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Esponda GM, Hartman S, Qureshi O, Sadler E, Cohen A, Kakuma R. Barriers and facilitators of mental health programmes in primary care in low-income and middle-income countries. Lancet Psychiatry 2020; 7:78-92. [PMID: 31474568 DOI: 10.1016/s2215-0366(19)30125-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/19/2022]
Abstract
Integration of services into primary health care for people with common mental disorders is considered a key strategy to improve access to mental health care in low-income and middle-income countries, yet services at the primary care level are largely unavailable. We did a systematic review to understand the barriers and facilitators in the implementation of mental health programmes. We searched five databases and included studies published between Jan 1, 1990, and Sept 1, 2017, that used qualitative methods to assess the implementation of programmes for adults with common mental disorders at primary health-care settings in low-income and middle-income countries. The Critical Appraisal Skills Programme Qualitative Checklist was used to assess the quality of eligible papers. We used the so-called best fit framework approach to synthesise findings according to the Consolidated Framework for Implementation Research. We identified 24 papers for inclusion. These papers described the implementation of nine programmes in 11 countries. Key factors included: the extent to which an organisation is ready for implementation; the attributes, knowledge, and beliefs of providers; complex service user needs; adaptability and perceived advantage of interventions; and the processes of planning and evaluating the implementation. Evidence on implementation of mental health programmes in low-income and middle-income countries is scarce. Synthesising results according to the Consolidated Framework for Implementation Research helped to identify key areas for future action, including investment in primary health-care strengthening, capacity building for health providers, and increased support to address the social needs of service users.
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Affiliation(s)
- Georgina Miguel Esponda
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Sarah Hartman
- Clinical Psychology Department, Clark University, Worcester, Massachusetts, MA, USA
| | - Onaiza Qureshi
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Euan Sadler
- Health Service and Population Research Department, King's Improvement Science and Centre for Implementation Science, King's College London, London, UK; Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Alex Cohen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Ritsuko Kakuma
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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202
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Morténius H, Baigi A. Promoting the creation of R&D intentions in primary healthcare measured by a validated instrument. Health Res Policy Syst 2019; 17:107. [PMID: 31888656 PMCID: PMC6937941 DOI: 10.1186/s12961-019-0513-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary healthcare has a long and successful patient care history in Sweden. Nevertheless, a research-oriented attitude has been more or less absent in this context. In society today, access to information has significantly influenced the nature of patients' demand for up-to-date healthcare. A prerequisite for this new demand is health professionals who are interested in novel ways of thinking and view a change of work practices as necessary. One way to achieve this goal is by means of strategic communication, which is a relatively new interdisciplinary field. The aim of this study was to analyse the role of strategic communication in the creation of intentions in Research and Development (R&D) among primary healthcare staff as measured by a validated instrument. METHODS An intervention study on staff was performed. A 15-item questionnaire was validated and implemented. All primary healthcare staff from the southwestern Swedish province of Halland were included. In total, 846 employees (70%) agreed to participate in the measurements. After 12 years, 352 individuals who had participated in the intervention and remained in the organisation were identified and followed up. The intervention comprised established communication channels. The measurements were performed after 7 and 12 years. A questionnaire was designed for this purpose. The questions were validated by a factor analysis, and the degree of reliability was measured with Cronbach's alpha coefficient. χ2 and Fisher's exact tests were used as statistical tests in comparisons. RESULTS Factor analysis identified five pure factors (most Cronbach's alpha > 0.70). Strategic communication contributed to a significant improvement in the staff members' interest in R&D and willingness to change in both the short (P < 0.05) and long (P < 0.05) term. The positive attitude was stable over time. CONCLUSIONS Strategic communication seems to be a significant tool for creating a stable positive attitude towards R&D in the primary healthcare context. The creation of a positive attitude towards a scientific approach is a relevant finding that deserves special attention in a context as complex as healthcare. Using a validated instrument seems to contribute to pure results in this case.
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Affiliation(s)
- Helena Morténius
- Department of Health Care, Region Halland, Box 517, 301 80, Halmstad, Sweden. .,Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Amir Baigi
- Department of Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research and Development, Region Halland, Halmstad, Sweden
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Goedken CC, Livorsi DJ, Sauder M, Vander Weg MW, Chasco EE, Chang NC, Perencevich E, Reisinger HS. "The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions. Implement Sci 2019; 14:110. [PMID: 31870453 PMCID: PMC6929350 DOI: 10.1186/s13012-019-0943-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. METHODS An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. RESULTS A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. CONCLUSIONS Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
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Affiliation(s)
- Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Daniel J. Livorsi
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Michael Sauder
- Department of Sociology, University of Iowa, 140 Seashore Hall West, Iowa City, IA 52242 USA
| | - Mark W. Vander Weg
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
- Department of Psychological and Brain Sciences, University of Iowa, W311 Seashore Hall, Iowa City, IA 52242-1407 USA
| | - Emily E. Chasco
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Nai-Chung Chang
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132 USA
| | - Eli Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
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Oosterveld-Vlug M, Onwuteaka-Philipsen B, ten Koppel M, van Hout H, Smets T, Pivodic L, Tanghe M, Van Den Noortgate N, Hockley J, Payne S, Moore DC, Kijowska V, Szczerbińska K, Kylänen M, Leppäaho S, Mercuri C, Rossi P, Mercuri M, Gambassi G, Bassal C, de Paula EM, Engels Y, Deliens L, Van den Block L, Pasman HR. Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework. Implement Sci 2019; 14:107. [PMID: 31856882 PMCID: PMC6924025 DOI: 10.1186/s13012-019-0953-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/08/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. TRIAL REGISTRATION The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.
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Affiliation(s)
- Mariska Oosterveld-Vlug
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maud ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hein van Hout
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tinne Smets
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Pivodic
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Marc Tanghe
- VUB-UGhent End-of-Life Care Research Group, Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- VUB-UGhent End-of-Life Care Research Group, Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - Sheila Payne
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, UK
| | | | - Violetta Kijowska
- Unit for Research on Ageing Society, Epidemiology and Preventive Medicine Chair, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Szczerbińska
- Unit for Research on Ageing Society, Epidemiology and Preventive Medicine Chair, Medical Faculty, Jagiellonian University Medical College, Kraków, Poland
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Suvi Leppäaho
- National Institute for Health and Welfare, Helsinki, Finland
| | - Claudia Mercuri
- Department of Internal Medicine & Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paola Rossi
- Department of Internal Medicine & Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Mercuri
- Department of Internal Medicine & Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Gambassi
- Department of Internal Medicine & Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Catherine Bassal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability (CIGEV), University of Geneva, Geneva, Switzerland
| | - Emilie Morgan de Paula
- HE-Arc Santé, HES-SO University of Applied Sciences and Arts Western Switzerland, Neuchâtel, Switzerland
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luc Deliens
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- VUB-UGhent End-of-Life Care Research Group, Department of Public Helath and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- VUB-UGhent End-of-Life Care Research Group, Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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205
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Ashrafzadeh S, Metlay JP, Choudhry NK, Emmons KM, Asgari MM. Using Implementation Science to Optimize the Uptake of Evidence-Based Medicine into Dermatology Practice. J Invest Dermatol 2019; 140:952-958. [PMID: 31862108 DOI: 10.1016/j.jid.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/18/2019] [Accepted: 10/08/2019] [Indexed: 11/19/2022]
Abstract
An estimated 17-year lag exists between evidence generation and its integration into routine clinical care. The field of implementation science has emerged to close this gap by applying rigorous methods to systematically study the obstacles and facilitators of the uptake of evidence-based practices. However, implementation science has not gained wide traction in dermatology. In this narrative review, we use literature and expert input to introduce implementation science and key frameworks for implementing interventions and evaluating their uptake. We then highlight opportunities for dermatology-specific interventions at the patient-, provider-, system-, and population-levels, and advocate for the field's expansion into dermatology.
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Affiliation(s)
- Sepideh Ashrafzadeh
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Joshua P Metlay
- Division of General Internal Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Niteesh K Choudhry
- Center for Healthcare Delivery Sciences, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maryam M Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Population Medicine, Harvard Medical School and the Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
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206
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Bor J, Thirumurthy H. Bridging the Efficacy-Effectiveness Gap in HIV Programs: Lessons From Economics. J Acquir Immune Defic Syndr 2019; 82 Suppl 3:S183-S191. [PMID: 31764253 PMCID: PMC7388866 DOI: 10.1097/qai.0000000000002201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Bridging the efficacy-effectiveness gap in HIV prevention and treatment requires policies that account for human behavior. SETTING Worldwide. METHODS We conducted a narrative review of the literature on HIV in the field of economics, identified common themes within the literature, and identified lessons for implementation science. RESULTS The reviewed studies illustrate how behaviors are shaped by perceived costs and benefits across a wide range of health and nonhealth domains, how structural constraints shape decision-making, how information interventions can still be effective in the epidemic's fourth decade, and how lessons from behavioral economics can be used to improve intervention effectiveness. CONCLUSION Economics provides theoretical insights and empirical methods that can guide HIV implementation science.
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Affiliation(s)
- Jacob Bor
- Department of Global Health, Boston University, Boston, MA
| | - Harsha Thirumurthy
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
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207
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Abstract
BACKGROUND Health services across the world are constantly introducing changes into their workplaces and these affect many people. As new robust and reliable evidence becomes available, it is important that changes to practice are made. As health professionals, we have to be flexible and accommodate this change; for some this means disruption, challenge and having to learn new ways of doing things. Barriers exist that prevent or delay changes being made to established practice in all organizations, whatever the culture. This is a world-wide problem. It is important to understand the barriers to change so that solutions can be found. Some changes that are needed don't occur, because clinicians are unaware of the new evidence, while for others there needs to be something introduced to drive forward the change. This process is not a passive one; active involvement is needed for the change to be successful. Individual attitudes and beliefs play a significant part in change, and their influences are often underestimated, so these also need to be explored. Practice change may require new skills to be learnt - another obstacle for change. AIM In this short communication, the science behind evidence implementation is introduced and then some of the factors that impact on change are explored, drawing on three useful models and frameworks. CONCLUSION Ultimately there remains a gap between interventions that research has shown to be effective and their translation into practice; this has to be closed.
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208
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Kinney MV, Walugembe DR, Wanduru P, Waiswa P, George AS. Implementation of maternal and perinatal death reviews: a scoping review protocol. BMJ Open 2019; 9:e031328. [PMID: 31780590 PMCID: PMC6886965 DOI: 10.1136/bmjopen-2019-031328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Maternal and perinatal death surveillance and response (MPDSR), or any related form of audit, is a systematic process used to prevent future maternal and perinatal deaths. While the existence of MPDSR policies is routinely measured, measurement and understanding of policy implementation has lagged behind. In this paper, we present a theory-based conceptual framework for understanding MPDSR implementation as well as a scoping review protocol to understand factors influencing MPDSR implementation in low/ middle-income countries (LMIC). METHODS AND ANALYSIS The Consolidated Framework for Implementation Research will inform the development of a theory-based conceptual framework for MPDSR implementation. The methodology for the scoping review will be guided by an adapted Arksey and O'Malley approach. Documents will include published and grey literature sourced from electronic databases (PubMed, CINAHL, SCOPUS, Web of Science, JSTOR, LILACS), the WHO Library, Maternal Death Surveillance and Response Action Network, Google, the reference lists of key studies and key experts. Two reviewers will independently screen titles, abstracts and full studies for inclusion. All discrepancies will be resolved by an independent third party. We will include studies published in English from 2004 to July 2018 that present results on factors influencing implementation of MPDSR, or any related form. Qualitative content and thematic analysis will be applied to extracted data according to the theory-based conceptual framework. Stakeholders will be consulted at various stages of the process. ETHICS AND DISSEMINATION The scoping review will synthesise implementation factors relating to MPDSR in LMIC as described in the literature. This review will contribute to the work of the Countdown to 2030 Drivers Group, which seeks to explore key contextual drivers for equitable and effective coverage of maternal and child health interventions. Ethics approval is not required. The results will be disseminated through various channels, including a peer-reviewed publication.
