Table 4 Linking CFIR/RE-AIM to thematic analysis of staff and patient participant perceptions of intervention
CFIR | Domain | Staff Representative Quote | Patient Participant Representative Quote |
|---|---|---|---|
Intervention characteristics | Advantages | It allows us to provide our intensive lifestyle therapy to those unable to be here on a weekly basis. | It definitely saves you in traveling and trying to schedule an appointment to come down, and so you don’t have to get out of work to take an appointment or whatever, so it’s definitely easier scheduling wise. |
Inner setting | Workflow interference | Space was a big one, and tight scheduling was another one, and sometimes that was back-to-back telemedicine visits where patients were scheduling us in around their workday, and so they didn’t necessarily have the flexibility to start late or whatnot | The dietitian was way behind on schedule and caused me to miss [a session] one day |
Change in work hours | There were occasions when I [administrative staff] didn’t get lunch. | ---- | |
Barriers to success | We need a clinic place where we can actually think and not be interrupted and be able to be setup appropriately for this. That was a huge struggle for me in particular because I don’t have a room. | Sometimes I found that like when, like the health coach or dietitian, they were going through their spiel and I wanted to put my little two sense in, they were on their roll. And it was hard to get that in. Where maybe if you were face to face, they’d read that body language that you had something you wanted to say. That would be my only negative to that. | |
It was just the exhaustion that I’ve repeated myself for 30 minutes of information | I think, it really depends on kind of the provider having, being ready and having their material ready. I think people were pretty good in this study but, yeah, it’s a little, it’s maybe a little stiffer. It’s a little harder to kind of have a back and forth sometimes, but. | ||
There should be more flexibility in the scheduling; especially not having back-to-back times, even if there was a 15-minute buffer in there following an appointment to allow for (i.e., tight scheduling) | The disadvantages is, that I felt like I had a make my schedule all around this, and they, we did switch to, and they switched too | ||
Enablers and facilitators | I think it’s a great way to deliver this information and a great way [convenience] to access those people who can’t make it in here | They give you exercises, they give you nutrition information, they give you health coaching information, like ways to help deal with stressful eating and fast hurried eating, not paying attention eating. Then you go and test when you start, and then you get to test again when you end and see how much you’ve progressed. | |
Telemedicine saves on transportation, time, mobility. | As long as they’ve got connections, it can save them the drive | ||
I think it’s a way to do a quick check-in, if you will, an assessment. It’s kind of another touchpoint where they can feel connected. | Definitely it can help you keep in touch with the provider instead of having to make an appointment, you can get ahold of them. | ||
For a relationship perspective, because you don’t have the in-person face-to-face thing, you do lose energy, and only see part of the person. | Well, the lack of human support, the supportive group concept, the weighing in piece | ||
Outer setting | External policies | From a billing standpoint, we potentially lost four dietitian billable appointments per person, | – |
Characteristics of individuals | Motivation | It really depends largely on the patient participants’ readiness for change to participate | It’s a stepping stone to kick-start some motivation, and to definitely increase stream of consciousness. If somebody is unsure how to begin a program, this is certainly a good framework for helping them get started. |
RE-AIM | |||
Reach | Effect on number of patients treated | I’m not sure how it would differ in terms of versus a class, where you could fit 14 to 15 people in an hour. I still think the group model either way is a great one and less resource intense. | I don’t know, maybe like a group session [is needed], maybe each quarter throughout the program |
Adoption | Workflow interference | We would have to take a closer look at the workflow related to scheduling and the space before I would I say, “Yeah, I’d love to do telemedicine.” | – |