primary Care Setting (AcTi)

NCT04799860 | Completed

• 1 other identifier: 275301
• Study Type: interventional
• Target: 12,000
• Locations: 1 country
• Sites: 1

Brief Summary

The study will support implementation of a health promotive work-way in primary care setting by using external and internal facilitators, with the aim to identify effective implementation strategies and to evaluate intervention uptake. Data will be collected from multiple perspecitves.

Conditions

Health Knowledge, Attitudes, Practice

Keywords

implementation; primary care; process evaluation

Outcome Measures

Primary Outcomes (4)

• Change and trend from baseline documented codes in medical records

  specific codes are used for measures related to the guideline recommendations for grade of advice for insufficient physical activity, unhealthy eating habits, hazardous use of alcohol and tobacco use and prescribed physical activity

  Change from baseline (6 months), through study completion up to 6 months after end of implementation support

• Change and trend from baseline documented codes in medical records

  specific codes are used for measures related to the guideline recommendations for grade of advice for insufficient physical activity, unhealthy eating habits, hazardous use of alcohol and tobacco use and prescribed physical activity

  Change from baseline (6 months), through study completion up to 18 months after end of implementation support

• Change in S-NoMAD score (Swedish translation of NoMAD

  23-item questionnaire covering the constructs coherence, cognitive participation, collective action and reflexive monitoring

  Change from baseline S-Nomad score up to 4 to 6 months after end of study completion

• Change in S-NoMAD score (Swedish translation of NoMAD

  23-item questionnaire covering the constructs coherence, cognitive participation, collective action and reflexive monitoring

  Change from baseline S-Nomad score up to 16 to 18 months after end of study completion

Secondary Outcomes (3)

• Change in perceived clincial intervention by a study specific questionnaire

  Change from baseline up to 4 to 6 months after end of implementation support

• Change in perceived appropriateness (AIM), feasability (FIM) and acceptability (IAM) of the clinical intevention.

  Change from baseline in AIM,IAM and FIM up to 4 to 6 months after end of implementation support

• Change in perceived appropriateness (AIM), feasability (FIM) and acceptability (IAM) of the clinical intevention.

  Change from baseline in AIM,IAM and FIM up to 16 to18 months after end of implementation support

Other Outcomes (4)

• Interviews to tailor strategies and evaluate implementation process

  Interviews pre-intervention and up to 3 to 6 months after end of implementation support

• Interviews to evaluate implementation support, clinical process and thoughts about up-scaling

  Interviews pre-intervention and up to 16 to18 months after end of implementation support

• Person centered processmapping

  At baseline

Study Arms (2)

health promotive work-way

EXPERIMENTAL

Six primary care units that voluntarily enrolls as experimental units. The units will receive implementation support based on previous research and tailored to the specific prerequisits and context for each unit. Strategies includes involvement of target groups; informationa and interactive education;use of external and internal facilitators tarined for the purpose; systematic feedback and learning dialogs during the project. The implementation support will take approximately 12 months.

Behavioral: health promotive work-way

Control

NO INTERVENTION

Six primary care centers of similar size and socioeconomic background in the population listed to each center.

Interventions

health promotive work-way BEHAVIORAL

Clinical intervention: The patient is asked to fill in a screening form with life-style related questions. The caregiver takes adequate measures according to the recommendations of the national guideline and the filled in screeing form. The caregiver documents the measures taken. Implementation intervention as described previously: using tailored strategies to support implementation of the gudieline-based recommendations

health promotive work-way

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• being a caregiver meeting patients and/or
• being assigned a role as internal or external facilitator in the project
• years or older
• visiting primary care units a specific time pre- or post implementation support
• \* : having one or more unhealthy life-style habit 18 years or older
• \* being a manager at a primary care unit or at higher level

Sponsors & Collaborators

• Region Örebro County: lead

Study Sites (1)

Region Örebro County

Örebro, 70185, Sweden

Location

Related Publications (11)

• Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O'Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015 Mar 19;350:h1258. doi: 10.1136/bmj.h1258.

