03166nas a2200337   4500000000100000008004100001653000900042653003100051653004400082653003000126653004300156653003500199653001900234653001800253653001700271100001400288700001400302700001500316700001100331700001300342700001900355700001200374700001000386700001400396245011700410856003300527300000700560490000700567520224000574022001402814       2018                            d10aCBPR10aChronic disease management10aChronic disease self-management program10aClinic-community linkages10aCommunity-Based Participatory Research10aEvidence-based programs (EBPs)10aImplementation10aMixed methods10aPrimary care1 aLeppin AL1 aSchaepe K1 aEgginton J1 aDick S1 aBranda M1 aChristiansen L1 aBurow N1 aGaw C1 aMontori V00aIntegrating community-based health promotion programs and primary care: a mixed methods analysis of feasibility.  uhttps://tinyurl.com/y99hxzyy  a720 v183 a<p><strong>BACKGROUND: </strong>Implementation of evidence-based programs (EBPs) for disease self-management and prevention is a policy priority. It is challenging to implement EBPs offered in community settings and to integrate them with healthcare. We sought to understand, categorize, and richly describe key challenges and opportunities related to integrating EBPs into routine primary care practice in the United States.</p>

<p><strong>METHODS: </strong>As part of a parent, participatory action research project, we conducted a mixed methods evaluation guided by the PRECEDE implementation planning model in an 11-county region of Southeast Minnesota. Our community-partnered research team interviewed and surveyed 15 and 190 primary care clinicians and 15 and 88 non-clinician stakeholders, respectively. We coded interviews according to pre-defined PRECEDE factors and by participant type and searched for emerging themes. We then categorized survey items-before looking at participant responses-according to their ability to generate further evidence supporting the PRECEDE factors and emerging themes. We statistically summarized data within and across responder groups. When consistent, we merged these with qualitative insight.</p>

<p><strong>RESULTS: </strong>The themes we found, "Two Systems, Two Worlds," "Not My Job," and "Seeing is Believing," highlighted the disparate nature of prescribed activities that different stakeholders do to contribute to health. For instance, primary care clinicians felt pressured to focus on activities of diagnosis and treatment and did not imagine ways in which EBPs could contribute to either. Quantitative analyses supported aspects of all three themes, highlighting clinicians' limited trust in community-placed activities, and the need for tailored education and system and policy-level changes to support their integration with primary care.</p>

<p><strong>CONCLUSIONS: </strong>Primary care and community-based programs exist in disconnected worlds. Without urgent and intentional efforts to bridge well-care and sick-care, interventions that support people's efforts to be and stay well in their communities will remain outside of-if not at odds with-healthcare.</p>
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