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Understanding and applying the RE-AIM framework: Clarifications and resources. J Clin Transl Sci 2021; 5:e126. [PMID: 34367671 PMCID: PMC8327549 DOI: 10.1017/cts.2021.789] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction: Understanding, categorizing, and using implementation science theories, models, and frameworks is a complex undertaking. The issues involved are even more challenging given the large number of frameworks and that some of them evolve significantly over time. As a consequence, researchers and practitioners may be unintentionally mischaracterizing frameworks or basing actions and conclusions on outdated versions of a framework. Methods: This paper addresses how the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework has been described, summarizes how the model has evolved over time, and identifies and corrects several misconceptions. Results: We address 13 specific areas where misconceptions have been noted concerning the use of RE-AIM and summarize current guidance on these issues. We also discuss key changes to RE-AIM over the past 20 years, including the evolution to Pragmatic Robust Implementation and Sustainability Model, and provide resources for potential users to guide application of the framework. Conclusions: RE-AIM and many other theories and frameworks have evolved, been misunderstood, and sometimes been misapplied. To some degree, this is inevitable, but we conclude by suggesting some actions that reviewers, framework developers, and those selecting or applying frameworks can do to prevent or alleviate these problems.
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Presseau J, Byrne-Davis LMT, Hotham S, Lorencatto F, Potthoff S, Atkinson L, Bull ER, Dima AL, van Dongen A, French D, Hankonen N, Hart J, Ten Hoor GA, Hudson K, Kwasnicka D, van Lieshout S, McSharry J, Olander EK, Powell R, Toomey E, Byrne M. Enhancing the translation of health behaviour change research into practice: a selective conceptual review of the synergy between implementation science and health psychology. Health Psychol Rev 2021; 16:22-49. [PMID: 33446062 DOI: 10.1080/17437199.2020.1866638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Health psychology is at the forefront of developing and disseminating evidence, theories, and methods that have improved the understanding of health behaviour change. However, current dissemination approaches may be insufficient for promoting broader application and impact of this evidence to benefit the health of patients and the public. Nevertheless, behaviour change theory/methods typically directed towards health behaviours are now used in implementation science to understand and support behaviour change in individuals at different health system levels whose own behaviour impacts delivering evidence-based health behaviour change interventions. Despite contributing to implementation science, health psychology is perhaps doing less to draw from it. A redoubled focus on implementation science in health psychology could provide novel prospects for enhancing the impact of health behaviour change evidence. We report a Health Psychology Review-specific review-of-reviews of trials of health behaviour change interventions published from inception to April 2020. We identified 34 reviews and assessed whether implementation readiness of behaviour change interventions was discussed. We then narratively review how implementation science has integrated theory/methods from health psychology and related discipline. Finally, we demonstrate how greater synergy between implementation science and health psychology could promote greater follow-through on advances made in the science of health behaviour change.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,School of Psychology, University of Ottawa, Ottawa, Canada
| | | | - Sarah Hotham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Sebastian Potthoff
- Department of Social Work, Education, and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Lou Atkinson
- School of Psychology, Aston University, Birmingham, UK
| | - Eleanor R Bull
- Research Centre for Health, Psychology and Communities, Manchester Metropolitan University, Manchester, UK
| | - Alexandra L Dima
- Health Services and Performance Research, University Claude Bernard Lyon 1, Lyon, France
| | | | - David French
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nelli Hankonen
- Social Psychology, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jo Hart
- Division of Medical Education, University of Manchester, Manchester, UK
| | - Gill A Ten Hoor
- Dept of Work & Social Psychology, Maastricht University, Maastricht, The Netherlands.,Dept of Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Kristian Hudson
- Centre for Aging and Rehabilitation, Bradford Institute for Health Research, Bradford, UK
| | - Dominika Kwasnicka
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Sanne van Lieshout
- Team Advies & Onderzoek, Municipal Health Service (GGD) Kennemerland, Haarlem, the Netherlands
| | - Jennifer McSharry
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Powell
- School of Health Sciences & Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Elaine Toomey
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland.,School of Allied Health, University of Limerick, Limerick, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, National University of Ireland, Galway, Ireland
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53