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Affiliation(s)
- Mary V Kinney
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Bellville, South Africa
| | - David Roger Walugembe
- School of Health Studies, Faculty of Information and Media Studies, University of Western Ontario, London, Ontario, Canada
| | - Phillip Wanduru
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peter Waiswa
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Asha S George
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, Bellville, South Africa
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209
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Klug N, Butow PN, Burns M, Dhillon HM, Sundaresan P. Unmasking Anxiety: A Qualitative Investigation of Health Professionals; Perspectives of Mask Anxiety in Head and Neck Cancer. J Med Imaging Radiat Sci 2019; 51:12-21. [PMID: 31759941 DOI: 10.1016/j.jmir.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/17/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND To ensure precision of treatment, patients requiring radiation therapy for treatment of head and neck cancer (HNC) are stabilized using a fitted thermoplastic immobilization mask. Despite evidence that many patients experience significant anxiety when restrained in the mask, there is a lack of proven interventions to prevent or manage mask-related anxiety. The Promoting Action on Research Implementation in Health Services implementation framework promotes consideration of context and culture when developing interventions to ensure successful implementation if proven effective. Health professionals (HPs) play a crucial role in the management of patients' psychological concerns, yet no studies have explored their perspectives of mask anxiety and how it should be managed. The aim of this study, therefore, was to elicit and analyse HPs' perspectives of mask anxiety, using the Promoting Action on Research Implementation in Health Services framework, to guide the development of implementation-ready interventions to reduce mask anxiety. METHODS Semistructured interviews were conducted with 20 HPs involved in the care of HNC patients, including radiation oncologists, radiation therapists, nurses, and psychologists, from nine hospitals in NSW, Australia. Framework analysis methods were used. RESULTS Participants were on average 40 years old (range, 27-56), the majority were female (75%), and they had worked from 1 to 22 years with HNC patients. Six emergent themes were identified: (1) Mask anxiety is a significant problem but is easily missed; (2) Context matters; (3) Trust is critical; (4) Choice and control facilitate adjustment; (5) Psychological strategies are valued; and (6) Culture matters. Subgroup analysis also highlighted differences in perspectives between specialties. CONCLUSIONS Participants identified key principles underlying successful intervention. Two significant barriers to mask-anxiety intervention were identified: (1) a lack of empirical evidence surrounding its prevalence and predictors and (2) contextual and systematic hurdles making the health system potentially unresponsive to change. These data suggest a need for further descriptive studies and careful development of interventions which will address these hurdles.
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Affiliation(s)
- Natalie Klug
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia.
| | - Melissa Burns
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making School of Psychology, University of Sydney, Sydney, New South Wales, Australia; Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Purnima Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Galway K, Forbes T, Mallon S, Santin O, Best P, Neff J, Leavey G, Pitman A. Adapting Digital Social Prescribing for Suicide Bereavement Support: The Findings of a Consultation Exercise to Explore the Acceptability of Implementing Digital Social Prescribing within an Existing Postvention Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4561. [PMID: 31752170 PMCID: PMC6888585 DOI: 10.3390/ijerph16224561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 11/21/2022]
Abstract
This paper describes a consultation exercise to explore the acceptability of adapting digital social prescribing (DSP) for suicide bereavement support. Bereavement by suicide increases the risk of suicide and mental health issues. Social prescribing improves connectedness and empowerment and can provide digital outcomes-based reporting to improve the capacity for measuring the effectiveness of interventions. Our aim was to consult on the acceptability and potential value of DSP for addressing the complexities of suicide bereavement support. Our approach was underpinned by implementation science and a co-design ethos. We reviewed the literature and delivered DSP demonstrations as part of our engagement process with commissioners and service providers (marrying evidence and context) and identified key roles for stakeholders (facilitation). Stakeholders contributed to a co-designed workshop to establish consensus on the challenges of providing postvention support. We present findings on eight priority challenges, as well as roles and outcomes for testing the feasibility of DSP for support after suicide. There was a consensus that DSP could potentially improve access, reach, and monitoring of care and support. Stakeholders also recognised the potential for DSP to contribute substantially to the evidence base for postvention support. In conclusion, the consultation exercise identified challenges to facilitating DSP for support after suicide and parameters for feasibility testing to progress to the evaluation of this innovative approach to postvention.
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Affiliation(s)
- Karen Galway
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast BT7 1NN, UK; (T.F.); (O.S.)
| | - Trisha Forbes
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast BT7 1NN, UK; (T.F.); (O.S.)
| | - Sharon Mallon
- Faculty of Wellbeing, Education and Language Studies, Open University, Walton Hall MK7 6AA, UK;
| | - Olinda Santin
- School of Nursing and Midwifery, Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast BT7 1NN, UK; (T.F.); (O.S.)
| | - Paul Best
- School of Social Sciences, Education and Social Work, Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | | | - Gerry Leavey
- Bamford Centre for Mental Health, Psychology Research Institute, Ulster University, Newtownabbey BT37 0QB, UK;
| | - Alexandra Pitman
- UCL Division of Psychiatry, University College London, London WC1E 6BT, UK;
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Abstract
BACKGROUND AND PURPOSE Clinician research competencies influence research use for evidence-based practice (EBP). We aimed to develop, refine, and psychometrically assess the Research Competencies Assessment Instrument for Nurses (RCAIN) to measure registered nurse research competencies (i.e., knowledge, skills, attitudes) focused on EBP-related domains: research process, knowledge synthesis, and knowledge translation activities. METHODS The preliminary psychometrics (face, content, construct/criterion validity) were evaluated based on 63 completed surveys. RESULTS The Cronbach's α coefficients were .871, .813, and .946 for each domain, respectively; interitem correlations ranged from .472 to .833 (explained variance: 68.5%). Three components/factors revealed: comprehension of and skills required in research process and application of knowledge and skills. The revised RCAIN consists of 19 five-point Likert-type questions. CONCLUSIONS The RCAIN assesses modifiable characteristics and explains variance in practice, health system, and patient outcomes. Further assessments are underway.
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212
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Giroux D, Vallée C, Provencher V, Delli Colli N, Poulin V, Giguère A, Careau E, Durand PJ, Carignan M. A computerized and innovative tool to guide interdisciplinary assessment: Exploring the feasibility of the implementation of the Competency Assessment Tool (CAT). Inform Health Soc Care 2019; 45:282-291. [PMID: 31696749 DOI: 10.1080/17538157.2019.1656211] [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: 10/25/2022]
Abstract
An electronic tool, the Competency Assessment Tool (CAT), was developed in order to guide interdisciplinary teams through clinical competency assessment. OBJECTIVES To support the implementation and perpetuation of the CAT, the objectives were: 1) document health and social service professionals' needs in order to support the use of the CAT; 2) identify the facilitating factors and those hindering the implementation of the CAT in a healthcare establishment; 3) identify strategies favoring the use of the CAT. PARTICIPANTS Health and social service professionals and doctors were recruited. METHODS A qualitative study was realized by conducting focus groups with health and social service professionals and individual interviews with doctors. RESULTS The results allowed us to bring to light the CAT's advantages, the issues associated with its implementation (facilitators and obstacles) and the needs to support its use. A number of avenues of intervention were identified and could be put in place to encourage the use of the CAT. CONCLUSION This study will support the implementation of the CAT and ultimately, this will allow for the assurance that the decisions taken on the need for protection of vulnerable individuals will be just, rigorous and the fruit of a concerted ethical reflection.
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Affiliation(s)
- Dominique Giroux
- Faculté de médecine, Université Laval , Québec, Canada.,Centre de recherche sur les soins et services de première ligne de l'Université Laval (CERSSPL-Université Laval) , Québec, Canada
| | - Catherine Vallée
- Faculté de médecine, Université Laval , Québec, Canada.,CERSSPL-Université Laval , Québec, Canada
| | - Véronique Provencher
- École de réadaptation, Université de Sherbrooke , Sherbrooke, Canada.,Centre de recherche sur le vieillissement de Sherbrooke (CDRV) , Sherbrooke, Canada
| | - Nathalie Delli Colli
- Centre de recherche sur le vieillissement de Sherbrooke (CDRV) , Sherbrooke, Canada.,École de travail social, Université de Sherbrooke , Sherbrooke, Canada
| | - Valérie Poulin
- Département d'ergothérapie, Université du Québec à Trois-Rivières , Trois-Rivières, Canada.,Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRIS) , Québec, Canada
| | - Anik Giguère
- Faculté de médecine, Université Laval , Québec, Canada.,IRDPQ, CERSSPL-Université Laval , Québec, Canada
| | - Emmanuelle Careau
- Faculté de médecine, Université Laval , Québec, Canada.,CEVQ-CERSSPL-Université Laval , Québec, Canada
| | - Pierre J Durand
- Faculté de médecine, Université Laval , Québec, Canada.,CEVQ-CERSSPL-Université Laval , Québec, Canada
| | - Maude Carignan
- Centre d'Excellence sur le Vieillissement de Québec (CEVQ) , Québec, Canada
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213
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Pigot M, Miller CE, Brockman R, Grenyer BFS. Barriers and facilitators to the implementation of a stepped care intervention for personality disorder in mental health services. Personal Ment Health 2019; 13:230-238. [PMID: 31411004 DOI: 10.1002/pmh.1467] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/15/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Individuals with personality disorders-particularly borderline personality disorder-are high users of mental health treatment services. Emergency service responses often focus on crisis management, and there are limited opportunities to provide appropriate longer term evidence-based treatment. Many individuals with personality disorders find themselves in a revolving cycle between emergency departments and waiting for community treatment. A stepped care approach may help to triage clients and allow access to interventions with minimal client, clinician and system burden. This study aims to understand the facilitators and barriers to real-world implementation of a stepped care approach to treating personality disorders. METHODS Managers and clinicians of health services engaged in implementation were interviewed to obtain accounts of experiences. Interviews were transcribed and thematically analysed to generate themes describing barriers and facilitators. RESULTS Participants identified personal attitudes, knowledge and skills as important for successful implementation. Existing positive attitudes and beliefs about treating people with a personality disorder contributed to the emergence of clinical champions. Training facilitated positive attitudes by justifying the psychological approach. Management support was found to bi-directionally effect implementation. CONCLUSIONS This study suggests specific organizational and individual factors may increase timely and efficient implementation of interventions for people with personality disorders. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- Melissa Pigot
- School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Caitlin E Miller
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Brockman
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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214
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Hockley J, Froggatt K, Van den Block L, Onwuteaka-Philipsen B, Kylänen M, Szczerbińska K, Gambassi G, Pautex S, Payne SA. A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: the PACE steps to success programme. BMC Health Serv Res 2019; 19:745. [PMID: 31651314 PMCID: PMC6814133 DOI: 10.1186/s12913-019-4587-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 10/09/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. METHODS The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. RESULTS Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. CONCLUSIONS There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.
