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Vamos CA, Salinas-Miranda AA, Daley EM, Kirby RS, Liller KD, Marshall J, Sappenfield WM, Wilson RE, Petersen DJ. MCH Leadership Training Program: An Innovative Application of an Implementation Science Framework. Matern Child Health J 2023; 27:597-610. [PMID: 36828973 PMCID: PMC9955516 DOI: 10.1007/s10995-023-03607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 02/26/2023]
Abstract
INTRODUCTION MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises). PURPOSE This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program. ASSESSMENT Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships. CONCLUSION Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems.
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Affiliation(s)
- Cheryl A Vamos
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA.
| | - Abraham A Salinas-Miranda
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
- The Harrell Center for the Study of Family Violence, College of Public Health, University of South Florida, Tampa, USA
| | - Ellen M Daley
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Russell S Kirby
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Karen D Liller
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
- Activist Lab, College of Public Health, University of South Florida, Tampa, USA
| | - Jennifer Marshall
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
- Sunshine Education and Research Center, College of Public Health, University of South Florida, Tampa, USA
| | - William M Sappenfield
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
- Florida Perinatal Quality Collaborative, College of Public Health, University of South Florida, Tampa, USA
| | - Roneé E Wilson
- USF's Center of Excellence in MCH Education, Science & Practice, The Chiles Center, College of Public Health, University of South Florida, Tampa, USA
| | - Donna J Petersen
- USF's Center of Excellence in MCH Education, Science & Practice, College of Public Health, University of South Florida, Tampa, USA
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Leader AE, Melillo RJ, Greene Q, Blanding-Godbolt J, Shimada A, Eischen CM, Aplin AE. Engaging community members in cancer research: an assessment of an NCI-designated cancer center. Cancer Causes Control 2023; 34:307-319. [PMID: 36598655 DOI: 10.1007/s10552-022-01666-8] [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: 04/26/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Despite the importance of engaging community members in research, multiple barriers exist. We conducted a mixed-methods evaluation to understand the opportunities and challenges of engaging community members in basic, clinical, translational, and population science research. METHODS We designed a survey and an interview guide based on the constructs of the Consolidated Framework for Implementation Research. Surveys were distributed electronically to all cancer center investigators and interviews were conducted virtually with a select group of basic, clinical, and population science investigators. Survey data (n = 77) were analyzed across all respondents using frequency counts and mean scores; bivariate analyses examined differences in responses by research program affiliation, gender, race, and faculty rank. Interviews (n = 16) were audio recorded, transcribed verbatim, and analyzed using a reflective thematic approach. RESULTS There was strong agreement among investigators that "Community engagement in research will help the SKCC address cancer disparities in the catchment area" (M 4.2, SD 0.9) and less agreement with items such as "I know how to find and connect with community members who I can engage in my research" (M 2.5, SD 1.3). Investigators mentioned challenges in communicating complex science to a lay audience but were open to training and workshops to acquire skills needed to integrate community members into their research. CONCLUSION Cancer centers should develop and promote training and collaborative opportunities for investigators and community members. Overcoming challenges will lead to more patient- and community-centered cancer research in the future.
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Affiliation(s)
- Amy E Leader
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA. .,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA. .,Thomas Jefferson University, 833 Chestnut Street, 11th Floor, Philadelphia, PA, 19107, USA.
| | - Rebecca J Melillo
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - Ayako Shimada
- Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christine M Eischen
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew E Aplin
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Cancer Biology, Thomas Jefferson University, Philadelphia, PA, USA
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Doorenbos AZ, Schlaeger JM, deMartelly VA, Burke LA, Boyd AD, Knisely MR, Leigh JW, Li H, Mandernach MW, Molokie RE, Patil CL, Steffen AD, Shah N, Ezenwa MO. Hybrid effectiveness-implementation trial of guided relaxation and acupuncture for chronic sickle cell disease pain (GRACE): A protocol. Contemp Clin Trials Commun 2023; 32:101076. [PMID: 36852100 PMCID: PMC9958255 DOI: 10.1016/j.conctc.2023.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/09/2022] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Background People with sickle cell disease frequently use complementary and integrative therapies to cope with their pain, yet few studies have evaluated their effectiveness. The 3-arm, 3-site pragmatic Hybrid Effectiveness-implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE) has 3 priorities: (1) evaluate guided relaxation and acupuncture to improve pain control; (2) determine the most appropriate and effective treatment sequence for any given patient based on their unique characteristics; and (3) describe the processes and structures required to implement guided relaxation and acupuncture within health care systems. Methods Participants (N = 366) are being recruited and randomized 1:1:1 to one of 2 intervention groups or usual care. The acupuncture intervention group receives 10 sessions over approximately 5 weeks. The guided relaxation intervention group receives access to video sessions ranging from 2 to 20 min each viewed daily over 5 weeks. The usual care group receives the standard of clinical care for sickle cell disease. Participants are re-randomized at 6 weeks depending on their pain impact score. Assessments occur at 6 weeks, 12 weeks, and 24 weeks. The primary outcome is the change in pain impact score and secondary measures include opioid use, anxiety, depression, sleep, pain catastrophizing, substance use, global impression of change, constipation, and hospitalizations. The GRACE study uses the Consolidated Framework for Implementation Research to plan, execute, and evaluate the associated implementation processes. Conclusion The results from GRACE will represent a critical step toward improving management of pain affecting patients with sickle cell disease.ClinicalTrials.gov Identifier: NCT04906447.
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Affiliation(s)
- Ardith Z. Doorenbos
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Judith M. Schlaeger
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Victoria A. deMartelly
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Larisa A. Burke
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Andrew D. Boyd
- College of Applied Health Sciences, 1919 W Taylor St, Chicago, IL, 60612, USA
| | | | - Jonathan W. Leigh
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Hongjin Li
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Molly W. Mandernach
- Department of Medicine, UF Health, PO Box 100278, Gainesville, FL, 32610, USA
| | - Robert E. Molokie
- College of Applied Health Sciences, 1919 W Taylor St, Chicago, IL, 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL, 60612, USA
| | - Crystal L. Patil
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Alana D. Steffen
- College of Nursing, University of Illinois Chicago, 845 S. Damen, Chicago, IL, 60612, USA
| | - Nirmish Shah
- Department of Medicine, Duke University, 40 Medicine Circle, Durham, NC, 27710, USA
| | - Miriam O. Ezenwa
- College of Nursing, University of Florida, 1225 Center Drive, PO Box 100197, Gainesville, FL, 32610-0197, USA
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Ahumada-Canale A, Jeet V, Bilgrami A, Seil E, Gu Y, Cutler H. Barriers and facilitators to implementing priority setting and resource allocation tools in hospital decisions: A systematic review. Soc Sci Med 2023; 322:115790. [PMID: 36913838 DOI: 10.1016/j.socscimed.2023.115790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/24/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Health care budgets in high-income countries are having issues coping with unsustainable growth in demand, particularly in the hospital setting. Despite this, implementing tools systematising priority setting and resource allocation decisions has been challenging. This study answers two questions: (1) what are the barriers and facilitators to implementing priority setting tools in the hospital setting of high-income countries? and (2) what is their fidelity? A systematic review using the Cochrane methods was conducted including studies of hospital-related priority setting tools reporting barriers or facilitators for implementation, published after the year 2000. Barriers and facilitators were classified using the Consolidated Framework for Implementation Research (CFIR). Fidelity was assessed using priority setting tool's standards. Out of thirty studies, ten reported program budgeting and marginal analysis (PBMA), twelve multi-criteria decision analysis (MCDA), six health technology assessment (HTA) related frameworks, and two, an ad hoc tool. Barriers and facilitators were outlined across all CFIR domains. Implementation factors not frequently observed, such as 'evidence of previous successful tool application', 'knowledge and beliefs about the intervention' or 'external policy and incentives' were reported. Conversely, some constructs did not yield any barrier or facilitator including 'intervention source' or 'peer pressure'. PBMA studies satisfied the fidelity criteria between 86% and 100%, for MCDA it varied between 36% and 100%, and for HTA it was between 27% and 80%. However, fidelity was not related to implementation. This study is the first to use an implementation science approach. Results represent the starting point for organisations wishing to use priority setting tools in the hospital setting by providing an overview of barriers and facilitators. These factors can be used to assess readiness for implementation or to serve as the foundation for process evaluations. Through our findings, we aim to improve the uptake of priority setting tools and support their sustainable use.
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Affiliation(s)
- Antonio Ahumada-Canale
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Anam Bilgrami
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Elizabeth Seil
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
| | - Henry Cutler
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Level 5, 75 Talavera Rd, Macquarie Park, New South Wales, 2109, Australia.
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Goldhaber-Fiebert SN, Frackman A, Agarwala AV, Doney A, Pian-Smith MCM. Emergency manual peri-crisis use six years following implementation: Sustainment of an intervention for rare crises. J Clin Anesth 2023; 87:111111. [PMID: 37003046 DOI: 10.1016/j.jclinane.2023.111111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE Use of cognitive aids during emergencies increases key actions and decreases omissions, both known to save lives. With little known about emergency manual (EM) clinical use, we aimed to help answer "Will EMs be used peri-crisis at a meaningful frequency?" and to explore clinical sustainment. DESIGN Prospective, observational study. SETTING Operating Rooms. PATIENTS All patients undergoing anesthesia at a major academic medical center during the study periods; ∼75,000 cases. INTERVENTION & MEASUREMENTS To understand the initial and sustainment phases of EM implementation, we placed a question regarding EM use at the end of every anesthetic case to prospectively measure EM use at: implementation, one-year later, and six years post-implementation. MAIN RESULTS For more than twenty-four thousand cases in each approximately 6-month study period, EMs were used peri-crisis (before, during or after a perioperative crisis) in 145 cases initially (0.55%; SE 0.045%), 42 cases one-year later (0.17%; SE 0.026%), and 57 cases (0.21%; SE 0.028%) six years post-implementation. Peri-crisis EM uses dropped 0.38% (97.5% CI: 0.26%, 0.49%) from initial to one-year post-implementation. After that, peri-crisis EM uses did not differ significantly from one-year to six years post-implementation, showing sustainment [increased 0.04% (97.5% CI: -0.05%, 0.12%)]. Among cases with cardiac arrest or CPR, as a subset proxy for relevant crises, EMs were used in 7/13 such cases initially (54%, SE 13.6%), 8/20 one-year later (40%; SE 10.9%) and 7/13 six years later (54%; SE 13.6%). CONCLUSIONS After an initial expected drop, EM peri-crisis use six years post-implementation was: sustained without intensive additional efforts, averaged ∼10 times per month at a single institution, and was reported in more than half of cases with cardiac arrest or CPR. Peri-crisis use of EMs is appropriately rare, though for relevant crises can have substantial positive impacts as described in prior literature. The sustained use of EMs may be related to increasing cultural acceptance of EMs, as reflected in survey result trends and broader cognitive aid literature.
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Affiliation(s)
- Sara N Goldhaber-Fiebert
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Dr. Rm H3674, Stanford, CA 94305, USA.
| | - Anna Frackman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Dr. Rm H3674, Stanford, CA 94305, USA.
| | - Aalok V Agarwala
- Department of Anesthesia, Massachusetts Eye and Ear Institute, 243 Charles Street, Boston, MA 02114, USA.
| | - Allison Doney
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - May C M Pian-Smith
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Basger BJ, Moles RJ, Chen TF. Uptake of pharmacist recommendations by patients after discharge: Implementation study of a patient-centered medicines review service. BMC Geriatr 2023; 23:183. [PMID: 36991378 PMCID: PMC10061906 DOI: 10.1186/s12877-023-03921-2] [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: 07/17/2022] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medicine use is common in older people, resulting in harm increased by lack of patient-centred care. Hospital clinical pharmacy services may reduce such harm, particularly prevalent at transitions of care. An implementation program to achieve such services can be a complex long-term process. OBJECTIVES To describe an implementation program and discuss its application in the development of a patient-centred discharge medicine review service; to assess service impact on older patients and their caregivers. METHOD An implementation program was begun in 2006. To assess program effectiveness, 100 patients were recruited for follow-up after discharge from a private hospital between July 2019 and March 2020. There were no exclusion criteria other than age less than 65 years. Medicine review and education were provided for each patient/caregiver by a clinical pharmacist, including recommendations for future management, written in lay language. Patients were asked to consult their general practitioner to discuss those recommendations important to them. Patients were followed-up after discharge. RESULTS Of 368 recommendations made, 351 (95%) were actioned by patients, resulting in 284 (77% of those actioned) being implemented, and 206 regularly taken medicines (19.7 % of all regular medicines) deprescribed. CONCLUSION Implementation of a patient-centred medicine review discharge service resulted in patient-reported reduction in potentially inappropriate medicine use and hospital funding of this service. This study was registered retrospectively on 12th July 2022 with the ISRCTN registry, ISRCTN21156862, https://www.isrctn.com/ISRCTN21156862 .
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Affiliation(s)
- Benjamin Joseph Basger
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia.
