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D'Lima D, Soukup T, Hull L. Evaluating the Application of the RE-AIM Planning and Evaluation Framework: An Updated Systematic Review and Exploration of Pragmatic Application. Front Public Health 2022; 9:755738. [PMID: 35155336 PMCID: PMC8826088 DOI: 10.3389/fpubh.2021.755738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background RE-AIM is one of the most widely applied frameworks to plan and evaluate the implementation of public health and health behavior change interventions. The objective of this review is to provide an updated synthesis of use of the RE-AIM (Reach Effectiveness Adoption Implementation and Maintenance) planning and evaluation framework and explore pragmatic use (i.e., partial application of the framework) and how this is reported. Methods Systematic review. MEDLINE (R) and PsycINFO were searched, via the Ovid interface, between January 2011 and December 2017. Studies that applied RE-AIM as a planning and/or evaluation framework were included. Results One hundred fifty-seven articles met inclusion criteria. One hundred forty-nine reported using RE-AIM for evaluation, three for planning and five for planning and evaluation. Reach was the most frequently reported dimension (92.9%), followed by implementation (90.3%), adoption (89.7%), effectiveness (84.5%), and maintenance (77.4%). One hundred forty-seven/one hundred fifty-seven articles originated from high-income economy countries. Within a sub-set analysis (10% of included articles), 9/15 articles evaluated all dimensions. Of the 6/15 articles that did not evaluate all dimensions, five provided no justification for pragmatic application. Conclusions RE-AIM has gained increased use in recent years and there is evidence that it is being applied pragmatically. However, the rationale for pragmatic use is often not reported. Systematic Review Registration PROSPERO (CRD42017054616).
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Affiliation(s)
- Danielle D'Lima
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, United Kingdom
| | - Tayana Soukup
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Louise Hull
- Centre for Implementation Science, Health Service and Population Research Department, King's College London, London, United Kingdom
- *Correspondence: Louise Hull
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Lui M, McKellar K, Cooper S, Eng JJ, Bird ML. Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study. BMC Health Serv Res 2022; 22:30. [PMID: 34986836 PMCID: PMC8729091 DOI: 10.1186/s12913-021-07436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background The transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one’s recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach. Methods The evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority. Results Two programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format. Conclusions This case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07436-7.
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Affiliation(s)
- Michelle Lui
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, Vancouver, BC, V6T 2B5, Canada
| | - Katherine McKellar
- Kelowna General Hospital, 2268 Pandosy Street, Kelowna, BC, V1Y 1T2, Canada
| | - Shari Cooper
- Parkinson's Recreation Centre, 1800 Parkinsons way, Kelowna, V17 4P9, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Research Laboratory, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
| | - Marie-Louise Bird
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Rehabilitation Research Program, GF Strong Rehabilitation Research Laboratory, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada. .,School of Health Sciences, University of Tasmania, Newnham Drive, Launceston, Tasmania, 7250, Australia.
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103
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Mog AC, Moldestad M, Kenney R, Stevenson L, Lee M, Ho PM, Sayre GG. “I was Unsure at First”: A Qualitative Evaluation of Patient Perceptions of VA Clinical Video Telehealth Visits in the V-IMPACT Program. J Patient Exp 2022; 9:23743735221107237. [PMID: 35813242 PMCID: PMC9260561 DOI: 10.1177/23743735221107237] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Virtual Integrated Multi-Site Patient Aligned Care Team (V-IMPACT) was a Veterans Health
Administration (VHA) initiative created to increase access to primary care for Veterans
through Clinical Video Telehealth (CVT) appointments. Between January and August 2019, we
conducted 48 semi-structured qualitative interviews with Veterans who had a V-IMPACT
appointment. Many participants shared feelings of skepticism before their first
appointments but for some, their opinions changed. Veterans talked about how their opinion
of video care changed for the better when it made care more convenient or timelier or met
their health care needs. For some Veterans, their opinion about video care stayed the same
or worsened because they had a poor relationship or rapport with their provider, did not
feel like they received needed care, or did not feel like video care was useful. These
findings offer an opportunity for telecare providers to better understand and support
patients and to deliver effective care in the context of rapidly growing telehealth
modalities.
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Affiliation(s)
- Ashley C Mog
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Megan Moldestad
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Rachael Kenney
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - Lauren Stevenson
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, USA
| | - Marcie Lee
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
| | - P Michael Ho
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
- University of Colorado Anschutz, Aurora, CO, USA
| | - George G Sayre
- The VA Collaborative Evaluation Center (VACE), Seattle, WA, Aurora, CO, Cleveland, OH, USA
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
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104
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Donald M, Beanlands H, Straus S, Harwood L, Herrington G, Waldvogel B, Delgado M, Sparkes D, Watson P, Elliott M, McBrien K, Bello A, Hemmelgarn B. A Research Protocol for Implementation and Evaluation of a Patient-Focused eHealth Intervention for Chronic Kidney Disease. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:85-94. [PMID: 35402999 PMCID: PMC8938369 DOI: 10.1007/s43477-022-00038-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/13/2022] [Indexed: 02/02/2023]
Abstract
Self-management in chronic kidney disease (CKD) can slow disease progression; however, there are few tools available to support patients with early CKD. My Kidneys My Health is a patient-focused electronic health (eHealth) self-management tool developed by patients and caregivers. This study will investigate the implementation of My Kidneys My Health across primary care and general nephrology clinics. The study aims to: (1) identify and address barriers and facilitators that may impact implementation and sustainability of the website into routine clinical care; (2) evaluate implementation quality to inform spread and scale-up. We will conduct a multi-stage approach using qualitative methods, guided by the Quality Implementation Framework and using a qualitative content analysis approach. First, we will identify perceived barriers and facilitators to implementation and considerations for sustainability through interviews with clinicians, based on the Readiness Thinking Tool and the Long Term Success Tool. Analysis will be guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Appropriate implementation strategies will be identified using the Expert Recommendations for Implementing Change compilation, and implementation plans will be developed based on Proctor's recommendations and the Action, Actor, Context, Target, Time framework. Finally, we will explore implementation quality guided by the RE-AIM framework. There is limited literature describing systematic approaches to implementing and sustaining patient-focused self-management tools into clinical care, in addition to employing tailored implementation strategies to promote adoption and sustainability. We aim to generate insights on how My Kidneys My Health can be integrated into clinical care and how to sustain use of patient-centric eHealth tools in clinical settings on a larger scale. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-022-00038-3.
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Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON Canada
| | - Lori Harwood
- London Health Sciences Centre, London, ON Canada
| | | | | | | | | | - Paul Watson
- Can-SOLVE CKD Patient Partner, Vancouver, BC Canada
| | - Meghan Elliott
- Department of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Kerry McBrien
- Department of Family Medicine, University of Calgary, Calgary, AB Canada
| | - Aminu Bello
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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Ogundele OJ, Fadel S, Braitstein P, Di Ruggiero E. Health actor approaches to financing universal coverage strategies for pneumococcal and rotavirus immunisation programmes in low-income and middle-income countries: a scoping review protocol. BMJ Open 2021; 11:e052381. [PMID: 34907060 PMCID: PMC8671985 DOI: 10.1136/bmjopen-2021-052381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/14/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Sustainable financing of immunisation programmes is an important step towards universal coverage of life-saving vaccines. Yet, financing mechanisms for health programmes could have consequences on the design of universal approaches to immunisation coverage. Effective implementation of immunisation interventions necessitates investigating the roles of institutions and power on interventions. This review aims to understand how sustainable financing and equitable immunisation are conceptualised by health actors like Gavi, and government-related entities across low-income and middle-income countries (LMICs) and how financing mechanisms can affect universal coverage of vaccines. METHODS AND ANALYSIS This study protocol outline a scoping review of the peer-reviewed and the grey literature, using established methodological framework for scoping review. Literature will be identified through a comprehensive search of multiple databases and grey literature. All peer-reviewed implementation research studies from the year 2002 addressing financing and universal coverage of immunisation programmes for the pneumococcal conjugated vaccine and rotavirus vaccines immunisation interventions will be included and grey literature published in/after the year 2015. For the study scope, population, concept and context are defined: Population as international and national health stakeholders financing immunisation programmes; Concept as implementation research on pneumococcal conjugate and rotavirus vaccination interventions; and Context as LMICs. Findings will be quantitatively summarised to provide an overview and narratively synthesised and analysed. Studies that do not use implementation research approaches, frameworks or models will be excluded. ETHICS AND DISSEMINATION Ethics approval is not required for this scoping review. Findings and recommendations will be presented to implementation researchers and health stakeholders.
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Affiliation(s)
- Oluwasegun Jko Ogundele
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Shaza Fadel
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Smith SL, Nyirandagijimana B, Hakizimana J, Levy RP, Bienvenu R, Uwamwezi A, Hakizimfura O, Uwimana E, Kundu P, Mpanumusingo E, Nshimyiryo A, Rusangwa C, Kateera F, Mukasakindi H, Raviola G. Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design. BMJ Open 2021; 11:e054630. [PMID: 34862298 PMCID: PMC8647529 DOI: 10.1136/bmjopen-2021-054630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda. METHODS AND ANALYSIS We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews. ETHICS AND DISSEMINATION This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.
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Affiliation(s)
- Stephanie L Smith
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Roger P Levy
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Giuseppe Raviola
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Jensen ML, Gonzalez W, Bolaños-Palmieri C, Monge-Rojas R, Frongillo EA. Implementation of a regulatory food policy to reduce availability of energy-dense foods in Costa Rican high schools. Public Health Nutr 2021; 24:6499-6511. [PMID: 34407907 PMCID: PMC11148610 DOI: 10.1017/s1368980021003013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the extent to which mandatory Guidelines to improve the school food environment were being implemented in Costa Rican high schools and to explore the perspectives of key policy actors towards the Guidelines. DESIGN Semi-structured interviews and site observations. Interviews were recorded, transcribed verbatim and imported to NVivo 12 for analysis. Inductive and deductive themes were identified, and elements of the RE-AIM framework and the social process framework were used when classifying these themes. SETTING Sixteen public high schools in San José, Costa Rica. PARTICIPANTS High school principal and kiosk concessionaires. RESULTS Products that did not adhere to the Guidelines were still widely available in schools, and amongst the most prevalent challenges to implementation that emerged from our interviews, were a lack of understanding of the policy content, a lack of monitoring and accountability, and competing values amongst actors which affected their views on the role that the school must have in offering a healthy food environment. CONCLUSION Most products offered in high schools did not meet the criteria required by the mandatory Guidelines, and several contextual factors were found to influence implementation. Strengthening the implementation of the Costa Rican Guidelines will require further actions at the governmental and school levels.
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Affiliation(s)
- Melissa L Jensen
- School of Nutrition, University of Costa Rica, Ciudad de la Investigación, Finca 2, San José, Sabanilla, Costa Rica
- Rudd Center for Food Policy, University of Connecticut, One Constitution Plaza, Suite 600, Hartford, CT06103, USA
| | - Wendy Gonzalez
- Global Alliance for Improved Nutrition, Geneva, Switzerland
| | | | - Rafael Monge-Rojas
- Nutrition and Health Unit, Costa Rican Institute of Research and Education on Nutrition and Health, Tres Ríos, Costa Rica
| | - Edward A Frongillo
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Booker SQ, Bartley EJ, Powell-Roach K, Palit S, Morais C, Thompson OJ, Cruz-Almeida Y, Fillingim RB. The Imperative for Racial Equality in Pain Science: A Way Forward. THE JOURNAL OF PAIN 2021; 22:1578-1585. [PMID: 34214701 PMCID: PMC9133713 DOI: 10.1016/j.jpain.2021.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022]
Abstract
Racial equity is imperative to the future and integrity of scientific inquiry. In 2020, citizens of the United States (and globally) witnessed one of the most vile and egregious experiences of police brutality and systemic racism in recent history, the public execution of a Black American man. While some may isolate this and other similar events from influencing the scientific endeavors of pain researchers, events such as this can have a direct impact on the study, lived experience, and expression of pain in Black Americans. To truly understand the biopsychosocial effects of inequality and injustice on pain disparities, we must consider the unintended consequences that our current research approaches have in limiting the reliability and validity of scientific discovery. As we reflect on our current research practices in an effort to improve pain science, this perspective article discusses ways to initiate positive change in order to advance the science of pain in more equitable ways, not just for Black Americans, but for all individuals that identify as part of an underrepresented group. PERSPECTIVE: Elimination of inequities in pain care and research requires the identification, naming, and mitigation of systemic discriminatory and biased practices that limit our understanding of pain disparities. Now is the time to divest from traditional research methods and invest in equitable and innovative approaches to support pain researchers in advancing the science and improving the lives of people with pain.
