Table 3 Provisionally selected implementation support strategies (n = 8) and sub-strategies (n = 29)
1. Health partnerships (year 1–3) [108] |
1.1. Partnership agreement signed by health districts or local government executive and local community leader |
1.2. New or existing Local Implementation Team oversees program |
1.3. The local Implementation Team is inclusive of a local clinician champion and community leaders to oversee the program and uses a self-assessment and action plan tool |
1.4. Local implementation team meets weekly; macro level committees meet twice per year |
2. Health workforce capacity development: Local clinicians (year 2) [55, 104, 105, 109,110,111,112,113] |
2.1. Group problem solving (with or without formal teams) or collaborative improvement every 2–3 months 2.2. Pre-service educational training: Local clinicians register and complete the 2 online educational training sessions at the beginning of year 2 2.3. On the job training: interactive workshop to ease knowledge integration, practice facilitation and educational outreach visits by a trained GSCI clinician overseeing patient encounters over 2–3 weeks using the Implementation Toolkit (Appendix 3, Table 1 and 3) 2.4. Local clinician Champion training –1-day of face-to-face training session by trained a GSCI clinician, hosted by Local Implementation Team 2.5. Peer coaching (improving routine supervision, benchmarking, or audit with feedback) by local champion for 12 months 2.6. Weekly contact made with GSCI trained clinician via email and/or Zoom |
3. Health workforce capacity development: Community health workers (CHW) (year 2)–Concurrent with item 2 |
3.1. CHWs’ training –1-day of face-to-face training session hosted by trained GSCI clinician, hosted by Local Implementation Team, and facilitated by the local clinician Champions. Accommodation, meals and transport costs covered by the grant 3.2. CHWs are trained to 1) recognize serious causes of spine problems via online or paper-based tools; and 2) deliver educational messages (reassurance, advice on self-care such as staying active, and basic exercise) for people with non-complicated spine symptoms/concerns (MoC class classes 1 through 3a, c and 4a) or to refer people with spine problems for further evaluation and treatments to local clinicians (MoC classes 3b, 4b and 5a, b and c). (Appendix 3, Table 2) 3.3. Equipping and motivating CHWs to conduct outreach and referrals process from community to health centers 3.4. Weekly contact made with in-community local clinician Champion via phone, email and/or face-to-face site visits for 12 months |
4. Educational tools to promote self-management (year 2–3) [112, 114,115,116,117,118,119,120] |
4.1. Self-administered online and paper format patient screening questionnaire to help make informed decision regarding the need to consult a licensed healthcare provider or to self-manage their spine pain (Appendix 3, Table 2) 4.2. Online and paper format educational and exercise booklet; develop/adapt 1-page information resources (https://www.ccgi-research.com/patient-resources) 4.3. Follow-up contact made by with in-Community Champion via phone, email and/or face-to-face site visits for 12 months |
5.1. In-Community Champion training –1-day of face-to-face training session hosted by Local Implementation Team in Term 1: train the trainer on adult yoga-like mind–body classes, whereby Yoga instructors are trained on spine health, who, in turn, will deliver consistent messaging on spine health issues |
5.2. Community support (community health education or social marketing of health services): spine health educational messages delivered monthly by CHWs through partnership with local community leaders at social gatherings (e.g., the village market or the church), clinic’s/healthcare centers, on social media platforms (Facebook via cell phones), using the local radio, and/or targeted at schoolchildren via their teachers 5.3. Co-design and animate locally accepted community activity/exercise program |
5.4. Follow-up contact made by local clinician Champion with in-community Champion via phone, email and/or face-to-face site visits for 12 months |
6. Resources (year 1–3) |
6.1. Printed posters outlining MoC Principles, triage system and care pathway to be displayed in the Nursing Station (Implementation Toolkit: Appendix 3, Table 1–2) |
6.2. Equipment provided to support the delivery of MoC |
6.3. Electronic resources housed on the program website (online) included: Overview of program presentation (Microsoft PowerPoint presentation) Project milestones to be achieved each term (over 3 years) Online quality training (GSCI videos), worksheet, peer observation materials Patient personal self-care plan templates Recess and lunch resources Policy templates Examples of community physical activity Tips and frequently asked questions |
7. Provision of prompts and reminders (year 2–3) [113] |
7.1. Weekly emails or phone calls made by the Local Implementation Team to local clinician and in-Community Champions to encourage implementation 7.2. Automated or paper-based messages sent each term via the program website or hand delivered to Champions, local clinicians and CHWs to prompt completion of educational training modules/videos/booklet chapters and online (or paper-based) termly performance monitoring and feedback surveys |
8. Implementation performance monitoring and feedback (year 2–3) [123] |
8.1. Champions, local clinicians and CHWs complete all surveys via the program website or paper-based 8.2. Feedback report sent to Champions, local clinicians and CHWs via email or hand-delivered |