- Wolper Jewish Hospital, 8 Trelawney Street, Woollahra, Sydney, NSW, 2025, Australia.
| | - Rebekah Jane Moles
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
| | - Timothy Frank Chen
- Discipline of Pharmacy Practice, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Room N517, A15 Science Road, Camperdown, Sydney, NSW, 2006, Australia
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Chamberlain SA, Warner G, Andrew MK, Hande MJ, Hubley E, Weeks LE, Keefe JM. With COVID Comes Complexity: Assessing the Implementation of Family Visitation Programs in Long-Term Care. THE GERONTOLOGIST 2023; 63:490-500. [PMID: 36462193 PMCID: PMC10028227 DOI: 10.1093/geront/gnac175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) pandemic visitor restrictions to long-term care facilities have demonstrated that eliminating opportunities for family-resident contact has devastating consequences for residents' quality of life. Our study aimed to understand how public health directives to support family visitations during the pandemic were navigated, managed, and implemented by staff. RESEARCH DESIGN AND METHODS Guided by the Consolidated Framework for Implementation Research, we conducted video/telephone interviews with 54 direct care and implementation staff in six long-term care homes in two Canadian provinces to assess implementation barriers and facilitators of visitation programs. Equity and inclusion issues were examined in the program's implementation. RESULTS Despite similar public health directives, implementation varied by facility, largely influenced by the existing culture and processes of the facility and the staff understanding of the program; differences resulted in how designated family members were chosen and restrictions around visitations (e.g., scheduling and location). Facilitators of implementation were good communication networks, leadership, and intentional planning to develop the visitor designation processes. However, the lack of consultation with direct care staff led to logistical challenges around visitation and ignited conflict around visitation rules and procedures. DISCUSSION AND IMPLICATIONS Insights into the complexities of implementing family visitation programs during a pandemic are discussed, and opportunities for improvement are identified. Our results reveal the importance of proactively including direct care staff and family in planning for future outbreaks.
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Affiliation(s)
- Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Warner
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary Jean Hande
- Department of Sociology, Trent University, Peterborough, Ontario, Canada
| | - Emily Hubley
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice M Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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Gallant NL, Hadjistavropoulos T, Stopyn RJN, Feere EK. Integrating Technology Adoption Models Into Implementation Science Methodologies: A Mixed-Methods Preimplementation Study. THE GERONTOLOGIST 2023; 63:416-427. [PMID: 35810405 PMCID: PMC10028232 DOI: 10.1093/geront/gnac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sustainable implementation of patient-oriented technologies in health care settings is challenging. Preimplementation studies guided by the Consolidated Framework for Implementation Research (CFIR) can provide opportunities to address barriers and leverage facilitators that can maximize the likelihood of successful implementation. When looking to implement patient-oriented technologies, preimplementation studies may also benefit from guidance from a conceptual framework specific to technology adoption such as the Unified Theory of Acceptance and Use of Technology. This study was, therefore, aimed at identifying determinants for the successful implementation of a patient-oriented technology (i.e., automated pain behavior monitoring [APBM] system) within a health care setting (i.e., long-term care [LTC] facility). RESEARCH DESIGN AND METHODS Using a mixed-methods study design, 164 LTC nurses completed a set of questionnaires and 68 LTC staff participated in individual interviews involving their perceptions of an APBM system in LTC environments. Quantitative data were analyzed using a series of mediation analyses and narrative responses were examined using directed content analysis. RESULTS Performance expectancy and effort expectancy partially and fully mediated the influence of implementation, readiness for organizational change, and technology readiness constructs on behavioral intentions to use the APBM system in LTC environments. Findings from the qualitative portion of this study provide guidance for the development of an intervention that is grounded in the CFIR. DISCUSSION AND IMPLICATIONS Based on our results, we offer recommendations for the implementation of patient-oriented technologies in health care settings.
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Affiliation(s)
- Natasha L Gallant
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Rhonda J N Stopyn
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Emma K Feere
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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159
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Sullivan JL, Montano ARL, Hughes JM, Davila HW, O'Malley KA, Engle RL, Hawley CE, Shin MH, Smith JG, Pimentel CB. A Citation Review of 83 Dissemination and Implementation Theories, Models, or Frameworks Utilized in U.S.-Based Aging Research. THE GERONTOLOGIST 2023; 63:405-415. [PMID: 35797202 DOI: 10.1093/geront/gnac096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dissemination-implementation.org outlines 110 theories, models, and frameworks (TMFs): we conducted a citation analysis on 83 TMFs, searching Web of Science and PubMed databases. RESEARCH DESIGN AND METHODS Search terms were broad and included "aging," "older," "elderly," and "geriatric." We extracted each TMF in identified articles from inception through January 28, 2022. Included articles must have used a TMF in research or quality improvement work directly linked to older adults within the United States. RESULTS We reviewed 2,681 articles of which 295 articles cited at least one of 56 TMFs. Five TMFs represented 50% of the citations: Reach, Effectiveness, Adoption, Implementation, and Maintenance 1.0, Consolidated Framework for Implementation Research, Greenhalgh Diffusion of Innovation in Service Organizations, Quality Enhancement Research Initiative, Community-Based Participatory Research, and Promoting Action on Research Implementation in Health Services. TMF application varied and there was a steady increase in TMF citations over time, with a 2- to 3-fold increase in citations in 2020-2021. We identified that only 41% of TMF use was meaningful. DISCUSSION AND IMPLICATIONS Our results suggest TMF utilization is increasing in aging research, but there is a need to more meaningful utilize TMFs. As the population of older adults continues to grow, there will be increasing demand for effective evidence-based practices and models of care to be quickly and effectively translated into routine care. Use of TMFs is critical to building such evidence and to identifying and evaluating methods to support this translation.
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Affiliation(s)
- Jennifer L Sullivan
- Center of Innovation in Long Term Services and Supports, Department of Veterans Affairs (VA) Providence Healthcare System, Providence, Rhode Island, USA
- Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Anna Rae L Montano
- Center of Innovation in Long Term Services and Supports, Department of Veterans Affairs (VA) Providence Healthcare System, Providence, Rhode Island, USA
- Department of Health Services, Practice and Policy, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jaime M Hughes
- Medical School, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Heather W Davila
- Center for Access and Delivery Research & Evaluation, VA Iowa City Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Kelly A O'Malley
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Ryann L Engle
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chelsea E Hawley
- Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Marlena H Shin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jason G Smith
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research and the New England Geriatric Research Education and Clinical Center, VA Bedford Healthcare System, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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Silver S, Jones KC, Redmond S, George E, Zornes S, Barwise A, Leppin A, Dong Y, Harmon LA, Kumar VK, Kordik C, Walkey AJ, Drainoni ML. Facilitators and barriers to the implementation of new critical care practices during COVID-19: a multicenter qualitative study using the Consolidated Framework for Implementation Research (CFIR). BMC Health Serv Res 2023; 23:272. [PMID: 36941593 PMCID: PMC10026230 DOI: 10.1186/s12913-023-09209-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic produced unprecedented demands and rapidly changing evidence and practices within critical care settings. The purpose of this study was to identify factors and strategies that hindered and facilitated effective implementation of new critical care practices and policies in response to the pandemic. METHODS We used a cross-sectional, qualitative study design to conduct semi-structured in-depth interviews with critical care leaders across the United States. The interviews were audio-taped and professionally transcribed verbatim. Guided by the Consolidated Framework for Implementation Research (CFIR), three qualitative researchers used rapid analysis methods to develop relevant codes and identify salient themes. RESULTS Among the 17 hospitals that agreed to participate in this study, 31 clinical leaders were interviewed. The CFIR-driven rapid analysis of the interview transcripts generated 12 major themes, which included six implementation facilitators (i.e., factors that promoted the implementation of new critical care practices) and six implementation barriers (i.e., factors that hindered the implementation of new critical care practices). These themes spanned the five CFIR domains (Intervention Characteristics, Outer Setting, Inner Setting, Characteristics of Individuals, and Process) and 11 distinct CFIR constructs. Salient facilitators to implementation efforts included staff resilience, commitment, and innovation, which were supported through collaborative feedback and decision-making mechanisms between leadership and frontline staff. Major identified barriers included lack of access to reliable and transferable information, available resources, uncollaborative leadership and communication styles. CONCLUSIONS Through applying the CFIR to organize and synthesize our qualitative data, this study revealed important insights into implementation determinants that influenced the uptake of new critical care practices during COVID-19. As the pandemic continues to burden critical care units, clinical leaders should consider emulating the effective change management strategies identified. The cultivation of streamlined, engaging, and collaborative leadership and communication mechanisms not only supported implementation of new care practices across sites, but it also helped reduce salient implementation barriers, particularly resource and staffing shortages. Future critical care implementation studies should seek to capitalize on identified facilitators and reduce barriers.
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Affiliation(s)
- Santana Silver
- Evans Center for Implementation & Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA.
| | - Kayla Christine Jones
- Evans Center for Implementation & Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
| | - Sarah Redmond
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Emily George
- Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Sarah Zornes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amelia Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron Leppin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
- Mayo Center for Clinical and Translational Science (CCaTS), 200 First Street SW, Rochester, MN, 55905, USA
| | - Yue Dong
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lori A Harmon
- Department of Research and Quality, Society of Critical Care Medicine, 500 Midway Drive, Mount Prospect, IL, 60056, USA
| | - Vishakha K Kumar
- Department of Research and Quality, Society of Critical Care Medicine, 500 Midway Drive, Mount Prospect, IL, 60056, USA
| | - Christina Kordik
- Department of Research and Quality, Society of Critical Care Medicine, 500 Midway Drive, Mount Prospect, IL, 60056, USA
| | - Allan J Walkey
- Evans Center for Implementation & Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
- The Pulmonary Center, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, 72 E. Concord St Housman (R), Boston, MA, 02118, USA
| | - Mari-Lynn Drainoni
- Evans Center for Implementation & Improvement Sciences (CIIS), Department of Medicine, Boston University School of Medicine, 72 East Concord St, Boston, MA, 02118, USA
- Section of Infectious Diseases, Boston University School of Medicine, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, 801 Massachusetts Avenue, Room 2014, Boston, MA, 02118, USA
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Ray AE, Mun EY, Lewis MA, Litt DM, Stapleton JL, Tan L, Buller DB, Zhou Z, Bush HM, Himelhoch S. Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial. JMIR Res Protoc 2023; 12:e43986. [PMID: 36716301 PMCID: PMC10131715 DOI: 10.2196/43986] [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: 11/01/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43986.
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Affiliation(s)
- Anne E Ray
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Dana M Litt
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Jerod L Stapleton
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Lin Tan
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | | | - Zhengyang Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Heather M Bush
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Seth Himelhoch
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
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Kirkland EB, Johnson E, Bays C, Marsden J, Verdin R, Ford D, King K, Sterba KR. Diabetes Remote Monitoring Program Implementation: A Mixed Methods Analysis of Delivery Strategies, Barriers and Facilitators. TELEMEDICINE REPORTS 2023; 4:30-43. [PMID: 36950477 PMCID: PMC10027345 DOI: 10.1089/tmr.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Remote patient monitoring (RPM) is being increasingly utilized as a type of telemedicine modality to improve access to quality health care, although there are documented challenges with this type of innovation. The goals of this study were to characterize clinic delivery strategies for an RPM program and to examine barriers and facilitators to program implementation in a variety of community clinic settings. METHODS Primary data were collected via individual and small group interviews and surveys of clinical staff from South Carolina primary care clinics participating in an RPM program for patients with diabetes mellitus type 2 in 2019. We used a parallel convergent mixed methods study design with six South Carolina primary care outpatient clinics currently participating in a diabetes remote monitoring program. Clinic staff participants completed surveys to define delivery strategies and experiences with the program in a variety of clinical settings. Interviews of clinic staff examined barriers and facilitators to program implementation guided by the Consolidated Framework for Implementation Research (CFIR). Quantitative survey data were summarized via descriptive statistics. Qualitative data from interviews were analyzed in a template analysis approach with primary themes identified and organized by two independent coders and guided by the CFIR. Quantitative and qualitative findings were then synthesized in a final step. RESULTS RPM program delivery strategies varied across clinic, patient population, and program domains, largely affected by staffing, leadership buy-in, resources, patient needs, and inter-site communication. Barriers and facilitators to implementation were linked to similar factors that influenced delivery strategy. DISCUSSION RPM programs were implemented in a variety of different clinic settings with program delivery tailored to fit within each clinic's workflow and meet patients' needs. By addressing the barriers identified in this study with focused training and support strategies, delivery processes can improve implementation of RPM programs and thus benefit patient outcomes in rural and community settings.
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Affiliation(s)
- Elizabeth B. Kirkland
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Johnson
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chloe Bays
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Justin Marsden
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rebecca Verdin
- Center for Telehealth, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Dee Ford
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kathryn King
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Katherine R. Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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163
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Kasal A, Táborská R, Juríková L, Grabenhofer-Eggerth A, Pichler M, Gruber B, Tomášková H, Niederkrotenthaler T. Facilitators and barriers to implementation of suicide prevention interventions: Scoping review. Glob Ment Health (Camb) 2023; 10:e15. [PMID: 37854412 PMCID: PMC10579684 DOI: 10.1017/gmh.2023.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
We know that suicide is preventable, yet hundreds of thousands of people still die due to suicide every year. Many interventions were proven to be effective, and dozens of others showed promising results. However, translating these interventions into new settings brings several challenges. One of the crucial obstacles to success is not anticipating possible barriers to implementation nor enhancing possible benefits of factors facilitating the implementation. While we witnessed great support for suicide prevention activities globally in the past years, implementation barriers and facilitating factors are yet to be comprehensively mapped to help implementation activities worldwide. This scoping review maps current knowledge on facilitators and barriers to the implementation of suicide prevention interventions while using the Consolidated Framework for Implementation Research (CFIR) for classification. We included 64 studies. Barriers and facilitators were most commonly identified in the outer setting CFIR domain, namely in the sub-domain of patient needs and resources, which refers to the way in which these needs and resources are reflected by the reviewed interventions. The second most saturated CFIR domain for facilitators was intervention characteristics, where relative advantage, adaptability and cost of intervention sub-domains were equally represented. These sub-domains refer mostly to how the intervention is perceived by key stakeholders, to what extent it can be tailored to the implementation context and how much it costs. While intervention characteristics domain was the second most common also for barriers, the complexity sub-domain referring to high perceived difficulty of implementation was the most frequently represented. With reference to the results, we recommend adapting interventions to the needs of the target groups. Furthermore, carefully selecting the intervention to suit the target context concerning their adaptability, costs and complexity is vital for a successful implementation. Further implications for practice and research are discussed.