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Affiliation(s)
- Staja Q Booker
- College of Nursing, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida.
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Keesha Powell-Roach
- College of Nursing, University of Florida, Gainesville, Florida; Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Shreela Palit
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Calia Morais
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Osheeca J Thompson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; College of Dentistry, University of Florida, Gainesville, Florida
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Foldal VS, Solbjør M, Standal MI, Fors EA, Hagen R, Bagøien G, Johnsen R, Hara KW, Fossen H, Løchting I, Eik H, Grotle M, Aasdahl L. Barriers and Facilitators for Implementing Motivational Interviewing as a Return to Work Intervention in a Norwegian Social Insurance Setting: A Mixed Methods Process Evaluation. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:785-795. [PMID: 33761083 PMCID: PMC8558277 DOI: 10.1007/s10926-021-09964-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 05/03/2023]
Abstract
Purpose The aim of this study was to evaluate potential barriers and facilitators for implementing motivational interviewing (MI) as a return to work (RTW) intervention in a Norwegian social insurance setting. Methods A mixed-methods process evaluation was conducted alongside a randomized controlled trial involving MI sessions delivered by social insurance caseworkers. The study was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework using focus groups with the caseworkers. MI fidelity was evaluated through audio-recordings of MI sessions and questionnaires to sick-listed participants. Results Lack of co-worker and managerial support, time and place for practicing to further develop MI skills, and a high workload made the MI intervention challenging for the caseworkers. The MI method was experienced as useful, but difficult to master. MI fidelity results showed technical global scores over the threshold for "beginning proficiency" whereas the relational global score was under the threshold. The sick-listed workers reported being satisfied with the MI sessions. Conclusions Despite caseworker motivation for learning and using MI in early follow-up sessions, MI was hard to master and use in practice. Several barriers and facilitators were identified; these should be addressed before implementing MI in a social insurance setting.Trial registration ClinicalTrials.gov: NCT03212118 (registered July 11, 2017).
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Affiliation(s)
- Vegard Stolsmo Foldal
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marit Solbjør
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Martin Inge Standal
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Egil Andreas Fors
- Department of Public Health and Nursing, General Practice Research Unit, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad, Oslo, Norway
| | - Gunnhild Bagøien
- Division of Psychiatry, Tiller Community Mental Health Centre, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Roar Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Karen Walseth Hara
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
- Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heidi Fossen
- The Norwegian Labour and Welfare Service of Trøndelag, Trondheim, Norway
| | - Ida Løchting
- Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Hedda Eik
- Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Faculty of Health Science, Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI) Clinic for Surgery and Neurology, Oslo University Hospital, Oslo, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway.
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Kadiamada-Ibarra H, Hawley NL, Sosa-Rubí SG, Wilson-Barthes M, Galárraga O, Franco RR. Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework. BMC Public Health 2021; 21:2174. [PMID: 34837988 PMCID: PMC8626882 DOI: 10.1186/s12889-021-12167-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12167-9.
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Affiliation(s)
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Sandra G Sosa-Rubí
- Division of Health Economics, National Institute of Public Health (INSP), 62100, Cuernavaca, CP, Mexico
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Roxana Rodríguez Franco
- Center for Demographic, Urban, and Environmental Studies (CEDUA), The College of Mexico, 14110, Mexico City, CP, Mexico.
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Lewis C, Buchanan J, Clarke A, Clement E, Friedrich B, Hastings-Ward J, Hill M, Horn R, Lucassen AM, Patch C, Pickard A, Roberts L, Sanderson SC, Wynn SL, Vindrola-Padros C, Lakhanpaul M. Mixed-methods evaluation of the NHS Genomic Medicine Service for paediatric rare diseases: study protocol. NIHR OPEN RESEARCH 2021; 1:23. [PMID: 35098132 PMCID: PMC7612282 DOI: 10.3310/nihropenres.13236.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
Background A new nationally commissioned NHS England Genomic Medicine Service (GMS) was recently established to deliver genomic testing with equity of access for patients affected by rare diseases and cancer. The overarching aim of this research is to evaluate the implementation of the GMS during its early years, identify barriers and enablers to successful implementation, and provide recommendations for practice. The focus will be on the use of genomic testing for paediatric rare diseases. Methods This will be a four-year mixed-methods research programme using clinic observations, interviews and surveys. Study 1 consists of qualitative interviews with designers/implementers of the GMS in Year 1 of the research programme, along with documentary analysis to understand the intended outcomes for the Service. These will be revisited in Year 4 to compare intended outcomes with what happened in practice, and to identify barriers and facilitators that were encountered along the way. Study 2 consists of clinic observations (pre-test counselling and results disclosure) to examine the interaction between health professionals and parents, along with follow-up interviews with both after each observation. Study 3 consists of a longitudinal survey with parents at two timepoints (time of testing and 12 months post-results) along with follow-up interviews, to examine parent-reported experiences and outcomes. Study 4 consists of qualitative interviews and a cross-sectional survey with medical specialists to identify preparedness, facilitators and challenges to mainstreaming genomic testing. The use of theory-based and pre-specified constructs will help generalise the findings and enable integration across the various sub-studies. Dissemination We will disseminate our results to policymakers as findings emerge, so any suggested changes to service provision can be considered in a timely manner. A workshop with key stakeholders will be held in Year 4 to develop and agree a set of recommendations for practice.
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Affiliation(s)
- Celine Lewis
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford,, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Angus Clarke
- Division of Cancer and Genetics, Cardiff University School of Medicine, Cardiff, UK
| | - Emma Clement
- Clinical Genetics and Genomic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Bettina Friedrich
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | | | - Melissa Hill
- London North Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Ruth Horn
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Department of Population Health, University of Oxford, Oxford, UK
| | - Anneke M. Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Chris Patch
- Genomics England, Queen Mary University of London, London, UK
- Counselling, Society and Ethics Research, Wellcome Genome Campus, Cambridge, UK
| | | | | | | | - Sarah L. Wynn
- Unique – the Rare Chromosome Disorder Support Group, Oxted, UK
| | - Cecilia Vindrola-Padros
- Department of Targeted Intervention and Rapid Research Evaluation and Appraisal Lab (RREAL),, University College London, London, UK
| | - Monica Lakhanpaul
- Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
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Capio CM, Ng CSM, Chung KKH, Jones RA, Sit CHP. Evaluation of a school-based dissemination of the movement guidelines for young children in Hong Kong: Study protocol. ACTA ACUST UNITED AC 2021; 79:184. [PMID: 34688306 PMCID: PMC8542331 DOI: 10.1186/s13690-021-00705-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/07/2021] [Indexed: 12/01/2022]
Abstract
Background Healthy movement behaviors in early childhood are believed to track to adulthood, potentially imparting protective benefits against non-communicable diseases. Highlighting the collaborative and complementary roles of parents and educators in promoting health of young children, this study aims to enable parents and teachers to successfully promote healthy movement behaviors in young children. Guidelines for physical activity, sedentary screen time, and sleep of children aged 2 to 6 years will be systematically disseminated to parents and teachers of children enrolled in early childhood education centers (ECECs) in Hong Kong. An evaluation will be conducted to assess the implementation process and the outcomes of the dissemination of said guidelines. Methods The evaluation will include formative and summative components to examine the implementation (i.e., process evaluation) and the outcomes (i.e., outcome evaluation). Participants include teachers, parents, and children from ECECs in Hong Kong. The process evaluation will be guided by the RE-AIM framework (i.e., reach, efficacy, adaptation, implementation, maintenance). Data gathering and analysis will take a mixed-methods triangulation design - convergence model. The outcome evaluation consists of a non-randomized observational study, using quantitative data from questionnaires and accelerometers. The primary outcome to be measured is the extent to which children meet the guidelines for physical activity, sedentary screen time, and sleep; the secondary outcome is teachers’ and parents’ knowledge and awareness of the guidelines. Discussion Young children who engage in healthy movement behaviors are likely to become adults who will have the disposition to engage in behaviors that have protective effects against non-communicable diseases. The findings of this evaluation are expected to contribute to improving the strategies of systems and government agencies that aspire to promote healthy movement behaviors of young children.
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Affiliation(s)
- Catherine M Capio
- Early Childhood Education Department, Education University of Hong Kong, Hong Kong, China. .,School of Public Health, The University of Hong Kong, Hong Kong, China. .,Health Science Department, Ateneo de Manila University, Quezon City, Philippines.
| | - Catalina S M Ng
- Early Childhood Education Department, Education University of Hong Kong, Hong Kong, China
| | - Kevin K H Chung
- Early Childhood Education Department, Education University of Hong Kong, Hong Kong, China
| | - Rachel A Jones
- School of Education, University of Wollongong, Wollongong, Australia
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
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Gholami M, Jackson NJ, Chung UYR, Duru OK, Shedd K, Soetenga S, Loeb T, Elashoff D, Hamilton AB, Mangione CM, Slusser W, Moin T. Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative. BMC Public Health 2021; 21:1775. [PMID: 34592981 PMCID: PMC8482560 DOI: 10.1186/s12889-021-11731-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.
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Affiliation(s)
| | - Nicholas J Jackson
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Un Young Rebecca Chung
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Kelly Shedd
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tamara Loeb
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - David Elashoff
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Alison B Hamilton
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Wendelin Slusser
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Tannaz Moin
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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McCullough MB, Zogas A, Gillespie C, Kleinberg F, Reisman JI, Ndiwane N, Tran MH, Ourth HL, Morreale AP, Miller DR. Introducing clinical pharmacy specialists into interprofessional primary care teams: Assessing pharmacists' team integration and access to care for rural patients. Medicine (Baltimore) 2021; 100:e26689. [PMID: 34559093 PMCID: PMC8462613 DOI: 10.1097/md.0000000000026689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/17/2021] [Indexed: 01/05/2023] Open
Abstract
Clinical pharmacy specialists (CPS) were deployed nationally to improve care access and relieve provider burden in primary care.The aim of this study was to assess CPS integration in primary care and the Clinical Pharmacy Specialist Rural Veteran Access (CRVA) initiative's effectiveness in improving access.Concurrent embedded mixed-methods evaluation of participating CRVA CPS and their clinical team members (primary care providers, others).Health care providers on primary care teams in Veterans Health Administration (VHA).Perceived CPS integration in comprehensive medication management assessed using the MUPM and semi-structured interviews, and access measured with patient encounter data.There were 496,323 medical encounters with CPS in primary care over a 3-year period. One hundred twenty-four CPS and 1177 other clinical team members responded to a self-administered web-based questionnaire, with semi-structured interviews completed by 22 CPS and clinicians. Survey results indicated that all clinical provider groups rank CPS as making major contributions to CMM. CPS ranked themselves as contributing more to CMM than did their physician team members. CPS reported higher job satisfaction, less burn out, and better role fit; but CPS gave lower scores for communication and decision making as clinic organizational attributes. Themes in provider interviews focused on value of CPS in teams, relieving provider burden, facilitators to integration, and team communication issues.This evaluation indicates good integration of CPS on primary care teams as perceived by other team members despite some communication and role clarification challenges. CPS may play an important role in improving access to primary care.