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Affiliation(s)
- Jo Hockley
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG UK
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG UK
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of- Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marika Kylänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Katarzyna Szczerbińska
- Unit for Research on Aging Society, Department of Sociology, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Universita’ Catholica del Sacro Cuore, Rome, Italy
| | - Sophie Pautex
- Division of Palliative Medicine, University Hospital Geneva and University of Geneva, Geneva, Switzerland
| | - Sheila Alison Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YG UK
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215
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Unique Features of the INESSS-ONF Rehabilitation Guidelines for Moderate to Severe Traumatic Brain Injury: Responding to Users' Needs. J Head Trauma Rehabil 2019; 33:296-305. [PMID: 30188459 DOI: 10.1097/htr.0000000000000428] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Traumatic brain injury (TBI) clinical practice guidelines are a potential solution to rapidly expanding literature. The project objective was to convene experts to develop a unique set of TBI rehabilitation recommendations incorporating users' priorities for format and implementation tools including indicators of adherence. METHODS The Guidelines Adaptation & Development Cycle informed recommendation development. Published TBI recommendations were identified and tabulated. Experts convened to adapt or, where appropriate, develop new evidence-based recommendations. These draft recommendations were validated by systematically reviewing relevant literature. Surveys of experts and target users were triangulated with strength of evidence to identify priority topics. RESULTS The final recommendation set included a rationale, implementation tools (algorithms/adherence indicators), key process indicators, and evidence summaries, and were divided in 2 sections: Section I: Components of the Optimal TBI Rehabilitation System (71 recommendations) and Section II: Assessment and Rehabilitation of Brain Injury Sequelae (195 recommendations). The recommendations address top priorities for the TBI rehabilitation system: (1) intensity/frequency of interventions; (2) rehabilitation models; (3) duration of interventions; and (4) continuity-of-care mechanisms. Key sequelae addressed (1) behavioral disorders; (2) cognitive dysfunction; (3) fatigue and sleep disturbances; and (4) mental health. CONCLUSION This TBI rehabilitation guideline used a robust development process to address users' priorities.
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216
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Ogrinc G, Armstrong GE, Dolansky MA, Singh MK, Davies L. SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education): Publication Guidelines for Educational Improvement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1461-1470. [PMID: 30998575 PMCID: PMC6760810 DOI: 10.1097/acm.0000000000002750] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence) guidelines were published in 2015 to increase the completeness, precision, and transparency of published reports about efforts to improve the safety, value, and quality of health care. The principles and methods applied in work to improve health care are often applied in educational improvement as well. In 2016, a group was convened to develop an extension to SQUIRE that would meet the needs of the education community. This article describes the development of the SQUIRE-EDU extension over a three-year period and its key components. SQUIRE-EDU was developed using an international, interprofessional advisory group and face-to-face meeting to draft initial guidelines; pilot testing of a draft version with nine authors; and further revisions from the advisory panel with a public comment period. SQUIRE-EDU emphasizes three key components that define what is necessary in systematic efforts to improve the quality and value of health professions education. These are a description of the local educational gap; consideration of the impacts of educational improvement to patients, families, communities, and the health care system; and the fidelity of the iterations of the intervention. SQUIRE-EDU is intended for the many and complex range of methods used to improve education and education systems. These guidelines are projected to increase and standardize the sharing and spread of iterative innovations that have the potential to advance pedagogy and occur in specific contexts in health professions education.
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Affiliation(s)
- Greg Ogrinc
- G. Ogrinc is senior associate dean for medical education and professor of medicine and of the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Gail E. Armstrong
- G.E. Armstrong is associate professor, University of Colorado College of Nursing, Aurora, Colorado
| | - Mary A. Dolansky
- M.A. Dolansky is associate professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, and Department of Veterans Affairs Louis Stokes Medical Center, Cleveland, Ohio
| | - Mamta K. Singh
- M.K. Singh is assistant dean, Health Systems Science, and associate professor of medicine, Case Western Reserve University School of Medicine and Department of Veterans Affairs Louis Stokes Medical Center, Cleveland, Ohio
| | - Louise Davies
- L. Davies is associate professor, Section of Otolaryngology–Head & Neck Surgery and Dartmouth Institute, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and associate professor, Department of Veterans Affairs Medical Center, White River Junction, Vermont
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217
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Sterling MR, Echeverria SE, Commodore-Mensah Y, Breland JY, Nunez-Smith M. Health Equity and Implementation Science in Heart, Lung, Blood, and Sleep-Related Research: Emerging Themes From the 2018 Saunders-Watkins Leadership Workshop. Circ Cardiovasc Qual Outcomes 2019; 12:e005586. [PMID: 31610713 PMCID: PMC6812546 DOI: 10.1161/circoutcomes.119.005586] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Disparities in health outcomes for heart, lung, blood, and sleep-related health conditions are pervasive in the United States, with an unequal burden experienced among structurally disadvantaged populations. One reason for this disparity is that despite the existence of effective interventions that promote health equity, few have been translated and implemented consistently in the healthcare system. To achieve health equity, there is a dire need to implement and disseminate effective evidence-based interventions that account for the complex and multilayered social determinants of health among marginalized groups across healthcare settings. To that end, the National Heart, Lung, and Blood Institute's Center for Translation Research and Implementation Science invited early stage investigators to participate in the inaugural Saunders-Watkins Leadership Workshop in May of 2018 at the National Institutes of Health. The goals of the workshop were to: (1) present an overview of health equity research, including areas which require ongoing investigation; (2) review how the fields of health equity and implementation science are related; (3) demonstrate how implementation science could be utilized to advance health equity; and (4) foster early stage investigator career success in heart, lung, blood, and sleep-related research. Herein, we highlight key themes from the 2-day workshop and offer recommendations for the future direction of health equity and implementation science research in the context of heart, lung, blood, and sleep-related health conditions.
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Affiliation(s)
- Madeline R. Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Sandra E. Echeverria
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, NC
| | - Yvonne Commodore-Mensah
- Johns Hopkins School of Nursing, Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD
| | - Jessica Y Breland
- Center for Innovation to Implementation, Veterans Affairs, Palo Alto Health Care System, Menlo Park, CA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Division of General Internal Medicine, Yale University School of Medicine, New Haven, CT
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218
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Zaltz DA, Pate RR, O'Neill JR, Neelon B, Benjamin-Neelon SE. Barriers and Facilitators to Compliance with a State Healthy Eating Policy in Early Care and Education Centers. Child Obes 2019; 14:349-357. [PMID: 30199292 PMCID: PMC10771878 DOI: 10.1089/chi.2018.0077] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early care and education (ECE) policies can improve childhood obesity risk factors. We evaluated barriers and facilitators to implementing mandatory nutrition standards for foods provided in South Carolina ECE centers serving low-income children, comparing centers participating in the Child and Adult Care Food Program (CACFP) with non-CACFP centers. METHODS We mailed 261 surveys (demographics, policies and practices, barriers and facilitators) to center directors after new state nutrition standards were implemented in South Carolina. We conducted univariate and bivariate analyses to explore relationships between barriers, facilitators, and center-level characteristics, by CACFP status. RESULTS We received 163 surveys (62% response rate). Centers had a median [interquartile range (IQR)] of 5 (4-7) classrooms and 59 (37.5-89) total children enrolled. More than half (60.1%) of directors reported they were moderately or fully informed about the standards. The most common barriers were food costs (17.8%) and children's food preferences (17.8%). More non-CACFP directors reported food costs as a barrier (28.6% vs. 6.5%, p < 0.001), having to spend additional money on healthier foods (48.8% vs. 28.6%, p = 0.01), and having to provide additional nutrition education to parents (28.6% vs. 11.7%, p = 0.01), compared with CACFP directors. CONCLUSIONS Center directors were generally well informed about the nutrition standards. The most common barriers to implementing the standards were food costs and children's food preferences. Centers participating in CACFP may be in a better position to adhere to new state nutrition standards, as they receive some federal reimbursement for serving healthy foods and may be more accustomed to regulation.
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Affiliation(s)
- Daniel A. Zaltz
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Russell R. Pate
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Jennifer R. O'Neill
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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219
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Rycroft-Malone J, Gradinger F, Owen Griffiths H, Anderson R, Crane RS, Gibson A, Mercer SW, Kuyken W. 'Mind the gaps': the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study. BMJ Open 2019; 9:e026244. [PMID: 31501097 PMCID: PMC6738673 DOI: 10.1136/bmjopen-2018-026244] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Mindfulness-based cognitive therapy (MBCT) is an evidence-based approach for people at risk of depressive relapse to support their long-term recovery. However, despite its inclusion in guidelines, there is an 'implementation cliff'. The study objective was to develop a better explanation of what facilitates MBCT implementation. SETTING UK primary and secondary care mental health services. DESIGN, PARTICIPANTS AND METHODS A national two-phase, multi-method qualitative study was conducted, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework. Phase I involved interviews with stakeholders from 40 service providers about current provision of MBCT. Phase II involved 10 purposively sampled case studies to obtain a more detailed understanding of MBCT implementation. Data were analysed using adapted framework analysis, refined through stakeholder consultation. RESULTS Access to MBCT is variable across the UK services. Where available, services have adapted MBCT to fit their context by integrating it into their care pathways. Evidence was often important to implementation but took different forms: the NICE depression guideline, audits, evaluations, first person accounts, experiential taster sessions and pilots. These were used to build a platform from which to develop MBCT services. The most important aspect of facilitation was the central role of the MBCT implementers. These were generally self-designated individuals who 'championed' grass-roots implementation. Our explanatory framework mapped out a prototypical implementation journey, often over many years with a balance of bottom-up and top-down factors influencing the fit of MBCT into service pathways. 'Pivot points' in the implementation journey provided windows of either challenge or opportunity. CONCLUSIONS This is one of the largest systematic studies of the implementation of a psychological therapy. While access to MBCT across the UK is improving, it remains patchy. The resultant explanatory framework about MBCT implementation provides a heuristic that informed an implementation resource.
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Affiliation(s)
| | - Felix Gradinger
- Institute of Health Research, University of Exeter, Exeter, UK
| | | | - Rob Anderson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, Exeter, UK
| | | | - Andy Gibson
- Health and Social Sciences, University of the West of England, Bristol, UK
| | - Stewart W Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Rojas SM, Carter SP, McGinn MM, Reger MA. A Review of Telemental Health as a Modality to Deliver Suicide-Specific Interventions for Rural Populations. Telemed J E Health 2019; 26:700-709. [PMID: 31502929 DOI: 10.1089/tmj.2019.0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Despite recent advancements in the development of new suicide prevention interventions, suicide rates continue to rise in the United States. As such, suicide prevention efforts must continue to focus on expanding dissemination of suicide-specific interventions. Methods: This review explores telemental health through two-way synchronous clinical video telehealth (CVT) technologies as one approach to improving access to suicide-specific interventions. Results: Studies were reviewed if (1) the modality of interest was telemental health by CVT and (2) management, assessment, or intervention of suicidal thoughts or behaviors was discussed. A total of 22 studies were included. Conclusions: Findings from the limited existing studies are synthesized, and recommendations are provided for future research, clinical, and educational advancements.
