1094 — The SMILE BP Toolkit: Intervention Translation into Toolkit, Formative Evaluation of Toolkit Implementation, and Finalization for Dissemination

Jung S, VA New York Harbor Healthcare System; Rodriguez MA, VA New York Harbor Healthcare System; Yeh MC, VA New York Harbor Healthcare System & CUNY School of Public Health; Friedberg J, VA New York Harbor Healthcare System & NYU School of Medicine; Natarajan S, VA New York Harbor Healthcare System & NYU School of Medicine;

Objectives:
We demonstrated that a telephone-delivered Transtheoretical intervention improved blood pressure (BP) in Veterans with uncontrolled BP. In the SMILE BP [stage-matched intervention to lower elevated BP] Toolkit project, we developed a toolkit based on the trial for dissemination.

Methods:
In Phase 1, we interviewed RCT counselors/staff, clinicians, and informaticians to create a prototype using heuristic evaluation and usability testing. In Phase 2, We conducted formative evaluation of toolkit implementation with end-users including 4 pharmacists and 7 nurses. After achieving competency, they counseled actual patients with hypertension. In Phase 3, we used the same methods from phase 1 to get opinions on the translated SMI. Final revisions were made to the SMILE BP Toolkit.

Results:
In Phase 1, after interviewing the 6 RCT counselors/staff, we made the SMI less scripted and more conversational, removed redundancy and irrelevance, emphasized short-term goals and changed the manual design. Then, 7 clinicians (2 doctors, 2 nurses, 1 social worker, 1 dietitian, 1 pharmacist), and 2 informaticians evaluated the prototype. At the end of Phase 1 our initial "translated intervention" consisted of the: 1) Counseling Package, 2) Training Manual, and 3) Sample counseling sessions created for the toolkit. In Phase 2, 4 pharmacists and 7 nurses participated in qualitative interviews and completed usability questionnaires. Qualitative interviews were completed with the 27 patients. Patients responded positively, many reporting the intervention would help diet and exercise. Clinicians and patients suggested reducing the call length. In Phase 3, we solicited opinions on all aspects of the toolkit. Final revisions were made to the SMILE BP Toolkit.

Implications:
This toolkit is part of an efficient dissemination strategy to make our study findings actionable and useful at different VAMC's. By piloting this toolkit with different disciplines, we addressed unforeseen barriers to implementation of the intervention in clinical practice and made it easy for a variety of clinicians to use.

Impacts:
We created the toolkit to improve hypertension control based on results from a rigorous RCT that found substantial improvement in BP control. If implemented at other VA sites, this translated self-contained toolkit can help clinicians to effectively support Veterans in controlling their BP.