Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach

T Jiancaro; A M Bayoumi; F Ibáñez-Carrasco; B Torres; K McDuff; D A Brown; S Chan Carusone; A Tang; M Loutfy; S Cobbing; K K O'Brien

doi:10.3389/fresc.2023.1176960

Factors influencing initial implementation of an online community-based exercise intervention with adults living with HIV: a systems approach

Front Rehabil Sci. 2023 Jul 20:4:1176960. doi: 10.3389/fresc.2023.1176960. eCollection 2023.

Authors

T Jiancaro¹, A M Bayoumi^{2

3

4}, F Ibáñez-Carrasco⁵, B Torres¹, K McDuff¹, D A Brown⁶, S Chan Carusone⁷, A Tang⁸, M Loutfy^{4

9}, S Cobbing^{1

10

11}, K K O'Brien^{1

2

12}

Affiliations

¹ Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
³ MAP Centre, St. Michael's Hospital, Toronto, ON, Canada.
⁴ Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
⁶ Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
⁷ McMaster Collaborative Centre for Health and Aging, McMaster University, Hamilton, ON, Canada.
⁸ School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada.
⁹ Maple Leaf Medical Clinic, Toronto, ON, Canada.
¹⁰ The Institute of Education Research, University Health Network, Toronto, ON, Canada.
¹¹ Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa.
¹² Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, ON, Canada.

Abstract

Introduction: Online community-based exercise (CBE) is a digital health intervention and rehabilitation strategy that promotes health among people living with HIV. Our aim was to describe the factors influencing initial implementation of a pilot online CBE intervention with adults living with HIV using a systems approach, as recommended by implementation science specialists.

Methods: We piloted the implementation of a 6-month online CBE intervention and 6-month independent exercise follow up, in partnership with the YMCA in Toronto, Canada. We recruited adults living with HIV who identified themselves as safe to engage in exercise. The intervention phase included personalized exercise sessions online with a personal trainer; exercise equipment; access to online exercise classes; and a wireless physical activity monitor. Two researchers documented implementation factors articulated by participants and the implementation team during early implementation, defined as recruitment, screening, equipment distribution, technology orientation, and baseline assessments. Data sources included communication with participants; daily team communication; weekly team discussions; and in-person meetings. We documented implementation factors in meeting minutes, recruitment screening notes, and email communication; and analyzed the data using a qualitative descriptive approach using a systems engineering method called Cognitive Work Analysis.

Results: Thirty-three adults living with HIV enrolled in the study (n = 33; median age: 52 years; cis-men: 22, cis-women: 10, non-binary: 1). Fifty-five factors influencing implementation, spanned five layers: (i) Natural, including weather and the COVID-19 virus; (ii) Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups); (iii) Organizational, including information dissemination (e.g. tech support) and logistics (e.g. scheduling); (iv) Personal, including physical setting (e.g. space) and digital setting (e.g. device access); and (v) Human, including health (e.g. episodic illness) and disposition (e.g. motivation). The implementation team experienced heightened needs to respond rapidly; sustain engagement; and provide training and support. Additional organizational factors included a committed fitness training and research team with skills spanning administration and logistics, participant engagement, technology training, physical therapy, and research ethics.

Conclusion: Fifty-five factors spanning multiple layers illustrate the complexities of online CBE with adults living with HIV. Initial implementation required a dedicated, rehabilitation-centred, multi-skilled, multi-stakeholder team to address a diverse set of factors.

Keywords: cognitive work analysis; exercise. factors influencing initial implementation; hiv/aids; implementation science; physical activity; systems engineering.

Grants and funding

This research is supported by the Ontario HIV Treatment Network HIV Endgame Funding Program – Breaking New Ground (Grant Number: EFP-1121-BNG) and Connaught Community Partner Research Programme (University of Toronto). KO is supported by a Canada Research Chair in Episodic Disability and Rehabilitation from the Canada Research Chairs Programme.