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Affiliation(s)
- Alexandr Kasal
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Faculty of Social Sciences, Charles University, Prague, Czech Republic
| | - Roksana Táborská
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Laura Juríková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | | | - Michaela Pichler
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Beate Gruber
- Department of Psychosocial Health, Gesundheit Österreich GmbH, Wien, Austria
| | - Hana Tomášková
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
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164
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Brien R, Volpe I, Grigg J, Lyons T, Hughes C, McKinnon G, Tzanetis S, Crawford S, Eade A, Lee N, Barratt MJ. Co-designing drug alerts for health and community workers for an emerging early warning system in Victoria, Australia. Harm Reduct J 2023; 20:30. [PMID: 36894933 PMCID: PMC9995746 DOI: 10.1186/s12954-023-00761-6] [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: 03/23/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. METHODS An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey (n = 184) informed five qualitative co-design workshops (n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. RESULTS Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves 'conduits' for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be 'shareable' across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. DISCUSSION Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.
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Affiliation(s)
- Rita Brien
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Isabelle Volpe
- Social and Global Studies Centre, RMIT University, Melbourne, Australia.,Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Jasmin Grigg
- Turning Point, Eastern Health Statewide Services, Richmond, Australia.,Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Tom Lyons
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Caitlin Hughes
- Law and Commerce, Flinders University, Adelaide, Australia.,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia
| | - Ginny McKinnon
- Department of Health, State Government of Victoria, Melbourne, Australia
| | - Stephanie Tzanetis
- Harm Reduction Victoria (DanceWize), Melbourne, Australia.,CanTEST - Directions Health Services, Canberra, Australia
| | - Sione Crawford
- Harm Reduction Victoria (DanceWize), Melbourne, Australia
| | - Alan Eade
- Safer Care Victoria, Melbourne, Australia.,Department of Paramedicine, Monash University, Melbourne, Australia
| | - Nicole Lee
- 360Edge, Melbourne, Australia.,National Drug Research Institute, Curtin University, Perth, Australia
| | - Monica J Barratt
- Social and Global Studies Centre, RMIT University, Melbourne, Australia. .,National Drug and Alcohol Research Centre, UNSW, Sydney, Australia. .,Digital Ethnography Research Centre, RMIT University, Melbourne, Australia.
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165
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Hamilton AB, Finley EP, Bean-Mayberry B, Lang A, Haskell SG, Moin T, Farmer MM. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 QUERI: study protocol for a cluster-randomized hybrid type 3 effectiveness-implementation trial. Implement Sci Commun 2023; 4:23. [PMID: 36890587 PMCID: PMC9994412 DOI: 10.1186/s43058-022-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Women Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women's regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas. METHODS EMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women's health programs and policies. DISCUSSION EMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions. TRIAL REGISTRATION ClinicalTrials.gov, NCT05050266 . Registered on 20 September 2021.
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Affiliation(s)
- Alison B Hamilton
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ariel Lang
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sally G Haskell
- VA HSR&D Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tannaz Moin
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Melissa M Farmer
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Barwick M, Brown J, Petricca K, Stevens B, Powell BJ, Jaouich A, Shakespeare J, Seto E. The Implementation Playbook: study protocol for the development and feasibility evaluation of a digital tool for effective implementation of evidence-based innovations. Implement Sci Commun 2023; 4:21. [PMID: 36882826 PMCID: PMC9990055 DOI: 10.1186/s43058-023-00402-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/12/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Evidence-based innovations can improve health outcomes, but only if successfully implemented. Implementation can be complex, highly susceptible to failure, costly and resource intensive. Internationally, there is an urgent need to improve the implementation of effective innovations. Successful implementation is best guided by implementation science, but organizations lack implementation know-how and have difficulty applying it. Implementation support is typically shared in static, non-interactive, overly academic guides and is rarely evaluated. In-person implementation facilitation is often soft-funded, costly, and scarce. This study seeks to improve effective implementation by (1) developing a first-in-kind digital tool to guide pragmatic, empirically based and self-directed implementation planning in real-time; and (2) exploring the tool's feasibility in six health organizations implementing different innovations. METHODS Ideation emerged from a paper-based resource, The Implementation Game©, and a revision called The Implementation Roadmap©; both integrate core implementation components from evidence, models and frameworks to guide structured, explicit, and pragmatic planning. Prior funding also generated user personas and high-level product requirements. This study will design, develop, and evaluate the feasibility of a digital tool called The Implementation Playbook©. In Phase 1, user-centred design and usability testing will inform tool content, visual interface, and functions to produce a minimum viable product. Phase 2 will explore the Playbook's feasibility in six purposefully selected health organizations sampled for maximum variation. Organizations will use the Playbook for up to 24 months to implement an innovation of their choosing. Mixed methods will gather: (i) field notes from implementation team check-in meetings; (ii) interviews with implementation teams about their experience using the tool; (iii) user free-form content entered into the tool as teams work through implementation planning; (iv) Organizational Readiness for Implementing Change questionnaire; (v) System Usability Scale; and (vi) tool metrics on how users progressed through activities and the time required to do so. DISCUSSION Effective implementation of evidence-based innovations is essential for optimal health. We seek to develop a prototype digital tool and demonstrate its feasibility and usefulness across organizations implementing different innovations. This technology could fill a significant need globally, be highly scalable, and potentially valid for diverse organizations implementing various innovations.
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Affiliation(s)
- Melanie Barwick
- Research Institute, The Hospital for Sick Children, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Kadia Petricca
- Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Bonnie Stevens
- Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St Louis, St. Louis, MO, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.,Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Alexia Jaouich
- Stepped Care Solutions, Mount Pearl, Newfoundland, Canada
| | - Jill Shakespeare
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Canada
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Woods-Hill CZ, Nelson MN, Eriksen W, Rendle KA, Beidas RS, Bonafide CP, Brajcich MR, Milstone AM, Shea JA. Determinants of Blood Culture Use in Critically Ill Children: A Multicenter Qualitative Study. Pediatr Qual Saf 2023; 8:e647. [PMID: 37051407 PMCID: PMC10085482 DOI: 10.1097/pq9.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023] Open
Abstract
Blood cultures are fundamental in diagnosing and treating sepsis in the pediatric intensive care unit (PICU), but practices vary widely. Overuse can lead to false positive results and unnecessary antibiotics. Specific factors underlying decisions about blood culture use and overuse are unknown. Therefore, we aimed to identify perceived determinants of blood culture use in the PICU. Methods We conducted semistructured interviews of clinicians (M.D., D.O., R.N., N.P., P.A.) from 6 PICUs who had participated in a quality improvement collaborative about blood culture practices. We developed interview questions by combining elements of the Consolidated Framework for Implementation Research and behavioral economics. We conducted telephone interviews, open-coded the transcripts, and used modified content analysis to determine key themes and mapped themes to elements of Consolidated Framework for Implementation Research and behavioral economics. Results We reached thematic saturation in 24 interviews. Seven core themes emerged across 3 Consolidated Framework for Implementation Research domains: individual characteristics [personal belief in the importance of blood cultures, the perception that blood cultures are a low-risk test]; inner setting [adherence to site-specific usual practices, site-specific overall approach to PICU care (collaborative versus hierarchical), influence of non-PICU clinicians on blood culture decisions]; and outer setting [patient-specific risk factors, sepsis guidelines]. In addition, outcome bias, default bias, and loss aversion emerged as salient behavioral economics concepts. Conclusions Determinants of blood culture use include individual clinician characteristics, inner setting, and outer setting, as well as default bias, outcome bias, and loss aversion. These determinants will now inform the development of candidate strategies to optimize culture practices.
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Affiliation(s)
- Charlotte Z. Woods-Hill
- From the Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia Pa
| | - Maria N. Nelson
- University of Pennsylvania Mixed Methods Research Laboratory
| | | | | | | | - Christopher P. Bonafide
- Section of Pediatric Hospital Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michelle R. Brajcich
- From the Division of Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Aaron M. Milstone
- Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Judy A. Shea
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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168
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Meyer JKV, Diaspro G, Muñoz I, Burmeister C, García-Huidobro D. A mixed-methods evaluation of the ¡Vamos por Más! parenting program implementation in Chile. JBI Evid Implement 2023; 21:101-112. [PMID: 36378094 DOI: 10.1097/xeb.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Substance use is a significant global concern. Strengthening parenting in families with adolescents has been shown to reduce substance use initiation. The ¡Vamos por Más! (¡VxM!) program is a positive-parenting program developed in Chile to improve family relations and reduce adolescent substance use that combines in-person school workshops, multimedia messaging and personalized support. This manuscript reports a mixed-methods evaluation of the pilot implementation of the ¡VxM! program utilizing the Consolidated Framework for Implementation Research and Proctor's taxonomy for process outcomes. METHODS An explanatory sequential design was used. Quantitative methods evaluated program use, acceptability, appropriateness, and fidelity, and were followed by qualitative focus groups (FGs) to assess the implementation process and understand these outcomes. Thirteen FGs stratified by school and role, including school leaders, program facilitators, participants, and researchers, were conducted. RESULTS The program was implemented in three schools, reaching 253 families with in-person workshops (40.5% of potential participants), 257 parents who viewed on average 72.1% of sent multimedia messages, and 2 families who used the personalized support (0.3%). Overall, the program was viewed as acceptable and appropriate by participants and implementers due to the high quality of program materials, targeted content, and activities. Implementation differed by schools. Key implementation factors were the outer context, inner school setting, and implementation processes. CONCLUSIONS This comprehensive evaluation, including both intervention implementers and participants, identified implementation facilitators, barriers, and outcomes. Future ¡VxM! implementations should alter program components of schools with lower engagement to improve program implementation and outcomes.
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Affiliation(s)
- Jessica K V Meyer
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- University of Rochester Family Medicine Residency, Rochester, New York, USA
| | - Gabriela Diaspro
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Iván Muñoz
- Fundación Paréntesis, Hogar de Cristo, Santiago, Chile
| | | | - Diego García-Huidobro
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Courtwright SE, Jones J, Barton A, Peterson K, Eigen K, Feuerstein J, Pawa A, Pawa A, Northridge J, Pall H. Including Voices of Adolescents With Chronic Conditions in the Redesign of Children's Mental Health Systems: Implications for Resource Allocation. J Pediatr Health Care 2023. [PMID: 36863886 DOI: 10.1016/j.pedhc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Adolescents with chronic conditions have disparate mental health outcomes. This study aimed to explore the perspectives of adolescents with chronic conditions on mental health system redesign to improve outcomes. METHOD Within an interpretive phenomenological approach, semistructured interviews with 17 adolescents aged 10-20 years with chronic conditions were conducted. Purposive sampling and recruitment occurred at three ambulatory sites. Data were analyzed using inductive and deductive thematic analysis until information saturation was achieved. RESULTS Four themes were identified: (1) Brushed off: I need to be heard, (2) I need someone I can really talk to and trust, (3) They need to reach out to us. Check in on us, and (4) the school nurse is for physical illness only. DISCUSSION Mental health system redesign should be considered for adolescents with chronic conditions. The findings can inform future research to test innovative health care delivery models to reduce mental health disparities in this vulnerable population.
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Affiliation(s)
- Suzanne E Courtwright
- Suzanne E. Courtwright, Postdoctoral Research Fellow, College of Nursing, University of Colorado, Aurora, CO; Center for Healthcare Delivery Research and Innovations, Columbia University School of Nursing, New York, NY.
| | - Jacqueline Jones
- Jacqueline Jones, Professor of Nursing, Assistant Dean and PhD Program Director, College of Nursing, University of Colorado, Aurora, CO
| | - Amy Barton
- Amy Barton, Professor, Senior Associate Dean for Faculty and Students, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing, College of Nursing, University of Colorado, Aurora, CO
| | - Kerry Peterson
- Kerry Peterson, Associate Professor, Specialty Director of the PMHNP program, University of Colorado, Aurora, CO
| | - Karen Eigen
- Karen Eigen, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatric Emergency Medicine Physician, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Feuerstein
- Jessica Feuerstein, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Pediatrician, Departments of Emergency Medicine and Adolescent Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, and Pediatrician; Department of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anil Pawa
- Anil Pawa, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Section Chief, Primary Care Pediatrics, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
| | - Akhil Pawa
- Akhil Pawa, Research Assistant, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Research Assistant, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Jessica Northridge
- Jessica Northridge, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Section Chief, Adolescent Medicine, Department of Emergency Medicine, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ
| | - Harpreet Pall
- Harpreet Pall, Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Chair of Pediatrics, and Professor, Department of Pediatrics, K. Hovnanian Children's Hospital, Jersey Shore University Medical Center, Neptune, NJ
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Stevens G, Johnson LC, Saunders CH, Schmidt P, Sierpe A, Thomeer RP, Little NR, Cantrell M, Yen RW, Pogue JA, Holahan T, Schubbe DC, Forcino RC, Fillbrook B, Sheppard R, Wooten C, Goldmann D, O’Malley AJ, Dubé E, Durand MA, Elwyn G. The CONFIDENT study protocol: a randomized controlled trial comparing two methods to increase long-term care worker confidence in the COVID-19 vaccines. BMC Public Health 2023; 23:384. [PMID: 36823559 PMCID: PMC9948785 DOI: 10.1186/s12889-023-15266-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Clinical and real-world effectiveness data for the COVID-19 vaccines have shown that they are the best defense in preventing severe illness and death throughout the pandemic. However, in the US, some groups remain more hesitant than others about receiving COVID-19 vaccines. One important group is long-term care workers (LTCWs), especially because they risk infecting the vulnerable and clinically complex populations they serve. There is a lack of research about how best to increase vaccine confidence, especially in frontline LTCWs and healthcare staff. Our aims are to: (1) compare the impact of two interventions delivered online to enhanced usual practice on LTCW COVID-19 vaccine confidence and other pre-specified secondary outcomes, (2) determine if LTCWs' characteristics and other factors mediate and moderate the interventions' effect on study outcomes, and (3) explore the implementation characteristics, contexts, and processes needed to sustain a wider use of the interventions. METHODS We will conduct a three-arm randomized controlled effectiveness-implementation hybrid (type 2) trial, with randomization at the participant level. Arm 1 is a dialogue-based webinar intervention facilitated by a LTCW and a medical expert and guided by an evidence-based COVID-19 vaccine decision tool. Arm 2 is a curated social media web application intervention featuring interactive, dynamic content about COVID-19 and relevant vaccines. Arm 3 is enhanced usual practice, which directs participants to online public health information about COVID-19 vaccines. Participants will be recruited via online posts and advertisements, email invitations, and in-person visits to care settings. Trial data will be collected at four time points using online surveys. The primary outcome is COVID-19 vaccine confidence. Secondary outcomes include vaccine uptake, vaccine and booster intent for those unvaccinated, likelihood of recommending vaccination (both initial series and booster), feeling informed about the vaccines, identification of vaccine information and misinformation, and trust in COVID-19 vaccine information provided by different people and organizations. Exploration of intervention implementation will involve interviews with study participants and other stakeholders, an in-depth process evaluation, and testing during a subsequent sustainability phase. DISCUSSION Study findings will contribute new knowledge about how to increase COVID-19 vaccine confidence and effective informational modalities for LTCWs. TRIAL REGISTRATION NCT05168800 at ClinicalTrials.gov, registered December 23, 2021.