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Wolfenden L, Foy R, Presseau J, Grimshaw JM, Ivers NM, Powell BJ, Taljaard M, Wiggers J, Sutherland R, Nathan N, Williams CM, Kingsland M, Milat A, Hodder RK, Yoong SL. Designing and undertaking randomised implementation trials: guide for researchers. BMJ 2021; 372:m3721. [PMID: 33461967 PMCID: PMC7812444 DOI: 10.1136/bmj.m3721] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Implementation science is the study of methods to promote the systematic uptake of evidence based interventions into practice and policy to improve health. Despite the need for high quality evidence from implementation research, randomised trials of implementation strategies often have serious limitations. These limitations include high risks of bias, limited use of theory, a lack of standard terminology to describe implementation strategies, narrowly focused implementation outcomes, and poor reporting. This paper aims to improve the evidence base in implementation science by providing guidance on the development, conduct, and reporting of randomised trials of implementation strategies. Established randomised trial methods from seminal texts and recent developments in implementation science were consolidated by an international group of researchers, health policy makers, and practitioners. This article provides guidance on the key components of randomised trials of implementation strategies, including articulation of trial aims, trial recruitment and retention strategies, randomised design selection, use of implementation science theory and frameworks, measures, sample size calculations, ethical review, and trial reporting. It also focuses on topics requiring special consideration or adaptation for implementation trials. We propose this guide as a resource for researchers, healthcare and public health policy makers or practitioners, research funders, and journal editors with the goal of advancing rigorous conduct and reporting of randomised trials of implementation strategies.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family Medicine and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St Louis, St Louis, MI, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Andrew Milat
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Sze Lin Yoong
- Swinburne University of Technology, School of Health Sciences, Faculty Health, Arts and Design, Hawthorn, VIC, Australia
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Nilsen P, Potthoff S, Birken SA. Conceptualising Four Categories of Behaviours: Implications for Implementation Strategies to Achieve Behaviour Change. FRONTIERS IN HEALTH SERVICES 2021; 1:795144. [PMID: 36926485 PMCID: PMC10012728 DOI: 10.3389/frhs.2021.795144] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
Background: Effectiveness of implementation strategies is influenced by the extent to which they are based on appropriate theories concerning the behaviours that the strategies intend to impact. Effectiveness may be limited simply because the strategies are based on theories that are limited in scope or are derived from partially inaccurate assumptions about the behaviours in question. It may therefore be important to combine insights from various theories to cover the range of influences on the behaviours that will be changed. Aim: This article aims to explore concepts, theories and empirical findings from different disciplines to categorise four types of behaviours and discuss the implications for implementation strategies attempting to change these behaviours. Influences on behaviours: Multilevel influences on behaviours are dichotomized into individual-level and collective-level influences, and behaviours that are guided by conscious cognitive processes are distinguished from those that rely on non-conscious processing. Combining the two dimensions (levels and cognitive modes) creates a 2 x 2 conceptual map consisting of four categories of behaviours. Explicitly conceptualising the levels and cognitive modes is crucial because different implementation strategies are required depending on the characteristics of the behaviours involved in the practise that needs to be changed. Conclusion: The 2 x 2 conceptual map can be used to consider and reflect on the nature of the behaviours that need to be changed, thus providing guidance on the type of theory, model or framework that might be most relevant for understanding and facilitating behaviour change.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, NC, United States
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Geyer NR, Kessler FC, Lengerich EJ. LionVu 2.0 Usability Assessment for Pennsylvania, United States. ISPRS INTERNATIONAL JOURNAL OF GEO-INFORMATION 2020; 9:619. [PMID: 35496652 PMCID: PMC9052878 DOI: 10.3390/ijgi9110619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The Penn State Cancer Initiative implemented LionVu 1.0 (Penn State University, United States) in 2017 as a web-based mapping tool to educate and inform public health professionals about the cancer burden in Pennsylvania and 28 counties in central Pennsylvania, locally known as the catchment area. The purpose of its improvement, LionVu 2.0, was to assist investigators answer person-place-time questions related to cancer and its risk factors by examining several data variables simultaneously. The primary objective of this study was to conduct a usability assessment of a prototype of LionVu 2.0 which included area- and point-based data. The assessment was conducted through an online survey; 10 individuals, most of whom had a masters or doctorate degree, completed the survey. Although most participants had a favorable view of LionVu 2.0, many had little to no experience with web mapping. Therefore, it was not surprising to learn that participants wanted short 10-15-minute training videos to be available with future releases, and a simplified user-interface that removes advanced functionality. One unexpected finding was the suggestion of using LionVu 2.0 for teaching and grant proposals. The usability study of the prototype of LionVu 2.0 provided important feedback for its future development.