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Affiliation(s)
- Megan B. McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- University of Massachusetts, Lowell, Zuckerberg School of Health Sciences, Department of Public Health, Lowell, MA
| | - Anna Zogas
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA
| | - Chris Gillespie
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Felicia Kleinberg
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Joel I. Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Ndindam Ndiwane
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Michael H. Tran
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Heather L. Ourth
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Anthony P. Morreale
- Pharmacy Benefits Management Services, Veterans Health Administration Central Office, Department of Veterans Affairs, Washington, DC
| | - Donald R. Miller
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
- University of Massachusetts, Lowell, Center for Population Health, Department of Biomedical and Nutritional Sciences, Lowell, MA
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Jones W, Somerset S, Evans C, Whittingham K, Middleton M, Blake H. Test@work: evaluation of workplace HIV testing for construction workers using the RE-AIM framework. BMC Public Health 2021; 21:1737. [PMID: 34560853 PMCID: PMC8464147 DOI: 10.1186/s12889-021-11739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community testing for HIV can reach previously untested populations but is rarely offered in workplaces. Targeting the construction sector could reach workers from high risk populations. METHODS The RE-AIM framework was used to evaluate Test@Work, a workplace HIV testing intervention for construction workers implemented at 21 events (10 companies) in the UK. Test@Work had three components: 1) an online health toolkit to inform managers about health screening and HIV testing; 2) general health checks; and 3) opt-in HIV consultation and testing. Quantitative data were collected using registration and exit questionnaires with workers (n = 426) and pre/post-event questionnaires with managers (n = 15), with qualitative analysis of free text responses. RESULTS Reach 426 individuals had health checks. Participants were broadly representative of the UK construction workforce, but with a higher proportion of permanent workers. Most workers reported being in good health but also believed their work had an adverse impact on their health. Effectiveness: 97% of health check participants opted to have a consultation about sexual health (n = 413) and 82% had an HIV test (n = 348), of whom 78% had not previously been tested. All HIV tests were non-reactive. HIV testing at work was considered acceptable by most participants. Participants reported learning new things about their health (74%), said they would make changes as a result (70%) and felt confident of success (median score 8/10). Adoption: Recruitment of companies was challenging and time consuming. Seven of the participating companies were very large, employing over 1000 workers, which is atypical of construction generally. IMPLEMENTATION All events were completed as planned and were considered successful by all parties. Maintenance: All managers would arrange further events if they were offered them. Six managers incorporated sexual health awareness into their health programmes, but this was not possible for many as health agendas were set centrally by their organisations. CONCLUSIONS Opt-in HIV testing, when embedded within a general health check, has high uptake and acceptability in the UK construction sector, and reaches individuals at risk for HIV who may not otherwise attend for testing. Cost-effectiveness of this approach is yet to be determined. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04292002 .
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Affiliation(s)
- Wendy Jones
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Somerset
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK.
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
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Yin X, Tian M, Sun L, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, Chu H, Pearson SA, Neal B, Liu H. Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients 2021; 13:nu13093225. [PMID: 34579109 PMCID: PMC8471368 DOI: 10.3390/nu13093225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
- School of Public Health, Harbin Medical University, Harbin 150081, China
- Correspondence: ; Tel.: +86-(0)451-8750-2881
| | - Lingli Sun
- The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China;
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Mark D. Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - J. Jaime Miranda
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
| | - Matti Marklund
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Department of Public Health and Caring Sciences, Uppsala University, 75236 Uppsala, Sweden
| | - Jason H. Y. Wu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
| | - Laura K. Cobb
- Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY 10005, USA;
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China;
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Bruce Neal
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia; (X.Y.); (J.W.); (K.T.); (M.D.H.); (J.J.M.); (M.M.); (J.H.Y.W.); (B.N.); (H.L.)
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW 2050, Australia
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Yong FR, Hor SY, Bajorek BV. Considerations of Australian community pharmacists in the provision and implementation of cognitive pharmacy services: a qualitative study. BMC Health Serv Res 2021; 21:906. [PMID: 34479542 PMCID: PMC8413700 DOI: 10.1186/s12913-021-06838-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Australian federally-funded cognitive pharmacy services (CPS) (e.g. medication management and reconciliation services) have not been translated into practice consistently. These health services are purportedly accessible across all Australian community pharmacies, yet are not delivered as often as pharmacists would like. There are international indicators that pharmacists lack the complete behavioural control required to prioritise CPS, despite their desire to deliver them. This requires local investigation. Objective To explore Australian pharmacists’ perspectives [1] as CPS providers on the micro level, and [2] on associated meso and macro level CPS implementation issues. Methods Registered Australian community pharmacists were recruited via professional organisations and snowball sampling. Data were collected via an online demographic survey and semi-structured interviews until data saturation was reached. Interview transcripts were de-identified then verified by participants. Content analysis was performed to identify provider perspectives on the micro level. Framework analysis using RE-AIM was used to explore meso and macro implementation issues. Results Twenty-three participants across Australia gave perspectives on CPS provision. At the micro level, pharmacists did not agree on a single definition of CPS. However, they reported complexity in interactional work and patient considerations, and individual pharmacist factors that affected them when deciding whether to provide CPS. There was an overall deficiency in pharmacy workplace resources reported to be available for implementation and innovation. Use of an implementation evaluation framework suggested CPS implementation is lacking sufficient structural support, whilst reach into target population, service consistency and maintenance for CPS were not specifically considered by pharmacists. Conclusions This analysis of pharmacist CPS perspectives suggests slow uptake may be due to a lack of evidence-based, focused, multi-level implementation strategies that take ongoing pharmacist role transition into account. Sustained change may require external change management and implementation support, engagement of frontline clinicians in research, and the development of appropriate pharmacist practice models to support community pharmacists in their CPS roles. Trial registration This study was not a clinical intervention trial. It was approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC 19–3417) on the 26th of April 2019.
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Affiliation(s)
- Faith R Yong
- Discipline of Pharmacy, Graduate School of Health, Faculty of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia.
| | - Su-Yin Hor
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Building 10, 15 Broadway, Ultimo, Sydney, NSW, 2007, Australia
| | - Beata V Bajorek
- Discipline of Pharmacy, Graduate School of Health, Faculty of Health, University of Technology Sydney, 100 Broadway, Chippendale, Sydney, NSW, 2008, Australia
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Le Goff D, Barais M, Perraud G, Derriennic J, Aujoulat P, Guillou-Landreat M, Le Reste JY. Innovative cardiovascular primary prevention population-based strategies: a 2-year hybrid type 1 implementation randomised control trial (RCT) which evaluates behavioural change conducted by community champions compared with brief advice only from the SPICES project (scaling-up packages of interventions for cardiovascular disease prevention in selected sites in Europe and sub-Saharan Africa). BMC Public Health 2021; 21:1422. [PMID: 34281516 PMCID: PMC8287807 DOI: 10.1186/s12889-021-11443-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/01/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cardiovascular diseases (CVD) caused 17.9 million deaths worldwide in 2016, being the world’s leading cause of death. Prevention of CVD in high-income countries is expensive and fails to reach the population at risk. In low-income countries, it is under-developed. The SPICES project implements a community-based program to improve CVD prevention in 3 European countries and 2 Sub-Saharan countries, based on using community champions to effect behavioural changes. In France, the project operates in “Pays Centre Ouest Bretagne” (COB) which is the Central West Brittany area, and a vulnerable, rural setting. The aim of this study is to assess this innovative prevention strategy versus brief advice. Methods A two-step RCT hybrid type 1 implementation study will first of all screen a population using the Non-Laboratory INTERHEART Score (NL-IHRS) and will involve health-care students at public events in the COB area until 1000 participants have been recruited. Second, a RCT will be carried out. The research team will contact each participant with an intermediate NL-IHRS in order to include them. Participants will be over 18 years of age and work or live in the COB area. Participants will be equally randomised in two groups. The intervention group will receive brief advice plus behavioural change guidance carried out by community champions. The control group will receive brief advice only. The main objective for the RCT is to assess a difference of at least 15% in the NL-IHRS between the two groups after 24 months. The primary outcome will be analysed with intention to treat. Secondary outcomes for the RCT will be assessed using validated questionnaires: the WHOQOL-BREF, the DASH Q questionnaire, the IPAQ-short; smoking level will be assessed according to the NL-IHRS scoring system; a modified self-declared alcohol consumption questionnaire has been developed and gauges will be used to assess BMI. The implementation strategy will use mixed methods: qualitative research methods and quantitative epidemiological studies. Discussion A difference in the mean NL-IHRS of 15% will provide an argument in favour of reorganising prevention policies. A substantial change would favour relocating primary prevention from healthcare professionals to lay people and the community. Trial registration Clinical Trials NCT03886064 - the study was recorded on ClinicalTrials.gov, the 22nd of March 2019.
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Affiliation(s)
- Delphine Le Goff
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France.
| | - Marie Barais
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France
| | - Gabriel Perraud
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France
| | - Jeremy Derriennic
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France
| | - Paul Aujoulat
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France
| | | | - Jean Yves Le Reste
- EA 7479 SPURBO, Department of general practice, University of Western Brittany, Brest, France
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Kocanda L, Brain K, Frawley J, Schumacher TL, May J, Rollo ME, Brown LJ. The Effectiveness of Randomized Controlled Trials to Improve Dietary Intake in the Context of Cardiovascular Disease Prevention and Management in Rural Communities: A Systematic Review. J Acad Nutr Diet 2021; 121:2046-2070.e1. [PMID: 34247977 DOI: 10.1016/j.jand.2021.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 05/07/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dietary intake is an important modifiable risk factor for cardiovascular disease. However, to our knowledge, there are no systematic reviews of nutrition interventions in the context of cardiovascular disease prevention and management within rural communities. This is important to investigate, given the unique geographic, social, and contextual factors associated with rurality. OBJECTIVE Our primary objective was to systematically assess evidence on the effectiveness of randomized controlled trials to improve dietary intake in the context of cardiovascular disease prevention and management in rural communities. METHODS Nine electronic databases were searched from inception to June 2020, including MEDLINE, The Cochrane Library, Embase, Emcare, PsycINFO, Scopus, Rural and Remote Health, CINAHL, and AMED. Randomized controlled trials that reported results of interventions with adult, rural populations and measured change in dietary intake compared to usual care, alternative intervention, or no intervention controls were included. Included randomized controlled trials were also assessed according to the TIDieR (Template for Intervention Description and Reporting) checklist and RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework. RESULTS Thirteen articles reporting results of randomized controlled trials were identified. Included articles reported a range of nutrition interventions and measured 18 dietary intake outcomes. Most studies (n = 10) demonstrated effectiveness in altering at least 1 dietary intake outcome, including fruit and/or vegetable (n = 9), fiber (n = 2), Dietary Risk Assessment score (n = 2), energy, dairy, carotene, vitamin C and sodium (all n = 1). However, there was wide variation in the reporting of intervention components (according to the TIDieR checklist) and impact (according to RE-AIM framework), resulting in difficulty interpreting the "real-world" implications of these results. CONCLUSIONS Through this systematic review, we found limited evidence of improvement in dietary intakes due to nutrition interventions in the context of cardiovascular disease prevention and management in rural communities. Fruit and/or vegetable intakes were the most frequently reported dietary intake outcomes, and most likely to be improved across the included studies. Included studies were generally not well reported, which may hinder replication by clinicians and consolidation of the evidence base by other researchers. Given the substantial burden of cardiovascular disease experienced by those living in rural areas of developed countries, additional high-quality nutrition research that acknowledges the complexities of rural health is required.
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Sperber NR, Dong OM, Roberts MC, Dexter P, Elsey AR, Ginsburg GS, Horowitz CR, Johnson JA, Levy KD, Ong H, Peterson JF, Pollin TI, Rakhra-Burris T, Ramos MA, Skaar T, Orlando LA. Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network. J Pers Med 2021; 11:647. [PMID: 34357114 PMCID: PMC8306482 DOI: 10.3390/jpm11070647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project's strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study's implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.
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Affiliation(s)
- Nina R. Sperber
- Duke Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27701, USA
- Durham VA Health Care System, Durham, NC 27705, USA
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (O.M.D.); (G.S.G.); (T.R.-B.); (L.A.O.)
| | - Olivia M. Dong
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (O.M.D.); (G.S.G.); (T.R.-B.); (L.A.O.)
| | - Megan C. Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Paul Dexter
- Regenstrief Institute, Indianapolis, Indiana University School of Medicine and Clem McDonald Center for Biomedical Informatics, Indianapolis, IN 46202, USA;
| | - Amanda R. Elsey
- Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610, USA; (A.R.E.); (J.A.J.)
| | - Geoffrey S. Ginsburg
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (O.M.D.); (G.S.G.); (T.R.-B.); (L.A.O.)
| | - Carol R. Horowitz
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Julie A. Johnson
- Center for Pharmacogenomics and Precision Medicine, Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610, USA; (A.R.E.); (J.A.J.)
| | - Kenneth D. Levy
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, 950 W. Walnut Street, Indianapolis, IN 46202, USA; (K.D.L.); (T.S.)
| | - Henry Ong
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (H.O.); (J.F.P.)
| | - Josh F. Peterson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (H.O.); (J.F.P.)
| | - Toni I. Pollin
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Tejinder Rakhra-Burris
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (O.M.D.); (G.S.G.); (T.R.-B.); (L.A.O.)
| | - Michelle A. Ramos
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Todd Skaar
- Division of Clinical Pharmacology, Department of Medicine, Indiana University School of Medicine, 950 W. Walnut Street, Indianapolis, IN 46202, USA; (K.D.L.); (T.S.)
| | - Lori A. Orlando
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, Durham, NC 27708, USA; (O.M.D.); (G.S.G.); (T.R.-B.); (L.A.O.)
