Table 4 Concordance/discordance of adaptations found across data sources

Follow-up or tracking

(Ex: began contacting patients before sessions)

Mean score: 2.3

Counts

Completely different (1): 8

Some similarities (2): 2

Mostly similar (3): 6

Same data (4): 4

• Interview and facilitator note data was similar in sharing stories of changes to participant follow-up and data collection

• The most descriptive data was in the facilitator notes with regard to understanding and asking for permission on patient-reported outcomes

• This was generally not covered in the observations unless a survey was to be completed during the specific class session in which it could be seen if this was done or not

Program content

(Ex: not all curriculum content covered during session)

Mean score: 2.2

Counts

Completely different (1): 4

Some similarities (2): 10

Mostly similar (3): 4

Same data (4): 2

• Found in all data sources but different emphasis and perspectives

• The interview data provided more perceptions of the curriculum and why changes were made, the facilitator notes reported difficulties with the content and the observations noted when content had been altered but not why

Recruitment

(Ex: expanded focus of recruitment past patients with high A1c)

Mean score: 2.4

Counts

Completely different (1): 7

Some similarities (2): 2

Mostly similar (3): 7

Same data (4): 4

• Almost all practices had adaptations in their recruitment strategies, ranging from small changes to completely different strategies. This was discussed in interviews and in facilitator notes, with differences in levels of detail

• Almost entirely missing from observations, except one key point (type 1 diabetic patient found)

Resources

(Ex: began utilizing whiteboard)

Mean score: 2.6

Counts

Completely different (1): 9

Some similarities (2): 1

Mostly similar (3): 0

Same data (4): 10

• Mostly, no data reported in any source (4), but when it was reported, tended to come out in either interviews or facilitator notes or both

• Observations were lacking in this data

Scheduling

(Ex: changed to weekly sessions from monthly sessions)

Mean score: 2.1

Counts

Completely different (1): 9

Some similarities (2): 2

Mostly similar (3): 7

Same data (4): 2

• Mostly reported in interviews, sometimes in facilitator notes

• Not reported in observations

Time devoted

(Ex: classes shorter than 120 min)

Mean score: 1.7

Counts

Completely different (1): 13

Some similarities (2): 2

Mostly similar (3): 3

Same data (4): 2

• Primarily mentioned only in observations, coming across as shorter sessions

• Other sources sometimes showed differences in time devoted by administrative personnel

Who is involved

(Ex: class facilitator resigned and replaced)

Mean score: 2.8

Counts

Completely different (1): 2

Some similarities (2): 4

Mostly similar (3): 11

Same data (4): 3

• Some similarities between interviews and facilitator notes

• Seemed to come in to play from all sources

Other

(Ex: practice staff began using instant messaging rather than meetings)

Mean score: 2.9

Counts

Completely different (1): 6

Some similarities (2): 2

Mostly similar (3): 0

Same data (4): 4

• Mostly not reported by any source, likely due to good characterization of data

• Mostly came from one source for each practice, varied between observations and interviews

• Did not occur in observations

Overall

Mean score: 2.4

Counts

Completely different (1): 58

Some similarities (2): 25

Mostly similar (3): 38

Same data (4): 39

• All data sources had unique data present

• Observation data was most relevant for timing of sessions

• Facilitator note data had most instances of background for adaptations

• Interviews and facilitator notes matched up a lot of the time; observation data was more likely to be independent

• 36% of data was completely different between sources