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Affiliation(s)
- Nathaniel R. Geyer
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA 17033, USA
| | - Fritz C. Kessler
- Department of Geography, College of Earth and Mineral Sciences, Penn State University, PA 16801, USA
| | - Eugene J. Lengerich
- Department of Public Health Sciences, Penn State College of Medicine, Penn State University, Hershey, PA 17033, USA
- Penn State Cancer Institute, Hershey, PA 17033, USA
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Birken SA, Haines ER, Hwang S, Chambers DA, Bunger AC, Nilsen P. Advancing understanding and identifying strategies for sustaining evidence-based practices: a review of reviews. Implement Sci 2020; 15:88. [PMID: 33036653 PMCID: PMC7545853 DOI: 10.1186/s13012-020-01040-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation science has focused mainly on the initial uptake and use of evidence-based practices (EBPs), with less attention to sustainment-i.e., continuous use of these practices, as intended, over time in ongoing operations, often involving adaptation to dynamic contexts. Declining EBP use following implementation is well-documented yet poorly understood. Using theories, models, and frameworks (TMFs) to conceptualize sustainment could advance understanding. We consolidated knowledge from published reviews of sustainment studies to identify TMFs with the potential to conceptualize sustainment, evaluate past uses of TMFs in sustainment studies, and assess the TMFs' potential contribution to developing sustainment strategies. METHODS We drew upon reviews of sustainment studies published within the past 10 years, evaluated the frequency with which included articles used a TMF for conceptualizing sustainment, and evaluated the relevance of TMFs to sustainment research using the Theory, Model, and Framework Comparison and Selection Tool (T-CaST). Specifically, we examined whether the TMFs were familiar to researchers, hypothesized relationships among constructs, provided a face-valid explanation of relationships, and included sustainment as an outcome. FINDINGS Nine sustainment reviews referenced 648 studies; these studies cited 76 unique TMFs. Only 28 TMFs were used in more than one study. Of the 19 TMFs that met the criteria for T-CaST analysis, six TMFs explicitly included sustainment as the outcome of interest, 12 offered face-valid explanations of proposed conceptual relationships, and six identified mechanisms underlying relationships between included constructs and sustainment. Only 11 TMFs performed adequately with respect to all these criteria. CONCLUSIONS We identified 76 TMFs that have been used in sustainment studies. Of these, most were only used once, contributing to a fractured understanding of sustainment. Improved reporting and use of TMFs may improve understanding of this critical topic. Of the more consistently used TMFs, few proposed face-valid relationships between included constructs and sustainment, limiting their ability to advance our understanding and identify potential sustainment strategies. Future research is needed to explore the TMFs that we identified as potentially relevant, as well as TMFs not identified in our study that nonetheless have the potential to advance our understanding of sustainment and identification of strategies for sustaining EBP use.
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Affiliation(s)
- Sarah A. Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 1103E McGavran-Greenberg, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC 27599-7411 USA
| | - Emily R. Haines
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, 1101B McGavran - Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411 USA
| | - Soohyun Hwang
- Department of Health Policy and Management, The University of North Carolina at Chapel Hill, 1101B McGavran - Greenberg Hall, CB# 7411, Chapel Hill, NC 27599-7411 USA
| | - David A. Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Room 3E414, Rockville, MD 20850 USA
| | - Alicia C. Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210 USA
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83 Linköping, Sweden
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Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, Mukasa B, Aarons GA. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 2020. [PMID: 32885199 DOI: 10.1186/s43058‐020‐00023‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Søborg, Western Australia 6102 Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
| | - Bianca Albers
- European Implementation Collaborative, Odense, Denmark.,School of Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC 3053 Australia
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Sarabeth Broder-Fingert
- School of Medicine, Department of Pediatrics, Boston Medical Center and Boston University, 801 Albany Street, Boston, MA 02114 USA
| | - Barbara Mukasa
- Mildmay Uganda, 24985 Lweza, Entebbe Road, Kampala, Uganda
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
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Beauchemin M, Cohn E, Shelton RC. Implementation of Clinical Practice Guidelines in the Health Care Setting: A Concept Analysis. ANS Adv Nurs Sci 2020; 42:307-324. [PMID: 30839334 PMCID: PMC6717691 DOI: 10.1097/ans.0000000000000263] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The literature is replete with clinical practice guidelines (CPGs) and evidence supporting them. Translating guidelines into practice, however, is often challenging. We conducted a concept analysis to define the concept of "implementation of CPGs in health care settings." We utilized Walker and Avant's methodology to define the concept of "implementation of CPGs in health care settings." This included a focused review of the literature, defining the relevant attributes, defining implementation, case examples, and antecedents and potential consequences from implementation of CPGs in health care settings. The concept "implementation" is complex, with numerous frameworks, facilitators, and barriers to implementation described in the literature. The existing literature supports our definition of implementation of CPGs in a health care setting as a process of changing practice in health care while utilizing the best level of evidence that is available in the published literature. These include 7 attributes necessary for effective implementation. Implementation of CPGs in health care settings requires an ongoing iterative process that considers these attributes and is inclusive to administrators, clinicians, and patients to ensure guidelines are understood, accepted, implemented, and evaluated for continued adoption of best practices. Ongoing efforts inclusive at all steps of implementation across multiple levels are needed to effectively change practice.
