Lost in knowledge translation: time for a map?

CARD (Comfort Ask Relax Distract) and community pharmacy vaccinations: Evaluation of implementation outcomes from a cluster randomized trial

The CARD system (Comfort Ask Relax Distract) is a protocol for vaccine delivery that includes interventions that facilitate vaccine recipient coping and improve the vaccination experience. CARD was compared to control (usual care) in a pragmatic hybrid effectiveness-implementation cluster randomized trial. Of 25 participating community pharmacies, 12 were randomized to CARD and 13 to control for all vaccines administered between November 2023 and January 2024. Implementation strategies planned to support CARD integration included an educational webinar, customized implementation recommendations, change equipment, online chat group, and audit and feedback. Educational outreach was added to improve intervention fidelity. This paper reports on implementation outcomes of the trial. Provider surveys and focus groups revealed acceptability and feasibility of CARD and implementation strategies. Vaccinators in CARD pharmacies (vs. control) reported higher satisfaction with vaccine recipient interactions and that overall, CARD was time neutral. They also reported higher utilization of some CARD-recommended injection techniques. Administrative data verified utilization of the CARD coping checklist, which solicits vaccine recipient coping preferences, in 96% of vaccine recipients that participated. Post-vaccination feedback surveys were available for 90% of vaccine recipients that participated. Implementation results were aligned with trial effectiveness outcomes, and support routine use of CARD in community pharmacies.Trial registration : NCT06098703.

Teaching and interconnecting research and evidence-based practice in midwifery and nursing education: A mixed methods systematic review

OBJECTIVE

To examine current approaches in research, teaching, and Evidence Based Practice (EBP) in midwifery and nursing education and how they interconnect.

DESIGN

A mixed-methods systematic review.

DATA SOURCES

Seven databases were used: Academic Search Complete, ASSIA, CINAHL, Cochrane Library, Education Source, Medline, and Scopus. Grey literature was searched from GreyNet International, The Society for Research on Educational Effectiveness, Virginia Henderson Global Nursing e-Repository, The National Institutes for Health Library, and the DART-Europe E-theses Portal.

METHODS

This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. It includes studies conducted in higher and professional practice education in midwifery and nursing between 2013 and 2024. Included studies were published in English, reported the design, development, implementation, and/or evaluation of research or EBP intervention with primary data as part of their research, regardless of study design. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Extracted data were analysed using reflective thematic analysis and descriptive statistics.

RESULTS

A total of 59 studies, and 7214 participants were included. Four themes representing the interconnections between teaching, research and EBP were identified: 1) Pedagogical approaches employed in teaching and learning interventions 2) Theories, models, and frameworks to bridge the theory-practice gap 3) Collaborative approaches and partnerships as a conduit for the acquisition of knowledge and transferable skills 4) Capabilities developed in research and EBP.

CONCLUSIONS

This review is the first to demonstrate how different educational interventions, models and findings relate to teaching research and EBP and their application in midwifery and nursing. Despite numerous educational strategies for integrating research into teaching, there is no conclusive evidence on the best methods for teaching EBP. The field needs clear guidelines, educational toolkits, and comprehensive materials to effectively bridge the gap between knowledge and practice and to address the challenges of EBP education and its clinical application.

Development of a resource toolkit to integrate qualitative methodology into physical therapy education, research, and practice: a descriptive case report

INTRODUCTION

Qualitative research contributes to evidence-based practice, yet its presence in physical therapy literature is limited. To improve integration and implementation of qualitative research evidence in physical therapy, an American Physical Therapy Association component taskforce conducted a needs assessment. Findings revealed a gap in available qualitative research resources and the need for a centralized repository to support qualitative research and knowledge translation to clinical practice.

PURPOSE

This descriptive case report aims to describe the systematic development of a web-based resource toolkit to promote awareness, information sharing, and support for the integration of qualitative research into physical therapist education, research, and practice.

METHODS

Informed by the Knowledge-to-Action Framework and published recommendations, toolkit development engaged stakeholders and followed a rigorous, collaborative process consisting of a predetermined sequence of steps: preparation, development, review, pilot test, implementation and evaluation.

