Table 1 Steps in the collaborative modeling of the PVS implementation strategy under a participatory action research framework involving primary care staff and community members supported by external facilitation provided by the research team
Implementation goals | Contents and activities | Techniques of consensus, planning, quality improvement and evaluation |
|---|---|---|
1st—descriptive stage (three or four 90–120 min sessions) | ||
To obtain the commitment of the majority of the professionals to a common health promotion goal, after prioritizing which behaviors and groups to target | Presentation of PVS objectives and plan Assessment of attitudes, perceived practice and organizational climate in the primary health care center Gathering of information on general and local epidemiology of unhealthy behaviors | Strategic evaluation of healthy lifestyle promotion practice (audit and feedback) Individual identification of areas for improvement (gaps and needs assessment) Prioritization and consensus (nominal group) |
2nd—creative stage (three 90–120 min sessions) | ||
To acquire competence in planning the preliminary intervention program: specify objectives and actions, and identify agents and resources involved | Analysis of determinants of behavior Review of evidence-based interventions Tailoring of interventions to the actual context of the center Redesign of workflows and staff roles | Educational sessions on theoretical models and health promotion interventions Group discussion—consensus and planning Specific objectives (behavior determinants) Mapping of actions and interventions Redistribution of tasks and responsibilities: what, who, how, when and where |
3rd—piloting stage (four to six 90–120 min sessions) | ||
To achieve active cooperation among the multidisciplinary team within the center and with community agents, optimization of intervention components and their sustainable integration | Practical exercise of implementing intervention actions in real-world conditions, for the identification of feasible strategies Monitoring of performance measures Standardization of preliminary program on the basis of feasibility | Brief Plan-Do-Study-Act cycles for piloting Audit and feedback in group sessions Learning sessions to identify readjustments Strategic evaluation of the center’s capability to address the planned programs and availability of resources necessary for their implementation (SWOT matrix) |