Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky
Abstract Background Prevalence of type 2 diabetes (T2D) in Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is an evidence-based intervention that teaches people living with T2D to self-manage their disease but is underutilized in Kentucky de...
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2025-05-01
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| Online Access: | https://doi.org/10.1186/s12913-025-12911-6 |
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| author | Aaron J. Kruse-Diehr Borsika A. Rabin Jessica Elliott Vance Drakeford Laura Wright Brent McKune Russell E. Glasgow Key C. Douthitt James W. Keck Mary E. Lacy |
| author_facet | Aaron J. Kruse-Diehr Borsika A. Rabin Jessica Elliott Vance Drakeford Laura Wright Brent McKune Russell E. Glasgow Key C. Douthitt James W. Keck Mary E. Lacy |
| author_sort | Aaron J. Kruse-Diehr |
| collection | DOAJ |
| description | Abstract Background Prevalence of type 2 diabetes (T2D) in Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is an evidence-based intervention that teaches people living with T2D to self-manage their disease but is underutilized in Kentucky despite being available free-of-charge to residents of every county. One promising strategy to improve DSMES utilization is clinic participation in a learning collaborative, wherein participants undertake small tests of change to improve the referral process. The purpose of this study was to identify determinants related to successful implementation of the learning collaborative, as well as perceived progress on implementation outcomes, as experienced by previous collaborative participants. Methods Semi-structured Zoom interviews were conducted with three discrete groups of learning collaborative participants (N = 26): (1) clinic practitioners and support staff (n = 13); (2) health department educators (n = 8) who received DSMES referrals from clinics; and (3) staff of a regional extension center (n = 5) who facilitated the collaboratives. Questions were aligned with Practical, Robust Implementation and Sustainability Model (PRISM) domains, and responses were transcribed verbatim. Data were coded using a matrix-based approach, with codes grouped into overarching themes within each domain to describe salient determinants. Results Participants most frequently identified facilitators and barriers aligned with the PRISM domains of organizational perspectives on intervention, organizational and patient characteristics, and implementation and sustainability infrastructure. Multiple strategies and adaptations were used throughout implementation to leverage strengths and mitigate barriers. For example, whereas clinic participants identified competing priorities, such as reporting requirements, as an infrastructure barrier, they successfully utilized morning huddles to ensure collaborative goals were met. Conclusions Data from this study provided context for determinants that positively and negatively impacted implementation of the collaborative, as well as strategies used by implementers to address these determinants. These data will be used to refine the collaborative and select responsive implementation strategies to address identified barriers for an upcoming cohort of clinic participants in which we will evaluate this framework as a model for increasing referrals to, and engagement with, DSMES among patients living with diabetes from two healthcare systems in Appalachia Kentucky. |
| format | Article |
| id | doaj-art-7f7768d45ced4e3793e2045699a96d23 |
| institution | OA Journals |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-7f7768d45ced4e3793e2045699a96d232025-08-20T02:34:17ZengBMCBMC Health Services Research1472-69632025-05-0125111110.1186/s12913-025-12911-6Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in KentuckyAaron J. Kruse-Diehr0Borsika A. Rabin1Jessica Elliott2Vance Drakeford3Laura Wright4Brent McKune5Russell E. Glasgow6Key C. Douthitt7James W. Keck8Mary E. Lacy9Department of Family and Community Medicine, University of Kentucky College of MedicineHerbert Wertheim School of Public Health, University of California San DiegoKentucky Regional Extension Center, The University of Kentucky and UK HealthCareKentucky Regional Extension Center, The University of Kentucky and UK HealthCareKentucky Regional Extension Center, The University of Kentucky and UK HealthCareKentucky Regional Extension Center, The University of Kentucky and UK HealthCareDepartment of Family Medicine and Adult and Child Center for Research in Delivery Science, Anschutz Medical Campus, University of ColoradoDepartment of Family and Community Medicine, University of Kentucky College of MedicineWWAMI School of Medical Education, University of Alaska AnchorageDepartment of Epidemiology and Environmental Health, University of Kentucky College of Public HealthAbstract Background Prevalence of type 2 diabetes (T2D) in Kentucky is among the highest in the United States. Diabetes self-management education and support (DSMES) is an evidence-based intervention that teaches people living with T2D to self-manage their disease but is underutilized in Kentucky despite being available free-of-charge to residents of every county. One promising strategy to improve DSMES utilization is clinic participation in a learning collaborative, wherein participants undertake small tests of change to improve the referral process. The purpose of this study was to identify determinants related to successful implementation of the learning collaborative, as well as perceived progress on implementation outcomes, as experienced by previous collaborative participants. Methods Semi-structured Zoom interviews were conducted with three discrete groups of learning collaborative participants (N = 26): (1) clinic practitioners and support staff (n = 13); (2) health department educators (n = 8) who received DSMES referrals from clinics; and (3) staff of a regional extension center (n = 5) who facilitated the collaboratives. Questions were aligned with Practical, Robust Implementation and Sustainability Model (PRISM) domains, and responses were transcribed verbatim. Data were coded using a matrix-based approach, with codes grouped into overarching themes within each domain to describe salient determinants. Results Participants most frequently identified facilitators and barriers aligned with the PRISM domains of organizational perspectives on intervention, organizational and patient characteristics, and implementation and sustainability infrastructure. Multiple strategies and adaptations were used throughout implementation to leverage strengths and mitigate barriers. For example, whereas clinic participants identified competing priorities, such as reporting requirements, as an infrastructure barrier, they successfully utilized morning huddles to ensure collaborative goals were met. Conclusions Data from this study provided context for determinants that positively and negatively impacted implementation of the collaborative, as well as strategies used by implementers to address these determinants. These data will be used to refine the collaborative and select responsive implementation strategies to address identified barriers for an upcoming cohort of clinic participants in which we will evaluate this framework as a model for increasing referrals to, and engagement with, DSMES among patients living with diabetes from two healthcare systems in Appalachia Kentucky.https://doi.org/10.1186/s12913-025-12911-6DiabetesLearning collaborativeImplementation science |
| spellingShingle | Aaron J. Kruse-Diehr Borsika A. Rabin Jessica Elliott Vance Drakeford Laura Wright Brent McKune Russell E. Glasgow Key C. Douthitt James W. Keck Mary E. Lacy Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky BMC Health Services Research Diabetes Learning collaborative Implementation science |
| title | Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky |
| title_full | Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky |
| title_fullStr | Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky |
| title_full_unstemmed | Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky |
| title_short | Using the Practical, Robust Implementation and Sustainability Model to identify implementation determinants of a statewide diabetes learning collaborative in Kentucky |
| title_sort | using the practical robust implementation and sustainability model to identify implementation determinants of a statewide diabetes learning collaborative in kentucky |
| topic | Diabetes Learning collaborative Implementation science |
| url | https://doi.org/10.1186/s12913-025-12911-6 |
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