Table 3 MyComrade study process evaluation framework, including implementation outcomes framework
Process evaluation framework and implementation outcomes framework | MyComrade process evaluation questions | Intervention or control | Data source to answer process evaluation question | ||
|---|---|---|---|---|---|
Interview | Other sources | ||||
Domain | |||||
 1. Recruitment of clusters | How were practices sampled and recruited? | Both | No | Study records | |
Why did practices agree to participate (or not)? | Both | GPs/PBPs Practice administrative staff | Â | ||
 2. Delivery to clusters | How was MC delivered to the practices? | Intervention | GPs/PBPs | Study records | |
 3. Response of clusters | How has completing trial-related work impacted the practice? At the practice level, how is MC and related research work perceived? How has the practice been found working with the research team? Time taken to complete study activities? | Both | Practice administrative staff GPs/PBPs |  | |
How were patients identified/reviewed? Are they representative/is there a selection bias? Time taken to complete? | Both | Practice administrative staff GPs/PBPs | Â | ||
What were the processes involved in addressing the recruitment packs and conducting mail-outs and what was the time taken to complete? | Both | Practice administrative staff GPs/PBPs | Â | ||
What is the practice level protocol for usual care? | Control | Practice administrative staff GPs/PBPs | Â | ||
 4. Recruitment and reach in individuals | Who within each practice actually received the MC training? Are they representative/is there a selection bias? | Intervention | Practice administrative staff GPs/PBPs | Study records of attendance at the intervention introduction session | |
 5. Delivery to individuals | Implementation outcomes framework 1. Fidelity | What do GPs/PBPs implement as usual care? | Control | GPs/PBPs |  |
How are GPs/PBPs implementing MC? How many BCTs did pairs implement the following? | Intervention | GPs/PBPs | Â | ||
i. Plan reviews: restructuring social environment, Action planning | Intervention | GPs/PBPs | Checklist completion GP fellow calls | ||
ii. Conduct reviews: social support | Intervention | GPs/PBPs | Checklist completion GP fellow calls Scanned checklists to patient record | ||
iii. Use checklist: prompts/cues | Intervention | GPs/PBPs | Checklist completion Scanned checklists to patient record | ||
iv. Submit for annual appraisal or points/reimbursement: self-incentives; material incentive | Intervention | GPs/PBPs | Submission of MC activities for annual appraisal Receipt of reimbursement | ||
 6. Response of individuals | 1. Acceptability 2. Adoption 3. Appropriateness 4. Feasibility | Is MC acceptable/agreeable/satisfactory to GPs/PBPs? What was GP/PBP initial intention/plan for MC? Did implementation of MC change over the course of the study (e.g. use of checklist)? Is MC compatible/relevant for general practice and multimorbidity? Is MC practical/feasible for GPs/PBPs to implement? | Intervention | GPs/PBPs |  |
| Â | Has the GP/PBP ever reviewed their medication with them? How do they feel about two GPs, or GP and PBP discussing their medications without them? Did they experience any changes to their medication during the course of the study? | Both | Patients | Â | |
 7. Maintenance | 1. Acceptability 2. Adoption 3. Appropriateness 4. Feasibility | Has MC become integrated into practice over the course of the study? What components? Do GPs/PBPs think MC could become routine practice? Are there any opportunity costs of implementing MC? | Intervention | GPs/PBPs |  |
 8. Unintended consequences | Were there unintended consequences, outcomes or changes in the processes? | Intervention | GPs/PBPs |  | |
 9. Theory | Proposed mechanisms of impact: How did GPs/PBPs feel about formally allocating time to review medications? Did the MC intervention help in any way in dealing with that uncertainties related to medications and considering options? Has taking part in the trial had any impact on the way GP/PBP communicates with their patients about their medications? Did GP/PBP submit details of their MC involvement as part of annual appraisal submission? | Intervention | GPs/PBPs |  | |
 10. Context | What are the differences in experiences between the NI and ROI practices in all of the framework domains, e.g.: Practice resources prescribing guidelines practice context, e.g. practice size and setting | Both | All | Practice profile questionnaire | |
 11. Effectiveness | Did pairs complete active medication reviews? Were there changes made to the number of repeat medications prescribed (additions and de-prescribing)? Were there changes related to potentially inappropriate prescribing? | Both | GPs/PBPs | Checklist completion GP fellow calls Patient record | |
Patient outcomes: Quality of life Multimorbidity treatment burden | Both | Patient | Patient questionnaires Patient record | ||