Analysis

Using ATLAS.ti version 22 (22), SAB and CRW then coded the existing LIFT documents and interview transcripts using the Model for Adaptation Design and Impact (23). Thematic analysis was used to understand how LIFT was integrated into clinical practice (implementation core functions) and decreased FT (intervention core functions). Themes were initially built by identifying patterns related to LIFT core functions and organizing those themes into related groups. In a thorough member-checking exercise, SAB and CRW met with interview participants to refine the themes. They first discussed an initial draft of themes with SBW and DR, LIFT developers, to refine the themes based on their experience with LIFT. CW and SAB then presented the refined themes in two subsequent meetings with other interview participants. Once interview participants had no additional feedback on the themes, CW and SAB classified themes as either implementation or intervention core functions. Intervention core functions were defined as intervention components that were necessary and sufficient in combination to achieve the intended effectiveness outcome of reduced FT. Implementation core functions were components that were necessary and sufficient in combination to achieve the intended implementation outcomes of acceptability and feasibility. We then developed a spreadsheet with this information for interview participants' final review of core functions' accuracy and comprehensiveness.

Finally, to explain the change underlying LIFT's implementation and effectiveness—i.e., the mechanism(s) thought to drive LIFT's integration into practice and reduction of FT—SAB identified relevant organization theories. Based on concepts related to power, autonomy, and control, organization theories explain how and why interventions such as LIFT are adopted, implemented, and sustained in new contexts.