Medicines support and socIal prescribing to aDdress pAtient prioritieS in multimorbidity (MIDAS): A process evaluation protocol

<ns3:p> Introduction Multimorbidity, living with ≥ two chronic conditions, is associated with adverse health outcomes and increased health service use. The ‘ <ns3:italic>Medicines support and socIal prescribing to aDdress pAtient prioritieS in multimorbidity</ns3:italic> ’ (MIDAS) cluster randomised controlled trial (RCT) is evaluating the effectiveness and cost-effectiveness of two interventions aimed at improving multimorbidity outcomes in primary care: 1) MyComrade: practice-based pharmacists supporting general practitioners (GPs) to manage medicines, and; 2) LinkMM: practice-based link workers providing social prescribing support. The process evaluation will explore the implementation of both interventions in the general practice setting. Methods We will use a convergent parallel mixed methods design. We will assess reach, fidelity, and dose using patient questionnaires and intervention logs. Qualitative data will be collected through semi-structured interviews post-intervention in a purposive sample of GPs, practice nurses, intervention personnel (i.e., pharmacists and link workers), and patients. Mobile Instant Messaging Ethnography (MIME) will be used to collect real-time data from a subset of intervention personnel. This approach involves the research team communicating with intervention personnel via Threema (a secure instant messaging mobile application) at three phases of the intervention (beginning, middle, end). The message prompts will encourage intervention personnel to share reflections on what worked well, challenges encountered, and contextual factors influencing intervention delivery. Quantitative data will be analysed descriptively, and qualitative data using thematic analysis. Findings from both strands of data will be integrated using a triangulation protocol. Further, composite narratives will be constructed using these data to provide an overarching view of how the interventions were delivered and experienced. Discussion The process evaluation will provide a detailed understanding of implementation, contextual factors, and mechanisms influencing the effectiveness of the MyComrade and LinkMM interventions. The findings will contribute to evidence on implementing complex interventions to improve care for people living with multimorbidity in primary care settings. Trial registration ISRCTN11585238; 17th April 2024 </ns3:p>