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Affiliation(s)
- Gabrielle Stevens
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, US.
| | - Lisa C. Johnson
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Catherine H. Saunders
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Peter Schmidt
- grid.137628.90000 0004 1936 8753Department of Neurology, Grossman School of Medicine, New York University, New York, NY US
| | - Ailyn Sierpe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachael P. Thomeer
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - N. Ruth Little
- grid.255364.30000 0001 2191 0423Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC US
| | - Matthew Cantrell
- National Association of Health Care Assistants, Carl Junction, MO US
| | - Renata W. Yen
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Jacqueline A. Pogue
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Timothy Holahan
- grid.16416.340000 0004 1936 9174Department of Geriatric Medicine, University of Rochester, Rochester, NY US
| | - Danielle C. Schubbe
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Rachel C. Forcino
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | | | | | | | - Don Goldmann
- grid.418700.a0000 0004 0614 6393Institute for Healthcare Improvement, Boston, MA US
| | - A. James O’Malley
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
| | - Eve Dubé
- grid.23856.3a0000 0004 1936 8390Department of Anthropology, Faculty of Social Sciences, Laval University, Quebec City, QC Canada
| | - Marie-Anne Durand
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US ,grid.511931.e0000 0004 8513 0292Unisanté, Centre universitaire de médecine générale et santé publique, Rue du Bugnon 44, Lausanne Switzerland ,CERPOP, Université de Toulouse, Inserm, Toulouse, UPS France
| | - Glyn Elwyn
- grid.254880.30000 0001 2179 2404The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH US
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Brimblecombe J, Miles B, Chappell E, De Silva K, Ferguson M, Mah C, Miles E, Gunther A, Wycherley T, Peeters A, Minaker L, McMahon E. Implementation of a food retail intervention to reduce purchase of unhealthy food and beverages in remote Australia: mixed-method evaluation using the consolidated framework for implementation research. Int J Behav Nutr Phys Act 2023; 20:20. [PMID: 36803988 PMCID: PMC9938595 DOI: 10.1186/s12966-022-01377-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/08/2022] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Adoption of health-enabling food retail interventions in food retail will require effective implementation strategies. To inform this, we applied an implementation framework to a novel real-world food retail intervention, the Healthy Stores 2020 strategy, to identify factors salient to intervention implementation from the perspective of the food retailer. METHODS A convergent mixed-method design was used and data were interpreted using the Consolidated Framework for Implementation Research (CFIR). The study was conducted alongside a randomised controlled trial in partnership with the Arnhem Land Progress Aboriginal Corporation (ALPA). Adherence data were collected for the 20 consenting Healthy Stores 2020 study stores (ten intervention /ten control) in 19 communities in remote Northern Australia using photographic material and an adherence checklist. Retailer implementation experience data were collected through interviews with the primary Store Manager for each of the ten intervention stores at baseline, mid- and end-strategy. Deductive thematic analysis of interview data was conducted and informed by the CFIR. Intervention adherence scores derived for each store assisted interview data interpretation. RESULTS Healthy Stores 2020 strategy was, for the most part, adhered to. Analysis of the 30 interviews revealed that implementation climate of the ALPA organisation, its readiness for implementation including a strong sense of social purpose, and the networks and communication between the Store Managers and other parts of ALPA, were CFIR inner and outer domains most frequently referred to as positive to strategy implementation. Store Managers were a 'make-or-break' touchstone of implementation success. The co-designed intervention and strategy characteristics and its perceived cost-benefit, combined with the inner and outer setting factors, galvanised the individual characteristics of Store Managers (e.g., optimism, adaptability and retail competency) to champion implementation. Where there was less perceived cost-benefit, Store Managers seemed less enthusiastic for the strategy. CONCLUSIONS Factors critical to implementation (a strong sense of social purpose; structures and processes within and external to the food retail organisation and their alignment with intervention characteristics (low complexity, cost advantage); and Store Manager characteristics) can inform the design of implementation strategies for the adoption of this health-enabling food retail initiative in the remote setting. This research can help inform a shift in research focus to identify, develop and test implementation strategies for the wide adoption of health-enabling food retail initiatives into practice. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN 12,618,001,588,280.
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Affiliation(s)
- Julie Brimblecombe
- Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168, Australia. .,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT, 0810, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD, 4006, Australia.
| | - Bethany Miles
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia
| | - Emma Chappell
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Khia De Silva
- Arnhem Land Progress Aboriginal Corporation, 70 O’Sullivan Cct, East Arm, NT 0828 Australia
| | - Megan Ferguson
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia ,grid.1003.20000 0000 9320 7537School of Public Health, Faculty of Medicine, The University of Queensland, Public Health Building, Level 4, Herston, QLD 4006 Australia
| | - Catherine Mah
- grid.55602.340000 0004 1936 8200Dalhousie University, 5850 College Street, Second Floor, PO Box 15000, Halifax, NS B3H 4R2 Canada ,grid.17063.330000 0001 2157 2938University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Eddie Miles
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Anthony Gunther
- Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
| | - Thomas Wycherley
- grid.1026.50000 0000 8994 5086Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, North Terrace, Adelaide, South Australia 5000 Australia
| | - Anna Peeters
- grid.1021.20000 0001 0526 7079Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Leia Minaker
- grid.46078.3d0000 0000 8644 1405School of Planning, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Emma McMahon
- grid.1002.30000 0004 1936 7857Department of Nutrition Dietetics and Food, Monash University, Level 1 264 Ferntree Gully Rd, Notting Hill, Victoria, 3168 Australia ,Menzies School of Health Research, Charles Darwin University, Royal Darwin Hospital Campus, Building 58 Rocklands Drive, Tiwi, NT 0810 Australia
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Tjilos M, Tamlyn AL, Ragan EJ, Assoumou SA, Barnett KG, Martin P, Perkins RB, Linas BP, Drainoni ML. "Community members have more impact on their neighbors than celebrities": leveraging community partnerships to build COVID-19 vaccine confidence. BMC Public Health 2023; 23:350. [PMID: 36797724 PMCID: PMC9933023 DOI: 10.1186/s12889-023-15198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. This paper describes the themes which resulted from these community-engaged conversations and proposes next steps for healthcare leaders. METHODS We accessed nine publicly available recordings of the community-engaged conversations which were held between March 2021 and September 2021 and ranged from 8 to 122 attendees. Six conversations prioritized specific groups: the Haitian-Creole community, the Cape Verdean community, the Latino community, the Black Christian Faith community, guardians who care for children living with disabilities, and individuals affected by systemic lupus erythematosus. Remaining conversations targeted the general public of the Greater Boston Area. We employed a Consolidated Framework for Implementation Research-driven codebook to code our data. Our analysis utilized a modified version of qualitative rapid analysis methods. RESULTS Five main themes emerged from these community-engaged conversations: (1) Structural factors are important barriers to COVID-19 vaccination; (2) Mistrust exists due to the negative impact of systemic oppression and perceived motivation of the government; (3) There is a desire to learn more about biological and clinical characteristics of the COVID-19 vaccine as well as the practical implications of being vaccinated; (4) Community leaders emphasize community engagement for delivering COVID-19 information and education and; (5) Community leaders believe that the COVID-19 vaccine is a solution to address the pandemic. CONCLUSION This study illustrates a need for community-engaged COVID-19 vaccine messaging which reflects the nuances of the COVID-19 vaccine and pandemic without oversimplifying information. In highlighting common concerns of the Greater Boston Area which contribute to a lack of confidence in the COVID-19 vaccine, we underscore important considerations for public health and healthcare leadership in the development of initiatives which work to advance health equity.
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Affiliation(s)
- Maria Tjilos
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
| | - Autumn L. Tamlyn
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
| | - Elizabeth J. Ragan
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
| | - Sabrina A. Assoumou
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
- Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US
| | - Katherine Gergen Barnett
- Department of Family Medicine, Boston Medical Center, 1 Boston Medical Center Place, 02118 Boston, MA US
- Department of Family Medicine, Boston University Chobanian & Edward Avedisian School of Medicine, 72 E Concord St, MA 02118 Boston, United States
- Harvard Center for Primary Care, Harvard Medical School, 25 Shattuck St, MA 02115 Boston, US
| | - Petrina Martin
- Boston Medical Center, Boston Medical Center Health System, 85 East Concord Street, 02118 Boston, MA US
| | - Rebecca B. Perkins
- Department of Obstetrics and Gynecology, Boston University Chobanian & Edward Avedisian School of Medicine, 72 E Concord St, 02118 Boston, MA US
- Department of Obstetrics and Gynecology, Boston Medical Center, 775 Albany St, MA 02118 Boston, US
| | - Benjamin P. Linas
- Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Ave. Crosstown Center, 2nd Floor, 02118 Boston, MA US
- Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, 02118 Boston, MA US
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Boston University Chobanian & Edward Avedisian School of Medicine, Boston Medical Center, 72 E Concord St, 02118 Boston, MA US
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany St, MA 02118 Boston, US
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Glenwright BG, Simmich J, Cottrell M, O’Leary SP, Sullivan C, Pole JD, Russell T. Facilitators and barriers to implementing electronic patient-reported outcome and experience measures in a health care setting: a systematic review. J Patient Rep Outcomes 2023; 7:13. [PMID: 36786914 PMCID: PMC9928985 DOI: 10.1186/s41687-023-00554-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE This systematic literature review aimed to identify factors that influence the implementation of electronic patient-reported outcome measures (ePROMs) and patient-reported experience measures (ePREMs) in healthcare settings. INTRODUCTION Improvements in health care through increased patient engagement have gained traction in recent years. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are tools used to improve the quality of care from the patient perspective. The influence of implementing PROMs and PREMs using electronic information systems (ePROMs and ePREMs) is not well understood. INCLUSION CRITERIA Studies with information related to the implementation of ePROMs and/or ePREMs with a focus on health-related services, irrespective of provider type, were included. METHODS A literature search of peer-reviewed databases was conducted on the 24th of January 2022 for articles about barriers and facilitators of the implementation of ePROMs/ePREMs in healthcare settings. Two reviewers independently extracted relevant findings from the included studies and performed a descriptive code-based synthesis before collaboratively creating a final consensus set of code categories, which were then mapped to the consolidated framework of implementation research (CFIR). Study quality was appraised using a mixed-methods appraisal tool (MMAT). RESULTS 24 studies were eligible for inclusion in the screening of 626 nonduplicate studies. Quality assessment using the MMAT revealed that 20/24 studies met at least 60% of the MMAT criteria. Ninety-six code categories were identified and mapped to the constructs across all CFIR domains. CONCLUSION To guide the effective implementation of ePROMs/ePREMs in healthcare settings, factors shown to influence their implementation have been summarised as an implementation checklist for adoption and use by clinicians, organisations, and policymakers.
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Affiliation(s)
- Ben G. Glenwright
- grid.413210.50000 0004 4669 2727Physiotherapy Department, Cairns Hospital, Cairns Hinterland and Hospital Health Service, Orthopaedic Ward, D6, Cairns Hospital, 165 The Esplanade, Cairns, QLD 4870 Australia ,grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Joshua Simmich
- grid.1003.20000 0000 9320 7537RECOVER Injury Research Centre, University of Queensland, Brisbane, Australia
| | - Michelle Cottrell
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Shaun P. O’Leary
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia ,grid.416100.20000 0001 0688 4634Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Clair Sullivan
- grid.1003.20000 0000 9320 7537Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Jason D. Pole
- grid.1003.20000 0000 9320 7537Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Trevor Russell
- grid.1003.20000 0000 9320 7537School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia ,grid.1003.20000 0000 9320 7537RECOVER Injury Research Centre, University of Queensland, Brisbane, Australia
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Fu BQ, Zhong CCW, Wong CHL, Ho FF, Nilsen P, Hung CT, Yeoh EK, Chung VCH. Barriers and Facilitators to Implementing Interventions for Reducing Avoidable Hospital Readmission: Systematic Review of Qualitative Studies. Int J Health Policy Manag 2023; 12:7089. [PMID: 37579466 PMCID: PMC10125127 DOI: 10.34172/ijhpm.2023.7089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 01/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Avoidable hospital readmission is a major problem among health systems. Although there are effective peri-discharge interventions for reducing avoidable hospital readmission, successful implementation is challenging. This systematic review of qualitative studies aimed to identify barriers and facilitators to implementing peri-discharge interventions from providers' and service users' perspectives. METHODS We searched four databases for potentially eligible qualitative studies from databases' inception to March 2020, and updated literature search for studies published between January 2020 to October 2021. Barriers and facilitators to implementing peri-discharge interventions were identified and mapped onto the Consolidated Framework for Implementation Research (CFIR) constructs. Inductive analysis of the CFIR constructs was performed to yield thematic areas that illustrated the relationship between various facilitators and barriers, generating practical insights to key implementation issues. RESULTS Thirteen qualitative studies were included in this systematic review. Key issues were clustered in the CFIR constructs of Design Quality and Complexity of the intervention, strength of Network and Communication, being responsive to Patient Needs with sufficient Resource support, and External Incentives. The three thematic areas were rationality of the interventions, readiness and effort of multidisciplinary implementation teams, and influence of external stakeholders. Common barriers included (i) limited resources, (ii) poor communication among team members, (iii) incompatibility between the new intervention and existing work routine, (iv) complicated implementation process, (v) low practicality of supporting instruments, and (vi) lack of understanding about the content and effectiveness of the new interventions. Common facilitators were (i) information sharing via regular meetings on implementation issues, (ii) organizational culture that values quality and accountability, (iii) financial penalties for hospitals with high avoidable readmissions rates, (iv) external support offered via quality improvement programs and community resources, and (v) senior leadership support. CONCLUSION This study synthesized commonly-presenting barriers and facilitators to implementing peri-discharge interventions among different healthcare organizations. Findings may inform development of implementation strategies in different health systems after appropriate tailoring, based on a consensus-based formative research process.
