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Implementing Kanyini GAP, a pragmatic randomised controlled trial in Australia: findings from a qualitative study

Overview of attention for article published in Trials, September 2015
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Title
Implementing Kanyini GAP, a pragmatic randomised controlled trial in Australia: findings from a qualitative study
Published in
Trials, September 2015
DOI 10.1186/s13063-015-0956-y
Pubmed ID
Authors

Hueiming Liu, Luciana Massi, Anne-Marie Eades, Kirsten Howard, David Peiris, Julie Redfern, Tim Usherwood, Alan Cass, Anushka Patel, Stephen Jan, Tracey-Lea Laba

Abstract

Pragmatic randomised controlled trials (PRCTs) aim to assess intervention effectiveness by accounting for 'real life' implementation challenges in routine practice. The methodological challenges of PRCT implementation, particularly in primary care, are not well understood. The Kanyini Guidelines Adherence to Polypill study (Kanyini GAP) was a recent primary care PRCT involving multiple private general practices, Indigenous community controlled health services and private community pharmacies. Through the experiences of Kanyini GAP participants, and using data from study materials, this paper identifies the critical enablers and barriers to implementing a PRCT across diverse practice settings and makes recommendations for future PRCT implementation. Qualitative data from 94 semi-structured interviews (47 healthcare providers (pharmacists, general practitioners, Aboriginal health workers; 47 patients) conducted for the process evaluation of Kanyini GAP was used. Data coded to 'trial impact', 'research motivation' and 'real world' were explored and triangulated with data extracted from study materials (e.g. Emails, memoranda of understanding and financial statements). PRCT implementation was facilitated by an extensive process of relationship building at the trial outset including building on existing relationships between core investigators and service providers. Health providers' and participants' altruism, increased professional satisfaction, collaboration, research capacity and opportunities for improved patient care enabled implementation. Inadequate research infrastructure, excessive administrative demands, insufficient numbers of adequately trained staff and the potential financial impact on private practice were considered implementation barriers. These were largely related to this being the first experience of trial involvement for many sites. The significant costs of addressing these barriers drew study resources from the task of achieving recruitment targets. Conducting PRCTs is crucial to generating credible evidence of intervention effectiveness in routine practice. PRCT implementation needs to account for the particular challenges of implementing collaborative research across diverse stakeholder organisations. Reliance on goodwill to participate is crucial at the outset. However, participation costs, particularly for organisations with little or no research experience, can be substantial and should be factored into PRCT funding models. Investment in a pool to fund infrastructure in the form of primary health research networks will offset some of these costs, enabling future studies to be implemented more cost-effectively. ACTRN126080005833347.

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The data shown below were compiled from readership statistics for 138 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 138 100%

Demographic breakdown

Readers by professional status Count As %
Researcher 18 13%
Student > Master 15 11%
Student > Bachelor 13 9%
Student > Ph. D. Student 12 9%
Other 8 6%
Other 31 22%
Unknown 41 30%
Readers by discipline Count As %
Medicine and Dentistry 23 17%
Nursing and Health Professions 15 11%
Pharmacology, Toxicology and Pharmaceutical Science 14 10%
Psychology 7 5%
Social Sciences 7 5%
Other 17 12%
Unknown 55 40%