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Table 3 Distinguishing construct themes and exemplary quotes

From: Inner and outer setting factors that influence the implementation of the National Diabetes Prevention Program (National DPP) using the Consolidated Framework for Implementation Research (CFIR): a qualitative study

Construct themes

Positive/mixed quote

Negative quote

Structural characteristics: comprised of many traditional measures of context and organization characteristics (organization size, type, location, etc.)

 High and medium reach organizations described both positive and negative examples related to implementation, while low reach organizations discussed mostly negative examples

“so, we’re a pretty big organization. […] There are pros and cons to everything. So I think our size is a pro just because we have a large population, like a patient population, in which to draw from. […] One thing that can make it a barrier, though, as far as trying to get referrals and spread the word is when it’s a huge organization and there’s a lot going on, sometimes it is hard to get the message across when there’s just so much other stuff going on.”

Interviewee M2

Medium reach

Healthcare

“[…] for us to start applying for a grant, we somewhere in our process have to involve the city council. And in addition to that process once the city council okays on us applying for the grant, we receive the grant. Now we have to implement that grant into the city’s budget. So that becomes really tedious and becomes a really huge pain as opposed to a nonprofit.”

Interviewee L9

Low reach

Government agency

Compatibility: a subconstruct of implementation climate and relates to how the intervention fits within the organization and its existing workflows, systems, and services

 High and medium reach organizations described how the National DPP was complementary to similar services and programs, had systems that could easily integrate the National DPP, and overall better fit compared to medium and low reach organizations

“[…] for example if we see a patient who’s interested […] the most common one of course is DPP and then the diabetes health management. […] ‘And hey, you have diabetes, it runs in your family, well this program would be better for you and vice versa. Oh, well you have diabetes, we’d love to have you, you’d still benefit but, this one might be a little bit more appropriate for you.’ But I think it’s a nice complement and it nicely rounds out the services that we offer.”

Interviewee H8

High reach

Health insurer

“We have to force it to fit…I feel like it needs to be a part of the entire process, like if someone’s coming in for one particular service they should be screened for being at risk of having Type 2 diabetes. And we've done it, but it's only been during specific times and then it goes away…So I would love to see it more integrated into all of the programs.”

Interviewee L7

Low reach

Government agency

Goals and feedback: a subconstruct of implementation climate and refers to the degree to which goals are clearly communicated, acted upon, and fed back to staff, as well as the alignment of that feedback with goals

 High reach organizations discussed formal enrollment goals and provided feedback to team around goals, while medium and low reach organizations tended to have no formal goals set

“[…] we always have a goal an enrollment goal. So we always reach the goal and we have a waiting list. There’s always a waiting list and as I said, that’s something that we’re very proud of. […] it’s nice to have the number, I like numbers. Tell me what you want, I'll go for that number.”

Interviewee H3

High reach

Community-based healthcare

“It’s so new that I don’t think that they would even know where to begin […] we have this great program that’s been developed by the CDC and we're implementing it, but until we kind of establish a firmer way of recruitment, they’re not too hardcore.”

Interviewee L6

Low reach

Health insurer and employer

Leadership engagement: a subconstruct of readiness for implementation and refers to the commitment, involvement, and accountability of leaders and managers with the implementation of the program

 High reach organizations included strong examples of leadership engagement leading to increased enrollment/scaling. Lower reach group described leadership as not being engaged enough; not doing enough to understand the program, and taking a “hands off” approach

“Our leadership has been great […] I'll just give an example when we were going to be Medicare suppliers or applying for Medicare reimbursement. […] And because we had physicians on our board and people that knew about the program, they knew about the process even with Medicare we really had buy-in there because they were able to explain it […] So they really came together and got everybody on board and we were able to get those numbers and submit the application.”

Interviewee H6

High reach

Community-based organization

“[…] I think leadership – just to actually sit down and know – understand the program a little bit better and understanding the goals that are attached to it and understanding the work that’s needed to get done. That’s it. I think that’s where the gap comes in.”

Interviewee L8

Low reach

Government agency