RESULTS

Systematic toolkit development resulted in an online open-access collection of annotated lists, critical appraisal tools, articles, textbooks, discussion forums and training resources. Pilot-testing with 33 stakeholders yielded data on perceived relevance, usability, content, website design, and overall satisfaction, with a 60% survey response rate. Most respondents (94%) indicated the toolkit would effectively serve their diverse needs as physical therapist researchers, educators, and clinicians. Findings informed subsequent revisions to the toolkit's organization, navigation structure, and content expansion.

CONCLUSIONS

Toolkit development adhered to established guidelines, engaged experts and incorporated stakeholder input to produce a comprehensive resource hub for educators, researchers, and clinicians. The toolkit can advance physical therapy practice and patient outcomes by promoting the use of qualitative research evidence in clinical decision-making. Future study on toolkit uptake and outcomes is warranted. The toolkit is publicly available on the Academy for Physical Therapy Research website and will be updated annually.

The State of the Art of Telemedicine Implementation Architecture: Rapid Umbrella Review of Systematic Reviews

BACKGROUND

The global push to scale up telemedicine services is challenged by complex, multilevel, multifaceted implementation and a lack of consensus on what the evidence-based essential building blocks of implementation are.

OBJECTIVE

We aimed to evaluate the evidence base supporting telemedicine implementation knowledge tools; identify shared conceptual constructs and outliers; and formulate recommendations to guide the design, development, and optimization of telemedicine services.

METHODS

We conducted implementation research using a rapid umbrella review, that is, an overview of systematic reviews, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). In total, we searched 3 databases (PubMed, Web of Science, and Scopus) for studies focusing on telemedicine implementation frameworks, models, and tools, collectively referred to as "knowledge tools." Reviews meeting the operational definition of a systematically undertaken, secondary evidence synthesis, such as systematic and scoping reviews, and those published from January 2018 to May 2024 were considered. A meta-aggregative qualitative analysis was undertaken, comprising inductive thematic synthesis.

RESULTS

In total, 18 reviews were selected, encompassing 973 primary studies. Global perspectives were reflected in 61% (n=11) of the reviews, while 33% (n=6) focused on low- and middle-income country contexts. The primary research included in the reviews represented 63 countries, spanning the Americas, Europe, Africa, the Middle East, and Asia and the Pacific. Findings indicated substantial heterogeneity across the identified telemedicine implementation theories, models, and frameworks. However, following evidence synthesis, considerable convergence was observed, highlighting a state-of-the-art understanding of the essential requirements for a national telemedicine implementation ecosystem. These were categorized into "process" and "thematic" dimensions. Process dimensions included readiness and needs assessment, road map and planning, managing change, implementing telemedicine services, and continuous improvement and measuring performance. Thematic dimensions covered human and sociocultural aspects; organization, operations, management, and leadership; communication and coordination; policy, legal, and financial considerations; clinical health condition and quality of care; and the wider context.

CONCLUSIONS

The findings of this study inform a pressing translational research knowledge gap in telemedicine implementation, hindering the implementation of high-quality, sustainable, and scalable telemedicine systems. The study contributes to building global consensus on the state of the art of key constructs in telemedicine implementation and recommends that future research focus on field-testing the evidence-based implementation tools to evaluate their usability and adaptability across diverse telemedicine contexts.

Challenges and opportunities in community pharmacists' identification and management of dry eye disease: a qualitative study

OBJECTIVE

To explore Malaysian community pharmacists' (CP) challenges in identifying and managing dry eye disease (DED) and opportunities to optimize DED care, as previous studies reported inconsistencies in DED identification by community pharmacy staff, and few publications describe Malaysian CP views on DED management in community pharmacy settings.

METHOD

Using the Social Ecological Theory for Community Health Promotion, individual in-depth interviews were conducted (May-June 2023) with 20 CP in Malaysia's Klang Valley. Participants with diverse DED management experiences were recruited using purposive and snowball sampling until data saturation. Interviews were audio-recorded, transcribed, independently coded by two researchers, and thematically analysed.