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Affiliation(s)
- Becky Q Fu
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Claire CW Zhong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charlene HL Wong
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fai Fai Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Per Nilsen
- Department of Medicine, Health and Caring Sciences, Linköping University, Linköping, Sweden
| | - Chi Tim Hung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng Kiong Yeoh
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent CH Chung
- Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Anderson DM, Bear AB, Zacher T, Endres K, Saxton R, Richards F, Robe LB, Harvey D, Best LG, Cloud RR, Thomas ED, Gittelsohn J, O’Leary M, Navas-Acien A, George CM. Implementing a Community-Led Arsenic Mitigation Intervention for Private Well Users in American Indian Communities: A Qualitative Evaluation of the Strong Heart Water Study Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2681. [PMID: 36768048 PMCID: PMC9915175 DOI: 10.3390/ijerph20032681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Arsenic is a naturally occurring toxicant in groundwater, which increases cancer and cardiovascular disease risk. American Indian populations are disproportionately exposed to arsenic in drinking water. The Strong Heart Water Study (SHWS), through a community-centered approach for intervention development and implementation, delivered an arsenic mitigation program for private well users in American Indian communities. The SHWS program comprised community-led water arsenic testing, point-of-use arsenic filter installation, and a mobile health program to promote sustained filter use and maintenance (i.e., changing the filter cartridge). Half of enrolled households received additional in-person behavior change communication and videos. Our objectives for this study were to assess successes, barriers, and facilitators in the implementation, use, and maintenance of the program among implementers and recipients. We conducted 45 semi-structured interviews with implementers and SHWS program recipients. We analyzed barriers and facilitators using the Consolidated Framework for Implementation Research and the Risks, Attitudes, Norms, Abilities, and Self-regulation model. At the implementer level, facilitators included building rapport and trust between implementers and participating households. Barriers included the remoteness of households, coordinating with community plumbers for arsenic filter installation, and difficulty securing a local supplier for replacement filter cartridges. At the recipient level, facilitators included knowledge of the arsenic health risks, perceived effectiveness of the filter, and visual cues to promote habit formation. Barriers included attitudes towards water taste and temperature and inability to procure or install replacement filter cartridges. This study offers insights into the successes and challenges of implementing an arsenic mitigation program tailored to American Indian households, which can inform future programs in partnership with these and potentially similar affected communities. Our study suggests that building credibility and trust between implementers and participants is important for the success of arsenic mitigation programs.
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Affiliation(s)
- Darcy M. Anderson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Annabelle Black Bear
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Tracy Zacher
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Ronald Saxton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Francine Richards
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Lisa Bear Robe
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - David Harvey
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Indian Health Service, Rockville, MD 20857, USA
| | - Lyle G. Best
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Reno Red Cloud
- Environmental Resource Department, Oglala Sioux Tribe, Pine Ridge, SD 57770, USA
| | - Elizabeth D. Thomas
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research, Cheyenne River Sioux Tribe, Eagle Butte, SD 57625, USA
| | - Ana Navas-Acien
- Department of Environmental Health Science, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Ross AJ, Sherriff A, Kidd J, Deas L, Eaves J, Blokland A, Wright B, King P, McMahon AD, Conway DI, Macpherson LMD. Evaluating childsmile, Scotland's National Oral Health Improvement Programme for children. Community Dent Oral Epidemiol 2023; 51:133-138. [PMID: 36753390 DOI: 10.1111/cdoe.12790] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/08/2022] [Accepted: 08/15/2022] [Indexed: 02/09/2023]
Abstract
In the early 2000s, a Scottish Government Oral Health Action Plan identified the need for a national programme to improve child oral health and reduce inequalities. 'Childsmile' aimed to improve child oral health in Scotland, reduce inequalities in outcomes and access to dental services, and to shift the balance of care from treatment to prevention through targeted and universal components in dental practice, community and educational settings. This paper describes how an embedded, theory-based research and evaluation arm with multi-disciplinary input helps determine priorities and provides important strategic direction. Programme theory is articulated in dedicated, dynamic logic models, and evaluation themes are as follows: population-level data linkage; trials and economic evaluations; investigations drawing from behavioural and implementation science; evidence reviews and updates; and applications of systems science. There is also a growing knowledge sharing network internationally. Collaborative working from all stakeholders is necessary to maintain gains and to address areas that may not be working as well, and never more so with the major disruptions to the programme from the COVID-19 pandemic and response. Conclusions are that evaluation and research are synergistic with a complex, dynamic programme like Childsmile. The evidence obtained allows for appraisal of the relative strengths of component interventions and the reach and impact of Childsmile to feed into national policy.
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Affiliation(s)
- Alastair J Ross
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrea Sherriff
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Jamie Kidd
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Leigh Deas
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Jenny Eaves
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex Blokland
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Bill Wright
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Peter King
- Public Dental Service, NHS Lanarkshire, Glasgow, UK
| | - Alex D McMahon
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - David I Conway
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Lorna M D Macpherson
- Community Oral Health Group, University of Glasgow Dental School, School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
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Davis SD, Bayes S, Geraghty S. Development of a tool to identify barriers and enablers to practice innovation in midwifery: A participatory action research study. Eur J Midwifery 2023; 7:1. [PMID: 36761447 PMCID: PMC9885374 DOI: 10.18332/ejm/157459] [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: 07/29/2022] [Revised: 03/18/2022] [Accepted: 12/14/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Transferring research evidence into midwifery practice is fraught with challenges and obstacles. Implementation tools can streamline the process and are most effective when they are discipline-specific; however, there are currently no midwifery specific implementation tools. The aim of this study was to develop a midwifery specific tool to identify barriers and enablers to evidence-informed practice change within the clinical setting. METHODS Participatory action research methodology was employed to ensure potential end-users contributed to content and format of the tool. Purposeful sampling ensured participants were selected from a range of midwifery practice settings in Western Australia and the United Kingdom. Data were collected through stakeholder advisory groups (SAGs) and online surveys. RESULTS Ten midwives participated in this project. Consultation occurred through face-to-face SAG meetings and online surveys until consensus was reached among participants about the content, format, and functionality of the end product which we called the 'Midwifery Tool for Change' (MT4C). CONCLUSIONS To our knowledge, the MT4C is the first readiness for change context assessment tool specific to midwifery practice settings. Evaluation of the MT4C in real-world practice change implementation initiatives will enable further refinement of the tool.
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Affiliation(s)
- Sara D. Davis
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Sara Bayes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Sadie Geraghty
- School of Nursing, Midwifery, Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Australia
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Prausnitz S, Altschuler A, Herrinton LJ, Avins AL, Corley DA. The implementation checklist: A pragmatic instrument for accelerating
research‐to‐implementation
cycles. Learn Health Syst 2023. [DOI: 10.1002/lrh2.10359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Stephanie Prausnitz
- The Permanente Medical Group, Delivery Science and Applied Research Program Kaiser Permanente Northern California Oakland California USA
| | - Andrea Altschuler
- The Permanente Medical Group, Delivery Science and Applied Research Program Kaiser Permanente Northern California Oakland California USA
| | - Lisa J. Herrinton
- The Permanente Medical Group, Delivery Science and Applied Research Program Kaiser Permanente Northern California Oakland California USA
| | - Andrew L. Avins
- The Permanente Medical Group, Delivery Science and Applied Research Program Kaiser Permanente Northern California Oakland California USA
| | - Douglas A. Corley
- The Permanente Medical Group, Delivery Science and Applied Research Program Kaiser Permanente Northern California Oakland California USA
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179
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Freund J, Ebert DD, Thielecke J, Braun L, Baumeister H, Berking M, Titzler I. Using the Consolidated Framework for Implementation Research to evaluate a nationwide depression prevention project (ImplementIT) from the perspective of health care workers and implementers: Results on the implementation of digital interventions for farmers. Front Digit Health 2023; 4:1083143. [PMID: 36761450 PMCID: PMC9907445 DOI: 10.3389/fdgth.2022.1083143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/28/2022] [Indexed: 01/24/2023] Open
Abstract
Introduction Depression has a significant impact on individuals and society, which is why preventive measures are important. Farmers represent an occupational group exposed to many risk factors for depression. The potential of guided, tailored internet-based interventions and a personalized telephone coaching is evaluated in a German project of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). While user outcomes are promising, not much is known about actual routine care use and implementation of the two digital health interventions. This study evaluates the implementation from the perspective of social insurance employees to understand determinants influencing the uptake and implementation of digital interventions to prevent depression in farmers. Methods The data collection and analysis are based on the Consolidated Framework for Implementation Research (CFIR). Health care workers (n = 86) and implementers (n = 7) completed online surveys and/or participated in focus groups. The surveys consisted of validated questionnaires used in implementation research, adapted items from the CFIR guide or from other CFIR studies. In addition, we used reporting data to map implementation based on selected CFIR constructs. Results Within the five CFIR dimensions, many facilitating factors emerged in relation to intervention characteristics (e.g., relative advantage compared to existing services, evidence and quality) and the inner setting of the SVLFG (e.g., tension for change, compatibility with values and existing working processes). In addition, barriers to implementation were identified in relation to the outer setting (patient needs and resources), inner setting (e.g., available resources, access to knowledge and information) and characteristics of individuals (e.g., self-efficacy). With regard to the implementation process, facilitating factors (formal implementation leaders) as well as hindering factors (reflecting and evaluating) were identified. Discussion The findings shed light on the implementation of two digital prevention services in an agricultural setting. While both offerings seem to be widely accepted by health care workers, the results also point to revealed barriers and contribute to recommendations for further service implementation. For instance, special attention should be given to "patient needs and resources" by raising awareness of mental health issues among the target population as well as barriers regarding the inner setting. Clinical Trial Registration German Clinical Trial Registration: [DRKS00017078]. Registered on 18.04.2019.
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Affiliation(s)
- Johanna Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany,TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany,Correspondence: Johanna Freund
| | | | - Janika Thielecke
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany,TUM Department of Sport and Health Sciences, TU Munich, Munich, Germany
| | - Lina Braun
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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180
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Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
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Jesus TS, Kamalakannan S, Bhattacharjya S, Bettger JP, Jacobs K, Hoenig H. Which factors affect the implementation of telerehabilitation? Study protocol for a mixed-methods systematic review with a framework synthesis. Work 2023:WOR210745. [PMID: 36683522 DOI: 10.3233/wor-210745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Telehealth approaches are promising for the delivery of rehabilitation services but may be under-used or under-implemented. OBJECTIVE To report a review protocol to identify how much telerehabilitation (telehealth approaches to the delivery of rehabilitation services) have been used and implemented, and which factors have affected such implementation. METHODS A mixed-methods systematic review with a framework synthesis. Six databases for the scientific literature will be searched, complemented by snowballing searches and additional references coming from key informants (i.e., rehabilitation researchers from a networking group in health services research). We will include English-language empirical research examining the routine use or implementation of telehealth technologies in physical rehabilitation services or by physical rehabilitation professionals from a range of study designs, excepting case studies, case reports, and qualitative studies with n < 5. Two independent reviewers will perform the screenings, quality appraisals (using the Joanna Briggs Institutes' appraisal checklists), and the data extractions. The Consolidated Framework for Implementation Research will be used to synthesize the data on the enablers and barriers of the implementation of telerehabilitation approaches. All the authors will be involved at this synthesis, and key informants will provide feedback. CONCLUSION The results can inform further implementation endeavours.
