Background: A tailored implementation programme to improve cardiovascular risk management (CVRM) in general\npractice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on\ncounselling skills and CVRM knowledge of practice nurses, (2) their use of the various components of the\nintervention programme and adoption of recommended practices and (3) patients� perceptions of counselling for\nCVRM.\nMethods: A mixed-methods process evaluation was conducted. We assessed practice nurses� motivational\ninterviewing skills on audio-taped consultations using Motivational Interviewing Treatment Integrity (MITI). They also\ncompleted a clinical knowledge test. Both practice nurses and patients reported on their experiences in a written\nquestionnaire and interviews. A multilevel regression analysis and an independent sample t test were used to\nexamine motivational interviewing skills and CVRM knowledge. Framework analysis was applied to analyse\nqualitative data.\nResults: Data from 34 general practices were available, 19 intervention practices and 14 control practices. No\nimprovements were measured on motivational interviewing skills in both groups. There appeared to be better\nknowledge of CVRM in the control group. On average half of the practice nurses indicated that they adopted the\nrecommended interventions, but stated that they did not necessarily record this in patients� medical files. The\ntailored programme was perceived as too large. Time, follow-up support and reminders were felt to be lacking.\nAbout 20% of patients in the intervention group visited the general practice during the intervention period, yet\nonly a small number of these patients were referred to recommended options.\nConclusions: The tailored programme was only partly used by practice nurses and had little impact on either their\nclinical knowledge and communication skills or on patient reported healthcare. If the assumed logical model of\nchange is valid, a more intensive programme is needed to have an impact on CVRM in general practice at all.
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