Barriers to Balance implementation
RECRUITMENT
Respondents described several barriers to the implementation of Balance within their health system. These included initial concerns about trial referral processes and the potential time burden on providers and other staff; limited health center space for trial activities; and staff shortages and turnover.Several respondents discussed the challenges of referring interested patients to the trial. An administrative leader commented on provider concerns regarding the potential impact on patient flow and wait times, during already short visits:“Another administrative leader also recalled the importance of the initial meetings between the research team and providers to explain the study to providers and how it could potentially help their patients:“In addition to concerns about provider time, limited physical space for regular health center operations, with the addition of trial recruitment activities, was described as a challenge by several participants. One leader commented that Staff turnover during the enrollment period of Balance also posed another barrier to trial implementation - particularly the impact on recruitment flow and awareness of the trial. One provider commented:“Staff hiring and departures and the timing of trial introductory meetings with the research team and PHS may have impacted the awareness of the trial. In fact, one-third of participants stated they had no awareness of Balance and therefore could not comment extensively on the challenges with trial implementation.