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Puchalski Ritchie LM, Kip EC, Mundeva H, van Lettow M, Makwakwa A, Straus SE, Hamid JS, Zwarenstein M, Schull MJ, Chan AK, Martiniuk A, van Schoor V. Process evaluation of an implementation strategy to support uptake of a tuberculosis treatment adherence intervention to improve TB care and outcomes in Malawi. BMJ Open 2021; 11:e048499. [PMID: 34215610 PMCID: PMC8256754 DOI: 10.1136/bmjopen-2020-048499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence. DESIGN Mixed-methods design including a cluster randomised controlled trial and process evaluation informed by the RE-AIM framework. SETTING Forty-five health centres (HCs) in four districts in the south east zone of Malawi, who had an opportunity to receive cascade training. PARTICIPANTS Forty-five peer-trainers (PTs), 23 patients and 20 LHWs. INTERVENTION Implementation strategy employing peer-led educational outreach, a clinical support tool and peer support network to implement a TB treatment adherence intervention. OUTCOME MEASURES Process data were collected from study initiation to the end-of-study PT meeting, and included: LHW and patient interviews, quarterly PT meeting notes, training logs and study team observations and meeting notes. Data sources were first analysed in isolation, followed by method, data source and analyst triangulation. Analyses were conducted independently by two study team members, and themes revised through discussion and involvement of additional study team members as needed. RESULTS Forty-one HCs (91%) trained at least one LHW. Of 256 LHWs eligible to participate at study start 152 (59%) completed training, with the proportion trained per HC ranging from 0% to 100% at the end of initial cascade training. Lack of training incentives was the primary barrier to implementation, with intrinsic motivation to improve knowledge and skills, and to improve patient care and outcomes the primary facilitators of participation. CONCLUSION We identified important challenges to and potential facilitators of implementation, scalability and sustainability, of the TB treatment adherence intervention. Findings provide guidance to scale-up, and use of the implementation strategies employed, to address LHW training and supervision in other areas. TRIAL REGISTRATION NUMBER NCT02533089.
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Affiliation(s)
- Lisa M Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Emergency Medicine, University Health Netowrk, Toronto, Ontario, Canada
- Institute of Health policy, management, and evaluation, university of toronto, toronto, ontario, canada
| | | | - Hayley Mundeva
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Knowledge Translation Program, St Michael's Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Ontario, Canada
| | - Merrick Zwarenstein
- Family Medicine, Schulich School of Medicine and Dentistry Department of Family Medicine, London, Ontario, Canada
| | - Michael J Schull
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexandra Martiniuk
- The George Institute for Global Health, Newtown, New South Wales, Australia
- The University of Sydney, Sydney, New South Wales, Australia
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Pinheiro-Carozzo NP, Murta SG, Vinha LGDA, da Silva IM, Fontaine AMGV. Beyond effectiveness of the Strengthening Families Program (10-14): a scoping RE-AIM-based review. PSICOLOGIA-REFLEXAO E CRITICA 2021; 34:16. [PMID: 34131838 PMCID: PMC8206301 DOI: 10.1186/s41155-021-00182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.
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Affiliation(s)
- Nádia P Pinheiro-Carozzo
- Departamento de Psicologia, Centro de Ciências Humanas, Universidade Federal do Maranhão, Cidade Universitária Dom Delgado, Avenida dos Portugueses, 1966, Bacanga, São Luis, MA, 65080-805, Brazil.
| | - Sheila G Murta
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Luís Gustavo do A Vinha
- Departamento de Estatística, Instituto de Ciências Exatas, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Isabela M da Silva
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Anne Marie G V Fontaine
- Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
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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: 111] [Impact Index Per Article: 37.0] [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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Luo L, King AA, Carroll Y, Baumann AA, Brambilla D, Carpenter CR, Colla J, Gibson RW, Gollan S, Hall G, Klesges L, Kutlar A, Lyon M, Melvin CL, Norell S, Mueller M, Potter MB, Richesson R, Richardson LD, Ryan G, Siewny L, Treadwell M, Zun L, Armstrong-Brown J, Cox L, Tanabe P. Electronic Health Record-Embedded Individualized Pain Plans for Emergency Department Treatment of Vaso-occlusive Episodes in Adults With Sickle Cell Disease: Protocol for a Preimplementation and Postimplementation Study. JMIR Res Protoc 2021; 10:e24818. [PMID: 33861209 PMCID: PMC8087964 DOI: 10.2196/24818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 01/02/2023] Open
Abstract
Background Individuals living with sickle cell disease often require aggressive treatment of pain associated with vaso-occlusive episodes in the emergency department. Frequently, pain relief is poor. The 2014 National Heart, Lung, and Blood Institute evidence-based guidelines recommended an individualized treatment and monitoring protocol to improve pain management of vaso-occlusive episodes. Objective This study will implement an electronic health record–embedded individualized pain plan with provider and patient access in the emergency departments of 8 US academic centers to improve pain treatment for adult patients with sickle cell disease. This study will assess the overall effects of electronic health record–embedded individualized pain plans on improving patient and provider outcomes associated with pain treatment in the emergency department setting and explore barriers and facilitators to the implementation process. Methods A preimplementation and postimplementation study is being conducted by all 8 sites that are members of the National Heart, Lung, and Blood Institute–funded Sickle Cell Disease Implementation Consortium. Adults with sickle cell disease aged 18 to 45 years who had a visit to a participating emergency department for vaso-occlusive episodes within 90 days prior to enrollment will be eligible for inclusion. Patients will be enrolled in the clinic or remotely. The target analytical sample size of this study is 160 patient participants (20 per site) who have had an emergency department visit for vaso-occlusive episode treatment at participating emergency departments during the study period. Each site is expected to enroll approximately 40 participants to reach the analytical sample size. The electronic health record–embedded individualized pain plans will be written by the patient’s sickle cell disease provider, and sites will work with the local informatics team to identify the best method to build the electronic health record–embedded individualized pain plan with patient and provider access. Each site will adopt required patient and provider implementation strategies and can choose to adopt optional strategies to improve the uptake and sustainability of the intervention. The study is informed by the Technology Acceptance Model 2 and the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Provider and patient baseline survey, follow-up survey within 96 hours of an emergency department vaso-occlusive episode visit, and selected qualitative interviews within 2 weeks of an emergency department visit will be performed to assess the primary outcome, patient-perceived quality of emergency department pain treatment, and additional implementation and intervention outcomes. Electronic health record data will be used to analyze individualized pain plan adherence and additional secondary outcomes, such as hospital admission and readmission rates. Results The study is currently enrolling study participants. The active implementation period is 18 months. Conclusions This study proposes a structured, framework-informed approach to implement electronic health record–embedded individualized pain plans with both patient and provider access in routine emergency department practice. The results of the study will inform the implementation of electronic health record–embedded individualized pain plans at a larger scale outside of Sickle Cell Disease Implementation Consortium centers. Trial Registration ClinicalTrials.gov NCT04584528; https://clinicaltrials.gov/ct2/show/NCT04584528. International Registered Report Identifier (IRRID) DERR1-10.2196/24818
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Affiliation(s)
- Lingzi Luo
- Washington University School of Medicine, St Louis, MO, United States
| | - Allison A King
- Washington University School of Medicine, St Louis, MO, United States
| | - Yvonne Carroll
- St Jude Children's Research Hospital, Memphis, TN, United States
| | - Ana A Baumann
- Washington University in St. Louis, St Louis, MO, United States
| | | | | | - Joseph Colla
- University of Illinois Chicago, Chicago, IL, United States
| | | | | | - Greg Hall
- Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Klesges
- Washington University School of Medicine, St Louis, MO, United States.,University of Memphis, Memphis, TN, United States
| | | | | | - Cathy L Melvin
- Medical University of South Carolina, Charleston, SC, United States
| | - Sarah Norell
- University of Illinois Chicago, Chicago, IL, United States
| | - Martina Mueller
- Medical University of South Carolina, Charleston, SC, United States
| | - Michael B Potter
- University of California San Francisco, San Francisco, CA, United States
| | | | | | - Gery Ryan
- The RAND Corporation, Santa Monica, CA, United States
| | | | - Marsha Treadwell
- University of California San Francisco, San Francisco, CA, United States
| | - Leslie Zun
- Chicago Medical School, North Chicago, IL, United States
| | | | - Lisa Cox
- RTI International, Durham, NC, United States
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Galligan MM, Wolfe HA, Papili KE, Porter E, O'Shea K, Liu H, Colfer A, Neiswender K, Granahan K, McGowan N, McGrath AM, Shaw KN, Sutton RM. Implementation of a Multidisciplinary Debriefing Process for Pediatric Ward Deterioration Events. Hosp Pediatr 2021; 11:454-461. [PMID: 33858988 DOI: 10.1542/hpeds.2020-002014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Event debriefing has established benefit, but its adoption is poorly characterized among pediatric ward providers. To improve patient safety, our hospital restructured its debriefing process for ward deterioration events culminating in ICU transfer. The aim of this study was to describe this process' implementation. METHODS In the restructured process, multidisciplinary ward providers are expected to debrief all ICU transfers. We conducted a multimethod analysis using facilitative guides completed by debriefing participants. Monthly debriefing completion served as an adoption metric. RESULTS Between March 2019 and February 2020, providers across 9 wards performed debriefing for 134 of 312 PICU transfers (43%). Bedside nurses participated most frequently (117 debriefings [87%]). There was no significant difference in debriefing by unit, acuity, season, or nurse staffing. Compared with units fully staffed by rotational frontline clinicians (FLCs; eg, resident physicians), units with dedicated FLCs whose responsibilities are primarily limited to that unit (eg, oncology hospitalists) completed significantly more monthly debriefings (average [SD] 57% [30%] vs 33% [28%] of PICU transfers; P = .004). FLC participation was also higher on these units (50% of debriefings [37%] vs 24% [37%]; P = .014). Through qualitative analysis, we identified distinct debriefing themes, with teaming activities such as communication cited most often. CONCLUSIONS Implementation of a multidisciplinary debriefing process for ward deterioration events culminating in ICU transfer was associated with differential adoption across providers and FLC staffing models but not acuity or nurse staffing. Teaming activities were a debriefing priority. Future study will assess patient safety outcomes.
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Affiliation(s)
- Meghan M Galligan
- Departments of Pediatrics, .,Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather A Wolfe
- Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and.,Anesthesiology and Critical Care Medicine
| | | | - Ezra Porter
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kelly O'Shea
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Andrea Colfer
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kristin Neiswender
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | | | - Anne Marie McGrath
- Center for Healthcare Quality and Analytics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Kathy N Shaw
- Departments of Pediatrics.,Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, and
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Miller DM, Gaviglio A, Zierhut HA. Development of an Implementation Framework for Overcoming Underdiagnoses of Familial Hypercholesterolemia in the USA. Public Health Genomics 2021; 24:110-122. [PMID: 33853081 DOI: 10.1159/000513872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a genetic condition which causes elevated low-density lipoprotein cholesterol from birth. With a prevalence of 1 in 250 and the availability of effective treatments, the diagnostic rate of <1 to 10% is unacceptably low. Screening for FH is supported by multiple organizations, but it has not been broadly adopted and implemented across the USA. To investigate the implementation of FH screening, key informants were recruited from across the USA for their expertise in FH-related literature, guidelines, public health, and/or advocacy to complete -semistructured interviews guided by implementation science (RE-AIM framework). Sixteen semistructured interviews were analyzed with directed content and thematic analyses, yielding specific barriers and recommendations to improve FH screening. Barriers to FH screening included patient recruitment and participation, equitable access to healthcare, provider discomfort with screening and treating FH, provider burden, lack of public health and legislative support, FH awareness, guideline complexity, facilitation of genetic testing and cascade screening, and lack of coordination between stakeholders. Awareness, engagement, communication, and collaboration between stakeholders is integral to successful FH screening. Individualized plans will be required at national, regional, and institutional levels. FH screening implementation can be achieved through practice facilitation, streamlined screening approaches, electric medical record tools, and consensus guidelines to increase screening adoption and consistent delivery. Reliable funding and established lines of communication between stakeholders can maintain efforts as FH screening progresses.