KEY FINDINGS

CP faced 12 challenges in identifying and managing DED: patient-related (brand rigidity, 'quick fix' attitude, inadequate health literacy, and self-efficacy skills), provider-related (imprecise assessment, referral difficulties, knowledge gaps), therapeutics-related (short shelf life, affordability), and pharmacy-related (limited manpower, inadequate private consultation space, low eye health visibility). The 12 opportunities for optimizing DED care were community-related (eye health education, holistic approaches, public awareness), profession-related (decision-support mobile health applications integrated with evidence-based DED management protocols to streamline consultation processes, interdisciplinary collaborations), industry-related (pharmaceutical and medical device advancements, comparative data on medication value, promotion of proactive management), and organization-related (management-mandated resource allocation, ancillary staff education, and expanded products and services).

CONCLUSION

Malaysian CP encountered challenges in identifying and managing DED. Knowledge sharing and collaborations with ophthalmologists improve DED management by CP, while clinicians can stay updated on medication-related recommendations and treatment adherence. The role of digital health in these processes requires further study.

Advancing laryngology through artificial intelligence: a comprehensive review of implementation frameworks and strategies

PURPOSE OF REVIEW

This review aims to explore the integration of artificial intelligence (AI) in laryngology, with specific focus on the barriers preventing translation from pilot studies into routine clinical practice and strategies for successful implementation.

RECENT FINDINGS

Laryngology has seen an increasing number of pilot and proof-of-concept studies demonstrating AI's ability to enhance diagnostics, treatment planning, and patient outcomes. Despite these advancements, few tools have been successfully adopted in clinical settings. Effective implementation requires the application of established implementation science frameworks early in the design phase. Additional factors required for the successful integration of AI applications include addressing specific clinical needs, fostering diverse and interdisciplinary teams, and ensuring scalability without compromising model performance. Governance, epistemic, and ethical considerations must also be continuously incorporated throughout the project lifecycle to ensure the safe, responsible, and equitable use of AI technologies.

SUMMARY

While AI hold significant promise for advancing laryngology, its implementation in clinical practice remains limited. Achieving meaningful integration will require a shift toward practical solutions that prioritize clinicians' and patients' needs, usability, sustainability, and alignment with clinical workflows.

The Welsh Institute of Performance Science: A Decade of Integrated Knowledge Translation in Elite Sport

Sport science researchers and practitioners have noted a gap between research and practice for some time. Although several solutions have been proposed, few recommendations have been made for researchers to follow that are based on successful, long-term sport science research programmes aimed at translating research into practice. Therefore, the purpose of this article is to outline a decade of work completed by the Welsh Institute of Performance Science as an institute for sport-based integrated knowledge translation. The aim is to provide a framework for other researchers and institutes to follow when engaging with organisations for long-term research-to-practice partnerships. In addition to outlining the development and functioning of the Welsh Institute of Performance Science to guide others, limitations of the approach used are also presented and considered to facilitate the future development of sport-specific models of knowledge translation, ensuring that the excellent research conducted across the disciplines of sport science effectively impacts the work of practitioners.

Ethical principles for regulatory risk decision-making

Risk assessors, managers, and decision-makers are responsible for evaluating diverse human, environmental, and animal health risks. Although the critical elements of risk assessment and management are well-described in national and international documents, the ethical issues involved in risk decision-making have received comparatively little attention to date. To address this aspect, this article elaborates fundamental ethical principles designed to support fair, balanced, and equitable risk-based decision-making practices. Experts and global thinkers in risk, health, regulatory, and animal sciences were convened to share their lived experiences in relation to the intersection between risk science and analysis, regulatory science, and public health. Through a participatory and knowledge translation approach, an integrated risk decision-making model, with ethical principles and considerations, was developed and applied using diverse, contemporary risk decision-making and regulatory contexts. The ten principles - autonomy, minimize harm, maintain respect and trust, adaptability, reduce disparities, holistic, fair and just, open and transparent, stakeholder engagement, and One Health lens - demonstrate how public sector values and moral norms (i.e., ethics) are relevant to risk decision-making. We also hope these principles and considerations stimulate further discussion, debate, and an increased awareness of the application of ethics in identifying, assessing, and managing health risks.

