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Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation

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Translational Behavioral Medicine


The Telephone Lifestyle Coaching (TLC) program provided telephone-based coaching for six lifestyle behaviors to 5321 Veterans at 24 Veterans Health Administration (VHA) medical facilities. The purpose of the study was to conduct an evaluation of the TLC program to identify factors associated with successful implementation. A mixed-methods study design was used. Quantitative measures of organizational readiness for implementation and facility complexity were used to purposively select a subset of facilities for in-depth evaluation. Context assessments were conducted using interview transcripts. The Consolidated Framework for Implementation Research (CFIR) was used to guide qualitative data collection and analysis. Factors most strongly correlated with referral rates included having a skilled implementation leader who used effective multi-component strategies to engage primary care clinicians as well as general clinic structures that supported implementation. Evaluation findings pointed to recommendations for local and national leaders to help anticipate and mitigate potential barriers to successful implementation.

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This work was funded by Veteran Affairs medical care funds (XVA 41-047) and by the Quality Enhancement Research Initiative (QUERI) program (QLP 92-024). The views expressed in this article are those of the authors and do not represent the views of the Veterans Health Administration. We appreciate all the efforts of the individuals at the demonstration facilities who were committed to implementing the TLC program to improve access to services for Veterans.

Authors’ contributions

LJD and EZO conceived the study design and obtained funding. LJD drafted the initial manuscript and all authors made significant edits. All authors read and approved the final manuscript. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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Corresponding author

Correspondence to Laura J. Damschroder.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Informed Consent Statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Additional information

This research was supported by Veteran Affairs medical care funds (XVA 41-047) and by the Quality Enhancement Research Initiative (QUERI) program (QLP 92-024).


Practice: To successfully implement a telephone lifestyle coaching program, it is necessary to identify a skilled implementation leader who uses effective multi-component strategies to engage key stakeholders.

Policy: Funding for evidence-based telephone-based lifestyle coaching programs is necessary to expand access to individuals who are unable to participate in on-site programs.

Research: Research on the implementation of different types of interventions can forward implementation science by understanding what contextual factors may lead to implementation success under what circumstances.

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Damschroder, L.J., Reardon, C.M., Sperber, N. et al. Implementation evaluation of the Telephone Lifestyle Coaching (TLC) program: organizational factors associated with successful implementation. Behav. Med. Pract. Policy Res. 7, 233–241 (2017).

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