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Affiliation(s)
- Tiago S Jesus
- Center for Education in Health Sciences, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Sureshkumar Kamalakannan
- Public Health Foundation of India (PHFI), South Asia Centre for Disability Inclusive Development and Research (SACDIR), Indian Institute of Public Health - Hyderabad (IIPH-H), Hyderabad, India
| | - Sutanuka Bhattacharjya
- Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | | | - Karen Jacobs
- Department of Occupational Therapy, College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC, USA.,Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC, USA
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Nelson PA, Bradley F, Ullah A, Whittaker W, Brunton L, Calovski V, Money A, Dowding D, Cullum N, Wilson P. Implementation, uptake and use of a digital COVID-19 symptom tracker in English care homes in the coronavirus pandemic: a mixed-methods, multi-locality case study. Implement Sci Commun 2023; 4:7. [PMID: 36650559 PMCID: PMC9843982 DOI: 10.1186/s43058-022-00387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND COVID-19 spread rapidly in UK care homes for older people in the early pandemic. National infection control recommendations included remote resident assessment. A region in North-West England introduced a digital COVID-19 symptom tracker for homes to identify early signs of resident deterioration to facilitate care responses. We examined the implementation, uptake and use of the tracker in care homes across four geographical case study localities in the first year of the pandemic. METHODS This was a rapid, mixed-methods, multi-locality case study. Tracker uptake was calculated using the number of care homes taking up the tracker as a proportion of the total number of care homes in a locality. Mean tracker use was summarised at locality level and compared. Semi-structured interviews were conducted with professionals involved in tracker implementation and used to explore implementation factors across localities. Template Analysis with the Consolidated Framework for Implementation Research (CFIR) guided the interpretation of qualitative data. RESULTS Uptake varied across the four case study localities ranging between 13.8 and 77.8%. Tracker use decreased in all localities over time at different rates, with average use ranging between 18 and 58%. The implementation context differed between localities and the process of implementation deviated over time from the initially planned strategy, for stakeholder engagement and care homes' training. Four interpretative themes reflected the most influential factors appearing to affect tracker uptake and use: (1) the process of implementation, (2) implementation readiness, (3) clarity of purpose/perceived value and (4) relative priority in the context of wider system pressures. CONCLUSIONS Our study findings resonate with the digital solutions evidence base prior to the COVID-19 pandemic, suggesting three key factors that can inform future development and implementation of rapid digital responses in care home settings even in times of crisis: an incremental approach to implementation with testing of organisational readiness and attention to implementation climate, particularly the innovation's fit with local contexts (i.e. systems, infrastructure, work processes and practices); involvement of end-users in innovation design and development; and enabling users' easy access to sustained, high-quality, appropriate training and support to enable staff to adapt to digital solutions.
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Affiliation(s)
- Pauline A. Nelson
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Fay Bradley
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Akbar Ullah
- grid.5379.80000000121662407Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Will Whittaker
- grid.5379.80000000121662407Manchester Centre for Health Economics, Faculty of Biology Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Lisa Brunton
- grid.5379.80000000121662407Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Vid Calovski
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Annemarie Money
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Dawn Dowding
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Nicky Cullum
- grid.5379.80000000121662407Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Room 6.312, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Paul Wilson
- grid.5379.80000000121662407Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
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Le Goff D, Perraud G, Aujoulat P, Deriennic J, Guillou M, Barais M, Le Reste JY. Screening for cardiovascular risk in the general population: The SPICES implementation survey. Front Med (Lausanne) 2023; 9:1058090. [PMID: 36726352 PMCID: PMC9885854 DOI: 10.3389/fmed.2022.1058090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background In 2019, cardiovascular diseases (CVD) caused 32% of deaths worldwide. The SPICES survey involved five countries in an international primary CVD prevention implementation study in the general population. The French SPICES survey was implemented in the Centre Ouest Bretagne area (COB), which is a rural, economically deprived, medically underserved territory with high cardiovascular mortality. A CVD screening in the general population was needed to select the implementation population without overburdening family practitioner (FP) workforces. The efficacy and the replicability of such a screening were unknown. The aims of this study were to identify the characteristics of the individuals undergoing CVD risk assessment with the Non-Laboratory Interheart risk score (NL-IHRS), and to identify barriers and explore facilitators when screening the general population. Methods An implementation study combining a cross-sectional descriptive study with qualitative interviews was undertaken. The NL-IHRS was completed by trained screeners selected from health students, pharmacists, nurses, and physiotherapists in the area with a dedicated e-tool in sport and cultural events and public places. After the screening, all screener groups were interviewed until theoretical saturation for each group. Thematic analysis was performed using double-blind coding. Results In 5 months, 3,384 assessments were undertaken in 60 different places, mostly by health students. A total of 1,587, 1,309, and 488 individuals were at low, moderate, and high CVD risk. Stressed or depressed individuals were remarkably numerous (40.1 and 24.5% of the population, respectively). Forty-seven interviews were conducted. The main facilitators were willingness of the population, trust between screeners and the research team, and media publicity. The main barriers were lack of motivation of some screeners, some individuals at risk, some stakeholders and difficulties in handling the e-tool. Conclusion The efficacy of CVD risk screening while using mostly health students was excellent and preserved the FP workforce. Replicability was highly feasible if research teams took great care to establish and maintain trust between screeners and researchers. The e-tools should be more user-friendly.
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Affiliation(s)
- Delphine Le Goff
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France,*Correspondence: Delphine Le Goff,
| | - Gabriel Perraud
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Paul Aujoulat
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Jeremy Deriennic
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Morgane Guillou
- ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Marie Barais
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France
| | - Jean-Yves Le Reste
- Department of General Practice, University of Western Brittany, Brest, France,ER 7479 SPURBO, University of Western Brittany, Brest, France
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Duran AT, Keener-DeNoia A, Stavrolakes K, Fraser A, Blanco LV, Fleisch E, Pieszchata N, Cannone D, McKay CK, Whittman E, Edmondson D, Shelton RC, Moise N. User-centered design of a telehealth-enhanced hybrid cardiac rehabilitation program as hospital quality improvement. RESEARCH SQUARE 2023:rs.3.rs-2475875. [PMID: 36711987 PMCID: PMC9882652 DOI: 10.21203/rs.3.rs-2475875/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Innovative program designs and strategies are needed to support the widespread uptake of cardiac rehabilitation (CR) programs in the post-COVID19 era. We combined user-centered design (UCD) and implementation science (ImS) principles to design a novel telehealth-enhanced hybrid (home and clinic-based) CR (THCR) program. Methods As part of a New York Presbyterian Hospital (NYPH) quality improvement initiative (March 2020-February 2022), we designed a THCR program using an iterative 3 step UCD process informed by the Theoretical Domains Framework and Consolidated Framework for Implementation Research to: 1) identify user and contextual barriers to CR uptake (stakeholder interviews), 2) design an intervention prototype (design workshops and journey mapping), and 3) refine the prototype (usability testing). The process was optimized for usability and implementation outcomes. Results Step 1: Semi-structured interviews with stakeholders (n = 9) at 3 geographically diverse academic medical centers revealed behavioral (e.g., self-efficacy, knowledge) and contextual (e.g., social distancing guidelines, physical space, staffing, reimbursement) barriers to uptake. Step 2: Design workshops (n = 20) and journey-mapping sessions (n = 3) with multi-disciplinary NYPH stakeholders (e.g., digital health team, CR clinicians, creative director) yielded a THCR prototype that leveraged NYPH's investment in their remote patient monitoring (RPM) platform to optimize feasibility of home-based CR sessions. Step 3: Usability testing with CR clinicians (n = 2) administering and CR patients (n = 3) participating in home-based sessions revealed usability challenges (e.g., RPM devices/exercise equipment usability; Wi-Fi/Bluetooth connectivity/syncing; patient safety/knowledge and protocol flexibility). Design workshops (n = 24) and journey-mapping sessions (n = 3) yielded design solutions (e.g., onboarding sessions, safety surveys, fully supervised remote sessions) and a refined THCR prototype. Conclusion Combining UCD and ImS methods while engaging multi-disciplinary stakeholders in an iterative process yielded a theory-informed telehealth-enhanced hybrid CR program targeting user and contextual barriers to real-world CR implementation. We provide a detailed summary of the process, and guidance for incorporating UCD and ImS methods in early-stage intervention development. THCR may shrink the evidence-to-practice gap in CR implementation. A future hybrid type I effectiveness-implementation trial will determine its feasibility, acceptability, and effectiveness.
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Lin X, Yuen JYE, Chan WQJ, Divakar TG, Keong NCH, Lee LCH, Kumar S, Tan CS, Soon KCP, Chew YPA, Yazid HM, Saleh FJM, Cai F, Chai FC, Azwan NFM, Faizal NM, Lou SC, Tan SSP, Jarimin CM, Stanley GM, Hussien K, Sanmwan N, Amran NH, Ramli N, Neo SXM, Tan LCS, Tan EK, Lum E. Using the consolidated framework for implementation research to guide a pilot of implementing an institution level patient informed consent process for clinical research at an outpatient setting. Pilot Feasibility Stud 2023; 9:6. [PMID: 36635739 PMCID: PMC9835029 DOI: 10.1186/s40814-023-01234-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/02/2023] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND In Singapore, research teams seek informed patient consent on an ad hoc basis for specific clinical studies and there is typically a role separation between operational and research staff. With the enactment of the Human Biomedical Research Act, there is increased emphasis on compliance with consent-taking processes and research documentation. To optimize resource use and facilitate long-term research sustainability at our institution, this study aimed to design and pilot an institution level informed consent workflow (the "intervention") that is integrated with clinic operations. METHODS We used the Consolidated Framework for Implementation Research (CFIR) as the underpinning theoretical framework and conducted the study in three stages: Stage 1, CFIR constructs were used to systematically identify barriers and facilitators of intervention implementation, and a simple time-and-motion study of the patient journey was used to inform the design of the intervention; Stage 2, implementation strategies were selected and mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy; Stage 3, we piloted and adapted the implementation process at two outpatient clinics and evaluated implementation effectiveness through patient participation rates. RESULTS We identified 15 relevant CFIR constructs. Implementation strategies selected to address these constructs were targeted at three groups of stakeholders: institution leadership (develop relationships, involve executive boards, identify and prepare champions), clinic management team (develop relationships, identify and prepare champions, obtain support and commitment, educate stakeholders), and clinic operations staff (develop relationships, assess readiness, conduct training, cyclical tests of change, model and simulate change, capture and share local knowledge, obtain and use feedback). Time-and-motion study in clinics identified the pre-consultation timepoint as the most appropriate for the intervention. The implementation process was adapted according to clinic operations staff and service needs. At the conclusion of the pilot, 78.3% of eligible patients provided institution level informed consent via the integrated workflow implemented. CONCLUSIONS Our findings support the feasibility of implementing an institution level informed consent workflow that integrates with service operations at the outpatient setting to optimize healthcare resources for research. The CFIR provided a useful framework to identify barriers and facilitators in the design of the intervention and its implementation process.
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Affiliation(s)
- Xuling Lin
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Joanne Yong Ern Yuen
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Wei Quan Jeremy Chan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Tushar Gosavi Divakar
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nicole Chwee Har Keong
- grid.276809.20000 0004 0636 696XDepartment of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Lester Chee How Lee
- grid.276809.20000 0004 0636 696XDepartment of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sumeet Kumar
- grid.276809.20000 0004 0636 696XDepartment of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Chew Seah Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Kim Chin Pauline Soon
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Yee Pheng Amy Chew
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Heriati Mohd Yazid
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Farah Julieanna Mohd Saleh
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Fenglong Cai
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Fui Chih Chai
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nur Fakhirah Mohamed Azwan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Nurhidayah Mohamad Faizal
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Siew Choo Lou
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Siew Sin Priscilla Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Cut Marini Jarimin
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Gowri Michael Stanley
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Khadijah Hussien
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nurhazah Sanmwan
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nur Hidayah Amran
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Nurliana Ramli
- grid.163555.10000 0000 9486 5048Specialist Outpatient Clinic Ambulatory Department, Singapore General Hospital, Singapore, Singapore
| | - Shermyn Xiu Min Neo
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Louis Chew Seng Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Eng King Tan
- grid.276809.20000 0004 0636 696XDepartment of Neurology, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Elaine Lum
- grid.428397.30000 0004 0385 0924Health Services & Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
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Campmans JMD, Smit DJM, van Oostrom SH, Engels JA, Proper KI. Barriers and facilitators to the implementation of workplace health promotion programs: Employers' perceptions. Front Public Health 2023; 10:1035064. [PMID: 36711336 PMCID: PMC9879575 DOI: 10.3389/fpubh.2022.1035064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background Workplace health promotion programs (WHPPs) can benefit the lifestyle and health of employees. However, not all WHPPs have been successful in their implementation, and thus their effectiveness. This study aimed to identify the barriers and facilitators to implementing an integrated WHPP, which targets multiple lifestyle factors at different levels (individual and organizational), from an employer's perspective. Methods Data were collected by two online focus groups among 18 representatives of eight different organizations. Data from the focus group discussions were transcribed verbatim and analyzed using thematic analysis. Data were coded both inductively and deductively, using the Consolidated Framework for Implementation Research (CFIR) consisting of the following five domains: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Ratings were performed to indicate the positive or negative influence and strength of a construct regarding the implementation of WHPPs. Results Barriers and facilitators in all domains of the CFIR were found. Regarding characteristics of the WHPP, complexity and costs hindered implementation, while high adaptability facilitated it. An organization that met the needs of employees (the outer setting) facilitated implementation. Available resources, access to knowledge, leadership involvement, and continuity of communication were facilitators within the inner setting. Barriers were different approaches to implementation within one organization and the perceived interference with employees' lives. For the implementation process, the involvement of key stakeholders, including employees, was identified as an important facilitator. Conclusion Various barriers and facilitators in different domains play a role in the implementation of integrated WHPPs, according to employers. Strategies that tackle the identified barriers and incorporate the facilitators will likely contribute to the successful implementation of integrated WHPPs.