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Affiliation(s)
| | - Elizabeth Cohn
- Hunter College, The Graduate Center, City University of New York, New York, 10016
| | - Rachel C. Shelton
- Mailman School of Public Health, Columbia University, New York, NY 10032
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Westgard C, Fleming WO. The Use of Implementation Science Tools to Design, Implement, and Monitor a Community-Based mHealth Intervention for Child Health in the Amazon. Front Public Health 2020; 8:411. [PMID: 32974257 PMCID: PMC7466738 DOI: 10.3389/fpubh.2020.00411] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/10/2020] [Indexed: 01/04/2023] Open
Abstract
It is essential to analyze the local context and implementation components to effectively deliver evidence-based solutions to public health problems. Tools provided by the field of implementation science can guide practitioners through a comprehensive implementation process, making innovations more adaptable, efficient, and sustainable. It is equally important to report on the design and implementation process so others can analyze, replicate, and improve on the progress made from an intervention. The current study reports on the design and implementation of an mHealth intervention to improve child health in the Amazon of Peru. The study aims to provide insight into how an implementation science tool can be used to improve implementation and reporting of an evidence-based intervention in a global health setting. Methods: Implementation of a community-based mHealth intervention is analyzed and reported through the lens of the Active Implementation Frameworks (AIF). The AIF is used to analyze the design, implementation, adaptation, and monitoring of the intervention. The implementation process is categorized in the four stages of implementation. The results of the analysis and subsequent implementation activities are reported. Results: The exploration stage was used to learn about the local context in the Amazonian communities and identify an evidence-based solution to address poor child health. Several potential solutions were combined to create an innovative mHealth tool. During the installation stage, the stakeholders worked together to improve the intervention and plan for implementation through human-centered design. The providers in the field were trained and data was gathered to monitor implementation. During initial implementation stage, electronic tablets were distributed to community health agents and continuous quality improvement activities allowed for rapid improvements to be implemented. The intervention moved on to full implementation stage as acceptance and fidelity approached 100%. Conclusion: The AIF highlighted several potential barriers to implementation that may have been overlooked without the guidance of a science-based implementation tool. Reporting on the implementation process shows how implementation science tools can be used to foresee and address potential threats to successful implementation. The results of this study provide insight into the components of implementation in Amazonian communities, as well as the process of using implementation science tools in any global health setting.
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Affiliation(s)
- Christopher Westgard
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, United States.,Department of Research, Elementos, Lima, Peru
| | - W Oscar Fleming
- National Implementation Research Network, Frank Porter Graham Developmental Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Etherington N, Rodrigues IB, Giangregorio L, Graham ID, Hoens AM, Kasperavicius D, Kelly C, Moore JE, Ponzano M, Presseau J, Sibley KM, Straus S. Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour. BMC Med Res Methodol 2020; 20:169. [PMID: 32590940 PMCID: PMC7318508 DOI: 10.1186/s12874-020-01056-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background A key component of the implementation process is identifying potential barriers and facilitators that need to be addressed. The Theoretical Domains Framework (TDF) is one of the most commonly used frameworks for this purpose. When applying the TDF, it is critical to understand the context in which behaviours occur. Intersectionality, which accounts for the interface between social identity factors (e.g. age, gender) and structures of power (e.g. ageism, sexism), offers a novel approach to understanding how context shapes individual decision-making and behaviour. We aimed to develop a tool to be used alongside applications of the TDF to incorporate an intersectionality lens when identifying implementation barriers and enablers. Methods An interdisciplinary Framework Committee (n = 17) prioritized the TDF as one of three models, theories, and frameworks (MTFs) to enhance with an intersectional lens through a modified Delphi approach. In collaboration with the wider Framework Committee, a subgroup considered all 14 TDF domains and iteratively developed recommendations for incorporating intersectionality considerations within the TDF and its domains. An iterative approach aimed at building consensus was used to finalize recommendations. Results Consensus on how to apply an intersectionality lens to the TDF was achieved after 12 rounds of revision. Two overarching considerations for using the intersectionality alongside the TDF were developed by the group as well as two to four prompts for each TDF domain to guide interview topic guides. Considerations and prompts were designed to assist users to reflect on how individual identities and structures of power may play a role in barriers and facilitators to behaviour change and subsequent intervention implementation. Conclusions Through an expert-consensus approach, we developed a tool for applying an intersectionality lens alongside the TDF. Considering the role of intersecting social factors when identifying barriers and facilitators to implementing research evidence may result in more targeted and effective interventions that better reflect the realities of those involved.
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Affiliation(s)
- Nicole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.
| | | | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Canada.,Schlegel-UW Research Institute for Aging and KITE Toronto Rehab-University Health Network, Toronto, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Alison M Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre of Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Richmond, Canada
| | | | - Christine Kelly
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Matteo Ponzano
- Department of Kinesiology, University of Waterloo, Waterloo, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Rm L1287, Ottawa, ON, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.,Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Sharon Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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Doucet S, Curran JA, Breneol S, Luke A, Dionne E, Azar R, Reid AE, McKibbon S, Horsman AR, Binns K. Programmes to support transitions in care for children and youth with complex care needs and their families: a scoping review protocol. BMJ Open 2020; 10:e033978. [PMID: 32565449 PMCID: PMC7307541 DOI: 10.1136/bmjopen-2019-033978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Children and youth with complex care needs (CCNs) and their families experience many care transitions over their lifespan and are consequently vulnerable to the discontinuity or gaps in care that can occur during these transitions. Transitional care programmes, broadly defined as one or more intervention(s) or service(s) that aim to improve continuity of care, are increasingly being developed to address transitions in care for children and youth with CCNs. However, this literature has not yet been systematically examined at a comprehensive level. The purpose of this scoping review is to map the range of programmes that support transitions in care for children and youth with CCNs and their families during two phases of their lifespan: (1) up to the age of 19 years (not including their transition to adult healthcare) and (2) when transitioning from paediatric to adult healthcare. METHODS AND ANALYSIS The Joanna Briggs Institute methodology for scoping reviews (ScR) will be used for the proposed scoping review. ScR are a type of knowledge synthesis that are useful for addressing exploratory research questions that aim to map key concepts and types of evidence on a topic and can be used to organise what is known about the phenomena. A preliminary search of PubMed was conducted in December 2018. ETHICS AND DISSEMINATION Ethical approval is not required where this study is a review of the published and publicly reported literature. The research team's advisory council will develop a research dissemination strategy with goals, target audiences, expertise/leadership, resources and deadlines to maximise project outputs. The end-of-grant activities will be used to raise awareness, promote action and inform future research, policy and practice on this topic.