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Affiliation(s)
- Dana M Miller
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy Gaviglio
- G2S Corporation/CDC Newborn Screening and Molecular Biology Branch, Atlanta, Georgia, USA
| | - Heather A Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
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Gustavson AM, LeDoux CV, Stutzbach JA, Miller MJ, Seidler KJ, Stevens-Lapsley JE. Mixed-Methods Approach to Understanding Determinants of Practice Change in Skilled Nursing Facility Rehabilitation: Adapting to and Sustaining Value With Postacute Reform. J Geriatr Phys Ther 2021; 44:108-118. [PMID: 33534337 PMCID: PMC8869848 DOI: 10.1519/jpt.0000000000000288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Postacute care reform is driving physical and occupational therapists in skilled nursing facilities (SNFs) to change how they deliver care to produce better outcomes in less time. However, gaps exist in understanding determinants of practice change, which limits translation of evidence into practice. This study explored what determinants impacted change in care delivery at 2 SNFs that implemented a high-intensity resistance training intervention. METHODS We used a mixed-methods, sequential explanatory design to explain quantitative findings using qualitative methods with a multiple-case study approach. Quantitative data were collected on therapists' attitudes toward evidence-based practice and aspects of intervention implementation. We conducted focus groups with therapists (N = 15) at 2 SNFs, classified as either high- (SNF-H) or low-performing (SNF-L) based on implementation fidelity and sustainability. RESULTS AND DISCUSSION Determinants of SNF rehabilitation practice change included the organizational system, team dynamics, patient and therapist self-efficacy, perceptions of intervention effectiveness, and ability to overcome preconceived notions. A patient-centered system, positive team dynamics, and ability to overcome preconceived notions fostered practice change at SNF-H. While self-efficacy and perception of effectiveness positively impacted change in practice at both SNFs, these determinants were not enough to overcome challenges at SNF-L. To adapt to changes and sustain rehabilitation value, further research must identify the combination of determinants that promote application of evidence-based practice. CONCLUSIONS This study is the first step in understanding what drives change in SNF rehabilitation practice. As SNF rehabilitation continues to face changes in health care delivery and reimbursement, therapists will need to adapt, by changing practice patterns and adopting evidence-based approaches, to demonstrate value in postacute care.
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Affiliation(s)
- Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Cherie V LeDoux
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - Julie A Stutzbach
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
| | - Matthew J Miller
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco
- Division of Geriatrics, University of California, San Francisco
| | - Katie J Seidler
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora
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JGIM Welcomes Quality Improvement and Implementation Science Submissions on Healthcare Delivery Change. J Gen Intern Med 2021; 36:857-860. [PMID: 33661487 PMCID: PMC8041953 DOI: 10.1007/s11606-021-06645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Purdy GM, Sobierajski FM, Dolgoy ND, McNeely ML. Evaluating implementation and pragmatism of cancer-specific exercise programs: a scoping review. J Cancer Surviv 2021; 16:374-387. [PMID: 33791956 DOI: 10.1007/s11764-021-01032-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Studies in exercise oncology are increasingly evaluating the implementation of cancer-specific exercise programming in real-world settings. Evaluating current implementation efforts and identifying current research gaps may inform future implementation. This scoping review explores studies implementing cancer-specific exercise programs to determine their pragmatic characteristics and evaluate potential for translation into practice. METHODS A systematic literature search was conducted using five databases (up to July 2020) to identify implementation studies that used qualitative or quantitative methods. Program pragmatism was evaluated using the PRECIS/RE-AIM tool. RESULTS Fourteen articles were included for review. While programs were moderately pragmatic (average: 3.4; range: 2.8-4.2), variability was observed between scoring domains. Programs scored higher (more pragmatic) in domains typical for effectiveness studies, including participant eligibility, follow-up intensity, primary trial outcome, and analysis of primary outcome. In contrast, programs scored lower (less pragmatic) in domains aligned with implementation science, including intervention flexibility, adoption, implementation, and maintenance. Limited information was reported regarding program fidelity, adaptations, and maintenance/sustainability. CONCLUSION Researchers should consider the pragmatism of interventions, the nuances of program adoption and implementation at the setting level, and the transition and integration of programming into the healthcare system. Future studies may benefit from the inclusion of decision-makers and implementation experts and shifting focus towards flexible programming. PRECIS/RE-AIM may facilitate the evaluation of programs throughout the study design and implementation process. IMPLICATIONS FOR CANCER SURVIVORS The implementation of pragmatic exercise programs that are both scalable and sustainable is needed so that cancer survivors can experience exercise-related benefits beyond research settings.
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Affiliation(s)
- Graeme M Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Frances M Sobierajski
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naomi D Dolgoy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada. .,Rehabilitation Medicine, Cross Cancer Institute, Edmonton, AB, Canada.
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Matlock DD, McIlvennan CK, Thompson JS, Morris MA, Venechuk G, Dunlay SM, LaRue SJ, Lewis EF, Patel CB, Blue L, Chaussee EL, Glasgow RE, Walsh MN, Allen LA. Decision Aid Implementation among Left Ventricular Assist Device Programs Participating in the DECIDE-LVAD Stepped-Wedge Trial. Med Decis Making 2021; 40:289-301. [PMID: 32428430 DOI: 10.1177/0272989x20915227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background. Despite demonstrated efficacy, patient decision aids (DAs) are rarely used in clinical practice in the absence of coverage mandates. Deciding whether to pursue a left ventricular assist device (LVAD) is a major, preference-sensitive decision-ideal for exploring implementation of a DA. Methods. We conducted a type II effectiveness-implementation hybrid trial at 6 LVAD programs using a stepped-wedge cluster-randomized design. Using the RE-AIM framework, we collected both quantitative and qualitative outcomes, including a checklist collected by study staff for each enrolled patient regarding DA use and interviews with LVAD program clinicians preintervention, 6 months postintervention, and at the conclusion of the study. Results. From June 2015 to January 2017, 248 patients and their caregivers were enrolled. A total of 69 interviews were conducted with 48 clinicians at 3 time points. The DA reached 95% of eligible patients. Adoption was 100%, as all sites approached agreed to participate in the trial. Interviews revealed several themes related to the implementation of the DA: clinicians had a strong desire to ensure patients were informed and embraced the DA. Despite this, they reported communication challenges among their team that impeded implementation. Five of the 6 sites have maintained use of the DA following the trial; 1 site reported concerns about decreased procedural volume with use of the DA as a reason for discontinuation. Conclusions. In this hybrid trial, a DA for patients considering LVADs and their caregivers demonstrated high reach. Adoption and implementation were facilitated by a strong desire to ensure that patients were well informed. Future dissemination research and practice should attend to concerns about procedure volume and coverage mandates and facilitate ongoing communication at sites using the DA.
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Affiliation(s)
- Daniel D Matlock
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA.,Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Colleen K McIlvennan
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jocelyn S Thompson
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan A Morris
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Grace Venechuk
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shannon M Dunlay
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Shane J LaRue
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Laura Blue
- Duke University Medical Center, Durham, NC, USA
| | - Erin L Chaussee
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Russell E Glasgow
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Mary Norine Walsh
- St. Vincent Heart Center, Division of Cardiology, Indianapolis, IN, USA
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
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O'Grady MA, Conigliaro J, Levak S, Morley J, Kapoor S, Ritter M, Marini C, Morgenstern J. "I Felt I Was Reaching a Point with My Health": Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care. J Prim Care Community Health 2021; 12:21501327211003005. [PMID: 33733921 PMCID: PMC7983431 DOI: 10.1177/21501327211003005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION/OBJECTIVES Despite increasing need, there are large gaps in provision of care for unhealthy alcohol use. Primary care practices have become increasingly important in providing services for unhealthy alcohol use, yet little is known about the reasons patients engage in these services and their views on acceptability of such programs. The purpose of this study was to examine primary care patients' reasons for engagement, experiences with, and acceptability of a primary care practice-based program for treating unhealthy alcohol use. METHODS This qualitative study was conducted in a primary care practice that was developing a collaborative care model for treating unhealthy alcohol use in primary care. Semi-structured interviews were conducted with 24 primary care patients. Data were analyzed using conventional qualitative content analysis. RESULTS Findings suggest that patients engaged for both internal (concerns about drinking and health) and external reasons (family or provider concern). Patient experiences in the program were shaped by their affective responses (enjoyable, enlightening), as well as therapeutic benefits (gaining new insights about drinking; staff/provider support). Acceptability was driven by core program elements (medication, therapy, integration) as well as positive impacts on drinking cognition and behavior and flexible, patient-centered approaches. CONCLUSIONS Offering flexible and comprehensive programs with mutiple elements and both abstinence and moderation goals could also improve patient engagement and views on acceptability. Primary care practices will need to be thoughtful about the resources needed to implement these programs in terms of staffing, training, and program support.
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Affiliation(s)
- Megan A O'Grady
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Joseph Conigliaro
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | - Jeanne Morley
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Sandeep Kapoor
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | | | | | - Jon Morgenstern
- Northwell Health, Manhasset, NY, USA.,Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
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Kepper MM, Walsh-Bailey C, Brownson RC, Kwan BM, Morrato EH, Garbutt J, de las Fuentes L, Glasgow RE, Lopetegui MA, Foraker R. Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model. Front Digit Health 2021; 3:648777. [PMID: 34713122 PMCID: PMC8521811 DOI: 10.3389/fdgth.2021.648777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Health information technology (HIT) has not been broadly adopted for use in outpatient healthcare settings to effectively address obesity in youth, especially among disadvantaged populations that face greater barriers to good health. A well-designed HIT tool can deliver behavior change recommendations and provide community resources to address this gap, and the Obesity-Related Behavioral Intervention Trials (ORBIT) model can guide its development and refinement. This article reports the application of the ORBIT model to (1) describe the characteristics and design of a novel HIT tool (the PREVENT tool) using behavioral theory, (2) illustrate the use of stakeholder-centered "designing for dissemination and sustainability" principles, and (3) discuss the practical implications and directions for future research. Two types of stakeholder engagement (customer discovery and user testing) were conducted with end users (outpatient healthcare teams). Customer discovery interviews (n = 20) informed PREVENT tool components and intervention targets by identifying (1) what healthcare teams (e.g., physicians, dietitians) identified as their most important "jobs to be done" in helping adolescents who are overweight/obese adopt healthy behaviors, (2) their most critical "pains" and "gains" related to overweight/obesity treatment, and (3) how they define success compared to competing alternatives. Interviews revealed the need for a tool to help healthcare teams efficiently deliver tailored, evidence-based behavior change recommendations, motivate patients, and follow-up with patients within the constraints of clinic schedules and workflows. The PREVENT tool was developed to meet these needs. It facilitates prevention discussions, delivers tailored, evidence-based recommendations for physical activity and food intake, includes an interactive map of community resources to support behavior change, and automates patient follow-up. Based on Self-Determination Theory, the PREVENT tool engages the patient to encourage competence and autonomy to motivate behavior change. The use of this intentional, user-centered design process should increase the likelihood of the intended outcomes (e.g., behavior change, weight stabilization/loss) and ultimately increase uptake, implementation success, and long-term results. After initial tool development, user-testing interviews (n = 13) were conducted using a think-aloud protocol that provided insight into users' (i.e., healthcare teams) cognitive processes, attitudes, and challenges when using the tool. Overall, the PREVENT tool was perceived to be useful, well-organized, and visually appealing.