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Affiliation(s)
- Sasha M Rojas
- VA Puget Sound Health Care System, Seattle, Washington.,University of Arkansas, Fayetteville, Arkansas, USA
| | - Sarah P Carter
- VA Puget Sound Health Care System, Seattle, Washington.,Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Meghan M McGinn
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mark A Reger
- VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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221
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Squires JE, Graham I, Bashir K, Nadalin‐Penno L, Lavis J, Francis J, Curran J, Grimshaw JM, Brehaut J, Ivers N, Michie S, Hillmer M, Noseworthy T, Vine J, Demery Varin M, Aloisio LD, Coughlin M, Hutchinson AM. Understanding context: A concept analysis. J Adv Nurs 2019; 75:3448-3470. [DOI: 10.1111/jan.14165] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/24/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Janet E. Squires
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Ian Graham
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
| | - Kainat Bashir
- Institute of Health Policy, Management, and Evaluation University of Toronto Toronto Ontario Canada
| | - Letitia Nadalin‐Penno
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - John Lavis
- Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton Ontario Canada
- McMaster Health Forum Hamilton Ontario Canada
| | - Jill Francis
- School of Health Sciences, City University of London London United Kingdom
| | - Janet Curran
- IWK Health Centre Halifax Nova Scotia Canada
- School of Nursing Dalhousie University Halifax Nova Scotia Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- Medicine University of Ottawa Ottawa Ontario Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- School of Epidemiology and Public Health University of Ottawa Ottawa Ontario Canada
| | - Noah Ivers
- Women's College Research Institute Toronto Ontario Canada
- Women's College Hospital Toronto Ontario Canada
- Department of Family and Community Medicine University of Toronto Toronto Ontario Canada
| | - Susan Michie
- Psychology Department University College London London United Kingdom
| | - Michael Hillmer
- Information Management, Data, and Analytics Ontario Ministry of Health and Long‐term Care Toronto Ontario Canada
| | - Thomas Noseworthy
- British Columbia Academic Health Science Network Vancouver British Columbia Canada
| | - Jocelyn Vine
- School of Nursing Dalhousie University Halifax Nova Scotia Canada
- Patient Care IWK Health Centre Halifax Nova Scotia Canada
| | - Melissa Demery Varin
- School of Nursing, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada
| | - Laura D. Aloisio
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Mary Coughlin
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Alison M. Hutchinson
- School of Nursing and Midwifery, Faculty of Health Deakin University Melbourne Victoria Australia
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KC A, Ewald U, Basnet O, Gurung A, Pyakuryal SN, Jha BK, Bergström A, Eriksson L, Paudel P, Karki S, Gajurel S, Brunell O, Wrammert J, Litorp H, Målqvist M. Effect of a scaled-up neonatal resuscitation quality improvement package on intrapartum-related mortality in Nepal: A stepped-wedge cluster randomized controlled trial. PLoS Med 2019; 16:e1002900. [PMID: 31498784 PMCID: PMC6733443 DOI: 10.1371/journal.pmed.1002900] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Improving quality of intrapartum care will reduce intrapartum stillbirth and neonatal mortality, especially in resource-poor settings. Basic neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality, if delivered in a high-quality health system, but there is a dearth of evidence on how to scale up such evidence-based interventions. We evaluated the scaling up of a quality improvement (QI) package for neonatal resuscitation on intrapartum-related mortality (intrapartum stillbirth and first day mortality) at hospitals in Nepal. METHODS AND FINDINGS We conducted a stepped-wedge cluster randomized controlled trial in 12 hospitals over a period of 18 months from April 14, 2017, to October 17, 2018. The hospitals were assigned to one of four wedges through random allocation. The QI package was implemented in a stepped-wedge manner with a delay of three months for each step. The QI package included improving hospital leadership on intrapartum care, building health workers' competency on neonatal resuscitation, and continuous facilitated QI processes in clinical units. An independent data collection system was set up at each hospital to gather data on mortality through patient case note review and demographic characteristics of women using semi-structured exit interviews. The generalized linear mixed model (GLMM) and multivariate logistic regression were used for analyses. During this study period, a total of 89,014 women-infant pairs were enrolled. The mean age of the mother in the study period was 24.0 ± 4.3 years, with 54.9% from disadvantaged ethnic groups and 4.0% of them illiterate. Of the total birth cohort, 54.4% were boys, 16.7% had gestational age less than 37 weeks, and 17.1% had birth weight less than 2,500 grams. The incidence of intrapartum-related mortality was 11.0 per 1,000 births during the control period and 8.0 per 1,000 births during the intervention period (adjusted odds ratio [aOR], 0.79; 95% CI, 0.69-0.92; p = 0.002; intra-cluster correlation coefficient [ICC], 0.0286). The incidence of early neonatal mortality was 12.7 per 1,000 live births during the control period and 10.1 per 1,000 live births during the intervention period (aOR, 0.89; 95% CI, 0.78-1.02; p = 0.09; ICC, 0.1538). The use of bag-and-mask ventilation for babies with low Apgar score (<7 at 1 minute) increased from 3.2% in the control period to 4.0% in the intervention period (aOR, 1.52; 95% CI, 1.32-1.77, p = 0.003). There were two major limitations to the study; although a large sample of women-infant pairs were enrolled in the study, the clustering reduced the power of the study. Secondly, the study was not sufficiently powered to detect reduction in early neonatal mortality with the number of clusters provided. CONCLUSION These results suggest scaled-up implementation of a QI package for neonatal resuscitation can reduce intrapartum-related mortality and improve clinical care. The QI intervention package is likely to be effective in similar settings. More implementation research is required to assess the sustainability of QI interventions and quality of care. TRIAL REGISTRATION ISRCTN30829654.
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Affiliation(s)
- Ashish KC
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
- Society of Public Health Physician Nepal, Kathmandu, Nepal
- * E-mail:
| | - Uwe Ewald
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | | | | | | | - Bijay Kumar Jha
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Anna Bergström
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
- UCL Institute for Global Health (IGH), University College London, London, United Kingdom
| | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Prajwal Paudel
- Nepal Health Research Council, RamshahPath, Kathmandu, Nepal
| | | | | | - Olivia Brunell
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Johan Wrammert
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Helena Litorp
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women’s and Children’s Health; Uppsala University, Uppsala, Sweden
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Bejarano CM, Snow K, Lane H, Calvert H, Hoppe K, Alfonsin N, Turner L, Carlson JA. Development of a novel tool for assessing coverage of implementation factors in health promotion program resources. Prev Med Rep 2019; 15:100909. [PMID: 31194155 PMCID: PMC6551551 DOI: 10.1016/j.pmedr.2019.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Carolina M. Bejarano
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, United States of America
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd St, Kansas City, MO, United States of America
| | - Kelli Snow
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd St, Kansas City, MO, United States of America
| | - Hannah Lane
- Department of Pediatrics, Division of Growth and Nutrition, University of Maryland School of Medicine, 737 W Lombard St, Baltimore, MD, United States of America
| | - Hannah Calvert
- College of Education, Boise State University, 1910 University Drive, Boise, ID, United States of America
| | - Kate Hoppe
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd St, Kansas City, MO, United States of America
| | - Nicole Alfonsin
- George Washington University Milken Institute, School of Public Health, 950 New Hampshire Avenue NW, Washington, DC, United States of America
| | - Lindsey Turner
- College of Education, Boise State University, 1910 University Drive, Boise, ID, United States of America
| | - Jordan A. Carlson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd St, Kansas City, MO, United States of America
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Alatawi SF. From theory to practice: a conceptual framework to facilitate implementation of evidence in stroke rehabilitation for local context in Saudi Arabia. J Multidiscip Healthc 2019; 12:515-525. [PMID: 31456641 PMCID: PMC6620773 DOI: 10.2147/jmdh.s212372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Implementing evidence into practice is a global priority with implications for patients, researchers, practitioners and policy-makers (stakeholders). The national clinical guideline (NCG) for stroke is one of the most important sources of robust evidence. However, implementation within real practice is often slow to respond. The knowledge to action (KTA) framework is one of several frameworks to facilitate implementation and enable evidence to be put into operation. This study aims to develop a conceptual framework to understand the process of implementation of an NCG for stroke in the local context of physiotherapy practice in the Kingdom of Saudi Arabia. Methods A qualitative–quantitative mixed methods study was conducted. The first method (panel meetings, 10 expert physiotherapists) was to chart the main concepts/domains of physiotherapy practice in the UK NCG for stroke. Drawing on panel meeting findings, 75 recommendations were released as an online questionnaire to 35 Saudi stroke specialist physiotherapists. This was followed by a focus group (second method) to capture the process of implementation of NCG for stroke in the Kingdom of Saudi Arabia. Results Sixty-one recommendations were accepted to be applied in real practice, whereas only 14 recommendations were rejected. The paper presents the first empirically derived framework that establishes the
contribution
of physiotherapy to stroke rehabilitation. This framework characterizes the real-world nature of the implementation of NCGs for stroke within physiotherapy practice. This framework reaffirms the importance of supportive organizational culture, the specific need of end users, patient factors, and finally transferability of the evidence. Discussion This conceptual framework appears to provide a reasonable approach for the development of implementation strategies for physiotherapist practice in stroke rehabilitation. Furthermore, it might be the first that reflects the real value of the KTA framework and tests it empirically. Conclusion The finding of this study provides a useful comprehensive framework to implement existing NCGs for stroke.
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Affiliation(s)
- Salem F Alatawi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk City, Kingdom of Saudi Arabia
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225
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Villalobos Dintrans P, Bossert TJ, Sherry J, Kruk ME. A synthesis of implementation science frameworks and application to global health gaps. Glob Health Res Policy 2019; 4:25. [PMID: 31485483 PMCID: PMC6712702 DOI: 10.1186/s41256-019-0115-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background Implementation science has been growing as discipline in the past decades, producing an increasing number of models in the area. On the other hand, most frameworks are intended to guide the implementation of programs, focusing on identifying elements and stages that increase their success. This article aims to structure this discussion, proposing a simplified tool that synthesizes common elements of other frameworks, and highlight the usefulness to use implementation science not only in identifying successful implementation strategies but as a tool to assess gaps in global health initiatives. Methods The study was carried out through a combined methodology that included an initial search of implementation science frameworks, experts’ opinions, and the use of references in frameworks to elaborate a list of articles to be reviewed. A total of 52 articles were analyzed, identifying their definitions of implementation science and the elements of different frameworks. Results The analysis of articles allowed identifying the main goals and definitions of implementation science. In a second stage, frameworks were classified into “time-based”, “component-based” and “mixed”, and common elements of each type of model were used to propose a synthetic framework with six elements: Diagnosis, Intervention provider/ system, Intervention, Recipient, Environment, and Evaluation. Finally, this simplified framework was used to identify gaps in global health was using The Lancet Global Health Series. Potential areas of intervention arise for five different global health issues: malaria, non-communicable diseases, maternal and child health, HIV/AIDS, and tuberculosis. Prioritization strategies differ for the different health issues, and the proposed framework can help identify and classify all these different proposals. Conclusions There is a huge variety of definitions and models in implementation science. The analysis showed the usefulness of applying an implementation science approach to identify and prioritize gaps in implementation strategies in global health. Electronic supplementary material The online version of this article (10.1186/s41256-019-0115-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Jim Sherry
- 3University Research Co., LLC, Chevy Chase, USA
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Brown SM, Azoulay E, Benoit D, Butler TP, Folcarelli P, Geller G, Rozenblum R, Sands K, Sokol-Hessner L, Talmor D, Turner K, Howell MD. The Practice of Respect in the ICU. Am J Respir Crit Care Med 2019; 197:1389-1395. [PMID: 29356557 DOI: 10.1164/rccm.201708-1676cp] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although "respect" and "dignity" are intuitive concepts, little formal work has addressed their systematic application in the ICU setting. After convening a multidisciplinary group of relevant experts, we undertook a review of relevant literature and collaborative discussions focused on the practice of respect in the ICU. We report the output of this process, including a summary of current knowledge, a conceptual framework, and a research program for understanding and improving the practice of respect and dignity in the ICU. We separate our report into findings and proposals. Findings include the following: 1) dignity and respect are interrelated; 2) ICU patients and families are vulnerable to disrespect; 3) violations of respect and dignity appear to be common in the ICU and overlap substantially with dehumanization; 4) disrespect may be associated with both primary and secondary harms; and 5) systemic barriers complicate understanding and the reliable practice of respect in the ICU. Proposals include: 1) initiating and/or expanding a field of research on the practice of respect in the ICU; 2) treating "failures of respect" as analogous to patient safety events and using existing quality and safety mechanisms for improvement; and 3) identifying both benefits and potential unintended consequences of efforts to improve the practice of respect. Respect and dignity are important considerations in the ICU, even as substantial additional research remains to be done.
