The results are presented per perspective for (1) the educational perspective concerning the feasibility of embedding the developed trainings and e-learning training in existing educational structures, and (2) the professional perspective for the feasibility of using and applying the knowledge and tools in practice. For readability, only the cross-project feasibility factors are presented (Table 2). In case no cross-project feasibility factors were found only the most important results will be presented in the result section below. The detailed results per tool from both perspectives can be found in Additional file 2.
1) Feasibility factors from an educational perspective
For the educational perspective, five interviews were held with trainers from educational institutes (Table 3). Two females and three males with a mean age of 54.4 years of age participated. All participants had insight into all available material of the training programs and e-learning training and received a description by the researchers (NZ and SvdB-V). For the analysis of the Bowen et al. outcomes, the cross-project analysis yielded several feasibility factors which are presented below (Table 3). However, these presented factors are not exhaustive and the detailed results per training program and e-learning training with accompanying tools can be found in Additional file 2.
Implementation
Different ‘factors affecting implementation ease or difficulty’ concerning the training and e-learning training, organization of the education, dissemination and personal factors were identified (Table 3). With regard to the training programs, to have an online version available was mentioned by the educational experts as a way to support implementation across all three projects. Specific factors related to the e-learning training included a ‘check if the e-learning training was completed’ and ‘the combination of educational forms towards blended learning’ (Additional file 2), as one trainer mentioned:
P12: “What we ultimately want to achieve is a form of blended learning in which physical and online education and e-learnings are all integrated into a complete package. And the great thing about this is, that they [students] can do a lot on their own, in their own time.”
The ‘check if the e-learning training was completed’ was mentioned by some participants as important. As this is already part of the current e-learning training, they felt this should stay in place as is. Moreover, it was mentioned that ‘sufficient interaction’ between participants during the trainings needs to be ensured for successful implementation (project 2) (Additional file 2). For the organization of the trainings, educational experts mentioned that good ‘coordination with the educational managers of the educational institutions’ is needed to ensure better implementation into educational structures (as to project 1 and 2). For both face-to-face training programs (project 1 and 2), ‘a train-the-trainer approach’ was indicated as a factor to support better implementation into educational structures, as well as to ‘make arrangements regarding the ownership of the training and e-learning’:
P16: “[…] on my practical experience, for example, […] an organization takes ownership and then it [the training] comes behind a pay-roll.”
Across the three projects no overarching feasibility factor related to the dissemination was found. A specific factor mentioned to enhance better dissemination of the e-learning training was ‘the use of role models or frontrunners’(Additional file 2):
P14: “Yes, my tip is […], implementations become successful because you have someone who is going to promote the product and actually implements it and just does it. Someone that sells it. That’s what it really comes down to.”
With regard to personal factors of educational experts that may hinder implementation no feasibility factor was found across all projects. However, it was specified that it is important to be aware that educational experts may be reluctant when it comes to incorporating new training materials from a third party (i.e., researchers) in the curriculum, which underlines the need to create good support from within the educational institutions (project 3) (Additional file 2).
Practicality
Across the projects no common feasibility factors were found for the outcome ‘positive/negative effects on target participants’ and ‘ability of participants to carry out intervention activities’. For project (1), it was indicated that with respect to the practicality outcome ‘positive/negative effects on target participants’, the added-value of the training for OPs needs to be clearly explained to enhance external and internal motivation to follow the training (Additional file 2). As to the ‘ability of participants to carry out educational activities’, some participants from project (2) mentioned the importance to match the educational content with the level of pre-existing knowledge and skills of participants as to offering the trainings to registered OPs and IPs or to resident doctors in training (Additional file 2). Furthermore, some participants from project (2) stressed the ‘difficulty to translate knowledge and skills into own practice’ which might hinder the practical uptake of the trainings into practice of the OPs and IPs:
P13: “What we notice in the training groups is that at least some of the participants say at the end of the day: ‘it was very useful, but I don’t see myself doing it [applying the knowledge in practice] yet’. And, therefore, they have a difficulty in translating it into practice, into their own practice.”
With respect to the costs of offering the trainings and e-learning training, some participants mentioned the following important factors to take into account: ‘costs for use of training facility e.g. rental costs’ (project 1 and 2) and ‘costs for accreditation’ of the training programs and e-learning training (project 1 and 3) (Table 3).
Integration
For the integration of both training programs and the e-learning training, the ‘perceived fit with educational infrastructure’ was evaluated (Table 3). For project (1) and (3) in terms of suitability within educational structures, participants mentioned that the training and e-learning training was ‘not suitable for the core curriculum of postgraduate medical training for OPs and IPs’ even though the ‘added-value of the training and e-learning training is evident’. Remarks were made regarding the integration in the current curriculum of the postgraduate medical training for OPs and IPs as to that there is ‘no unlimited place to embed new trainings in the current curriculum’ (project 2 and 3). Especially with respect to the training on strengthening self-control of workers with chronic health conditions (project 1), participants stressed that it can best be integrated towards the end of postgraduate medical training for OPs and IPs due the level of required pre-existing knowledge and skills, and they indicated that it predominantly fits the profession of OPs instead of IPs as the training is targeted at OPs (Additional file 2). For project (3), in terms of the outcome ‘perceived sustainability’, the ‘continuity after the research project ends’ was mentioned stressing the importance of continuity after an experimental setting of testing training programs.