Bridging innovation to implementation in artificial intelligence fracture detection : a commentary piece

The deployment of AI in medical imaging, particularly in areas such as fracture detection, represents a transformative advancement in orthopaedic care. AI-driven systems, leveraging deep-learning algorithms, promise to enhance diagnostic accuracy, reduce variability, and streamline workflows by analyzing radiograph images swiftly and accurately. Despite these potential benefits, the integration of AI into clinical settings faces substantial barriers, including slow adoption across health systems, technical challenges, and a major lag between technology development and clinical implementation. This commentary explores the role of AI in healthcare, highlighting its potential to enhance patient outcomes through more accurate and timely diagnoses. It addresses the necessity of bridging the gap between AI innovation and practical application. It also emphasizes the importance of implementation science in effectively integrating AI technologies into healthcare systems, using frameworks such as the Consolidated Framework for Implementation Research and the Knowledge-to-Action Cycle to guide this process. We call for a structured approach to address the challenges of deploying AI in clinical settings, ensuring that AI's benefits translate into improved healthcare delivery and patient care.

Knowledge, Attitude, and Motivation Regarding Transcranial Direct Current Stimulation (tDCS) Among Rehabilitation Specialists in Saudi Arabia: A Cross-Sectional Study

Background: Transcranial direct current stimulation (tDCS) has exhibited potential in augmenting motor functions, neuroplasticity, and cognitive abilities within neurological rehabilitation contexts. Despite these promising outcomes, the utilization of tDCS in both research and clinical environments in Saudi Arabia remains relatively unexplored. Objective: This study aims to evaluate the knowledge, attitudes, and motivations of rehabilitation specialists in Saudi Arabia concerning tDCS. Methods: A cross-sectional observational study was conducted through an online questionnaire, involving 112 registered rehabilitation professionals. Results: While 58% of respondents acknowledged tDCS as a therapeutic tool, the overall knowledge level was modest, with a mean score of 3.0 ± 2.7 out of 9. Enhanced levels of knowledge were associated with individuals holding doctoral degrees (p = 0.02) and those with international training exposure (p = 0.03). Despite the limited knowledge base, an overwhelming 94.64% of participants displayed a neutral to positive attitude towards tDCS, with 52.7% recognizing its potential efficacy in neurological recovery. Principal obstacles to implementation included safety-related concerns (21.4%) and the need for specialized training (23.3%). Conclusions: Rehabilitation specialists in Saudi Arabia generally hold a favorable view of tDCS and demonstrate an eagerness to pursue further training. The results underscore the imperative for enhanced educational initiatives and practical training to address knowledge deficiencies and facilitate the seamless integration of tDCS into clinical routines. The implementation of structured training programs could not only reinforce adoption rates but also optimize the role of tDCS within rehabilitation.

Advancing the selection of implementation science theories, models, and frameworks: a scoping review and the development of the SELECT-IT meta-framework

BACKGROUND

Theories, models, and frameworks (TMFs) are central to implementation practice and research. Selecting one or more TMF(s) for a project remains challenging due to numerous options and limited guidance. This study aimed to (1) identify and categorize the reported purposes and attributes of TMFs, as well as the practical considerations of TMF users, and (2) synthesize these findings into a meta-framework that supports implementation practitioners and researchers in selecting TMFs.

METHODS

A scoping review was conducted using Joanna Briggs Institute guidelines. Medline, Embase, and CINAHL were searched to identify articles on the selection of TMFs. Articles were selected and data extracted using Covidence. Inductive thematic analysis was used to refine and categorize purposes, attributes and practical considerations. The meta-framework was developed by mapping these categories onto a sequential process, pilot-testing through case studies, and iteratively refining it based on team feedback.