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Affiliation(s)
- Jennifer M. D. Campmans
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Denise J. M. Smit
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands,*Correspondence: Denise J. M. Smit ✉
| | - Sandra H. van Oostrom
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Josephine A. Engels
- Occupation & Health Research Group, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Karin I. Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, Netherlands,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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187
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Robinson CH, Damschroder LJ. A pragmatic context assessment tool (pCAT): using a Think Aloud method to develop an assessment of contextual barriers to change. Implement Sci Commun 2023; 4:3. [PMID: 36631914 PMCID: PMC9835384 DOI: 10.1186/s43058-022-00380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/27/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The Consolidated Framework for Implementation Research (CFIR) is a determinant framework that can be used to guide context assessment prior to implementing change. Though a few quantitative measurement instruments have been developed based on the CFIR, most assessments using the CFIR have relied on qualitative methods. One challenge to measurement is to translate conceptual constructs which are often described using highly abstract, technical language into lay language that is clear, concise, and meaningful. The purpose of this paper is to document methods to develop a freely available pragmatic context assessment tool (pCAT). The pCAT is based on the CFIR and designed for frontline quality improvement teams as an abbreviated assessment of local facilitators and barriers in a clinical setting. METHODS Twenty-seven interviews using the Think Aloud method (asking participants to verbalize thoughts as they respond to assessment questions) were conducted with frontline employees to improve a pilot version of the pCAT. Interviews were recorded and transcribed verbatim; the CFIR guided coding and analyses. RESULTS Participants identified several areas where language in the pCAT needed to be modified, clarified, or allow more nuance to increase usefulness for frontline employees. Participants found it easier to respond to questions when they had a recent, specific project in mind. Potential barriers and facilitators tend to be unique to each specific improvement. Participants also identified missing concepts or that were conflated, leading to refinements that made the pCAT more understandable, accurate, and useful. CONCLUSIONS The pCAT is designed to be practical, using everyday language familiar to frontline employees. The pCAT is short (14 items), freely available, does not require research expertise or experience. It is designed to draw on the knowledge of individuals most familiar with their own clinical context. The pCAT has been available online for approximately two years and has generated a relatively high level of interest indicating potential usefulness of the tool.
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Affiliation(s)
- Claire H Robinson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road (152), Ann Arbor, MI, 48105, USA.
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road (152), Ann Arbor, MI, 48105, USA
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Nabergoj Makovec U, Tomsic T, Kos M, Stegne Ignjatovic T, Poplas Susic A. Pharmacist-led clinical medication review service in primary care: the perspective of general practitioners. BMC PRIMARY CARE 2023; 24:6. [PMID: 36627568 PMCID: PMC9832745 DOI: 10.1186/s12875-022-01963-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND An advanced level medication review service (CMR) is systematically reimbursed and available nationwide in Slovenian primary care since 2016. CMR is performed by clinical pharmacists (CP). Close collaboration with general practitioner (GP) is required as they perform patient selection and make clinical decisions regarding patient's medication. METHODS A prospective observational study was conducted in 2018 aiming to evaluate the perspective of GPs on the implementation of pharmacist-led medication review service in Community Health Care Centre Ljubljana, Slovenia. GPs of the patients, who provided written informed consent were invited for the interviews. The semi-structured interview consisted of 5 open ended questions addressing reasons for referral of the patients, implementation of CP recommendations and the GPs' perspective of the service in general. Interviews were audio recorded with GPs written consent, transcribed verbatim and inductive content analysis was performed in NVivo11 Pro. RESULTS In total 38 interviews with 24 GPs were performed. The emerged themes were nested under 3 main domains representing Donabedian model of quality healthcare - structure, process, outcomes. The service structure is built on broad pharmacotherapy knowledge as the main CP competency, good accessibility, and complementarity of healthcare professions. Patients are mainly referred to the CMR due to polypharmacotherapy, however in majority there is a more in-depth reason behind (e.g., adverse events, etc.). Lack of time to recognize eligible patients and additional workload to study and implement the recommendations present the major challenges in the service process and therefore low number of referrals. CPs recommendations are mostly accepted, although the implementation time varies. When recommendation addresses medicines prescribed by a clinical specialist, the CMR report is forwarded to them for decision regarding implementation. The empowerment of the patients in medicines use was emphasized as the major benefit of the CMR, which consequently supports and enhances the quality of GP's patient care. Transferability of recommendations to similar cases and high satisfaction with the service of GPs and patients, were mentioned. CONCLUSION GPs experiences with CMR are encouraging and supportive and present a base for further growth of the service.
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Affiliation(s)
- Urska Nabergoj Makovec
- grid.8954.00000 0001 0721 6013University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Askerceva cesta 7, 1000 Ljubljana, Slovenia
| | - Tanja Tomsic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Mitja Kos
- grid.8954.00000 0001 0721 6013University of Ljubljana, Faculty of Pharmacy, Department of Social Pharmacy, Askerceva cesta 7, 1000 Ljubljana, Slovenia
| | - Tea Stegne Ignjatovic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Antonija Poplas Susic
- grid.457211.40000 0004 0597 4875Community Health Centre Ljubljana, Ljubljana, Slovenia
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189
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Hunter SC, Kim B, Kitson AL. Mobilising Implementation of i-PARIHS (Mi-PARIHS): development of a facilitation planning tool to accompany the Integrated Promoting Action on Research Implementation in Health Services framework. Implement Sci Commun 2023; 4:2. [PMID: 36624543 PMCID: PMC9830739 DOI: 10.1186/s43058-022-00379-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Facilitation makes the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework a popular framework in the field of implementation science. Facilitation allows for flexible application of the i-PARIHS framework by encouraging the iterative tailoring of implementation strategies to a dynamic context. However, successfully harnessing this flexibility can be challenging to navigate, particularly for novice facilitators. Therefore, to support and promote more widespread use of the i-PARIHS framework, and to make it easier for people who are already using i-PARIHS, we have undertaken the Mi-PARIHS Project-Mobilising Implementation of i-PARIHS, focused on developing a suite of practical and pragmatic i-PARIHS resources. METHODS Through a co-design approach drawing on end-users' experiences, we developed the Mi-PARIHS Facilitation Planning Tool, and this article reports on the final end-user feedback via an online survey. RESULTS A total of 58 participants completed the online survey. The survey focused on participants' previous experiences with i-PARIHS, their feedback on the background information provided with the Mi-PARIHS Tool, and their feedback on the tool itself (e.g. clarity, use, satisfaction, improvements). This feedback resulted in the development of a comprehensive 34-item Mi-PARIHS Facilitation Planning Tool that supports i-PARIHS users in their (1) assessment of the i-PARIHS framework's innovation, context, and recipient constructs; (2) development of a tailored facilitation plan; and (3) repeated use over time to evaluate the effectiveness of facilitation strategies. CONCLUSIONS The Mi-PARIHS Facilitation Planning Tool makes framework-guided implementation more accessible and reliable to a wider range of systems and stakeholders, thereby contributing to more consistent implementation of evidence-based practices and other innovations. It addresses the challenge of systematically assessing core constructs of the i-PARIHS framework to develop tailored facilitation strategies. The Mi-PARIHS Facilitation Planning Tool is freely available for use at the website https://www.flinders.edu.au/caring-futures-institute/Mi-PARIHS-tool .
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Affiliation(s)
- Sarah C. Hunter
- grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia ,grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia
| | - Bo Kim
- grid.410370.10000 0004 4657 1992Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130 USA ,grid.38142.3c000000041936754XDepartment of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115 USA
| | - Alison L. Kitson
- grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia ,grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia 5042 Australia
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Benz C, Dantas J, Welsh M, Norman R, Hendrie D, Robinson S. Telepractice implementation experiences during the COVID-19 pandemic, a qualitative exploration of Australian disability allied health providers: A diamond in the rough. Digit Health 2023; 9:20552076231211283. [PMID: 37936961 PMCID: PMC10627019 DOI: 10.1177/20552076231211283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023] Open
Abstract
Telepractice has existed for decades, but as a result of the COVID-19 pandemic, it gained value and increased desirability across the disability service and health sectors, as a mitigation strategy for the viral transmission risk. The increased desirability of telepractice encouraged organisations to invest and correspondingly enhance access to services delivered remotely via digital technology including allied health therapy interventions. The investment and uptake of telepractice provided greater learning opportunities and ability to investigate telepractice implementation in specific contexts such as disability services, enabling service providers the ability to tailor to specific population needs. Methods This study investigated the experience of telepractice implementation during the COVID-19 pandemic from 13 allied health clinicians and managers of disability organisations across Australia between November 2021 and February 2022. A contextualist and critical realist theory was applied through the study, with reflective thematic analysis used as the data analysis method and findings described using a metaphor method centring on diamond formation. The method selection aimed to produce findings grounded in qualitative methodology and methods while remaining accessible to the disability community. Results An exploration and analysis of the data by the authors identified six themes addressing the experiences of participants and used the metaphor of diamond formation to describe changes in allied health clinicians and disability organisations during the COVID-19 influenced telepractice implementation. Conclusion The allied health clinicians and managers who participated in this study demonstrated an overall sense of hope that telepractice would be a viable and sustainable delivery pathway for services in the future. This article endorses the integration of a planned telepractice delivery pathway that capitalises on the momentum created by the COVID-19 pandemic in a purposeful and accessible way that looks to enhance rather than replace current practices.
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Affiliation(s)
- Cloe Benz
- School of Population Health, Curtin University, Bentley, Australia
| | - Jaya Dantas
- School of Population Health, Curtin University, Bentley, Australia
| | - Mai Welsh
- Clinical Department, Rocky Bay, Mosman Park, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Bentley, Australia
| | - Delia Hendrie
- School of Population Health, Curtin University, Bentley, Australia
| | - Suzanne Robinson
- School of Population Health, Curtin University, Bentley, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Melbourne, Australia
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191
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Smit DJM, Proper KI, Engels JA, Campmans JMD, van Oostrom SH. Barriers and facilitators for participation in workplace health promotion programs: results from peer-to-peer interviews among employees. Int Arch Occup Environ Health 2023; 96:389-400. [PMID: 36305914 PMCID: PMC9614189 DOI: 10.1007/s00420-022-01930-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Workplace health promotion programs (WHPPs) have shown to be effective in improving lifestyle behaviors of employees. Despite potential benefits for employees, participation rates are generally low. The aim of this study was to gain deeper insight into barriers and facilitators for participation in WHPPs prior to implementation according to employees. METHODS Peer-to-peer interviewing, a method derived from citizen science, was used to actively involve employees in the data collection. Employees working in the cleaning-, ICT- and facility-sector were trained to interview their co-workers. Interviews were recorded and transcribed verbatim. Thematic analysis was performed using the Consolidated Framework for Implementation Research (CFIR), complemented with the constructs 'interpersonal factors' and 'intrapersonal factors' from the social ecological model. Data were coded deductively and inductively, and rated by two researchers independently. RESULTS Fourteen peer-interviewers conducted 62 peer-to-peer interviews. Main barriers for participation in WHPPs were an unsupportive organizational culture where lifestyle is not a common topic and programs that are not tailored to their needs. Support from peers and supervisors were facilitators. The availability of organizational resources, such as facilities and financial compensation, support participation. CONCLUSIONS To enhance participation of employees in WHPPs it is recommended to take into account the barriers and facilitators identified in this study. For instance, employees should be involved in the development and implementation of WHPPS by the employer and their needs and available resources should be taken into account. This may lead to more successful implementation and higher participation rates in future WHPPs.
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Affiliation(s)
- Denise J. M. Smit
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands ,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karin I. Proper
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands ,Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Josephine A. Engels
- HAN University of Applied Sciences, Occupation and Health Research Group, Nijmegen, The Netherlands
| | - Jennifer M. D. Campmans
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sandra H. van Oostrom
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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Eldridge LA, Meyerson BE, Agley J. Pilot implementation of the PharmNet naloxone program in an independent pharmacy. J Am Pharm Assoc (2003) 2023; 63:374-382.e12. [PMID: 36209035 DOI: 10.1016/j.japh.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The U.S. overdose epidemic has continued to escalate with more than 100,000 deaths per year in the past several years, most of which involve opioids. Widespread availability of naloxone is part of a national solution to the crisis, and community pharmacies are well-poised to facilitate such distribution and provide additional harm reduction services. OBJECTIVES The primary objectives of this study were to (a) examine the usability of each of the separate intervention components prepared for PharmNet, (b) observe intervention fidelity through regularly scheduled site visits, and (c) explore the association between PharmNet implementation and the volume of naloxone sales and distribution in the pilot site. PRACTICE DESCRIPTION Here, we describe a carefully designed and tailored pharmacy harm reduction intervention called PharmNet that is designed to maximize harm reduction impact while minimizing utilization of pharmacist resources. It is a pragmatic awareness, service provision, and referral program that was developed through careful, iterative feasibility studies with pharmacists. PRACTICE INNOVATION PharmNet procedures include tools and steps to create awareness (e.g., yard signs and messaging for patients, reminder tools for pharmacists), facilitation of naloxone delivery from nonprofits, and provision of referral cards featuring local resources. EVALUATION METHODS Evaluation included direct data collection and randomly scheduled fidelity site visits. RESULTS The intervention was associated with an increase of 3.33 naloxone doses/mo being dispensed at cost (34.4% relative increase) and an overall increase of 9.33 naloxone doses/mo being dispensed via any mechanism (96.48% relative increase). Around 2.85 referral cards were issued to patients daily. Intervention fidelity was moderate, and the study provides valuable information for how to modify the study prior to a randomized trial. CONCLUSION With modifications informed by this pilot study, the PharmNet intervention merits a randomized trial to determine whether it causes increased naloxone dispensing in independent community pharmacies.
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Wendt J, Scheller DA, Flechtner-Mors M, Meshkovska B, Luszczynska A, Lien N, Forberger S, Banik A, Lobczowska K, Steinacker JM. Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research-A cross-sectional study. Front Public Health 2023; 11:935292. [PMID: 36908436 PMCID: PMC9992422 DOI: 10.3389/fpubh.2023.935292] [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: 05/03/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023] Open
Abstract
Background Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals. Methods A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools (n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants. Results In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92-15.05], available resources (OR: 2.15, 95% CI: 1.18-3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09-4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24-9.75). Conclusions This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.
