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Open Access Correspondence

Implementation salvage experiences from the Melbourne diabetes prevention study

James Dunbar1*, Andrea Hernan1, Edward Janus12, Nathalie Davis-Lameloise1, Dino Asproloupos3, Sharleen O’Reilly3, Amy Timoshanko4, Elizabeth Stewart3, Catherine M Bennett3, Greg Johnson4, Rob Carter5 and on behalf of the Melbourne Diabetes Prevention Study research group

Author affiliations

1 Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC, 3280, Australia

2 Department of Medicine, North West Academic Centre, The University of Melbourne, Western Hospital, Footscray, VIC, 3011, Australia

3 Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia

4 Diabetes Australia – Victoria, 570 Elizabeth Street, Melbourne, VIC, 3000, Australia

5 Deakin Health Economics, Deakin Strategic Research Centre - Population Health, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia

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Citation and License

BMC Public Health 2012, 12:806  doi:10.1186/1471-2458-12-806

Published: 19 September 2012

Abstract

Background

Many public health interventions based on apparently sound evidence from randomised controlled trials encounter difficulties when being scaled up within health systems. Even under the best of circumstances, implementation is exceedingly difficult. In this paper we will describe the implementation salvage experiences from the Melbourne Diabetes Prevention Study, which is a randomised controlled trial of the effectiveness and cost-effectiveness nested in the state-wide Life! Taking Action on Diabetes program in Victoria, Australia.

Discussion

The Melbourne Diabetes Prevention Study sits within an evolving larger scale implementation project, the Life! program. Changes that occurred during the roll-out of that program had a direct impact on the process of conducting this trial. The issues and methods of recovery the study team encountered were conceptualised using an implementation salvage strategies framework. The specific issues the study team came across included continuity of the state funding for Life! program and structural changes to the Life! program which consisted of adjustments to eligibility criteria, referral processes, structure and content, as well as alternative program delivery for different population groups. Staff turnover, recruitment problems, setting and venue concerns, availability of potential participants and participant characteristics were also identified as evaluation roadblocks. Each issue and corresponding salvage strategy is presented.

Summary

The experiences of conducting such a novel trial as the preliminary Melbourne Diabetes Prevention Study have been invaluable. The lessons learnt and knowledge gained will inform the future execution of this trial in the coming years. We anticipate that these results will also be beneficial to other researchers conducting similar trials in the public health field. We recommend that researchers openly share their experiences, barriers and challenges when conducting randomised controlled trials and implementation research. We encourage them to describe the factors that may have inhibited or enhanced the desired outcomes so that the academic community can learn and expand the research foundation of implementation salvage.

Keywords:
Implementation; Salvage strategy; Type 2 diabetes; Prevention; Effectiveness; Randomised controlled trial