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Affiliation(s)
- Samuel M Brown
- 1 Center for Humanizing Critical Care, Intermountain Medical Center, Murray, Utah.,2 Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Elie Azoulay
- 3 Medical School, Paris Diderot University, Sorbonne Paris-Cité, Paris, France
| | - Dominique Benoit
- 4 Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.,5 Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | | | - Gail Geller
- 8 Berman Institute of Bioethics and.,9 School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Ronen Rozenblum
- 10 Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ken Sands
- 11 Clinical Services Group, Hospital Corporation of America, Nashville, Tennessee
| | | | - Daniel Talmor
- 12 Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kathleen Turner
- 13 Department of Nursing, University of California San Francisco Medical Center, San Francisco, California; and
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Ruest M, Léonard G, Thomas A, Desrosiers J, Guay M. French cross-cultural adaptation of the Organizational Readiness for Implementing Change (ORIC). BMC Health Serv Res 2019; 19:535. [PMID: 31366390 PMCID: PMC6668068 DOI: 10.1186/s12913-019-4361-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Organizational readiness is a factor known to influence the predisposition of individuals within an organization to change. Based on Weiner's organizational theory, the "Organizational Readiness for Implementing Change" (ORIC) questionnaire was developed and validated to measure organizational readiness in healthcare contexts. However, no such tools allow French-speaking organizations to measure this concept. The objectives of this study were to (1) conduct a French cultural adaptation of the ORIC questionnaire, and (2) initiate the study of its psychometric properties. METHODS (1) Cross-cultural adaptation and translation processes were first conducted with the methodologies of Beaton, Vallerand and Massoubre. (2) Subsequently, internal consistency was documented by calculating Cronbach's alpha and inter-item and item-to-scale correlations. The study of construct validity was initiated with a confirmatory factor analysis. RESULTS A French 10-item scale named the Réceptivité organisationnelle à l'implantation d'un changement (ROIC) was developed and pretested by 125 occupational therapists working in Quebec homecare services. Cronbach's alpha values for the 2 item subscales show satisfactory internal consistency (Commitment: α = 0.84 and Efficacy: α = 0.86). Inter-item correlations revealed that the ROIC's items are moderately related to each other while item-to-total scale correlations pinpoint items that accounts for variance and influence internal consistency. Confirmatory factor analysis allowed the initiation of a substantial documentation of ROIC's model fit with the original version (CFI = 0.89, TLI = 0.85, SRMR = 0.08, and RMSEA = 0.12). CONCLUSIONS The ROIC is a new theory-based and translated questionnaire that can be used to rigorously document the organizational readiness of French organizations. The ROIC has the potential to support members of different organizations in the identification of subsequent efforts for the implementation of a change.
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Affiliation(s)
- M. Ruest
- Health sciences research programs, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie - Centre hospitalier universitaire de Sherbrooke (CHUS), 1036, Belvédère Sud, Sherbrooke, Québec J1H 4C4 Canada
| | - G. Léonard
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie - Centre hospitalier universitaire de Sherbrooke (CHUS), 1036, Belvédère Sud, Sherbrooke, Québec J1H 4C4 Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - A. Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3654, Promenade Sir-William-Osler, Montréal, Québec H3G 1Y5 Canada
- Centre for Medical Education, Faculty of Medicine, McGill University – Lady Meredith House, 1110 Pine Avenue West, Rm 205, Montréal, Québec H3A 1A3 Canada
| | - J. Desrosiers
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
| | - M. Guay
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de l’Estrie - Centre hospitalier universitaire de Sherbrooke (CHUS), 1036, Belvédère Sud, Sherbrooke, Québec J1H 4C4 Canada
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec J1H 5N4 Canada
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Ramis MA, Chang A, Conway A, Lim D, Munday J, Nissen L. Theory-based strategies for teaching evidence-based practice to undergraduate health students: a systematic review. BMC MEDICAL EDUCATION 2019; 19:267. [PMID: 31319892 PMCID: PMC6637485 DOI: 10.1186/s12909-019-1698-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/08/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Undergraduate students across health professions are required to be capable users of evidence in their clinical practice after graduation. Gaining the essential knowledge and clinical behaviors for evidence-based practice can be enhanced by theory-based strategies. Limited evidence exists on the effect of underpinning undergraduate EBP curricula with a theoretical framework to support EBP competence. A systematic review was conducted to determine the effectiveness of EBP teaching strategies for undergraduate students, with specific focus on efficacy of theory-based strategies. METHODS This review critically appraised and synthesized evidence on the effectiveness of EBP theory-based teaching strategies specifically for undergraduate health students on long or short-term change in multiple outcomes, including but not limited to, EBP knowledge and attitudes. PubMed, CINAHL, Scopus, ProQuest Health, ERIC, The Campbell Collaboration, PsycINFO were searched for published studies and The New York Academy of Medicine, ProQuest Dissertations and Mednar were searched for unpublished studies. Two independent reviewers assessed studies using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. RESULTS Twenty-eight studies reporting EBP teaching strategies were initially selected for review with methodological quality ranging from low to high. Studies varied in course duration, timing of delivery, population and course content. Only five included papers reported alignment with, and detail of, one or more theoretical frameworks. Theories reported included Social Cognitive Theory (one study), Roger's Diffusion of Innovation Theory (two studies) and Cognitive Apprenticeship Theory (one study). Cognitive Flexibility Theory and Cognitive Load Theory were discussed in two separate papers by the same authors. All but one study measured EBP knowledge. Mixed results were reported on EBP knowledge, attitudes and skills across the five studies. CONCLUSIONS EBP programs for undergraduate health students require consideration of multiple domains, including clinical behaviors, attitudes and cognitive learning processes; Interventions grounded in theory were found to have a small but positive effect on EBP attitudes. The most effective theory for developing and supporting EBP capability is not able to be determined by this review therefore additional rigorous research is required.
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Affiliation(s)
- Mary-Anne Ramis
- Mater Health, Evidence in Practice Unit & Queensland Centre for Evidence Based Nursing and Midwifery, A Joanna Briggs Institute Centre of Excellence, South Brisbane, QLD 4101 Australia
- Queensland University of Technology, School of Nursing, Victoria Park Road, Kelvin Grove, Brisbane, Queensland 4059 Australia
| | - Anne Chang
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
| | - Aaron Conway
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5G 2N2 Canada
| | - David Lim
- School of Science and Health, Western Sydney University, Sydney, 2751 Australia
| | - Judy Munday
- Queensland University of Technology, School of Nursing, Kelvin Grove Campus, Victoria Park Road, Brisbane, 4059 Australia
- Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Lisa Nissen
- Queensland University of Technology, School of Clinical Sciences, Gardens Point Campus, QLD, Brisbane, 4000 Australia
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Smith SN, Almirall D, Prenovost K, Liebrecht C, Kyle J, Eisenberg D, Bauer MS, Kilbourne AM. Change in Patient Outcomes After Augmenting a Low-level Implementation Strategy in Community Practices That Are Slow to Adopt a Collaborative Chronic Care Model: A Cluster Randomized Implementation Trial. Med Care 2019; 57:503-511. [PMID: 31135692 PMCID: PMC6684247 DOI: 10.1097/mlr.0000000000001138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Implementation strategies are essential for promoting the uptake of evidence-based practices and for patients to receive optimal care. Yet strategies differ substantially in their intensity and feasibility. Lower-intensity strategies (eg, training and technical support) are commonly used but may be insufficient for all clinics. Limited research has examined the comparative effectiveness of augmentations to low-level implementation strategies for nonresponding clinics. OBJECTIVES To compare 2 augmentation strategies for improving uptake of an evidence-based collaborative chronic care model (CCM) on 18-month outcomes for patients with depression at community-based clinics nonresponsive to lower-level implementation support. RESEARCH DESIGN Providers initially received support using a low-level implementation strategy, Replicating Effective Programs (REP). After 6 months, nonresponsive clinics were randomized to add either external facilitation (REP+EF) or external and internal facilitation (REP+EF/IF). MEASURES The primary outcome was patient 12-item short form survey (SF-12) mental health score at month 18. Secondary outcomes were patient health questionnaire (PHQ-9) depression score at month 18 and receipt of the CCM during months 6 through 18. RESULTS Twenty-seven clinics were nonresponsive after 6 months of REP. Thirteen clinics (N=77 patients) were randomized to REP+EF and 14 (N=92) to REP+EF/IF. At 18 months, patients in the REP+EF/IF arm had worse SF-12 [diff, 8.38; 95% confidence interval (CI), 3.59-13.18] and PHQ-9 scores (diff, 1.82; 95% CI, -0.14 to 3.79), and lower odds of CCM receipt (odds ratio, 0.67; 95% CI, 0.30-1.49) than REP+EF patients. CONCLUSIONS Patients at sites receiving the more intensive REP+EF/IF saw less improvement in mood symptoms at 18 months than those receiving REP+EF and were no more likely to receive the CCM. For community-based clinics, EF augmentation may be more feasible than EF/IF for implementing CCMs.
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Affiliation(s)
- Shawna N Smith
- Department of Psychiatry, University of Michigan Medical School
- Institute for Social Research
| | - Daniel Almirall
- Institute for Social Research
- Department of Statistics, University of Michigan
| | | | - Celeste Liebrecht
- Department of Psychiatry, University of Michigan Medical School
- Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs
| | - Julia Kyle
- Department of Psychiatry, University of Michigan Medical School
| | - Daniel Eisenberg
- Department of Health Management and Policy, School of Public Health, University of Michigan Ann Arbor, MI
| | - Mark S Bauer
- US Department of Veterans Affairs, Center for Healthcare Organization and Implementation Research, US Department of Veterans Affairs, Boston Healthcare System and Harvard Medical School, Boston, MA
| | - Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School
- Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs
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Gurung R, Jha AK, Pyakurel S, Gurung A, Litorp H, Wrammert J, Jha BK, Paudel P, Rahman SM, Malla H, Sharma S, Gautam M, Linde JE, Moinuddin M, Ewald U, Målqvist M, Axelin A, Kc A. Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)-a stepped wedge cluster randomized controlled trial in public hospitals. Implement Sci 2019; 14:65. [PMID: 31217028 PMCID: PMC6582583 DOI: 10.1186/s13012-019-0917-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023] Open
Abstract
Background Each year, 2.2 million intrapartum-related deaths (intrapartum stillbirths and first day neonatal deaths) occur worldwide with 99% of them taking place in low- and middle-income countries. Despite the accelerated increase in the proportion of deliveries taking place in health facilities in these settings, the stillborn and neonatal mortality rates have not reduced proportionately. Poor quality of care in health facilities is attributed to two-thirds of these deaths. Improving quality of care during the intrapartum period needs investments in evidence-based interventions. We aim to evaluate the quality improvement package—Scaling Up Safer Bundle Through Quality Improvement in Nepal (SUSTAIN)—on intrapartum care and intrapartum-related mortality in public hospitals of Nepal. Methods We will conduct a stepped wedge cluster randomized controlled trial in eight public hospitals with each having least 3000 deliveries a year. Each hospital will represent a cluster with an intervention transition period of 2 months in each. With a level of significance of 95%, the statistical power of 90% and an intra-cluster correlation of 0.00015, a study period of 19 months should detect at least a 15% change in intrapartum-related mortality. Quality improvement training, mentoring, systematic feedback, and a continuous improvement cycle will be instituted based on bottleneck analyses in each hospital. All concerned health workers will be trained on standard basic neonatal resuscitation and essential newborn care. Portable fetal heart monitors (Moyo®) and neonatal heart rate monitors (Neobeat®) will be introduced in the hospitals to identify fetal distress during labor and to improve neonatal resuscitation. Independent research teams will collect data in each hospital on intervention inputs, processes, and outcomes by reviewing records and carrying out observations and interviews. The dose-response effect will be evaluated through process evaluations. Discussion With the global momentum to improve quality of intrapartum care, better understanding of QI package within a health facility context is important. The proposed package is based on experiences from a similar previous scale-up trial carried out in Nepal. The proposed evaluation will provide evidence on QI package and technology for implementation and scale up in similar settings. Trial registration number ISRCTN16741720. Registered on 2 March 2019.
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Affiliation(s)
| | - Anjani Kumar Jha
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | | | - Helena Litorp
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | - Johan Wrammert
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | - Bijay Kumar Jha
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | - Syed Moshfiqur Rahman
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | | | | | | | - Jorgen Erland Linde
- Department of Paediatrics, Stavanger University Hospital, Våland burrough, Stavanger, Norway
| | - Md Moinuddin
- Maternal and Child Health Division, ICDDR,B, Dhaka, Bangladesh
| | - Uwe Ewald
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden
| | | | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, Sweden. .,Society of Public Health Physicians Nepal, Lalitpur, Nepal.
