A mixed methods process evaluation exploring the iFraP intervention in Fracture Liaison Services: perceived acceptability, implementation, and mechanisms of impact

Laurna Bullock; Andrea Cherrington; Clark Emma M; Jane Fleming; Ida Bentley; Elaine Nicholls; David Webb; Jo Smith; Sarah Lewis; Robert Horne; O; Mallen Christian D; Clare Jinks; Zoe Paskins

doi:10.1530/obabs.08.OC3.1

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Bone Abstracts (2026) 8 OC3.1 | DOI: 10.1530/obabs.08.OC3.1

OP2026 Oral Communications Oral Communications 3: Research 2 (7 abstracts)

A mixed methods process evaluation exploring the iFraP intervention in Fracture Liaison Services: perceived acceptability, implementation, and mechanisms of impact

Laurna Bullock ¹ , Andrea Cherrington ² , Emma M Clark ³ , Jane Fleming ⁴ , Ida Bentley ⁵ , Elaine Nicholls ^1,2 , David Webb ² , Jo Smith ² , Sarah Lewis ² , Robert Horne ⁶ , Terence W O’Neill ^7,8 , Christian D Mallen ¹ , Clare Jinks ¹ & Zoe Paskins ^1,9

Author affiliations

¹Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Newcastle under Lyme, United Kingdom;²Keele Clinical Trials Unit, Keele University, Newcastle under Lyme, United Kingdom;³Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom;⁴Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom;⁵Keele School of Medicine People and Communities Group, Keele University, Newcastle under Lyme, United Kingdom;⁶Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, United Kingdom;⁷Centre for Epidemiology vs Arthritis, University of Manchester, Manchester, United Kingdom;⁸NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom;⁹Haywood Academic Rheumatology Centre, Midlands Partnership University NHS Foundation Trust, Stoke on Trent, United Kingdom

Background: The improving uptake of Fracture Prevention drug treatments (iFraP) randomised controlled trial (RCT) tested a complex intervention (advanced consultation skills clinician training; patient and clinician computerised decision support tool (DST); written information resources) to improve person-centred care and medicine uptake in UK Fracture Liaison Services (FLS). This process evaluation explored perceived acceptability, implementation, and hypothesised mechanisms of impact.

Methods: Quantitative and qualitative data were collected, using:

• Semi-structured interviews with patients receiving the iFraP intervention (n21), FLS clinicians delivering iFraP (n8), and GPs (n2), analysed using framework method.

• Recorded iFraP consultations (n17) analysed using fidelity checklists.

• Consultation skills training evaluation forms, completed after the eLearning (n10) and role play (n7) sessions.

• DST analytic data

Results: Acceptability: Overall, patients and clinicians perceived iFraP to be acceptable because it made sense and was perceived to address a need. This was reinforced by FLS clinicians evaluating the iFraP training to be good or very good in 98% of instances and expressing intent to use iFraP DST after the RCT. Implementation: Recorded consultations and DST analytics showed high intervention fidelity (DST used 187 times, n168 iFraP consultations). Analytics also demonstrated that FLS clinicians followed recommended practice in 90% of clinical DST uses. In the RCT, iFraP was delivered in telephone (64%) or face-to-face consultations (36%). Some patients receiving telephone appointments were unsure if the DST was used and/or did not receive the iFraP written information resources. The work required for FLS clinicians to integrate iFraP varied, with some voicing challenges related to IT skills and existing appointment lengths. Mechanisms of impact: Patients and FLS clinicians perceived iFraP to improve confidence in medicine decision-making by increasing patient involvement in discussions, supporting personalised and accessible information sharing, and providing patients with realistic expectations of fracture risk and medicine benefit. The iFraP written information resources, shared with the patients GP after their FLS appointment, supported GPs to act on FLS medicine recommendations.

Conclusion: The iFraP intervention was perceived as acceptable and implementable in FLS, with the potential to support medicine decision-making. Process evaluation findings will be integrated with RCT results to generate further insights about the iFraP intervention.