Developing a practical framework for facilitation to implement supported self-management of asthma in primary care; An exemplar from the IMP2ART Trial

Introduction: IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a programme of work developing and evaluating (in a trial) a strategy for implementing supported asthma self-management in UK primary care. Facilitation, as specified in the iPARIHS implementation theory, is a core component of IMP2ART but adaptation to practice need is key. The IMP2ART facilitators are respiratory nurse specialists with additional expertise in education and facilitation but with little experience of implementation research. This abstract reports the development of a framework to support the facilitation process and maintain fidelity to the IMP2ART Trial protocol. Methods: A team of educationalists, researchers and behavioural experts worked together to define facilitation for the purpose of the IMP2ART Trial developing 1) facilitator training 2) a schedule of core facilitator activity 3) a range of resources to support facilitation 4) a support and supervision system for facilitators. Results: A facilitator, defined as a trained individual linked to a practice to support and tailor IMP2ART resources, was allocated to the 73 practices in the implementation group. The schedule detailed the minimum number of contacts and suggested activity (e.g. workshop, meeting or email) and maximum facilitator support time (up to 12 hours) for each practice, but allowed flexibility within these limits. Resources included a core schedule, workshop guide and slide set, field notes template for each practice, and a range of adaptable email templates. Ongoing facilitator support included an online discussion forum and regular meetings with core activity including troubleshooting, sharing experiences, peer learning and support (see Table 1). Discussion: The framework enabled facilitators to structure their support for the practices for consistency, but crucially allowed them flexibility to adapt to individual practices and the contexts within which they were implementing the IMP2ART strategy.