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Wilde S, Sonley A, Crane C, Ford T, Raja A, Robson J, Taylor L, Kuyken W. Mindfulness Training in UK Secondary Schools: a Multiple Case Study Approach to Identification of Cornerstones of Implementation. Mindfulness (N Y) 2019; 10:376-389. [PMID: 31186817 PMCID: PMC6558285 DOI: 10.1007/s12671-018-0982-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This paper examined the facilitators and barriers to implementation of mindfulness training (MT) across seven secondary/high schools using a qualitative case study design. Schools varied in level of implementation. Within schools, head teachers, members of school senior leadership teams, and staff members involved in the implementation of MT were interviewed individually. In addition, focus groups were conducted with other members of school staff to capture a broad range of views and perspectives. Across the case studies, several key themes emerged, which suggested four corner stones to successful implementation of MT in schools. These were: people, specifically the need for committed individuals to champion the approach within their schools, with the support of members of the senior leadership teams; resources, both time and financial resources required for training and delivery of MT; journey, reflecting the fact that implementation takes time, and may be a non-linear process with stops and starts; and finally perceptions, highlighting the importance of members of the school community sharing an understanding what MT is and why it is being introduced in each school context. Similarities and differences between the current findings and those of research on implementation of other forms of school mental health promotion programs, and implementation of MT in healthcare settings, are discussed.
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Affiliation(s)
- Stephanie Wilde
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Anna Sonley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Catherine Crane
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Tamsin Ford
- Medical School, University of Exeter, Exeter, UK
| | - Anam Raja
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - James Robson
- Department of Education, University of Oxford, Oxford, UK
| | - Laura Taylor
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
| | - Willem Kuyken
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford OX3 7JX, UK
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232
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Thunberg G, Ferm U, Blom Å, Karlsson M, Nilsson S. Implementation of pictorial support for communication with people who have been forced to flee: Experiences from neonatal care. J Child Health Care 2019; 23:311-336. [PMID: 30587003 DOI: 10.1177/1367493518819210] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A first attempt was made to introduce picture-based communication at a Swedish neonatal ward to facilitate communication with immigrant patients having fled their country of origin. Six members of staff were interviewed about their experiences using semi-structured dyadic interviews. Their answers were analysed using inductive content analysis, and the results were related to a theoretical framework called Promoting Action on Research Implementation in Health Services. The staff found the pictures to be helpful in communication with refugees. They were motivated to use the pictorial support and experienced a great need for it. Two key prerequisites for successful implementation were identified: receiving training and having a person formally in charge of the implementation process.
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Affiliation(s)
- Gunilla Thunberg
- 1 Dart Center for Augmentative and Alternative Communication and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulrika Ferm
- 1 Dart Center for Augmentative and Alternative Communication and Assistive Technology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Blom
- 2 Speech and Language Pathology Unit, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Karlsson
- 2 Speech and Language Pathology Unit, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Nilsson
- 3 Institute of Health and Care Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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233
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Conklin J, Farrell B, Suleman S. Implementing deprescribing guidelines into frontline practice: Barriers and facilitators. Res Social Adm Pharm 2019; 15:796-800. [DOI: 10.1016/j.sapharm.2018.08.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
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234
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Eslava-Schmalbach J, Garzón-Orjuela N, Elias V, Reveiz L, Tran N, Langlois EV. Conceptual framework of equity-focused implementation research for health programs (EquIR). Int J Equity Health 2019; 18:80. [PMID: 31151452 PMCID: PMC6544990 DOI: 10.1186/s12939-019-0984-4] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/17/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Implementation research is increasingly used to identify common implementation problems and key barriers and facilitators influencing efficient access to health interventions. OBJECTIVE To develop and propose an equity-based framework for Implementation Research (EquIR) of health programs, policies and systems. METHODS A systematic search of models and conceptual frameworks involving equity in the implementation of health programs, policies and systems was conducted in Medline (PubMed), Embase, LILACS, Scopus and grey literature. Key characteristics of models and conceptual frameworks were summarized. We identified key aspects of equity in the context of seven Latin American countries-focused health programs We gathered information related to the awareness of inequalities in health policy, systems and programs, the potential negative impact of increasing inequalities in disadvantaged populations, and the strategies used to reduce them. RESULTS A conceptual framework of EquIR was developed. It includes elements of equity-focused implementation research, but it also links the population health status before and after the implementation, including relevant aspects of health equity before, during and after the implementation. Additionally, health sectors were included, linked with social determinants of health through the "health in all policies" proposal affecting universal health and the potential impact of the public health and public policies. CONCLUSION EquIR is a conceptual framework that is proposed for use by decision makers and researchers during the implementation of programs, policies or health interventions, with a focus on equity, which aims to reduce or prevent the increase of existing inequalities during implementation.
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Affiliation(s)
- J. Eslava-Schmalbach
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - N. Garzón-Orjuela
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
- Clinical Research Institute, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - V. Elias
- Evidence and Intelligence for Action in Health Department Pan American Health Organization, Washington, USA
| | - L. Reveiz
- Evidence and Intelligence for Action in Health Department Pan American Health Organization, Washington, USA
| | - N. Tran
- World Health Organization, Geneva, Switzerland
| | - E. V. Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
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235
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Sampson EL, Feast A, Blighe A, Froggatt K, Hunter R, Marston L, McCormack B, Nurock S, Panca M, Powell C, Rait G, Robinson L, Woodward-Carlton B, Young J, Downs M. Evidence-based intervention to reduce avoidable hospital admissions in care home residents (the Better Health in Residents in Care Homes (BHiRCH) study): protocol for a pilot cluster randomised trial. BMJ Open 2019; 9:e026510. [PMID: 31133585 PMCID: PMC6538003 DOI: 10.1136/bmjopen-2018-026510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Acute hospital admission is distressing for care home residents. Ambulatory care sensitive conditions, such as respiratory and urinary tract infections, are conditions that can cause unplanned hospital admission but may have been avoidable with timely detection and intervention in the community. The Better Health in Residents in Care Homes (BHiRCH) programme has feasibility tested and will pilot a multicomponent intervention to reduce these avoidable hospital admissions. The BHiRCH intervention comprises an early warning tool for noting changes in resident health, a care pathway (clinical guidance and decision support system) and a structured method for communicating with primary care, adapted for use in the care home. We use practice development champions to support implementation and embed changes in care. METHODS AND ANALYSIS Cluster randomised pilot trial to test study procedures and indicate whether a further definitive trial is warranted. Fourteen care homes with nursing (nursing homes) will be randomly allocated to intervention (delivered at nursing home level) or control groups. Two nurses from each home become Practice Development Champions trained to implement the intervention, supported by a practice development support group. Data will be collected for 3 months preintervention, monthly during the 12-month intervention and 1 month after. Individual-level data includes resident, care partner and staff demographics, resident functional status, service use and quality of life (for health economic analysis) and the extent to which staff perceive the organisation supports person centred care. System-level data includes primary and secondary health services contacts (ie, general practitioner and hospital admissions). Process evaluation assesses intervention acceptability, feasibility, fidelity, ease of implementation in practice and study procedures (ie, consent and recruitment rates). ETHICS AND DISSEMINATION Approved by Research Ethics Committee and the UK Health Research Authority. Findings will be disseminated via academic and policy conferences, peer-reviewed publications and social media (eg, Twitter). TRIAL REGISTRATION NUMBER ISRCTN74109734; Pre-results.
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Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Rachael Hunter
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Louise Marston
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | | | - Shirley Nurock
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Monica Panca
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Catherine Powell
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Greta Rait
- Research Dept of Primary Care and Population Health and PRIMENT Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Institute for Health and Society and Newcastle University Institute for Ageing, Newcastle University, Newcastle, UK
| | | | - John Young
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, University of Leeds, Bradford, UK
| | - Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, West Yorkshire, UK
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236
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Squires JE, Aloisio LD, Grimshaw JM, Bashir K, Dorrance K, Coughlin M, Hutchinson AM, Francis J, Michie S, Sales A, Brehaut J, Curran J, Ivers N, Lavis J, Noseworthy T, Vine J, Hillmer M, Graham ID. Attributes of context relevant to healthcare professionals' use of research evidence in clinical practice: a multi-study analysis. Implement Sci 2019; 14:52. [PMID: 31113449 PMCID: PMC6530177 DOI: 10.1186/s13012-019-0900-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To increase the likelihood of successful implementation of evidence-based practices, researchers, knowledge users, and healthcare professionals must consider aspects of context that promote and hinder implementation in their setting. The purpose of the current study was to identify contextual attributes and their features relevant to implementation by healthcare professionals and compare and contrast these attributes and features across different clinical settings and healthcare professional roles. METHODS We conducted a secondary analysis of 145 semi-structured interviews comprising 11 studies (10 from Canada and one from Australia) investigating healthcare professionals' perceived barriers and enablers to their use of research evidence in clinical practice. The data was collected using semi-structured interview guides informed by the Theoretical Domains Framework across different healthcare professional roles, settings, and practices. We analyzed these data inductively, using constant comparative analysis, to identify attributes of context and their features reported in the interviews. We compared these data by (1) setting (primary care, hospital-medical/surgical, hospital-emergency room, hospital-critical care) and (2) professional role (physicians and residents, nurses and organ donor coordinators). RESULTS We identified 62 unique features of context, which we categorized under 14 broader attributes of context. The 14 attributes were resource access, work structure, patient characteristics, professional role, culture, facility characteristics, system features, healthcare professional characteristics, financial, collaboration, leadership, evaluation, regulatory or legislative standards, and societal influences. We found instances of the majority (n = 12, 86%) of attributes of context across multiple (n = 6 or more) clinical behaviors. We also found little variation in the 14 attributes of context by setting (primary care and hospitals) and professional role (physicians and residents, and nurses and organ donor coordinators). CONCLUSIONS There was considerable consistency in the 14 attributes identified irrespective of the clinical behavior, setting, or professional role, supporting broad utility of the attributes of context identified in this study. There was more variation in the finer-grained features of these attributes with the most substantial variation being by setting.
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Affiliation(s)
- Janet E Squires
- Department of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Laura D Aloisio
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kainat Bashir
- Institute of Health Policy, Management, Evaluation, University of Toronto, Toronto, Canada
| | - Kristin Dorrance
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mary Coughlin
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Jill Francis
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- City University of London, London, UK
| | | | - Anne Sales
- University of Michigan, Ann Arbor, MI, USA
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Janet Curran
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Noah Ivers
- Women's College Hospital, Toronto, ON, Canada
| | - John Lavis
- McMaster University, Hamilton, ON, Canada
| | | | | | - Michael Hillmer
- Ontario Ministry of Health and Long-term Care, Toronto, ON, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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237
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Baloh J, Zhu X, Ward MM. What Influences Sustainment and Nonsustainment of Facilitation Activities in Implementation? Analysis of Organizational Factors in Hospitals Implementing TeamSTEPPS. Med Care Res Rev 2019; 78:146-156. [PMID: 31092101 DOI: 10.1177/1077558719848267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation processes are often long and complex, requiring sustained facilitation efforts. Drawing on organizational and implementation literature, we examined the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME) and team continuity (CONTINUITY) on sustainment of internal facilitation activities. For 2 years, we followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program, and conducted quarterly interviews with key informants. We coded, calibrated, and analyzed the data using the fuzzy-set qualitative comparative analysis. We found that five hospitals sustained facilitation activities and the combination of SMS, MMS, and CONTINUITY (i.e., presence of all three factors) was a sufficient condition for sustainment. Five other hospitals did not sustain facilitation activities and they either lacked MMS or lacked both TIME and CONTINUITY. In follow-up analyses, we found that team leadership continuity also influenced sustainment patterns. We discussed the implications for research and practice.