2) Feasibility factors from the professional perspective on embedding the trainings and tools in educational structures and practice of OPs and IPs
For the professional perspective, a total of N = 24 semi-structured interviews were conducted. Participants were N = 18 OPs and N = 6 IPs who participated in the previous evaluation studies [20,21,22] (see Table 4). In total N = 13 males participated and N = 11 females. The mean age of participants for project (1) are unknown. The mean age of participants of project (2) was 48.5 years of age and for project (3) 52.3 years of age. Years of experience in current work function was unknown for project (1). The professionals gave input on their practical experiences after attending the trainings or following the e-learning training, but also gave input regarding the possibilities for the implementation of the trainings and e-learning training in educational structures from the perspective of a potential receiver of the training and e-learning training.
For the analysis across the three projects from a professional perspective, common feasibility factors were only found for the feasibility aspect of implementation which entails the Bowen et al. outcome ‘factors affecting implementation ease or difficulty’ (Table 5). For the practicality and integration project-specific feasibility factors were found (Additional file 2).
Implementation
In terms of implementation, the outcome ‘factors affecting implementation ease or difficulty’ was evaluated. Based on the semi-structured interviews, the following factors were identified by professionals: personal factors;factors related to training programs and e-learning training and the tools; factors related to the organization of the training or e-learning training, and factors related to the dissemination were identified by the professionals. Factors concerning the training included the ‘use of actual cases from practice’ (project 1 and 2) and the ‘need for a periodic reminder or refresher about the topic’ (project 1 and 3). Specifically for project (1) on strengthening self-control, participants mentioned the necessity for ‘matching the training content with the needs within organizations’ to apply the Participatory Approach, targets organizations where OPs are involved in policy setting regarding support of workers with a chronic health condition (Additional file 2). Therefore, OPs need to be involved more in policy setting within organizations. With regard to the organization of the training and e-learning training no common feasibility factors were found across all three projects. For project (1) it was mentioned to ‘involve the researcher of the project’ when offering the training program. The ‘use of a desk manual or summary as a handy memory aid’ was mentioned for the use of the tools with regarding project (2) and 3).
In terms of dissemination factors for project (1) and (3), the suggestion was made to ‘embed the knowledge into guidelines’ (Table 5). In terms of the personal factors, no across-project factors were found, but project-specific factors important to consider included, for example, ‘sufficient time’ during the consultation to apply the acquired knowledge and skills (project 2) (Additional file 2):
P3: “Well, you always have to take the time yourself as an OP [during consultation].[…] I can take that [time] by doing longer consultation hours, that’s not the problem. (project 2)
For project (1) specific prerequisites for the implementation were mentioned including: organizational support, creating a sense of urgency, and creating recognition of importance for the target group. Concerning impeding factors for the implementation of project (1), the influence of the size and structure of the organization where the tool shall be applied is essential with higher chances for successful implementation in organizations with sufficient resources to invest in workplace improvement. With respect to the suitability, it was also mentioned that project (1) can be easier implemented among self-employed OPs as they have more freedom to make changes to their way of working (Additional file 2).
Practicality
For the outcomes on practicality, concerning the practical uptake of the developed training programs, e-learning training and accompanying tools into practice, the ‘ability of participants to carry out intervention activities’ (e.g. use of conversation tool and supporting material), ‘positive/negative effects on target participants’ and ‘cost analysis’ based on the suggested outcomes by Bowen et al. were evaluated from the professional perspective. As to the Bowen outcome ‘positive/negative effects on target participants’ feasibility factors were only found for project (3) and included the ‘added value for participants’ of the skills they acquire during the e-learning training (Additional file 2). No across-project feasibility factors were found for the outcome ‘ability of participants to carry out intervention activities’. As to project (2) about involving person-related factors, participants mentioned ‘not knowing it [the list of cognitions and perceptions] by heart after the training’ as a restrain for applying the knowledge in practice for the Bowen outcome ‘ability of participants to carry out intervention activities’ (Additional file 2):
P4: “You know, the moment that you are in a consultation hour, you will no longer have all those sample questions in front of you. So, you have to do it a bit by heart. Apparently, the material has not yet sunk in so that I know it all by heart, so to speak.” (project 2).
For project (3), the participants stressed that the theoretical knowledge increased their awareness in practice as it increased their sense of importance as to involving significant others during the consultation with a worker with a chronic health condition (Additional file 2). Regarding the practical application of the tool developed in project 1), the participants mentioned the need for ‘more support for unexperienced OPs’.
Also no common feasibility factor was found for the Bowen outcome ‘cost analysis’. As to project (1), in terms of the ‘costs analysis’, one participant expressed feelings of ‘uncertainty about cost-effectiveness of the tool’:
P20: “Well it also didn’t work on a small-scale, but maybe on a large-scale it would have succeeded, because then the time investment, so the total investment is the same, but perhaps much more profitable for an organization.” (project 1).
Integration
Professionals reported on the outcome ‘perceived fit with infrastructure’ for each of the three projects, but no common feasibility factor was found. However, project-specific factors were mentioned (Additional file 2). For project (1) a category on the integration at an organizational level was identified and included the following feasibility factors: ‘include in the organization’s annual plan’ and the ‘degree of professional flexibility of the OP’ which may contribute to better integration of the training program. Only for project (1) the outcome ‘perceived sustainability’ was mentioned as to no continuity of implementing the knowledge in practice after following the training can be guaranteed which is needed for the success of the training.