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Affiliation(s)
- Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,Melbourne School of Psychological Sciences, Melbourne Centre for Behavior Change, University of Melbourne, Melbourne, VIC, Australia
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
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Loch SF, Muhar A, Bouskill K, Stein BD, Shi Q, Bonnet K, Schlundt D, Sieger ML, Parker E, Orgel C, Patrick SW. "The Problem's Bigger than We Are": Understanding How Local Factors Influence Child Welfare Responses to Substance Use in Pregnancy, A Qualitative Study. CHILD WELFARE 2023; 101:193-224. [PMID: 38784918 PMCID: PMC11113001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
State eligibility for certain federal child welfare funding requires a gubernatorial assurance that infants affected by substances receive plans of safe care (POSC). We conducted 18 interviews with state and county child welfare staff to understand how POSC has been implemented and found variability in practice driven by vague policy, challenges of cross-system collaboration, and a lack of knowledge about substance use disorder. Policy improvements should align requirements with POSC practice and create shared accountability with key partners.
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Affiliation(s)
- Sarah F Loch
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
| | | | | | | | | | | | | | | | | | | | - Stephen W Patrick
- Vanderbilt Center for Child Health Policy, Vanderbilt University Medical Center
- RAND Corporation
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195
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Kerkhoff AD, Muiruri C, Geng EH, Hickey MD. A world of choices: preference elicitation methods for improving the delivery and uptake of HIV prevention and treatment. Curr Opin HIV AIDS 2023; 18:32-45. [PMID: 36409315 PMCID: PMC9772083 DOI: 10.1097/coh.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW Despite the growing availability of effective HIV prevention and treatment interventions, there are large gaps in their uptake and sustained use across settings. It is crucial to elicit and apply patients' and stakeholders' preferences to maximize the impact of existing and future interventions. This review summarizes quantitative preference elicitation methods (PEM) and how they can be applied to improve the delivery and uptake of HIV prevention and treatment interventions. RECENT FINDINGS PEM are increasingly applied in HIV implementation research; however, discrete choice experiments (DCEs) have predominated. Beyond DCEs, there are other underutilized PEM that may improve the reach and effectiveness of HIV prevention and treatment interventions among individuals by prioritizing their barriers to engagement and determining which attributes of interventions and delivery strategies are most valued. PEM can also enhance the adoption and sustained implementation of strategies to deliver HIV prevention and treatment interventions by assessing which attributes are the most acceptable and appropriate to key stakeholders. SUMMARY Greater attention to and incorporation of patient's and stakeholders' preferences for HIV prevention and treatment interventions and their delivery has the potential to increase the number of persons accessing and retained in HIV prevention and treatment services.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D. Hickey
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
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196
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Parks AV, Sakowski JA, Wear AG, Russell I, Nunnery D. Free and Charitable Clinic Perspectives on the Implementation and Utilization of Telehealth Services During the COVID-19 Pandemic. J Prim Care Community Health 2023; 14:21501319231213783. [PMID: 38041422 PMCID: PMC10693793 DOI: 10.1177/21501319231213783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The onset of the COVID-19 pandemic challenged healthcare providers to adapt their models of care and leverage technology to continue to provide necessary care while reducing the likelihood of exposure. One setting that faced a unique set of challenges and opportunities was free and charitable clinics. In response to the emerging pandemic, The North Carolina Association for Free and Charitable Clinics (NCAFCC) offered their 66 member clinics access to a telehealth platform, free of charge. OBJECTIVE This paper explores the varied perspectives of leaders in the NCAFCC member clinics regarding the implementation of telehealth services to facilitate continuity of care for patients during the height of the pandemic. DESIGN This qualitative study is part of a broader research effort to understand and contextualize the experience of implementing and using telehealth services by North Carolina free and charitable clinics during and after the COVID-19 pandemic. The research team conducted 13 key informant interviews and employed thematic analysis and grounded theory to explore critical themes and construct a model based on the CFIR to describe the use of telehealth in free and charitable clinics. RESULTS Twelve clinic managers and executive directors from free and charitable clinics across the state participated in the key informant interviews providing their unique perspective on the experience of implementing telehealth services in a free and charitable clinic environment during the COVID-19 pandemic. When examined within the lens of the consolidated framework for implementation research (CFIR), 3 key themes emerged from the key informant interviews: mission driven patient centered care, resilience and resourcefulness, and immediate implementation. CONCLUSIONS This study aligns with existing literature regarding telehealth implementation across other safety net provider settings and highlights the key implementation factors, organizational elements, provider perspectives, and patient needs that must collectively be considered when implementing new technologies, especially in a low-resource, high need healthcare setting. The study showcases the implementation climate, resourcefulness, and mission driven approach that allowed many NCAFCC clinics to respond to an emergent situation by adopting and implementing a telehealth platform in a period of 2 weeks or less.
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Affiliation(s)
| | | | | | - Ian Russell
- Appalachian State University, Boone, NC, USA
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197
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Tarp K, Nielsen SL, Holmberg TT, Dalsgaard CH, Borkner S, Skaarnes H, Jensen EK, Piera-Jiménez J, Vis C, Mathiasen K. Therapist perceptions of the implementation of a new screening procedure using the ItFits-toolkit in an iCBT routine care clinic: A mixed-methods study using the consolidated framework for implementation research. Front Psychiatry 2023; 14:1104301. [PMID: 37091699 PMCID: PMC10117952 DOI: 10.3389/fpsyt.2023.1104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction This study investigates the implementation of a new, more automated screening procedure using the ItFits-toolkit in the online clinic, Internet Psychiatry (iPsych) (www.internetpsykiatrien.dk), delivering guided iCBT for mild to moderate anxiety and depressive disorders. The study focuses on how the therapists experienced the process. Methods Qualitative data were collected from semi-structured individual interviews with seven therapists from iPsych. The interviews were conducted using an interview guide with questions based on the Consolidated Framework for Implementation Research (CFIR). Quantitative data on the perceived level of normalization were collected from iPsych therapists, administrative staff, and off-site professionals in contact with the target demographic at 10-time points throughout the implementation. Results The therapists experienced an improvement in the intake procedure. They reported having more relevant information about the patients to be used during the assessment and the treatment; they liked the new design better; there was a better alignment of expectations between patients and therapists; the patient group was generally a better fit for treatment after implementation; and more of the assessed patients were included in the program. The quantitative data support the interview data and describe a process of normalization that increases over time. Discussion The ItFits-toolkit appears to have been an effective mediator of the implementation process. The therapists were aided in the process of change, resulting in an enhanced ability to target the patients who can benefit from the treatment program, less expenditure of time on the wrong population, and more satisfied therapists.
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Affiliation(s)
- Kristine Tarp
- Research Unit for Digital Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
- *Correspondence: Kristine Tarp
| | - Søren Lange Nielsen
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Trine Theresa Holmberg
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Caroline Høier Dalsgaard
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Simone Borkner
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Helene Skaarnes
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Esben Kjems Jensen
- Research Unit for Digital Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System DS3-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Christiaan Vis
- Clinical, Neuro- & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Section for Research-Based Innovation, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kim Mathiasen
- Research Unit for Digital Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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Voelskow V, Meßner C, Kurth T, Busam A, Glatz T, Ebert N. Prospective mixed-methods study evaluating the potential of a voicebot (CovBot) to relieve German health authorities during the COVID-19 infodemic. Digit Health 2023; 9:20552076231180677. [PMID: 37325074 PMCID: PMC10262654 DOI: 10.1177/20552076231180677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/19/2023] [Indexed: 06/17/2023] Open
Abstract
Background During the COVID-19 pandemic, telephone hotlines of local health authorities in Germany were overloaded due to information requests by the public. Objective Evaluating the use of a COVID-19-specific voicebot (CovBot) in local health authorities in Germany during the COVID-19 pandemic. This study investigates the performance of the CovBot by assessing a perceptible relief of staff in the hotline service. Methods This prospective mixed-methods study enrolled local health authorities in Germany from 01 February 2021 to 11 February 2022 to deploy the CovBot, which was mainly designed to answer frequently asked questions. To capture the user perspective and acceptance, we performed semistructured interviews and online surveys with their staff, conducted an online survey among callers, and analyzed the performance metrics of the CovBot. Results The CovBot was implemented in 20 local health authorities serving 6.1 million German citizens and processed almost 1.2 million calls during the study period. The overall assessment was that the CovBot contributed to a perceived relief of the hotline service. In a survey among callers, 79% indicated that a voicebot could not replace a human. The analyzed anonymous metadata revealed that 15% of calls hung up immediately, 32% after hearing an FAQ answer, and 51% of calls were forwarded to the local health authority offices. Conclusions A voicebot primarily answering FAQs can provide additional support to relieve the hotline service of local health authorities in Germany during the COVID-19 pandemic. For complex concerns, a forwarding option to a human proved to be an essential functionality.
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Affiliation(s)
- Vanessa Voelskow
- Vanessa Voelskow, Institute of Public Health at Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | | | - Tobias Kurth
- Institute of Public Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Amelie Busam
- Institute of Public Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
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Hennein R, Goddard E, Sherman JD. Stakeholder perspectives on scaling up medical device reprocessing: A qualitative study. PLoS One 2022; 17:e0279808. [PMID: 36584081 PMCID: PMC9803114 DOI: 10.1371/journal.pone.0279808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The United States health care sector is one of the largest polluting industries, which has significant adverse effects on human health. Medical device reprocessing (MDR) is a sustainability solution that has the potential to decrease hospital waste, cut carbon emissions, reduce spending, and improve supply chain resiliency; however, only a small proportion of FDA-approved devices are actually reprocessed. Thus, we conducted a qualitative study to understand barriers and facilitators of scaling up MDR. METHODS AND FINDINGS We conducted in-depth interviews with 17 stakeholders (exceeding thematic saturation) at a large academic health system in New England and national MDR organizations. We also collected observations through site visits at the health system. We recruited participants from June 2021 to April 2022 through purposive sampling. Using an analytic approach guided by the Consolidated Framework for Implementation Research, we applied inductive and deductive codes related to key implementation constructs. We then conducted a thematic analysis and identified five overarching themes related to barriers and facilitators of MDR. First, respondents explained that regulatory bodies and original equipment manufacturers determine which devices can be reprocessed. For example, some respondents described that original equipment manufacturers use tactics of forced obsolescence that prevent their devices from being reprocessed. Second, respondents explained that MDR has variable compatibility with hospital priorities; for example, the potential cost savings of MDR is compatible with their priorities, while the perception of decreased functionality of reprocessed medical devices is incompatible. Third, respondents described that physician preferences influence which reprocessed devices get ordered. Fourth, respondents explained that variable staff knowledge and beliefs about MDR influence their motivations to select and collect reprocessable devices. Lastly, respondents emphasized that there was a lack of infrastructure for evaluating and maintaining MDR programs within their health system. CONCLUSIONS Based on our findings, we have outlined a number of recommendations that target these barriers and facilitators so that the environmental and financial benefits of MDR can be realized at this health system and nationally. For example, implementing federal policies that prevent original equipment manufacturers from using tactics of forced obsolescence can facilitate the scale-up of MDR nationally. Additionally, providing life cycle assessments that compare the environmental effects of single-use disposable, reprocessable disposable, and reusable devices could facilitate health systems' purchasing decisions. Creating and disseminating audit and feedback reports to hospital staff might also facilitate their continued engagement in the program. Lastly, hiring a full-time program manager that leads MDR programs within health systems could improve program sustainability.
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Affiliation(s)
- Rachel Hennein
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America,Yale School of Medicine, New Haven, CT, United States of America,* E-mail:
| | - Emily Goddard
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States of America
| | - Jodi D. Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, United States of America,Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, United States of America
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Prætorius T, Baymler Lundberg AS, Søndergaard E, Tang Knudsen S, Sandbæk A. The effect of virtual specialist conferences between endocrinologists and general practitioners about type 2 diabetes: study protocol for a pragmatic randomized superiority trial. Trials 2022; 23:1059. [PMID: 36578024 PMCID: PMC9795951 DOI: 10.1186/s13063-022-06961-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/25/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND To support the primary care sector in delivering high-quality type 2 diabetes (T2D), literature reviews emphasize the need for implementing models of collaboration that in a simple and effective way facilitate clinical dialogue between general practitioners (GPs) and endocrinologists. The overall aim of the project is to evaluate if virtual specialist conferences between GPs and endocrinologists about patients living with T2D is clinically effective and improves diabetes competences and organization in general practice in comparison to usual practice. METHODS A prospective, pragmatic, and superiority RCT with two parallel arms of general practices in the Municipality of Aarhus, Denmark. All general practices are invited (n = 100). The intervention runs for 12 months and consists of four virtual conferences between endocrinologists and an individual general practice. Before the first conference, an introductory webinar teaches GPs about how to use an IT-platform to identify and manage T2D patients. The main analysis (month 12) concerns the difference between the intervention and control arm. It is expected that the virtual conferences at the patient level will improve adherence to international recommendations on diabetes medication for T2D patients and improve the risk profile with a reduction in glycated haemoglobin, blood pressure, and cholesterol. The study design allows for identifying a significant difference between the intervention (n = 15) and control group (n = 15) regarding the three primary clinical outcomes with a power of 0.8870-0.9941. At the general practice level, it is expected that general practitioners and practice staff in the intervention group will improve self-reported diabetes competence and organization. The control arm will get the intervention when the primary intervention ends (months 12-24), and the intervention arm transitions to a maintenance phase. DISCUSSION The potential of virtual conferences is yet to be fully tapped because of methodological limitations. Studies have also not yet systematically evaluated virtual conferences in the context of chronic care using a high-quality research design. Given the nature of this real-life intervention, general practitioners and endocrinologists cannot be blinded to their allocation to either the intervention or comparison arm. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health trial ID: NCT05268081. Registered on 4 March 2022.
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Affiliation(s)
- Thim Prætorius
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Anne Sofie Baymler Lundberg
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Esben Søndergaard
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Søren Tang Knudsen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Annelli Sandbæk
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark ,grid.7048.b0000 0001 1956 2722 Department of Public Health, Aarhus University, Aarhus, Denmark
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