  PMID: 25791983 BACKGROUND

• Wandell PE, de Waard AM, Holzmann MJ, Gornitzki C, Lionis C, de Wit N, Sondergaard J, Sonderlund AL, Kral N, Seifert B, Korevaar JC, Schellevis FG, Carlsson AC. Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review. Fam Pract. 2018 Jul 23;35(4):383-398. doi: 10.1093/fampra/cmx137.

  PMID: 29385438 BACKGROUND

• Nilsen P, Schildmeijer K, Ericsson C, Seing I, Birken S. Implementation of change in health care in Sweden: a qualitative study of professionals' change responses. Implement Sci. 2019 May 14;14(1):51. doi: 10.1186/s13012-019-0902-6.

  PMID: 31088483 BACKGROUND

• Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017 Aug 29;12(1):108. doi: 10.1186/s13012-017-0635-3.

  PMID: 28851459 BACKGROUND

• Elf M, Nordmark S, Lyhagen J, Lindberg I, Finch T, Aberg AC. The Swedish version of the Normalization Process Theory Measure S-NoMAD: translation, adaptation, and pilot testing. Implement Sci. 2018 Dec 4;13(1):146. doi: 10.1186/s13012-018-0835-5.

  PMID: 30509289 BACKGROUND

• Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4:50. doi: 10.1186/1748-5908-4-50.

  PMID: 19664226 BACKGROUND

• Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999 Sep;89(9):1322-7. doi: 10.2105/ajph.89.9.1322.

  PMID: 10474547 BACKGROUND

• Nilsagard YE, Smith DR, Soderqvist F, Strid EN, Wallin L. Achieving health-promotion practice in primary care using a multifaceted implementation strategy: a non-randomized parallel group study. Implement Sci Commun. 2025 Apr 7;6(1):36. doi: 10.1186/s43058-025-00723-y.

  PMID: 40197376 DERIVED

• Nilsing Strid E, Wallin L, Nilsagard Y. Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scand J Prim Health Care. 2024 Mar;42(1):201-213. doi: 10.1080/02813432.2023.2301556. Epub 2024 Feb 7.

  PMID: 38241166 DERIVED

• Strid EN, Wallin L, Nilsagard Y. Expectations on implementation of a health promotion practice using individually targeted lifestyle interventions in primary health care: a qualitative study. BMC Prim Care. 2023 Jun 16;24(1):122. doi: 10.1186/s12875-023-02079-5.

  PMID: 37328813 DERIVED

• Strid EN, Wallin L, Nilsagard Y. Implementation of a Health Promotion Practice Using Individually Targeted Lifestyle Interventions in Primary Health Care: Protocol for the "Act in Time" Mixed Methods Process Evaluation Study. JMIR Res Protoc. 2022 Aug 19;11(8):e37634. doi: 10.2196/37634.

  PMID: 35984700 DERIVED

MeSH Terms

Conditions

Behavior

Study Officials

• Ylva Nilsagård

  University Health Care Research Center, Region Örebro County

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Model Details: A pre-post-intervention design with control group will be used to evaluate intervention uptake and implementation process effectiveness from the perspective of managers, primary care professionals, patients, and organisation. Primary care settings in central Sweden will be supported in implementing a guideline-based health-promoting way of working including screening of life-style habits, measures taken according to evidence based recommendations and documentation. Strategies will include interactive education sessions, external and internal facilitators, audit and feedback, and tools from theories of leading change; tailored according to contextual and participant needs.

Study Record Dates

• First Submitted: March 4, 2021
• First Posted: March 16, 2021
• Study Start: March 30, 2021
• Primary Completion: December 31, 2024
• Study Completion: December 31, 2024
• Last Updated: December 16, 2025

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

SE (1)