Understanding and improving facilitation in the IMP2ART primary care implementation trial: developing and using the FACE Instrument

Clinical Research Results Abstract IntroductionSupported self-management is a cornerstone of care for people with asthma, and recommended in inter/national clinical guidelines but only 1 in 3 people have an asthma action plan. IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a UK-wide trial which aims to address sub-optimal implementation. Facilitation is a central part of the implementation strategy through a workshop to introduce patient resources to support self-management, professional asthma self-management education for practice staff, organisational strategies. Facilitators provide ongoing tailored support for a further 12 months. This nested project aims to design and evaluate a bespoke tool to assess facilitators’ actions and competencies and use this to understand and enhance the facilitation process in IMP2ART and other studies.MethodsLiterature was reviewed to identify prior facilitation competency evaluation instruments. No evaluation instruments were found but a framework by Lessard et al. 2015 was identified as applicable to IMP2ART. Item generation based on the framework and a scoring system were developed and piloted to form a novel refined FACilitator Evaluation instrument (FACE). Six video-recorded facilitation workshops were double coded with the newly developed tool and analysed to understand facilitation in the pilot phase of IMP2ART.ResultsThe FACE instrument contains 68 items across five domains of facilitator competency comprising: managing introductions, interpreting audit, resources, practice planning and team dynamics. Across the six pilot practices “introducing resources” and “developing a team plan” were consistently the strongest domains, whilst “interpreting audits” and “managing dynamics” were the weakest, leading to further training support for facilitators. DiscussionThe development of an evidence-based facilitator competency instrument has helped understand the practice of facilitation in primary care and led to identification of further training needs. It will be validated in the full trial but has potential to support both evaluation and understanding of a key primary care implementation strategy. Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest The IMP2ART programme is independent research funded by the National Institute for Health Research under its Programme Grants for Applied Research Programme (Ref: RP-PG-1016-20008). References and Clinical Trial Registry Information Lessard 2015 https://implementationscience.biomedcentral.com/articles/10.1186/s13012-016-0458-7ISRCTN15448074 : Implementing improved asthma self-management as routine