Supplementary Material for: Co-developed logic model for surgical prehabilitation in an acute care setting: a qualitative study of stakeholders’ perspectives

Background: Prehabilitation programs treat modifiable risk factors to improve surgical outcomes. However, translation of research into practice remains slow. Logic models, visual representations of how a program works, have the potential to bridge research-to-practice gaps. We aimed to develop a logic model for prehabilitation programs in tertiary care centers by interviewing stakeholders about what should be the mission, inputs, outputs (activities and participants), and targeted outcomes for prehabilitation implementation and evaluation? Methods: A multi-site qualitative study was conducted. Interviews were analyzed using manifest summative content analysis to determine logic model items. Focus groups for member checking were performed with stakeholders throughout the analysis process. Results: Sixty-one interviews were conducted with stakeholders: prehabilitation staff (n=12), patients (n=10), perioperative care physicians (n=10), nurses (n=9), dietitians (n=9), physiotherapists (n=5), and hospital administrators (n=6). Our findings underscored unanimous support for prehabilitation yet revealed challenges that hindered efficient and equitable resource utilization, which have been addressed in the logic model. To evaluate the success of prehabilitation, both clinician- (n=44) and patient-oriented outcomes (n=32) were valued by stakeholders; however, priority outcomes varied by stakeholder group: intervention adherence (prehabilitation staff), experience and satisfaction (patients), and facilitation of discharge (clinicians and hospital administrators).
Conclusion: This co-developed logic model is designed to improve the efficiency, accessibility, and sustainability of acute care prehabilitation programs by offering a detailed blueprint. Researchers and clinicians can draw on the insights from this co-production process to develop, implement, and evaluate their own prehabilitation programs.