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Affiliation(s)
- Shelley Doucet
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Luke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Emilie Dionne
- St. Mary's Research Centre & Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Rima Azar
- Department of Psychology, Mount Allison University, Sackville, New Brunswick, Canada
| | - Amy E Reid
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Shelley McKibbon
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda R Horsman
- Interdisciplinary Studies, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Krystal Binns
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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62
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Riordan F, Racine E, Phillip ET, Bradley C, Lorencatto F, Murphy M, Murphy A, Browne J, Smith SM, Kearney PM, McHugh SM. Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening. Implement Sci 2020; 15:34. [PMID: 32429983 PMCID: PMC7236930 DOI: 10.1186/s13012-020-00982-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND 'Implementation interventions' refer to methods used to enhance the adoption and implementation of clinical interventions such as diabetic retinopathy screening (DRS). DRS is effective, yet uptake is often suboptimal. Despite most routine management taking place in primary care and the central role of health care professionals (HCP) in referring to DRS, few interventions have been developed for primary care. We aimed to develop a multifaceted intervention targeting both professionals and patients to improve DRS uptake as an example of a systematic development process combining theory, stakeholder involvement, and evidence. METHODS First, we identified target behaviours through an audit in primary care of screening attendance. Second, we interviewed patients (n = 47) and HCP (n = 30), to identify determinants of uptake using the Theoretical Domains Framework, mapping these to behaviour change techniques (BCTs) to develop intervention content. Thirdly, we conducted semi-structured consensus groups with stakeholders, specifically users of the intervention, i.e. patients (n = 15) and HCPs (n = 16), regarding the feasibility, acceptability, and local relevance of selected BCTs and potential delivery modes. We consulted representatives from the national DRS programme to check intervention 'fit' with existing processes. We applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) to select the final intervention components, drawing on findings from the previous steps, and a rapid evidence review of operationalised BCT effectiveness. RESULTS We identified potentially modifiable target behaviours at the patient (consent, attendance) and professional (registration) level. Patient barriers to consent/attendance included confusion between screening and routine eye checks, and fear of a negative result. Enablers included a recommendation from friends/family or professionals and recognising screening importance. Professional barriers to registration included the time to register patients and a lack of readily available information on uptake in their local area/practice. Most operationalised BCTs were acceptable to patients and HCPs while the response to feasibility varied. After considering APEASE, the core intervention, incorporating a range of BCTs, involved audit/feedback, electronic prompts targeting professionals, HCP-endorsed reminders (face-to-face, by phone and letter), and an information leaflet for patients. CONCLUSIONS Using the example of an intervention to improve DRS uptake, this study illustrates an approach to integrate theory with user involvement. This process highlighted tensions between theory-informed and stakeholder suggestions, and the need to apply the Theoretical Domains Framework (TDF)/BCT structure flexibly. The final intervention draws on the trusted professional-patient relationship, leveraging existing services to enhance implementation of the DRS programme. Intervention feasibility in primary care will be evaluated in a randomised cluster pilot trial.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Eunice T Phillip
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Strifler L, Barnsley JM, Hillmer M, Straus SE. Identifying and selecting implementation theories, models and frameworks: a qualitative study to inform the development of a decision support tool. BMC Med Inform Decis Mak 2020; 20:91. [PMID: 32408909 PMCID: PMC7227323 DOI: 10.1186/s12911-020-01128-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Implementation theories, models and frameworks offer guidance when implementing and sustaining healthcare evidence-based interventions. However, selection can be challenging given the myriad of potential options. We propose to inform a decision support tool to facilitate the appropriate selection of an implementation theory, model or framework in practice. To inform tool development, this study aimed to explore barriers and facilitators to identifying and selecting implementation theories, models and frameworks in research and practice, as well as end-user preferences for features and functions of the proposed tool. Methods We used an interpretive descriptive approach to conduct semi-structured interviews with implementation researchers and practitioners in Canada, the United States and Australia. Audio recordings were transcribed verbatim. Data were inductively coded by a single investigator with a subset of 20% coded independently by a second investigator and analyzed using thematic analysis. Results Twenty-four individuals participated in the study. Categories of barriers/facilitators, to inform tool development, included characteristics of the individual or team conducting implementation and characteristics of the implementation theory, model or framework. Major barriers to selection included inconsistent terminology, poor fit with the implementation context and limited knowledge about and training in existing theories, models and frameworks. Major facilitators to selection included the importance of clear and concise language and evidence that the theory, model or framework was applied in a relevant health setting or context. Participants were enthusiastic about the development of a decision support tool that is user-friendly, accessible and practical. Preferences for tool features included key questions about the implementation intervention or project (e.g., purpose, stage of implementation, intended target for change) and a comprehensive list of relevant theories, models and frameworks to choose from along with a glossary of terms and the contexts in which they were applied. Conclusions An easy to use decision support tool that addresses key barriers to selecting an implementation theory, model or framework in practice may be beneficial to individuals who facilitate implementation practice activities. Findings on end-user preferences for tool features and functions will inform tool development and design through a user-centered approach.