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Affiliation(s)
- Jure Baloh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xi Zhu
- University of Iowa, Iowa City, Iowa, USA
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238
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Cadilhac DA, Grimley R, Kilkenny MF, Andrew NE, Lannin NA, Hill K, Grabsch B, Levi CR, Thrift AG, Faux SG, Wakefield J, Cadigan G, Donnan GA, Middleton S, Anderson CS. Multicenter, Prospective, Controlled, Before-and-After, Quality Improvement Study (Stroke123) of Acute Stroke Care. Stroke 2019; 50:1525-1530. [PMID: 31084337 PMCID: PMC6553516 DOI: 10.1161/strokeaha.118.023075] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— Hospital uptake of evidence-based stroke care is variable. We aimed to determine the impact of a multicomponent program involving financial incentives and quality improvement interventions, on stroke care processes. Methods— A prospective study of interventions to improve clinical care quality indicators at 19 hospitals in Queensland, Australia, during 2010 to 2015, compared with historical controls and 23 other Australian hospitals. After baseline routine audit and feedback (control phase, 30 months), interventions involving financial incentives (21 months) and then addition of externally facilitated quality improvement workshops with action plan development (9 months) were implemented. Postintervention phase was 13 months. Data were obtained for the analysis from a previous continuous audit in Queensland and subsequently the Australian Stroke Clinical Registry. Primary outcome: change in median composite score for adherence to ≤8 indicators. Secondary outcomes: change in adherence to self-selected indicators addressed in action plans and 4 national indicators compared with other Australian hospitals. Multivariable analyses with adjustment for clustered data. Results— There were 17 502 patients from the intervention sites (median age, 74 years; 46% women) and 20 484 patients from other Australian hospitals. Patient characteristics were similar between groups. There was an 18% improvement in the primary outcome across the study periods (95% CI, 12%–24%). The largest improvement was following introduction of financial incentives (14%; 95% CI, 8%–20%), while indicators addressed in action plans provided an 8% improvement (95% CI, 1%–17%). The national score (4 indicators) improved by 17% (95% CI, 13%–20%) versus 0% change in other Australian hospitals (95% CI, −0.03 to 0.03). Access to stroke units improved more in Queensland than in other Australian hospitals (P<0.001). Conclusions— The quality improvement interventions significantly improved clinical practice. The findings were primarily driven by financial incentives, but were also contributed to by the externally facilitated, quality improvement workshops. Assessment in other regions is warranted.
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Affiliation(s)
- Dominique A Cadilhac
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Rohan Grimley
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Sunshine Coast Clinical School, The University of Queensland, Birtinya, Australia (R.G.).,Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Monique F Kilkenny
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Nadine E Andrew
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.).,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia (N.E.A.)
| | - Natasha A Lannin
- College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia (N.A.L.).,Occupational Therapy Department, Alfred Health, Prahran, Victoria, Australia (N.A.L.)
| | - Kelvin Hill
- Clinical Services, Stroke Foundation, Melbourne, Victoria, Australia (K.H.)
| | - Brenda Grabsch
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | | | - Amanda G Thrift
- From the Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia (D.A.C., R.G., M.F.K., N.E.A., A.G.T.)
| | - Steven G Faux
- University of New South Wales, Sydney, Australia (C.R.L., S.G.F.).,Department of Rehabilitation Medicine, St. Vincent's Health Australia (Sydney), New South Wales (S.G.F.)
| | - John Wakefield
- Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Greg Cadigan
- Clinical Excellence Division, Queensland Health, Brisbane, Australia (R.G., J.W., G.C.)
| | - Geoffrey A Donnan
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne Heidelberg, Victoria, Australia (D.A.C., M.F.K., B.G., G.A.D.)
| | - Sandy Middleton
- Nursing Research Institute, St. Vincent's Health Australia (Sydney) and Australian Catholic University, Sydney, New South Wales, Australia (S.M.)
| | - Craig S Anderson
- George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.).,The George Institute China at Peking University Health Science Center, Beijing, PR China (C.S.A.)
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Fossey J, Garrod L, Tolbol Froiland C, Ballard C, Lawrence V, Testad I. What influences the sustainability of an effective psychosocial intervention for people with dementia living in care homes? A 9 to 12-month follow-up of the perceptions of staff in care homes involved in the WHELD randomised controlled trail. Int J Geriatr Psychiatry 2019; 34:674-682. [PMID: 30706523 PMCID: PMC6594193 DOI: 10.1002/gps.5066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/25/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The study aims to understand the factors that care home staff felt enabled or hindered them in continuing to use the well-being and health for people with dementia (WHELD) psychosocial approach in their care home and investigate whether there was sustained activity 9 to 12 months after the study ended. METHODS This qualitative study is part of a wider clinical trial, which demonstrated effectiveness of a psychosocial intervention on quality of life outcomes and neuropsychiatric symptoms for residents. Forty-seven care home staff within nine care homes in the United Kingdom participated in focus groups, between 9 and 12 months after the intervention had finished. Inductive thematic analysis was used to identify themes and interpret the data. RESULTS The findings highlighted that staff continued to use a range of activities and processes acquired through the research intervention, after the study had ended. Three overarching themes were identified as influential: "recognising the value" of the approach for residents and staff, "being well practiced" with sufficient support and opportunity to consolidate skills prior to the withdrawal of the researchers, and "taking ownership of the approach" to incorporate it as usual care. CONCLUSIONS The WHELD approach can be sustained where the value of the approach is recognised, and sufficient support is provided during initial implementation for staff to build skills and confidence for it to become routine care. Further follow-up is required to understand longer term use and the impact for residents.
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Affiliation(s)
- Jane Fossey
- Fulbrook CentreOxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryUniversity of OxfordOxfordUK,Faculty of Health and Life SciencesOxford Brookes UniversityOxfordUK
| | - Lucy Garrod
- Fulbrook CentreOxford Health NHS Foundation TrustOxfordUK
| | | | - Clive Ballard
- Medical SchoolUniversity of ExeterExeterUK,King's College LondonWolfson Institute for Age‐Related DiseasesLondonUK
| | | | - Ingelin Testad
- Center for Age‐Related Medicine (SESAM)Stavanger University HospitalStavangerNorway,Medical SchoolUniversity of ExeterExeterUK,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
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240
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Harrison JD, Reddy S, Liu R, Adler SR, Chao MT. Implementing an Inpatient Acupuncture Service for Pain and Symptom Management: Identifying Opportunities and Challenges. J Altern Complement Med 2019; 25:503-508. [DOI: 10.1089/acm.2018.0348] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James D. Harrison
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA
| | - Sanjay Reddy
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, CA
| | - Rhianon Liu
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA
| | - Shelley R. Adler
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA
| | - Maria T. Chao
- Osher Center for Integrative Medicine, University of California San Francisco, San Francisco, CA
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241
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Towards greater understanding of implementation during systematic reviews of complex healthcare interventions: the framework for implementation transferability applicability reporting (FITAR). BMC Med Res Methodol 2019; 19:80. [PMID: 30999848 PMCID: PMC6472061 DOI: 10.1186/s12874-019-0723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 03/31/2019] [Indexed: 01/24/2023] Open
Abstract
Background There have been calls for greater consideration of applicability and transferability in systematic reviews, to improve their usefulness in informing policy and practice. Understanding how evidence is, or is not applicable and transferable to varying local situations and contexts, is a key challenge for systematic review synthesis in healthcare. Assessing applicability and transferability in systematic reviews is reported to be difficult, particularly in reviews of complex interventions. There is a need for exploration of factors perceived to be important by policy-makers, and for further guidance on which items should be reported. In this paper we focus on the process of development of a framework that can be used by systematic reviewers to identify and report data across studies relating to applicability and transferability. Methods The framework was developed by scrutinising existing literature on applicability and transferability, examining data during a systematic review of highly complex changes to health service delivery, and was informed by stakeholder engagement. The items of the framework were thus grounded in both data identified during a real review, and stakeholder input. The paper describes examples of data identified using the framework during a review of integrated care interventions, and outlines how it informed analysis and reporting of the review findings. Results The Framework for Implementation Transferability Applicability Reporting (FITAR) comprises 44 items which can be used to structure analysis and reporting across studies during systematic reviews of complex interventions. The framework prompts detailed consideration of contextual data during extraction and reporting, within areas of: patient type and populations; type of organisations and systems; financial and commissioning processes; systems leadership elements; features of services; features of the workforce; and finally elements of the interventions/initiatives. Conclusions Use of the framework during our review of complex healthcare interventions helped the review team to surface contextual data, which may not be commonly extracted, analysed and reported. Further exploration and evaluation of systems for identifying and reporting these factors during reviews is required. Electronic supplementary material The online version of this article (10.1186/s12874-019-0723-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK.
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA, UK
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Types of internal facilitation activities in hospitals implementing evidence-based interventions. Health Care Manage Rev 2019; 43:229-237. [PMID: 28125454 DOI: 10.1097/hmr.0000000000000145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Implementation models, frameworks, and theories recognize the importance of activities that facilitate implementation success. However, little is known about internal facilitation activities that hospital personnel engage in during implementation efforts. PURPOSE The aim of the study was to examine internal facilitation activities at 10 critical access hospitals in rural Iowa during their implementation of TeamSTEPPS, a patient safety intervention, and to identify characteristics that distinguish different types of facilitation activities. METHODS We followed 10 critical access hospitals for 2 years after the onset of implementation, conducting quarterly interviews with key informants. On the basis of the transcripts from the first two quarters, a coding template was developed using inductive analyses. The template was then applied deductively to code all interview transcripts. Using comparative analysis, we examined the characteristics that distinguish between the facilitation types. RESULTS We identified four types of facilitation activities-Leadership, Buy-in, Customization, and Accountability. Individuals and teams engaged in different types of facilitation activities, both in a planned and an ad hoc manner. These activities targeted at both people and practices and exhibited varying temporal patterns (start and peak time). CONCLUSION There are four types of facilitation activities that hospitals engage in while implementing evidence-based practices, offering a parsimonious way to characterize facilitation activities. New theoretical and empirical research opportunities are discussed. PRACTICE IMPLICATIONS Understanding the types of facilitation activities and their distinguishing characteristics can assist managers in planning and executing implementations of evidence-based interventions.
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Daivadanam M, Ingram M, Sidney Annerstedt K, Parker G, Bobrow K, Dolovich L, Gould G, Riddell M, Vedanthan R, Webster J, Absetz P, Mölsted Alvesson H, Androutsos O, Chavannes N, Cortez B, Devarasetty P, Fottrell E, Gonzalez-Salazar F, Goudge J, Herasme O, Jennings H, Kapoor D, Kamano J, Kasteleyn MJ, Kyriakos C, Manios Y, Mogulluru K, Owolabi M, Lazo-Porras M, Silva W, Thrift A, Uvere E, Webster R, van der Kleij R, van Olmen J, Vardavas C, Zhang P. The role of context in implementation research for non-communicable diseases: Answering the 'how-to' dilemma. PLoS One 2019; 14:e0214454. [PMID: 30958868 PMCID: PMC6453477 DOI: 10.1371/journal.pone.0214454] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Understanding context and how this can be systematically assessed and incorporated is crucial to successful implementation. We describe how context has been assessed (including exploration or evaluation) in Global Alliance for Chronic Diseases (GACD) implementation research projects focused on improving health in people with or at risk of chronic disease and how contextual lessons were incorporated into the intervention or the implementation process. Methods Using a web-based semi-structured questionnaire, we conducted a cross-sectional survey to collect quantitative and qualitative data across GACD projects (n = 20) focusing on hypertension, diabetes and lung diseases. The use of context-specific data from project planning to evaluation was analyzed using mixed methods and a multi-layered context framework across five levels; 1) individual and family, 2) community, 3) healthcare setting, 4) local or district level, and 5) state or national level. Results Project teams used both qualitative and mixed methods to assess multiple levels of context (avg. = 4). Methodological approaches to assess context were identified as formal and informal assessments, engagement of stakeholders, use of locally adapted resources and materials, and use of diverse data sources. Contextual lessons were incorporated directly into the intervention by informing or adapting the intervention, improving intervention participation or improving communication with participants/stakeholders. Provision of services, equipment or information, continuous engagement with stakeholders, feedback for personnel to address gaps, and promoting institutionalization were themes identified to describe how contextual lessons are incorporated into the implementation process. Conclusions Context is regarded as critical and influenced the design and implementation of the GACD funded chronic disease interventions. There are different approaches to assess and incorporate context as demonstrated by this study and further research is required to systematically evaluate contextual approaches in terms of how they contribute to effectiveness or implementation outcomes.