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Affiliation(s)
- Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Bethany M. Kwan
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Elaine H. Morrato
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Jane Garbutt
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Lisa de las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Russell E. Glasgow
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Marcelo A. Lopetegui
- Centro de Informática Biomédica, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Randi Foraker
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
- Center for Population Health Informatics, Institute for Informatics, Washington University in St. Louis, St. Louis, MO, United States
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Evaluating context-specific evidence-based quality improvement intervention on lymphatic filariasis mass drug administration in Northern Ghana using the RE-AIM framework. Trop Med Health 2021; 49:16. [PMID: 33602322 PMCID: PMC7890643 DOI: 10.1186/s41182-021-00305-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Over a decade of implementing a global strategy to eliminate lymphatic filariasis in Ghana through mass drug administration, the disease is still being transmitted in 11 districts out of an initial 98 endemic districts identified in 2000. A context-specific evidence-based quality improvement intervention was implemented in the Bole District of Northern Ghana after an initial needs assessment to improve the lymphatic filariasis mass drug administration towards eliminating the disease. Therefore, this study aimed to evaluate the process and impact of the lymphatic filariasis context-specific evidence-based quality improvement intervention in the Bole District of Northern Ghana. Method A cross-sectional mixed methods study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the context-specific evidence-based quality improvement intervention was employed. Quantitative secondary data was extracted from the neglected tropical diseases database. A community survey was conducted with 446 randomly selected participants. Qualitative data were collected from 42 purposively selected health workers, chiefs/opinion leaders and community drug distributors in the study area. Results The evaluation findings showed an improvement in social mobilisation and sensitisation, knowledge about lymphatic filariasis and mass drug administration process, willingness to ingest the medication and adherence to the direct observation treatment strategy. We observed an increase in coverage ranging from 0.1 to 12.3% after implementing the intervention at the sub-district level and reducing self-reported adverse drug reaction. The level of reach, effectiveness and adoption at the district, sub-district and individual participants’ level suggest that the context-specific evidence-based quality improvement intervention is feasible to implement in lymphatic filariasis hotspot districts based on initial context-specific needs assessment. Conclusion The study provided the groundwork for future application of the RE-AIM framework to evaluate the implementation of context-specific evidence-based quality improvement intervention to improve lymphatic filariasis mass drug administration towards eliminating the disease as a public health problem.
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Thompson JS, Fitzgerald MD, Allen LA, McIlvennan CK, Glasgow RE, Wynia M, Morris MA, Beilenson J, Gherst C, Matlock DD. Shared Decision-Making for Left Ventricular Assist Devices: Rationale and Design of a Nationwide Dissemination and Implementation Project. Circ Cardiovasc Qual Outcomes 2021; 14:e007256. [PMID: 33530698 PMCID: PMC7887063 DOI: 10.1161/circoutcomes.120.007256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The left ventricular assist device (LVAD) has become a common medical option for patients with end-stage heart failure. Although patients' chances of survival may increase with an LVAD compared with medical therapy, the LVAD poses many risks and requires major lifestyle changes, thus making it a complex medical decision. Our prior work found that a decision aid for LVADs significantly increased decision quality for both patients and caregivers and was successfully implemented at 6 LVAD programs. Methods In follow-up, we are conducting a nationwide dissemination and implementation project, with the goal of implementing the decision aid at as many of the 176 LVAD programs in the United States as possible. Guided by the Theory of Diffusion of Innovations, the project consists of 4 phases: (1) building a network; (2) promoting adoption; (3) supporting implementation; and (4) encouraging maintenance. Developing an LVAD network of contacts occurs by using a national baseline survey of LVAD clinicians, existing professional relationships, and an internet-based strategy. A suite of resources targeted to promote adoption and support implementation of the decision aid into standard LVAD education processes are provided to the network. Evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance framework, where clinician and patient surveys and qualitative interviews determine the reach, effectiveness, adoption, implementation, and maintenance achieved. Conclusions This project is a true dissemination study in that it targets the entire population of LVAD programs in the United States and is unique in its use of social marketing principles to promote adoption and implementation. The implementation plan is intended to serve as a test case and model for dissemination and implementation of other evidence-based decision support aids and strategies.
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Affiliation(s)
- Jocelyn S. Thompson
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Monica D. Fitzgerald
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Larry A. Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Colleen K. McIlvennan
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO
| | - Russell E. Glasgow
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
| | - Matthew Wynia
- Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, CO
| | - Megan A. Morris
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO
| | | | - Chris Gherst
- Strategic Communications and Planning, Inc., Wayne, PA
| | - Dan D. Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, CO
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO
- Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO
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Chung FR, Turecamo S, Cuthel AM, Grudzen CR. Effectiveness and Reach of the Primary Palliative Care for Emergency Medicine (PRIM-ER) Pilot Study: a Qualitative Analysis. J Gen Intern Med 2021; 36:296-304. [PMID: 33111240 PMCID: PMC7878660 DOI: 10.1007/s11606-020-06302-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Palliative care interventions in the ED capture high-risk patients at a time of crisis and can dramatically improve patient-centered outcomes. OBJECTIVE To understand the facilitators that contributed to the success of the Primary Palliative Care for Emergency Medicine (PRIM-ER) quality improvement pilot intervention. DESIGN Effectiveness was evaluated through semi-structured interviews. Reach outcomes were measured by percent of all full-time emergency providers (physicians, physician assistants, nurses) who completed the intervention education components and baseline survey assessing attitudes and knowledge on end-of-life care. PARTICIPANTS Emergency medicine providers affiliated with two medical centers (N = 197). Interviews conducted with six key informants at both institutions. APPROACH Interviews were recorded, transcribed, and analyzed using deductive and inductive approaches. Descriptive statistics include reach outcomes and baseline survey results. KEY RESULTS Both sites successfully implemented all components of the intervention and achieved a high level (> 75%) of intervention reach. Two themes emerged as facilitators to successful effectiveness facilitators of PRIM-ER: (1) institutional leadership support and (2) leveraging established quality improvement (QI) processes. Institutional support included leveraging leadership with authority to (a) mandate trainings; (b) substitute PRIM-ER education for normally scheduled education; and (c) provide protected time to implement intervention components. Effectiveness was also enhanced by capitalizing on existing QI processes which included (a) leveraging interdisciplinary partnerships and communication plans and (b) monitoring performance improvement data. CONCLUSIONS Capitalizing on strong institutional leadership support and established QI processes enhanced the reach and effectiveness of the PRIM-ER pilot. These findings will guide the PRIM-ER researchers in scaling up the intervention in the remaining 33 sites, as well as enhance the planning of other complex quality improvement interventions in clinical settings. REGISTRATION DETAILS ClinicalTrials.gov Identifier: NCT03424109; Grant Number: AT009844-01.
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Affiliation(s)
- Frank R Chung
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
| | - Sarah Turecamo
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
| | - Allison M Cuthel
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA.
| | - Corita R Grudzen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, 227 East 30th Street, 117, New York, NY, 10016, USA
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Kim J, Shakya PR, Choi S, Park JS, Tamrakar SR, Heo J, Kim WH. An evaluation of obstetric ultrasound education program in Nepal using the RE-AIM framework. BMC MEDICAL EDUCATION 2021; 21:57. [PMID: 33446193 PMCID: PMC7809758 DOI: 10.1186/s12909-021-02484-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nepal has a high prevalence of congenital anomaly contributing to high infant mortality. Ultrasound, an important tool to detect congenital anomalies and manage maternity-related risk factors, is not properly used in Nepal because Nepali doctors have limited opportunities for learning ultrasound techniques. Hence, we developed and implemented an ultrasound education program from 2016 to 2018. The objective of this study is to evaluate the education program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. METHODS We conducted a mixed-method study to evaluate each component of RE-AIM. The team collected quantitative data from administrative records, tests, surveys, and an online follow-up survey. Qualitative data were collected from individual in-depth interviews at least a year after the program. The proportions, means, and t-tests were used for quantitative data, and thematic coding for qualitative data. RESULTS A total of 228 healthcare workers representing 27.3% of the districts of Nepal were reached from 2016 to 2018. The program improved participants' knowledge (29.3, 8.7, and 23.8 increases out of 100, each year, p< 0.001, n=85) and self-confidence (0.6, 0.3, 1.3 increases out of 4.0, p< 0.01, n=111). The participants were highly satisfied with the program (4.2, 4.1, and 4.0 out of 5.0, n=162). Among the respondents of the online follow-up survey (n=28), 60.7% had used ultrasound in their daily practice after the education program, and a medical institution established an ultrasound training center. The absence of clear accreditation and practical guidelines in ultrasound use were presented as barriers for adoption and maintenance. CONCLUSION The program was successful in improving participant's knowledge and self-confidence in ultrasound techniques and showed great potential for the adoption and maintenance of the techniques in their practice. Continuous implementation of the program and institutional policy changes to facilitate ultrasound use may increase the ultrasound use and improve ultrasound service quality in Nepal.
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Affiliation(s)
- Jieun Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Prabin Raj Shakya
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Community Program, Dhulikhel Hospital-Kathmandu University Hospital, Kavre, Nepal
| | - Sugy Choi
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Joong Shin Park
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suman Raj Tamrakar
- Department of Obstetrics and Gynecology, Dhulikhel Hospital-Kathmandu University Hospital, Kavre, Nepal
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- National Assembly Futures Institute, Seoul, Republic of Korea.
| | - Woong-Han Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Jensen NH, Aaby A, Ryom K, Maindal HT. A CHAT about health literacy - a qualitative feasibility study of the Conversational Health Literacy Assessment Tool (CHAT) in a Danish municipal healthcare centre. Scand J Caring Sci 2020; 35:1250-1258. [PMID: 33314213 PMCID: PMC9290499 DOI: 10.1111/scs.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/04/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understanding individual health literacy needs is crucial when designing supportive and effective health care. However, tools assessing health literacy in practice are lacking. The Conversational Health Literacy Assessment Tool (CHAT) was recently developed, but its ability to assess health literacy remains unexplored. We aimed to investigate the implementation and adoption of CHAT, its ability to increase awareness of health literacy among healthcare providers, and if CHAT could assess health literacy needs in patients. METHODS We performed a qualitative feasibility study of CHAT among healthcare providers (nurses, physiotherapists and occupational therapists) who provide rehabilitation services for patients with noncommunicable diseases in a municipal healthcare centre in Denmark. The study used the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to structure interview guide and analysis. We collected qualitative data from four small focus groups with healthcare providers (n = 11). The data were analysed using a deductive thematic three-step method for organising and interpreting data. All informants provided written informed consent prior to data collection. RESULTS CHAT seems to be a feasible and efficient tool for assessing health literacy needs among individuals with different socio-demographic characteristics and with different diagnoses. CHAT was easiest implemented and adopted by healthcare providers, who were already familiarly with the concept of health literacy. The informants emphasised that an introduction to CHAT and health literacy as concept was valuable for the adoption. Some of them felt frustrated that they did not have opportunity and options to meet the health literacy needs identified by CHAT. CONCLUSIONS CHAT is a promising tool for assessing individual health literacy needs and increasing awareness of health literacy among healthcare providers. For successfully implementation of CHAT, we recommend developing a structured implementation programme, including an introduction to health literacy and an outline of the options for acting upon CHAT results.
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Affiliation(s)
| | - Anna Aaby
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Knud Ryom
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Health Promotion, Steno Diabetes Centre Copenhagen, Gentofte, Denmark
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Embedding Active Pedagogies within Pre-Service Teacher Education: Implementation Considerations and Recommendations. CHILDREN-BASEL 2020; 7:children7110207. [PMID: 33147706 PMCID: PMC7692750 DOI: 10.3390/children7110207] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
The physical activity levels of children in Australia are critically low and correlate with reduced academic achievement and poor health outcomes. Schools provide an ideal setting for physical activity interventions to help children move more. Instead of targeting in-service teachers, this study embedded an evidence-based active pedagogy program called Transform-Ed! into pre-service teacher education. Pre/post surveys and post-program interviews and focus group discussions were conducted with key stakeholders (n = 5), lecturers (n = 6), and pre-service teachers (n = 274) involved with the 12-week program. The design, implementation, and evaluation of the study were systematically guided by all five dimensions of Glasgow and colleagues’ RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Linear mixed models, descriptive analysis and a framework approach were used to analyse the data. Significant improvements were observed in pre-service teachers’ willingness, confidence, and competence to implement physically active pedagogic strategies following the intervention. Pre-service teacher perceived effectiveness of such strategies on student outcomes also significantly increased and perceived barriers decreased. High adherence was consistently reported and the program was maintained after completion of the implementation trial by all lecturers. Four key themes spanning multiple dimensions and participant levels informed recommendations for program scalability: an “inter-systemic approach”, a “co-design” approach, “embedded in professional practice”, and “evidence of impact” on teacher practice. Anchored in real-world settings and tethered by implementation science, Transform-Ed! could have the potential to advance the teaching capability of teachers, and transform the learning experience and physical and academic outcomes of primary school students.