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Affiliation(s)
- Lisa Strifler
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada.,Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1W8, Canada
| | - Jan M Barnsley
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada
| | - Michael Hillmer
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada.,Ontario Ministry of Health and Long-Term Care, 900 Bay Street, Toronto, Ontario, M7A 1R3, Canada
| | - Sharon E Straus
- Institute of Health Policy Management & Evaluation, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M6, Canada. .,Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, Toronto, Ontario, M5B 1W8, Canada. .,Department of Geriatric Medicine, University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A1, Canada.
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Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, Mukasa B, Aarons GA. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 2020; 1:42. [PMID: 32885199 PMCID: PMC7427911 DOI: 10.1186/s43058-020-00023-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/26/2020] [Indexed: 01/10/2023] Open
Abstract
Background Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Søborg, Western Australia 6102 Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
| | - Bianca Albers
- European Implementation Collaborative, Odense, Denmark.,School of Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC 3053 Australia
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Sarabeth Broder-Fingert
- School of Medicine, Department of Pediatrics, Boston Medical Center and Boston University, 801 Albany Street, Boston, MA 02114 USA
| | - Barbara Mukasa
- Mildmay Uganda, 24985 Lweza, Entebbe Road, Kampala, Uganda
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
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King DK, Shoup JA, Raebel MA, Anderson CB, Wagner NM, Ritzwoller DP, Bender BG. Planning for Implementation Success Using RE-AIM and CFIR Frameworks: A Qualitative Study. Front Public Health 2020; 8:59. [PMID: 32195217 PMCID: PMC7063029 DOI: 10.3389/fpubh.2020.00059] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) dissemination and implementation frameworks define theory-based domains associated with the adoption, implementation and maintenance of evidence-based interventions. Used together, the two frameworks identify metrics for evaluating implementation success, i.e., high reach and effectiveness resulting in sustained practice change (RE-AIM), and modifiable factors that explain and enhance implementation outcomes (CFIR). We applied both frameworks to study the implementation planning process for a technology-delivered asthma care intervention called Breathewell within an integrated care organization. The goal of the Breathewell intervention is to increase the efficiency of delivering resource-intensive asthma care services. Methods: We reviewed historical documents (i.e., meeting agendas; minutes) from 14 months of planning to evaluate alignment of implementation team priorities with RE-AIM domains. Key content was extracted and analyzed on topics, frequency and amount of discussion within each RE-AIM domain. Implementation team members were interviewed using questions adapted from the CFIR Interview Guide Tool to focus their reflection on the process and contextual factors considered during pre-implementation planning. Documents and transcripts were initially coded using RE-AIM domain definitions, and recoded using CFIR constructs, with intent to help explain how team decisions and actions can contribute to adoption, implementation and maintenance outcomes. Results: Qualitative analysis of team documents and interviews demonstrated strong alignment with the RE-AIM domains: Reach, Effectiveness, and Implementation; and with the CFIR constructs: formal inclusion of provider and staff stakeholders in implementation planning, compatibility of the intervention with workflows and systems, and alignment of the intervention with organizational culture. Focus on these factors likely contributed to RE-AIM outcomes of high implementation fidelity. However, team members expressed low confidence that Breathewell would be adopted and maintained post-trial. A potential explanation was weak alignment with several CFIR constructs, including tension for change, relative priority, and leadership engagement that contribute to organizational receptivity and motivation to sustain change. Conclusions: While RE-AIM provides a practical framework for planning and evaluating practice change interventions to assure their external validity, CFIR explains why implementation succeeded or failed, and when used proactively, identifies relevant modifiable factors that can promote or undermine adoption, implementation, and maintenance.
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Affiliation(s)
- Diane K. King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, Anchorage, AK, United States
| | - Jo Ann Shoup
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States
| | - Marsha A. Raebel
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States
| | - Courtney B. Anderson
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States
| | - Nicole M. Wagner
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States
| | - Debra P. Ritzwoller
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States
| | - Bruce G. Bender
- Department of Pediatrics, National Jewish Health, Denver, CO, United States
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Esmail R, Hanson HM, Holroyd-Leduc J, Brown S, Strifler L, Straus SE, Niven DJ, Clement FM. A scoping review of full-spectrum knowledge translation theories, models, and frameworks. Implement Sci 2020; 15:11. [PMID: 32059738 PMCID: PMC7023795 DOI: 10.1186/s13012-020-0964-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022] Open
Abstract
Background Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. Methods A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics. Results Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison. Conclusions A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions. Trial registration A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).
