Discussion
obesity
OBESITY
To better understand the barriers to and facilitators of the implementation of an obesity-related pragmatic clinical trial within a community health center setting, we conducted in-depth qualitative interviews with 18 professionals representing a variety of positions from across the health system. Respondents described a variety of challenges and strengths alike that impacted the implementation of the trial within their FQHC setting.Our findings contribute to the limited qualitative assessments conducted with professional stakeholders included in pragmatic clinical trial design. Results from this study echo those from a recent qualitative study by Brooks et al. with physicians regarding their motivation to participate in a larger pragmatic trial for obesity treatment within rural health centers [This qualitative study also supports previous findings of the importance of involving a diverse group of stakeholders within pragmatic clinical trial design [Respondents in our study who were involved in Balance – and thus aware of its components – highlighted its implementation as a positive research collaboration. They noted the integration of a pragmatic trial within the healthcare system without overburdening or impeding clinical operations. This has been previously noted as an important consideration for researchers. [This study has some limitations to note. First, despite our success in enrolling participants from across roles within PHS, our sample may not have been reflective of all perspectives across the organization. Second, although patient perspectives are important and were collected as part of post-trial satisfaction surveys, qualitative patient perspectives on the implementation of Balance were beyond the scope of this project. Third, participation in the interviews may have been influenced by selection bias; there were other individuals in the organization whose perspectives would have been helpful but did not respond to requests, and thus our qualitative data are limited to those who volunteered to take part. Specifically, the lack of participation from registered nurses who provide care at the participating health centers may have influenced our results. Finally, staff turnover, identified as an overall challenge within the health center network, may have impacted the scope of knowledge for some participants. In fact, a few staff members in our sample began working at the health system after Balance meetings and trainings had already been conducted and were thus less familiar with the study than other respondents and unable to provide specific feedback on Balance implementation.Strengths of this study include its addition to the limited qualitative research as part of pragmatic trials, especially among settings serving medically vulnerable populations. Participants highlighted the importance of implementing novel health improvement interventions, such as Balance, and the successes and challenges of conducting pragmatic research within a complex healthcare system that responds to the variety of patient needs. Respondents shared practical suggestions for implementing similar pragmatic research, especially in the design of interventions for medically vulnerable populations and within resource-constrained community healthcare settings. Ensuring transparency, consideration for time and resources; and aligned values and communication between the research and clinical site were all considered by respondents to be critical for successful implementation. This can ultimately facilitate strong collaboration between the healthcare setting and research partners, as has been previously noted. [