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139
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Gilleland Marchak J, Halpin SN, Escoffery C, Owolabi S, Mertens AC, Wasilewski-Masker K. Using formative evaluation to plan for electronic psychosocial screening in pediatric oncology. Psychooncology 2020; 30:202-211. [PMID: 32931620 DOI: 10.1002/pon.5550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/21/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To demonstrate how formative research methods can be used to plan for implementation of evidence-based psychosocial screening in pediatric oncology. METHODS Multidisciplinary pediatric oncology professionals participated in focus groups to adapt the distress thermometer for electronic administration and develop health systems processes to promote psychosocial screening in the pediatric oncology outpatient clinic setting. Seven 1-hour focus groups were conducted using a structured guide based on the reach, efficacy, adoption, implementation, and maintenance framework and transcribed verbatim. Two independent raters coded transcripts using a quasi-deductive approach with high inter-coder reliability (Cohen kappa >0.80). RESULTS Participants' (N = 44) responses were used to identify overarching topics related to the adoption, implementation, and maintenance of electronic screening (e-screening) including: barriers to meeting families' psychosocial needs, identification of champions, suggestions to adapt the proposed e-screening program, perceived barriers to e-screening, and potential impact of carrying out e-screening. Following review of qualitative data, we employed specific implementation strategies to promote adoption, implementation, and maintenance of an e-screening program. CONCLUSIONS Perceived barriers to the implementation of psychosocial screening remain substantial, yet enthusiasm for using electronic health records (EHRs) technology to help meet patient needs through regular assessment was evident among pediatric oncology professionals. Electronic administration of screening and integration of results into the EHR in real time were identified as critical needs to overcome barriers to e-screening. Formative research including qualitative data from stakeholders can be used to tailor implementation strategies to successfully support the adoption, implementation, and maintenance of e-screening programs in pediatric oncology.
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Affiliation(s)
- Jordan Gilleland Marchak
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Sean N Halpin
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Shadé Owolabi
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ann C Mertens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Karen Wasilewski-Masker
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Miller MJ, Pak SS, Keller DR, Barnes DE. Evaluation of Pragmatic Telehealth Physical Therapy Implementation During the COVID-19 Pandemic. Phys Ther 2020; 101:5930367. [PMID: 33284318 PMCID: PMC7665714 DOI: 10.1093/ptj/pzaa193] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/27/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective was to evaluate implementation of telehealth physical therapy in response to COVID-19 and identify implementation strategies to maintain and scale up telehealth physical therapy within a large urban academic medical center. METHODS The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework was used to evaluate telehealth physical therapy implementation. Patient-level data were extracted from electronic medical records between March 16, 2020, and May 16, 2020 (implementation phase). Reach was defined as the proportion of physical therapy sessions completed via telehealth. Effectiveness was assessed using a patient-reported satisfaction survey with a 5-point Likert scale. Adoption was defined as the proportion of physical therapists who used telehealth. Implementation was assessed through qualitative analysis of patient and clinician perspectives to identify emergent themes, retrospectively classify strategies used during the implementation phase, and prospectively identify evidence-based strategies to increase telehealth maintenance and scale-up. Maintenance of telehealth was defined as the proportion of patients who indicated they would attend another telehealth session. RESULTS There were 4548 physical therapy sessions provided by 40 therapists from March 22, 2020, to May 16, 2020, of which 3883 (85%) were telehealth. Ninety-four percent of patients were satisfied. All physical therapists (100%) used telehealth technology at least once. Retrospectively classified and prospectively identified evidence-based strategies were organized into 5 qualitative themes that supported implementation: organizational factors (policies, preexisting partnerships), engaging external stakeholders (satisfaction survey), champions (clinician leaders), clinician education (dynamic, ongoing training), and process (promote adaptability, small tests of change). Ninety-two percent of patients reported they would attend another telehealth session. CONCLUSION Findings from this study suggest that implementation of telehealth physical therapy during the COVID-19 pandemic was feasible and acceptable in this setting. IMPACT These results can be used to guide future health policy, quality improvement, and implementation science initiatives to expand the use and study of telehealth for physical therapy.
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Affiliation(s)
- Matthew J Miller
- Department of Physical Therapy and Rehabilitation Science, and Division of Geriatrics, University of California, San Francisco, 1500 Owens Street, Box 0736, San Francisco, CA 94158, USA,Address all correspondence to Dr Miller at:
| | - Sang S Pak
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Daniel R Keller
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Deborah E Barnes
- Department of Psychiatry and Behavioral Sciences, and Department of Epidemiology and Biostatistics, University of California, San Francisco; and San Francisco VA Health Care System, San Francisco, California, USA
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Whooten RC, Horan C, Cordes J, Dartley AN, Aguirre A, Taveras EM. Evaluating the Implementation of a Before-School Physical Activity Program: A Mixed-Methods Approach in Massachusetts, 2018. Prev Chronic Dis 2020; 17:E116. [PMID: 33006544 PMCID: PMC7553220 DOI: 10.5888/pcd17.190445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose and Objectives Our aim was to evaluate the implementation of a widely available, before-school, physical activity program in a low-resource, racially/ethnically and socioeconomically diverse, urban school setting to identify adaptations needed for successful implementation. Intervention Approach We used a collaborative effort with stakeholders to implement the Build Our Kids’ Success (BOKS) program in 3 schools in Revere, Massachusetts. Program structure followed a preexisting curriculum, including 60-minute sessions, 3 mornings per week, over 2 sessions (spring and fall 2018). Programs had a capacity of 40 students per school per session and the ability to adapt as needed. Evaluation Methods We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. RE-AIM domains were assessed by use of baseline and follow-up student measures, parent interviews, and program administrative records. Results From a district of 11 schools, 3 schools (2 elementary, 1 middle) implemented the BOKS program. Program enrollment reached 82% capacity (188 of 230 potential participants). Of the 188 enrolled students, 128 (68%) had parental consent for study participation. Among the 128 study participants, 61 (48%) were male, 52 (41%) identified as Hispanic/Latino, and mean age was 9.3 years (SD, 2.2). Program duration varied by school (25–60 minutes), with a mean of 33% (SD, 16%) of the session spent in actigraphy-measured moderate-to-vigorous physical activity (MVPA), or mean 16.3 (SD, 9.3) minutes of MVPA. Participants attended a median 90% (interquartile range [IQR], 56%–97%) of sessions. We observed no change in body mass index (BMI) z score or self-reported quality of life from baseline to follow-up assessment. Parents reported positive program effects. Enrollment was sustained in elementary schools and decreased in the middle school during the study period, expanding to 3 additional schools for spring 2019. Implications for Public Health Implementation and evaluation of an evidence-based physical activity program, in a low-resource setting, are feasible and yield relevant information about program adaptations and future dissemination of similar programs.
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Affiliation(s)
- Rachel C Whooten
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114. .,Division of Endocrinology, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jack Cordes
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
| | - Anna Nicole Dartley
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Annabelle Aguirre
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts.,Kraft Center for Community Health, Massachusetts General Hospital, Boston, Massachusetts.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
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Callejo-Black A, Wagner DV, Ramanujam K, Manabat AJ, Mastel S, Riley AR. A Systematic Review of External Validity in Pediatric Integrated Primary Care Trials. J Pediatr Psychol 2020; 45:1039-1052. [PMID: 32909603 DOI: 10.1093/jpepsy/jsaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. METHODS We searched Medline, CINAHL, PsycINFO, the Cochrane Center Register of Controlled Trials, and relevant literature to identify publications from 1998 to 2018 reporting on open, randomized, or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. For each publication, we extracted the information reported in each RE-AIM domain and calculated the proportion of the total studies reviewed. RESULTS Thirty-nine publications describing 25 studies were included in the review. Publications rarely reported some indicators of external validity, including the representativeness of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies reported on key pragmatic factors such as cost or organizational change processes related to implementation and maintenance. Strengths of some studies included comparisons of multiple active treatments, use of tailorable interventions, and implementation in "real world" settings. CONCLUSIONS Although IPC interventions appear efficacious under research conditions, there are significant knowledge gaps regarding the degree to which they reach and engage target recipients, what factors impact adoption and implementation of IPC interventions by clinicians, how fidelity can be maintained over time, and cost-effectiveness. Pediatric IPC researchers should embrace dissemination and implementation science methods to balance internal and external validity concerns moving forward.
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Affiliation(s)
| | - David V Wagner
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Krishnapriya Ramanujam
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | | | - Sarah Mastel
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Andrew R Riley
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
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143
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Mitchell-Gillespie B, Hashim H, Griffin M, AlHeresh R. Sustainable support solutions for community-based rehabilitation workers in refugee camps: piloting telehealth acceptability and implementation. Global Health 2020; 16:82. [PMID: 32933537 PMCID: PMC7491020 DOI: 10.1186/s12992-020-00614-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/03/2020] [Indexed: 11/21/2022] Open
Abstract
Background The lack of training and education of Community-Based Rehabilitation (CBR) workers poses one of the most significant barriers to receiving effective occupational, physical and speech therapy for individuals with disabilities in Low-to-Middle Income Countries (LMIC), especially in countries with significant refugee populations. The aim of this study was to successfully implement a telehealth support system for CBR workers, evaluate the feasibility and acceptability of this intervention’s implementation among CBR workers in the CBR setting, and further identify strategies to address the deficit of skilled rehabilitation workers in LMIC through technological intervention. Methods This pilot study included CBR workers and CBR managers to inform feasibility, acceptability, and sustainable implementation. The RE-AIM and Dynamic Sustainability Framework were incorporated to guide procedural design, survey development, data collection, data evaluation, and increase success of telehealth implementation. CBR workers participate in trainings, telehealth sessions, surveys and focus groups to inform feasibility and acceptability. CBR Managers participated in focus groups to inform feasibility and sustainable implementation. NVIVO 12 Software was utilized to develop themes from CBR worker and CBR manager responses. Results Findings from this study demonstrate the need for additional training support for CBR workers in CBR settings throughout the entire treatment process. The telehealth system demonstrated successful short-term implementation across several domains of feasibility. Telehealth utilization was also proven acceptable, appropriate and necessary. Cultural beliefs, CBR worker training, and CBR Center infrastructure pose the most significant barriers to implementation of telehealth technologies in CBR Centers. CBR workers and managers confirmed the demand for future telehealth-based support systems, strengthening effort towards sustainability and scale-up. Conclusions Telehealth can be utilized to support CBR workers that serve vulnerable and marginalized populations, and in turn improve the global health status among refugee populations by reducing inequitable access to quality health care. The results support the need for further research to rigorously evaluate effectiveness of telehealth interventions to support CBR workers.
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Affiliation(s)
- Bria Mitchell-Gillespie
- Occupational Therapy Department, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA, 02129, USA.
| | - Hiba Hashim
- Occupational Therapy Department, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA, 02129, USA
| | - Megan Griffin
- Occupational Therapy Department, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA, 02129, USA
| | - Rawan AlHeresh
- Occupational Therapy Department, MGH Institute of Health Professions, Charlestown Navy Yard, 36 1st Avenue, Boston, MA, 02129, USA
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Fishe JN, Hendry P, Brailsford J, Salloum RG, Vogel B, Finlay E, Palmer S, Datta S, Hendeles L, Blake K. Early administration of steroids in the ambulance setting: Protocol for a type I hybrid effectiveness-implementation trial with a stepped wedge design. Contemp Clin Trials 2020; 97:106141. [PMID: 32931918 DOI: 10.1016/j.cct.2020.106141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/17/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes. PURPOSE To describe the background and methods of a type 1 hybrid effectiveness-implementation trial of EMS-administered OCS for pediatric asthma patients incorporating a stepped wedge design and the RE-AIM framework. METHODS The study employs a non-randomized stepped wedge design where multiple EMS agencies adopt OCS as a treatment for pediatric asthma exacerbations at varying times. This design accommodates ethical considerations of studying pediatric subjects in the prehospital setting where informed consent is not feasible. We will compare hospitalization rates, ED LOS, and short-term healthcare costs between pediatric asthma patients who do and do not receive OCS from EMS. Using geographic information systems (GIS), we will measure how differences in outcomes scale with increasing EMS transport time. We will use the RE-AIM framework to guide a mixed methods analysis of barriers and enablers to EMS administration of OCS for pediatric asthma patients, including quantitative measures of adoption and uptake and qualitative EMS provider focus group data. CONCLUSION This trial will determine if earlier EMS administration of OCS to pediatric asthma patients decreases hospitalizations, ED LOS, and short-term healthcare costs, and if those outcomes scale with longer EMS transport times. We will identify barriers and enablers to implementing EMS-administered OCS for pediatric asthma patients.
