Table 2 Findings from implementation mapping steps 2 and 3 across groups (CHC, Community Health Center; EHR, electronic health record; ⥥implementation strategies based on the taxonomy of Waltz et al. [49])
Group | Performance objectives | Determinants | Implementation strategies⥥ | Practical applications |
|---|---|---|---|---|
CHC leadership and providers | Agree to participate in BeatPain | Knowledge of benefits of nonpharmacologic care for chronic back pain Knowledge of the BeatPain program | Train and educate stakeholders | Provide evidence supporting nonpharmacologic care for chronic back pain and potential benefits of telehealth delivery |
Ask and advise patients about BeatPain program during primary care visits | Self-efficacy to advise patients on non-pharmacologic care Positive expectations for outcomes of physical therapy | Provide ongoing consultation Support clinicians Feedback clinical data | Provide initial and ongoing training on BeatPain and the e-referral process Provide feedback to clinicians on status of referred patients and their outcomes | |
Refer interested patients to BeatPain | Skills to generate e-referral from EHR and manage technology-based issues that arise | Change the infrastructure Provide local technical assistance | E-referral process embedded in EHR Ongoing technological support for issues that arise during the study | |
Assist in sustaining clinic participation in BeatPain | Positive expectations for clinical workflows from e-referral process | Provide interactive assistance to avoid disruptions in workflows | Patient outreach using text messaging after in-clinic visits if in-clinic e-referral is not made | |
Patients | Provide consent for BeatPain study | Knowledge of telehealth physical therapy as a pain care option | Prepare consumers to be active participants | Education on BeatPain program and potential benefits of telehealth physical therapy |
Attend BeatPain telehealth sessions | Positive expectations for outcomes of telehealth physical therapy | |||
Engage in BeatPain treatments | Self-efficacy for active pain coping strategies | Adapt and tailor to context | Use of motivation and problem-solving strategies to provide telehealth physical therapy | |
Physical therapists | Attend PT trainings | Knowledge of strategies to provide care via telehealth | Create a clinical team Develop educational materials Conduct ongoing training | Create training materials and procedures for ongoing training on telehealth delivery. Integrate mHealth resources |
Incorporate cultural competencies with BeatPain core components | Self-efficacy for providing BeatPain core components in a patient-centered manner | Training on cultural competencies for providing care | ||
Training to integrate motivation and problem-solving strategies with the core components of BeatPain treatments | ||||
Provide patient-centered care | Regular team meetings for problem-solving and skills practice |