Pre-implementation Barriers and Facilitators to Integrating Complementary and Integrative Health Interventions into Clinic Workflow: The GRACE Trial, NIH Pragmatic Trials Collaboratory.

BACKGROUND: Even though there is clear evidence supporting the use of complementary and integrative health (CIH) interventions for chronic pain, their integration into clinical care is challenging. Thus, the purpose of this study was to understand how the integration of CIH interventions, namely, guided relaxation and acupuncture evaluated in the Hybrid Effectiveness-Implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE Trial), would impact clinic workflow at each study site. METHODS: We conducted a qualitative descriptive study using individual interviews with healthcare providers and staff working at GRACE Trial sites. Interview data were analyzed using modified rapid qualitative analysis. RESULTS: We interviewed 13 healthcare providers from three GRACE Trial sites. Two major themes were identified: (1) the variable impact of CIH integration on clinic operations, and (2) the introduction of CIH interventions into clinical practice. CONCLUSION: This study highlights the importance and value of participatory approaches in integrating CIH interventions into healthcare settings. This study contributes to the CIH literature by addressing chronic pain and informing the identification of strategies to target the multi-layered challenges of integrating evidence-based CIH interventions into practice.

Duke Scholars

Author Nirmish Ramesh Shah Medicine, Hematology

Author Mitchell Knisely School of Nursing

Author Stephanie Ibemere School of Nursing