The following is a summary of “Complex implementation mechanisms in primary care: do physicians’ beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study,” published in the June 2023 issue of Primary Care by Söling, et al.

Improving the quality of care for polypharmacy patients through the adoption of digital health technologies requires a better understanding of the complex implementation mechanisms involved, including the role of contextual factors. However, primary care research lacked evidence on the effects of context in adopting digital innovation for polypharmacy management. For a study, researchers sought to identify contextual factors relevant to physician behavior and examine how these factors mediate the adoption process of digital innovation for clinical decision-making in polypharmacy.

The study participants were physicians (n=218) who were part of the intervention group in a cluster-randomized controlled trial. The intervention group implemented a digital innovation for polypharmacy management. A three-step methodological approach was used: a realist inquiry approach to describe the context-mechanism-outcome configuration in primary care; a belief elicitation approach involving the qualitative content analysis and development of a quantitative latent contextualized scale; and a mediation analysis using structural equation modeling (SEM) based on survey data from physicians to assess the mediating role of the contextualized scale (n=179).

The study mapped and refined the key dimensions of the context-mechanism-outcome model. It identified a latent construct of physicians’ innovation beliefs related to the effectiveness of polypharmacy management practices. The mediation analysis revealed that physicians’ innovation beliefs mediate the relationship between organizational readiness for change and physicians’ behavioral intent to adopt digital innovation (p < 0.01; R = 0.645). The contextualized model demonstrated a significant mediation effect, with a relative size of 38%. The overall fit indices of the model indicated a good fit (CFI = 0.985, RMSEA = 0.034).

Physicians’ adoption of digital innovation is influenced by the readiness of primary care organizations for change. The mediation analysis highlighted the indirect influence of physicians’ beliefs about the effectiveness of digital innovation on their adoption behavior. Both individual physician beliefs and organizational capacity should be considered when developing implementation strategies. The methodological approach used in the study proved advantageous for the formative evaluation of complex implementation mechanisms.

Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-023-02081-x