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Affiliation(s)
- Rosmin Esmail
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Heather M Hanson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sage Brown
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Strifler
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fiona M Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D14A Teaching and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. .,Health Technology Assessment Unit, University of Calgary, Calgary, Alberta, Canada.
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Lima do Vale MR, Farmer A, Ball GDC, Gokiert R, Maximova K, Thorlakson J. Implementation of Healthy Eating Interventions in Center-Based Childcare: The Selection, Application, and Reporting of Theories, Models, and Frameworks. Am J Health Promot 2020; 34:402-417. [PMID: 31983219 DOI: 10.1177/0890117119895951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To explore the selection, use, and reporting of theories, models, and frameworks (TMFs) in implementation studies that promoted healthy eating in center-based childcare. DATA SOURCE We searched 11 databases for articles published between January 1990 and October 2018. We also conducted a hand search of studies and consulted subject matter experts. STUDY INCLUSION AND EXCLUSION CRITERIA We included studies in center-based settings for preschoolers that addressed the development, delivery, or evaluation of interventions or implementation strategies related to healthy eating and related subjects and that explicitly used TMF. Exclusion criteria include not peer reviewed or abstracts and not in English, French, German, and Korean. DATA EXTRACTION The first author extracted the data using extraction forms. A second reviewer verified data extraction. DATA SYNTHESIS Direct content analysis and narrative synthesis. RESULTS We identified 8222 references. We retained 38 studies. Study designs included quasi-experimental, randomized controlled trials, surveys, case studies, and others. The criteria used most often for selecting TMFs were description of a change process (n = 12; 23%) or process guidance (n = 8; 15%). Theories, models, and frameworks used targeted different socioecological levels and purposes. The application of TMF constructs (e.g., factors, steps, outcomes) was reported 69% (n = 34) of times. CONCLUSION Reliance on TMFs focused on individual-level, poor TMF selection, and application and reporting for the development of implementation strategies could limit TMF utility.
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Affiliation(s)
| | - Anna Farmer
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff D C Ball
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, Edmonton, Alberta, Canada
| | - Katerina Maximova
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jessica Thorlakson
- Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
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68
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Damschroder LJ. Clarity out of chaos: Use of theory in implementation research. Psychiatry Res 2020; 283:112461. [PMID: 31257020 DOI: 10.1016/j.psychres.2019.06.036] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 06/22/2019] [Indexed: 10/26/2022]
Abstract
Implementation science has been recognized as a potential catalyst for health system reform, in part, because of its contribution of well-grounded conceptual theories, often encapsulated in frameworks. Well-designed frameworks provide a semantic structure, a common language by which to guide systematic approaches to studying implementation and testing interventions. An overview of the types and roles of theory in advancing implementation science is offered in this article. Resources for selecting appropriate frameworks are described along with illustrative examples. The case is made that well-developed theory is what enables knowledge to emerge out of seeming chaos and for translation of that knowledge to be widely and reliably implemented into routine practice so that health and well-being of patients is maximized by delivery of interventions that are rooted in that knowledge.
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Gaskins NJ, Bray E, Hill JE, Doherty PJ, Harrison A, Connell LA. Factors influencing implementation of aerobic exercise after stroke: a systematic review. Disabil Rehabil 2019; 43:2382-2396. [DOI: 10.1080/09638288.2019.1704075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Nicola J. Gaskins
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Emma Bray
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - James E. Hill
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | | | | | - Louise A. Connell
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
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70
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Presseau J, McCleary N, Lorencatto F, Patey AM, Grimshaw JM, Francis JJ. Action, actor, context, target, time (AACTT): a framework for specifying behaviour. Implement Sci 2019; 14:102. [PMID: 31806037 PMCID: PMC6896730 DOI: 10.1186/s13012-019-0951-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Designing implementation interventions to change the behaviour of healthcare providers and other professionals in the health system requires detailed specification of the behaviour(s) targeted for change to ensure alignment between intervention components and measured outcomes. Detailed behaviour specification can help to clarify evidence-practice gaps, clarify who needs to do what differently, identify modifiable barriers and enablers, design interventions to address these and ultimately provides an indicator of what to measure to evaluate an intervention's effect on behaviour change. An existing behaviour specification framework proposes four domains (Target, Action, Context, Time; TACT), but insufficiently clarifies who is performing the behaviour (i.e. the Actor). Specifying the Actor is especially important in healthcare settings characterised by multiple behaviours performed by multiple different people. We propose and describe an extension and re-ordering of TACT to enhance its utility to implementation intervention designers, practitioners and trialists: the Action, Actor, Context, Target, Time (AACTT) framework. We aim to demonstrate its application across key steps of implementation research and to provide tools for its use in practice to clarify the behaviours of stakeholders across multiple levels of the healthcare system. METHODS AND RESULTS We used French et al.'s four-step implementation process model to describe the potential applications of the AACTT framework for (a) clarifying who needs to do what differently, (b) identifying barriers and enablers, (c) selecting fit-for-purpose intervention strategies and components and (d) evaluating implementation interventions. CONCLUSIONS Describing and detailing behaviour using the AACTT framework may help to enhance measurement of theoretical constructs, inform development of topic guides and questionnaires, enhance the design of implementation interventions and clarify outcome measurement for evaluating implementation interventions.
