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Table 1 Specification of WISE implementation strategy

From: Implementation of a self-management support approach (WISE) across a health system: a process evaluation explaining what did and did not work for organisations, clinicians and patients

  Specification of the implementation strategy
Actors The organisation: employs and supports lay trainers to deliver WISE to whole practice teams
Health care professionals: once trained, use WISE approach with their patients
Actions Practice teams given knowledge, skills and tools to improve self-management support
Action targets The organisation: facilitates training process (funding for training and employment of trainers), access to community resources (online directory of self-care organisations), develops management strategy, finds local GP champion
The practice: commit whole practice to attending training, nominate two practice champions for WISE, develop systems to ensure tools accessible to staff and patients, work with trainers in follow-up sessions to embed WISE, share and discuss learning within practice teams
Practice staff: use WISE approach knowledge, skills and tools to provide tailored support for self-management
Patients: given PRISMS form and informed of a change of approach by practice staff to help them manage their condition
Temporality Assumption that practice staff would start to use WISE approach with patients with long-term conditions after completing training
Dose Two training sessions of 3 h 1 month apart. Intermediate session and post-training support with trainers offered
Session 1: 3 h whole practice—GPs, nurses and administrative staff
  Brief introduction to WISE
  Care pathways exercise—mapping the process of care from reception to self-management
  Interactive session—making the WISE tools work in your practice:
   PRISMS form (Patient Report Informing Self-Management Support): designed to encourage patients to reflect on their support needs, how they were managing and which symptoms and illness-related matters required attention in their everyday lives. Patients' priorities to form a basis for negotiated decision-making and tailoring access to appropriate information or resources
   Guidebooks developed with patients to provide experientially based information, alongside medical evidence about treatment options [18],[19]. The guidebooks were intended to encourage patients to consider changes they could make to manage their condition
   Online directory of local services developed by the PCT providing up-to-date information about community services, support groups and education programmes. Linking to:
    Group training and support (Expert Patients Programme courses, group education, exercise classes)
    Voluntary sector and local support (patient support groups, health trainers)
Session 2: 3 h clinicians—GPs and nurses
   Refresh on WISE approach
   Show DVD giving examples of WISE approach consultations plus discussion
   Skills training—role play to practice three core skills:
    How to assess what each patient can do and needs to do
    How to share decisions with patients
    How to make sure patients get the right support
   Discussion on how to ensure sustainability of WISE
Implementation outcome affected Adoption and feasibility of the WISE approach at organisation, practice, professional and patient level
Justification Using NPT to explain how new or modified practices of thinking, enacting and organising work associated with WISE are operationalised in health care
  1. Education strategy.
  2. Training of mixed practice team (GPs, nurses and administrative staff) in using a structured whole systems approach to target and improve within practice communication, professional-patient communication, patient education and advice and patient self-management outcomes.