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Affiliation(s)
- Jennifer N Fishe
- Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America; Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America.
| | - Phyllis Hendry
- Department of Emergency Medicine, Division of Research, University of Florida College of Medicine, Jacksonville. 655 W. 8(th) St., Jacksonville, FL 32209, United States of America.
| | - Jennifer Brailsford
- Center for Data Solutions, University of Florida College of Medicine - Jacksonville, 655 W. 11(th) St., Jacksonville, FL 32209, United States of America.
| | - Ramzi G Salloum
- Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Bruce Vogel
- Department of Health Outcomes and Bioinformatics, University of Florida College of Medicine, 2004 Mowry Road, Gainesville, FL 32610, United States of America.
| | - Erik Finlay
- GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America.
| | - Sam Palmer
- GeoPlan Center, University of Florida College of Design, Construction, and Planning. 1480 Inner Rd, Gainesivlle, FL 32601, United States of America.
| | - Susmita Datta
- Department of Biostatistics, University of Florida. 2004 Mowry Road, 5(th) Floor CTRB, Gainesville, FL 32611, United States of America.
| | - Leslie Hendeles
- Department of Pediatrics, Pediatric Pulmonary Division, University of Florida College of Medicine, 1600 SW Archer Rd, Ste HD-506, Gainesville, FL 32610, United States of America
| | - Kathryn Blake
- Nemours Center for Pharmacogenomics and Translational Research, 807 Children's Way, Jacksonville, FL 32207, United States of America.
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MacKay D, Kirkham R, Freeman N, Murtha K, Van Dokkum P, Boyle J, Campbell S, Barzi F, Connors C, O'Dea K, Oats J, Zimmet P, Wenitong M, Sinha A, Hanley AJ, Moore E, Peiris D, McLean A, Davis B, Whitbread C, McIntyre HD, Mein J, McDermott R, Corpus S, Canuto K, Shaw JE, Brown A, Maple-Brown L. Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention. BMC Health Serv Res 2020; 20:814. [PMID: 32867837 PMCID: PMC7461356 DOI: 10.1186/s12913-020-05680-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes. METHODS A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines. DISCUSSION This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.
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Affiliation(s)
- D MacKay
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - R Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - N Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - K Murtha
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - P Van Dokkum
- Baker Heart & Diabetes Institute Central Australia, Alice Springs, Australia
| | - J Boyle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S Campbell
- College of Nursing and Midwifery, Charles Darwin University, Cairns, Australia
| | - F Barzi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - C Connors
- Top End Health Service, Northern Territory Department of Health, Darwin, Australia
| | - K O'Dea
- Population School of Health Research, University of South Australia, Adelaide, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - M Wenitong
- Apunipima Cape York Health Council, Bungalow, Australia
| | - A Sinha
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - D Peiris
- The George Institute for Global Health, Sydney, Australia
| | - A McLean
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - B Davis
- Cairns and Hinterland Hospital and Health Service, Cairns, Australia
| | - C Whitbread
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - J Mein
- Wuchopperen Health Service, Cairns, Australia
| | - R McDermott
- Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - K Canuto
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Aboriginal Health Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
- Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | - L Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Royal Darwin Hospital, Darwin, Australia.
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Lutz BJ, Reimold AE, Coleman SW, Guzik AK, Russell LP, Radman MD, Johnson AM, Duncan PW, Bushnell CD, Rosamond WD, Gesell SB. Implementation of a Transitional Care Model for Stroke: Perspectives From Frontline Clinicians, Administrators, and COMPASS-TC Implementation Staff. THE GERONTOLOGIST 2020; 60:1071-1084. [PMID: 32275060 PMCID: PMC7427484 DOI: 10.1093/geront/gnaa029] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke is a chronic, complex condition that disproportionally affects older adults. Health systems are evaluating innovative transitional care (TC) models to improve outcomes in these patients. The Comprehensive Post-Acute Stroke Services (COMPASS) Study, a large cluster-randomized pragmatic trial, tested a TC model for patients with stroke or transient ischemic attack discharged home from the hospital. The implementation of COMPASS-TC in complex real-world settings was evaluated to identify successes and challenges with integration into the clinical workflow. RESEARCH DESIGN AND METHODS We conducted a concurrent process evaluation of COMPASS-TC implementation during the first year of the trial. Qualitative data were collected from 4 sources across 19 intervention hospitals. We analyzed transcripts from 43 conference calls with hospital clinicians, individual and group interviews with leaders and clinicians from 9 hospitals, and 2 interviews with the COMPASS-TC Director of Implementation using iterative thematic analysis. Themes were compared to the domains of the RE-AIM framework. RESULTS Organizational, individual, and community factors related to Reach, Adoption, and Implementation were identified. Organizational readiness was an additional key factor to successful implementation, in that hospitals that were not "organizationally ready" had more difficulty addressing implementation challenges. DISCUSSION AND IMPLICATIONS Multifaceted TC models are challenging to implement. Facilitators of implementation were organizational commitment and capacity, prioritizing implementation of innovative delivery models to provide comprehensive care, being able to address challenges quickly, implementing systems for tracking patients throughout the intervention, providing clinicians with autonomy and support to address challenges, and adequately resourcing the intervention. CLINICAL TRIAL REGISTRATION NCT02588664.
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Affiliation(s)
- Barbara J Lutz
- School of Nursing, University of North Carolina at Wilmington
| | | | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy K Guzik
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Laurie P Russell
- Division of Public Health Sciences, Wake Forest University Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna M Johnson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Wayne D Rosamond
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Sabina B Gesell
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
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147
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Englund TR, Zhou M, Duffey KJ, Kraak VI. A Qualitative Study to Understand Stakeholders' Views About the Fruits & Veggies (FNV) Social Marketing Campaign to Promote Fruit and Vegetable Consumption in the United States. J Acad Nutr Diet 2020; 120:1986-1997.e3. [PMID: 32788099 DOI: 10.1016/j.jand.2020.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2015, the Partnership for a Healthier America (PHA) piloted a branded social marketing communications initiative called the FNV (Fruits & Veggies) Campaign to promote the sale and consumption of fruits and vegetables among mom and teen target audiences in 2 California and Virginia pilot markets. After the first year, FNV was expanded to multiple markets across the United States through diverse partnerships. Factors, resources, and strategies that contribute to the effectiveness and sustainability of the campaign need to be identified. OBJECTIVE The purpose of this qualitative study was to explore diverse stakeholders' views and expectations about the FNV Campaign design, reach, effectiveness, and impact and prospects for expansion, scale-up, and sustainability. DESIGN Semistructured interviews were conducted between July and October 2016 with stakeholders to elicit their perspectives and expectations of the FNV Campaign. PARTICIPANTS/SETTING A purposive sample of diverse stakeholders (n = 22) affiliated with national, state, and local industry and government and nongovernmental organizations. ANALYSIS Data were recorded, transcribed, input into NVivo 11 software (QSR International. Melbourne, Australia), coded and organized thematically using a conceptual framework that examined campaign design, reach, effectiveness, adoption, implementation, expansion, scaling up, and sustainability. RESULTS Opportunities, challenges, and expectations of stakeholders were reported for the FNV Campaign related to engaging future partners from different levels of community, government, and industry; conducting and disseminating findings from multifaceted evaluations; ensuring campaign effectiveness; and developing and improving campaign elements for target audiences and partner adoption. Conducting formative research, partner, and audience engagement, implementation, and evaluation are essential to the ensure effectiveness and sustainability of the FNV Campaign. CONCLUSIONS Insights from this study can inform the strategic use of social marketing campaign elements to facilitate the effectiveness and sustainability of the FNV Campaign as it expands and is scaled up across markets nationwide.
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148
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine and Dissemination and Implementation Science Program of the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine and Dissemination and Implementation Science Program of the Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Aurora, CO, USA
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149
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Hale-Gallardo JL, Kreider CM, Jia H, Castaneda G, Freytes IM, Cowper Ripley DC, Ahonle ZJ, Findley K, Romero S. Telerehabilitation for Rural Veterans: A Qualitative Assessment of Barriers and Facilitators to Implementation. J Multidiscip Healthc 2020; 13:559-570. [PMID: 32669850 PMCID: PMC7335893 DOI: 10.2147/jmdh.s247267] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Telerehabilitation (TR) is increasingly being used to meet the rehabilitation needs of individuals living in rural areas. Nevertheless, reports on TR implementation for rural patients remain limited. As part of a broader evaluation, this study investigated barriers and facilitators to the implementation of a national TR program to meet the needs of rural Veterans Health Administration (VHA) patients. Methods This study applied a qualitative approach to the RE-AIM framework to investigate barriers and facilitators impacting TR implementation. We conducted in-depth, semi-structured interviews with ten program managers and medical directors within the VHA at three time points during the first 18 months of implementation. Interviews were analyzed using thematic analysis. Results Three themes were identified describing key cultural, infrastructural and logistical, and environmental barriers impacting the reach, adoption, and implementation of TR. Within the themes, facilitators for TR were also identified to include, allowing providers flexibility in implementing TR, mentorship and development of creative approaches to TR training, overcoming infrastructural and logistical TR barriers through championing, and continuous sharing of lessons learned in a community of practice. Discussion This study explicates salient barriers and facilitators encountered during the first 18 months of implementation of a TR program within a national healthcare system in the United States. Implementing TR to meet the rehabilitation needs of Veterans in resource-limited rural environments requires creative approaches and flexibility, as well as perseverance and consistent championing in order to overcome cultural challenges. This, in combination with infrastructural challenges, such as lack of broadband, adds greater complexity to meeting the needs of rural patients. This study provides new and in-depth understanding of the processes by which TR is implemented in a large healthcare system and points to practical real-world lessons in implementing TR for rural patients.
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Affiliation(s)
- Jennifer L Hale-Gallardo
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Consuelo M Kreider
- Department of Veterans Affairs, Veterans Rural Health Resource Center-Gainesville, Office of Rural Health, Gainesville, Florida, USA.,Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA
| | - Huanguang Jia
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Gail Castaneda
- Department of Veterans Affairs, Veterans Rural Health Resource Center-Gainesville, Office of Rural Health, Gainesville, Florida, USA
| | - I Magaly Freytes
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Diane C Cowper Ripley
- Department of Veterans Affairs, Veterans Rural Health Resource Center-Gainesville, Office of Rural Health, Gainesville, Florida, USA
| | - Zaccheus J Ahonle
- Department of Occupational Therapy, University of Florida, Gainesville, Florida, USA
| | - Kimberly Findley
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA
| | - Sergio Romero
- Department of Veterans Affairs, North Florida/South Georgia Veterans Health System, Gainesville, Florida, USA.,Department of Veterans Affairs, Veterans Rural Health Resource Center-Gainesville, Office of Rural Health, Gainesville, Florida, USA
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150
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Goldthorpe J, Epton T, Keyworth C, Calam R, Armitage CJ. Are primary/elementary school-based interventions effective in preventing/ameliorating excess weight gain? A systematic review of systematic reviews. Obes Rev 2020; 21:e13001. [PMID: 32162477 DOI: 10.1111/obr.13001] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/21/2019] [Accepted: 12/17/2019] [Indexed: 11/30/2022]
Abstract
This systematic review of systematic reviews addresses a current gap in evidence by synthesizing findings relating to weight management interventions set entirely in primary/elementary schools targeting, diet, and/or physical activity as key strategies. Eight databases were searched for systematic reviews of trials of school-based interventions targeting children aged 4 to 12 years that looked at biometric and behavioral outcomes. From the 10 selected systematic reviews, we found that interventions designed to promote physical activity or reduce sedentary behavior were most effective for weight loss. Interventions designed to improve diet and nutrition had a small effect on behavioral and cognitive outcomes, and these outcomes could be enhanced through the use of experiential learning. The most effective interventions involved a range of stakeholders in the development process and included parents and families in implementation. This systematic review of systematic reviews offers evidence-based guidance for the development and implementation of multistrategy weight-management interventions in primary/elementary schools.
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Affiliation(s)
- Joanna Goldthorpe
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Tracy Epton
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Chris Keyworth
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences Coupland 1 Building, University of Manchester, M13 9PL, UK
| | - Rachel Calam
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, Zochonis Building, University of Manchester, M13 9PL, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Coupland 1 Building University of Manchester, M13 9PL, UK Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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