Adapting the IMP2ART implementation strategy to the context of primary care during a COVID-19 pandemic

Aim: Understanding and adapting to context is crucial if complex intervention implementation is to be successful. Within the IMP2ART programme, we had developed a theoretically-informed implementation strategy to improve supported self-management (SSM) for asthma in routine practice, with a cluster-randomised trial due to start in January 2020. The global COVID-19 pandemic dramatically changed the context and many aspects of the IMP2ART strategy required adaptation.Method: With input from patient and public involvement (PPI), and a professional advisory group, the programme team reviewed all components of the IMP2ART strategy. Changes were made to a) enable safe delivery of the implementation strategy in a pandemic, b) to offer advice on novel modes of practice, and c) to ensure resources reflected the new context.Results: Safe delivery of the IMP2ART strategy: Whole-practice SSM facilitation visits (IMP2ART workshops) to implementation practices will not be possible for the foreseeable future, so we adapted the facilitation for remote delivery. Novel modes of practice: We scoped and collated resources to support remote consultations, adapting them to provide advice on remote asthma reviews. Resources were provided for both practices and patients and made available on the IMP2ART trial website. On-line consultations were a new format and specific advice for asthma reviews was developed. Reflecting the new context: Educational modules were updated with examples of remote reviews and remote completion of action plans. Illustrations were checked to ensure some reflected remote delivery of care.Conclusion: Adapting the implementation strategy to the COVID-19 pandemic has been a comprehensive process, and some aspects (e.g. remote delivery of the IMP2ART workshop) required governance approvals. The adapted strategy is now ready be evaluated in the IMP2ART UK-wide cluster-RCT (n=144 practices), assessing its impact and cost-effectiveness. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Funding: NIHR PGfAR (RP-PG-1016-20008). References and Clinical Trial Registry Information