Study design
A pilot, observational, cross-sectional study was carried out between January and March 2023.
Questionnaire development
Innovations were defined as what perceived as new by end users [23,24].
The SPRINT Occitanie study was based on a questionnaire with two sections (PHC information and the modified ISSaQ questionnaire).
It was reported as per guidelines for nonrandomized pilot and feasibility studies [25] and in line with the CONSORT 2010 checklist for reporting a pilot or feasibility trial (items pertinent to randomization were considered not applicable) [26].
The first 16 questions (Additional file 1) were designed to identify the PHCs and respective innovations. These included: name of the PHC, single or multi-site nature, commune, status of the person answering the questionnaire (manager, coordinator, doctor, or other), e-mail address. It also included detailed information on the PHCs: year of creation, number of professionals, number of general practitioners, number of doctors in other specialties, number of university internship supervisors, previous responses to calls for projects (care, teaching or research), collaboration with the inter-regional grouping for clinical research and innovation (GIRCI). Specific information on innovations included were the name and abbreviation, description of the innovation, links with potential partners, communication around the project and purpose of the innovation. To characterize the type of innovation, the PHC correspondent had several modalities: program, model, approach, tool, instrument, indicator, algorithm, service, policy, practice or other, taken from the WHO's International Classification of Health Interventions [27]. This classification comprises three main axes: the target (entity on which the action was carried out), the action (act carried out by an actor on the target), and the means (processes and methods by which the action was carried out). Finally, the PHC correspondent could opt to have feedback on the scalability assessment.
The second section was adapted from the Innovation Scalability Self-Administered Questionnaire (ISSaQ), version of 2020 [11]. This questionnaire was adapted to suit the idioms of metropolitan French. The SPRINT Occitanie project team consisted of the questionnaire's end-users (teacher-researchers in general practice and PHC coordinators), a hospital specialist in innovation extraction and a public health physician methodologist. The questionnaire was tested with five PHC coordinators to check comprehension and confirm completion time. Concrete examples clarifying the questions were added following their feedback. The original questionnaire (ISSaQ) and the adapted questionnaire (modified ISSaQ) are presented in Additional file 2.
The ISSaQassessed data availability for three dimensions (theory, impact and coverage) with 16 closed questions and 6 possible answers: “Yes, No, Not planned, Not applicable or Under evaluation”. If “yes”, the user could complete the answer by mentioning what data or elements were related to the question in free text. The Theory dimension included a question on the conceptual model that may or may not have informed the development of the innovation. The Impact dimension assessed data on six elements: acceptability, feasibility, appropriation, potential effectiveness in an experimental context, effectiveness in a real-life context, and documentation of results. For the last dimension, Coverage, we could have answers on the scope of the innovation, its adoption by the PHC team, fidelity in implementation, sustainability, implementation in another context, compatibility with other similar interventions, conformity with health policy guidelines in the context, and finally, the presence of data on cost-effectiveness and financial and human resource requirements.
This questionnaire was transposed onto LimeSurvey software, licensed by the University of Montpellier, to be self-administered by each PHC correspondent in Occitanie.
It was possible to complete the questionnaire for a single innovation. If the PHC wished to identify more than one, the correspondent could restart the questionnaire at the beginning.
Population
The study population was all 279 PHCs in the Occitanie region that had received the regional health agency label. Health centers and communities of healthcare professionals were not included. In each PHC, a correspondent completed the questionnaire. This could be the coordinator, the manager, a medical doctor or another active member of the structure. To contact them, several e-mail reminders were sent by the university department of general practice of Montpellier-Nîmes and Toulouse to the university internship supervisor attached to them. Also, the Federation of Pluriprofessional Coordinated Practice [Fédération de l’Exercice Coordonné Pluriprofessionnel] (FECOP) contacted its members on 3 occasions, and the regional health agency of Occitanie, contacted all the PHC in the region. The FECOP is commissioned by regional health agency to support PHCs in project in the region, federate care teams in a network, offer them training and pool their innovations [28].
Statistical Analysis
For each innovation described, the PHC correspondent himself proposed the type of innovation from among the modalities previously described. Three members of the SPRINT Occitanie project team also ranked the innovation independently of each other and blind to the PHC correspondent's proposal. In the event of disagreement, they proposed a type of innovation by consensus.
The scalability score was calculated, as stipulated by ISSaQ, by summing up the only positive responses to the 16 scalability criteria. Responses of "No, not applicable, under evaluation or not planned" were considered null. The score obtained, a maximum of 16, was then classified into 3 categories in accordance with the proposals of Ben Charif et al. [29]. This hierarchical classification was made according to 3 modalities: "high" (scalability greater than or equal to 10), "low" (scalability less than or equal to 3) and “medium" for the remainder.
Descriptive statistics described demographic characteristics using frequencies with percentages for categorical variables and means and standard deviations or medians and interquartile ranges for continuous variables. Only complete responses were analysed.
Statistical analyses were carried out partly on Microsoft Excel® version 2304 and on RStudio® version 2023.03.1 using version R 4.2.3 with the package "stats" version 4.2.3.