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Table 1 Potential reasons for lack of effects in the TICD trials

From: The Tailored Implementation in Chronic Diseases (TICD) project: introduction and main findings

• Research evidence for some recommended clinical activities, which were targeted in the trails, is limited or mixed. Therefore, these recommendations might not have been credible for the targeted healthcare providers.

• The list of identified and targeted determinants of practice was not complete, so we might have failed to address key factors in the implementation programs. In addition, some determinants could not be adapted in the context of the TICD project, such as payments and organisation of healthcare delivery.

• The chosen implementation strategies were not sufficiently matched with targeted determinants, or not effective in the targeted groups and settings. Insight into the linkages of interventions and determinants is very limited.

• Health professionals’ agreement to participate in the implementation program was not a good predictor of intention to change behaviour. For instance, there are many competing priorities or participants may felt little ownership of the program, despite the tailoring.

• The provided tailored interventions were not used, thus could not have impact. The fidelity of the implementation programs was overall limited.

• Determinants, interventions and contextual factors interacted in complex ways, which reduced their impact. For instance, treatment targets for vascular risk may be used flexible in patients with complex morbidities.

• The primary outcomes were not adequately chosen, for instance because they were largely dependent on patents’ biology, or the available measures lacked responsiveness to change.

• The follow-up period in the TICD trials was too short to detect change, as most changes require much more time to happen.

• The pragmatic trials involved heterogeneous populations and low control of intervention delivery, which has reduced impact and hidden impact in subpopulations.

• Contextual factors led to improvements in the control groups, thus reducing the added value of the tailored implementation programs.