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Affiliation(s)
- Meena Daivadanam
- Department of Food, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Maia Ingram
- Department of Community, Environment and Policy, University of Arizona, Tucson, Arizona, United States of America
| | | | - Gary Parker
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Kirsty Bobrow
- Department of Medicine, University of Cape Town, Rondebosch, South Africa
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Gould
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Michaela Riddell
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rajesh Vedanthan
- Department of Population Health, New York University School of Medicine, New York City, New York, United States of America
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Pilvikki Absetz
- Collaborative Care Systems Finland, Helsinki, Finland
- University of Eastern Finland, Helsinki, Finland
| | | | - Odysseas Androutsos
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Briana Cortez
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Praveen Devarasetty
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Edward Fottrell
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Francisco Gonzalez-Salazar
- Department of Basic Sciences, Universidad de Monterrey, Monterrey, Nuevo Leon, Mexico
- Centro de Investigacion Biomedica, Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon, Mexico
| | - Jane Goudge
- Faculty of Health Sciences, University of the Witwatersrand, Centre for Health Policy, School of Public Health, Braamfontein, Johannesburg, South Africa
| | - Omarys Herasme
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Hannah Jennings
- Global Alliance for Chronic Diseases, University College London, London, United Kingdom
| | - Deksha Kapoor
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, Delhi, India
| | - Jemima Kamano
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Marise J. Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, School of Health Sciences & Education, Kallithea, Athens, Greece
| | - Kishor Mogulluru
- Population Health Division, The George Institute for Global Health- India, New Delhi, Delhi, India
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Maria Lazo-Porras
- Unidad de Conocimiento y Evidencia (CONEVID), CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Miraflores, Lima, Peru
| | - Wnurinham Silva
- School of Public Health, Imperial College London, London, United Kingdom
| | - Amanda Thrift
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ezinne Uvere
- Department of Medicine, University of Ibadan, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Ruth Webster
- The George Institute for Global Health, The University of New South Wales, Australia, Newtown New South Wales, Australia
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Josefien van Olmen
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
- University of Antwerp, Antwerpen, Belgium
| | | | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
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Tsang JLY, Ross K, Miller F, Maximous R, Yung P, Marshall C, Camargo M, Fleming D, Law M. Qualitative descriptive study to explore nurses' perceptions and experience on pain, agitation and delirium management in a community intensive care unit. BMJ Open 2019; 9:e024328. [PMID: 30948568 PMCID: PMC6500293 DOI: 10.1136/bmjopen-2018-024328] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The purpose of this study was to explore the experiences, beliefs and perceptions of intensive care unit (ICU) nurses on the management of pain, agitation and delirium (PAD) in critically ill patients. DESIGN A qualitative descriptive study. SETTING This study took place in a community hospital ICU located in a medium size Canadian city. PARTICIPANTS Purposeful sampling was conducted. Participants included full-time nurses working in the ICU. Forty-six ICU nurses participated. METHODS A total of five focus group sessions were held to collect data. There were one to three separate groups in each focus group session, with no more than seven participants in each group. There were 10 separate groups in total. A semistructured question guide was used. Thematic analysis method was adopted to analyse the data, and to search for emergent themes and patterns. RESULTS Three main themes emerged: (1) the professional perspectives on patient wakefulness state, (2) the professional perspectives on PAD management of critically ill patients and (3) the factors impacting PAD management. Nurses have different opinions on the optimal level of patient sedation and felt that many factors, including environmental, healthcare teams, patients and family members, can influence PAD management. This potentially leads to inconsistent PAD management in critically ill patients. The nurses also believed that PAD management requires a multidisciplinary approach including healthcare teams and patients' families. CONCLUSIONS Many external and internal factors contribute to the complexity of PAD management including the attitudes of nursing staff towards PAD. The themes emerged from this study suggested the need of a multifaceted and multidisciplinary quality improvement programme to optimise the management of PAD in the ICU.
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Affiliation(s)
- Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, Niagara Health System-Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Katie Ross
- Medicine, Niagara Health System-Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Franziska Miller
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Ramez Maximous
- Medicine, Niagara Health System-Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Priscilla Yung
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Carl Marshall
- McMaster University Michael G DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Mercedes Camargo
- Medicine, Niagara Health System-Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Dimitra Fleming
- Medicine, Niagara Health System-Saint Catharines Site, Saint Catharines, Ontario, Canada
| | - Madelyn Law
- Community Health Sciences, Brock University, St. Catherines, Ontario, Canada
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Hälleberg Nyman M, Forsman H, Wallin L, Ostaszkiewicz J, Hommel A, Eldh AC. Promoting evidence-based urinary incontinence management in acute nursing and rehabilitation care-A process evaluation of an implementation intervention in the orthopaedic context. J Eval Clin Pract 2019; 25:282-289. [PMID: 29411463 DOI: 10.1111/jep.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence-based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence-based practice for UI in patients aged 65 or older undergoing hip surgery. METHODS A 3-month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed. RESULTS Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence-based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit. CONCLUSION To promote evidence-based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence-based management of UI.
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Affiliation(s)
- Maria Hälleberg Nyman
- School of Health Sciences, Örebro University, Örebro, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Henrietta Forsman
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Lars Wallin
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joan Ostaszkiewicz
- Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Ami Hommel
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden.,Department of Orthopaedics, Skaane University Hospital, Lund, Sweden
| | - Ann Catrine Eldh
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Penuela MC, Law M, Chung HO, Faught BE, Tsang JLY. Impact of a multifaceted and multidisciplinary intervention on pain, agitation and delirium management in a Canadian community intensive care unit: a quality improvement study protocol. CMAJ Open 2019; 7:E430-E434. [PMID: 31243059 PMCID: PMC6597341 DOI: 10.9778/cmajo.20190015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pain and agitation are closely linked to the development of delirium, which affects 60%-87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). METHODS This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). INTERPRETATION The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs.
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Affiliation(s)
- Mercedes Camargo Penuela
- Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont
| | - Madelyn Law
- Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont
| | - Han-Oh Chung
- Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont
| | - Brent E Faught
- Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont
| | - Jennifer L Y Tsang
- Department of Health Sciences (Camargo Penuela, Law, Faught), Brock University; Niagara Health (Camargo Penuela, Chung, Tsang), St. Catharines, Ont.; Department of Medicine (Chung, Tsang), McMaster University, Hamilton, Ont.; Niagara Regional Campus (Chung, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.
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Shea G, Smith W, Koffarnus K, Knobloch MJ, Safdar N. Kamishibai cards to sustain evidence-based practices to reduce healthcare-associated infections. Am J Infect Control 2019; 47:358-365. [PMID: 30522838 DOI: 10.1016/j.ajic.2018.10.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sustaining healthcare-associated infection (HAI) prevention practices is complex. We examined the use of Kamishibai Cards (K Cards) as a tool to encourage compliance interactions between leaders and staff. METHODS We explored one unit of a children's hospital to assess acceptability of K Cards. Interactions were recorded (n = 14), and interviews were conducted (n = 22). We used the Health Belief Model (HBM) for analyses. Central line utilization, bundle compliance and rates of HAIs were also examined. RESULTS Staff members consider K Card interactions reminders of bundle elements and acceptable for creating positive interactions. Although no causal inference can be made, during K Card implementation, CLABSI rates dropped from 1.83 in 2015 to 0.0 through June 2018. Central line utilization decreased by 3%. DISCUSSION Moving beyond theory to providing practical sustainability tools is an important implementation step. Although our findings are not generalizable, capturing what occurred on one unit provides opportunity to discover how key leadership factors (communication and leadership style) influence the uptake, acceptability and sustained adoption of evidence-based practices. CONCLUSIONS K Cards are a practical tool to sustain evidence-based practices and promote communication between leadership and staff - keeping compliance on the minds of frontline workers.
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Affiliation(s)
- Grace Shea
- Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI
| | - Windy Smith
- Department of General Medical/Surgical Pediatrics, American Family Children's Hospital, Madison, WI
| | - Kirsten Koffarnus
- Department of General Medical/Surgical Pediatrics, American Family Children's Hospital, Madison, WI
| | - Mary Jo Knobloch
- Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI.
| | - Nasia Safdar
- Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI
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Eriksson C, Eriksson G, Johansson U, Guidetti S. Occupational therapists’ perceptions of implementing a client-centered intervention in close collaboration with researchers: A mixed methods study. Scand J Occup Ther 2019; 27:142-153. [DOI: 10.1080/11038128.2019.1573917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christina Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Gunilla Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Ulla Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Center for Research and Development, Region of Gävleborg, Uppsala University, Gävle, Sweden
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Smith TL, Kim B, Benzer JK, Yusuf Z, Fletcher TL, Walder AM. FLOW: Early results from a clinical demonstration project to improve the transition of patients with mental health disorders back to primary care. Psychol Serv 2019; 18:23-32. [PMID: 30869978 DOI: 10.1037/ser0000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Access to mental health (MH) care is of paramount concern to U.S. health care delivery systems, including the Veterans Health Administration. To improve access, there is a need to better focus existing MH resources toward care for those most in need of specialty-level MH treatment. This article provides early results of Project FLOW's (not an acronym) approach to developing and evaluating electronic medical record (EMR)-based criteria to identify clinically stable patients and promote their effective transition from specialty MH back to primary care (PC). Implementation utilized a blended facilitation approach consistent with Integrated Promoting Action on Research Implementation in Health Services (iPARIHS). The Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework guided measurement of implementation outcomes. During FLOW, 424 unique MH patients transitioned from MH to PC; of those, only 9 (2.1%) returned to MH after that transition. Most of those patients (n = 335; 79.0%) were first identified on the MH FLOW report, but 89 (21.0%) were other MH patients. The total number of patients discharged due to recovery or stabilization was 411. The 335 patients represent 21.3% of all unique patients (n = 1,566) who met the EMR criteria during the project. The 411 recovered/stabilized patients are 16.4% of all unique MH patients (n = 2,504) treated at the site. These early results suggest that this EMR-based system, combined with sound clinical practices, can be used to identify MH patients who are candidates for transition and foster their effective transition to care management in PC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Bo Kim
- Veterans Affairs Health Services Research and Development Service Center for Healthcare Organization and Implementation Research
| | - Justin K Benzer
- Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans
| | - Zenab Yusuf
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Terri L Fletcher
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Annette M Walder
- South Central Mental Illness Research Education and Clinical Care, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
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Parker SG, Downes T, Godfrey M, Matthews R, Martin FC. Age and Ageing to introduce a new category of paper: healthcare improvement science. Age Ageing 2019; 48:178-184. [PMID: 30395169 DOI: 10.1093/ageing/afy175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
Age and Ageing is now inviting papers on healthcare improvement for older people. In this article we outline the nature and scope of healthcare improvement and reference improvement models and the tools and methods of improvement science. We emphasise the issues of sustainability, including scale and spread; evaluation - including associated ethical consideration and the involvement of patients and the public in healthcare improvement and associated research. Throughout we refer to resources the authors have found useful in their own work, and provide a bibliography of sources and web-links which will provide essential guidance and support for potential contributors to this new category of submission to Age and Ageing.
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Affiliation(s)
- S G Parker
- Newcastle Institute for Ageing, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - T Downes
- Sheffield Teaching Hospitals - Geriatric Department Glossop Road, Sheffield, UK
| | - M Godfrey
- Leeds University, Faculty of Medicine and Health, Leeds, UK
| | - R Matthews
- National Institute for Health Research (NIHR), Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London, UK
| | - F C Martin
- St Thomas' Hospital - Lambeth Palace Road, London, UK
- King's College London School of Medical Education Division of Health and Social Care, London, UK
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