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Affiliation(s)
- Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,School of Psychology, University of Ottawa, Ottawa, Canada.
| | - Nicola McCleary
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Andrea M Patey
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Jill J Francis
- School of Health Sciences, City University of London, London, UK
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71
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An implementation science primer for psycho-oncology: translating robust evidence into practice. ACTA ACUST UNITED AC 2019. [DOI: 10.1097/or9.0000000000000014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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72
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Setty K, Cronk R, George S, Anderson D, O'Flaherty G, Bartram J. Adapting Translational Research Methods to Water, Sanitation, and Hygiene. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4049. [PMID: 31652610 PMCID: PMC6843932 DOI: 10.3390/ijerph16204049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/04/2019] [Accepted: 10/06/2019] [Indexed: 12/20/2022]
Abstract
Translational research applies scientific techniques to achieve practical outcomes, connecting pure research and pure practice. Many translational research types have arisen since the mid-1900s, reflecting the need to better integrate scientific advancement with policy and practice. Water, sanitation, and hygiene (WaSH) development efforts have aimed to reduce morbidity and mortality and improve service delivery; thus, associated research has a strong orientation toward applied studies that use diverse methods to support decision-making. Drawing from knowledge that emerged to support other professional fields, such as manufacturing and clinical healthcare, we characterize different types of translational research and clarify nomenclature and principles. We describe study approaches relevant to translational research questions, and offer overarching recommendations, specific examples, and resources for further study as practical advice to professionals who seek to apply translational methods to WaSH problems. To enhance collective outcomes, professionals should mindfully align projects within the translational spectrum. We further recommend overarching good practices such as documenting intervention adaptations, overtly considering contextual factors, and better distinguishing efficacy from effectiveness research by replicating studies in different contexts. By consciously improving the compatibility and linkages between WaSH science and practice, this guide can accelerate urgently needed progress toward global development goals.
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Affiliation(s)
- Karen Setty
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
| | - Ryan Cronk
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
| | - Shannan George
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
| | - Darcy Anderson
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
| | - Għanja O'Flaherty
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
| | - Jamie Bartram
- The Water Institute at UNC and Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 166 Rosenau Hall, CB #7431 Chapel Hill, NC 27599-7431, USA.
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Moullin JC, Dickson KS, Stadnick NA, Rabin B, Aarons GA. Systematic review of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Implement Sci 2019; 14:1. [PMID: 30611302 PMCID: PMC6321673 DOI: 10.1186/s13012-018-0842-6] [Citation(s) in RCA: 476] [Impact Index Per Article: 95.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Effective implementation of evidence-based practices (EBPs) remains a significant challenge. Numerous existing models and frameworks identify key factors and processes to facilitate implementation. However, there is a need to better understand how individual models and frameworks are applied in research projects, how they can support the implementation process, and how they might advance implementation science. This systematic review examines and describes the research application of a widely used implementation framework, the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Methods A systematic literature review was performed to identify and evaluate the use of the EPIS framework in implementation efforts. Citation searches in PubMed, Scopus, PsycINFO, ERIC, Web of Science, Social Sciences Index, and Google Scholar databases were undertaken. Data extraction included the objective, language, country, setting, sector, EBP, study design, methodology, level(s) of data collection, unit(s) of analysis, use of EPIS (i.e., purpose), implementation factors and processes, EPIS stages, implementation strategy, implementation outcomes, and overall depth of EPIS use (rated on a 1–5 scale). Results In total, 762 full-text articles were screened by four reviewers, resulting in inclusion of 67 articles, representing 49 unique research projects. All included projects were conducted in public sector settings. The majority of projects (73%) investigated the implementation of a specific EBP. The majority of projects (90%) examined inner context factors, 57% examined outer context factors, 37% examined innovation factors, and 31% bridging factors (i.e., factors that cross or link the outer system and inner organizational context). On average, projects measured EPIS factors across two of the EPIS phases (M = 2.02), with the most frequent phase being Implementation (73%). On average, the overall depth of EPIS inclusion was moderate (2.8 out of 5). Conclusion This systematic review enumerated multiple settings and ways the EPIS framework has been applied in implementation research projects, and summarized promising characteristics and strengths of the framework, illustrated with examples. Recommendations for future use include more precise operationalization of factors, increased depth and breadth of application, development of aligned measures, and broadening of user networks. Additional resources supporting the operationalization of EPIS are available. Electronic supplementary material The online version of this article (10.1186/s13012-018-0842-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Perth, 6102, Western Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.,Department of Child and Family Development, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA
| | - Borsika Rabin
- Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive (0725), La Jolla, San Diego, CA, 92093-0812, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA. .,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.
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