RESULTS

Of 9,276 records, 43 articles (2005-2024) were included. Most articles reported TMF purposes (41 articles), followed by attributes (30) and practical considerations (13). Seven distinct purposes were identified: (1) enhancing conceptual clarity, (2) anticipating change and guiding inquiry, (3) guiding the implementation process, (4) guiding identification of determinants, (5) guiding design and adaptation of strategies, (6) guiding evaluation and causal explanation, and (7) guiding interpretation and dissemination. Additionally, 24 TMF attributes were grouped into five domains: clarity and structure, scientific strength and evidence, applicability and usability, equity and sociocultural responsiveness, and system and partner integration. Ten practical considerations were grouped into three domains: team expertise and readiness, resource availability, and project fit. These findings informed the development of the Systematic Evaluation and Selection of Implementation Science Theories, Models and Frameworks (SELECT-IT) meta-framework, comprising four steps: (1) determine the purpose(s) of using TMF(s); (2) identify potential TMFs; (3) evaluate short-listed TMFs against attributes; and (4) assess practical considerations of using TMF(s) within the project context. A worked example and two user-friendly worksheets illustrate its utility.

CONCLUSIONS

This study advances understanding of the selection of implementation science TMFs by distinguishing inherent TMF attributes from practical considerations. The SELECT-IT meta-framework offers a structured, context-sensitive approach for selecting appropriate TMFs. Future research should evaluate its validity and utility across diverse contexts.

Assessing knowledge translation following a pre-cancer diagnosis: a multinational evaluation of online resources targeting patients with cervical dysplasia

BACKGROUND

Distressful clinician-to-patient dialogue such as a pre-cancer diagnosis of cervical dysplasia may interfere with information retention. Patient education material provided as an online resource offers a suitable option to review relevant health information outside the clinic. The aim of this study was to evaluate online resources (ORs) affiliated with healthcare institutions across Australia and the United Kingdom (UK) on their effectiveness to translate accessible and current knowledge to patients referred for loop electrosurgical excision procedure (LEEP) treatment.

METHODS

A comprehensive directory of ORs related to LEEP was compiled from public hospital websites across Australia and the UK. Quantitative and qualitative methods were applied to evaluate resource reading-level (measured using three validated readability indices); actionability and understandability (measured using the Patient Education Material Assessment Tool [PEMAT]); and content (described using content analysis to assess disclosure practices associated with LEEP-related complications).

RESULTS

All ORs (n = 39) exceeded the recommended reading level (Australia: x̄ = 10.07, σ = 1.01; UK: x̄ = 10.17, σ = 0.96). PEMAT results indicated higher percentages of ORs scored as understandable (Australia: 50.0%; UK: 69.7%) versus actionable (Australia: 33.3%; UK: 6.1%). Content analysis revealed widespread discordance in the disclosure of longer-term LEEP complications associated with pregnancy, fertility, and sexual function in both countries.

CONCLUSIONS

Disclosures with significant health and wellness implications should be made with clear reference to peer reviewed science. Wider application of purpose-designed health literacy tools could improve measures of readability, actionability and understandability. International collaborations may provide opportunities to develop more comprehensive and patient-centred education materials to improve provider-to-patient knowledge translation.

Cost-analysis and rationale for implementing semi-urgent laparoscopic cholecystectomy programs in a public healthcare system

Wait times for elective surgical procedures in publicly funded healthcare systems impede patient well-being and resource efficiency. Patients with gallstone disease requiring semi-urgent intervention are often treated via inpatient emergency pathways due to limited elective surgery access. This study aimed to evaluate the rationale and cost-effectiveness of providing timely outpatient semi-urgent cholecystectomy. We retrospectively reviewed 512 patients with urgent biliary disease (excluding cholecystitis) who underwent surgery between July 2019 and December 2022. The primary outcome was time from booking to operating room; the secondary was the estimated cost of prolonged hospital stays. Patients waited an average of 26.45 hours; 19.1% waited 48 hours or longer, and 6.2% waited 72 hours or more. The associated cost was $405,785 over 40 months. Implementing semi-urgent surgical resources could reduce costs, improve efficiency, and enhance patient quality of life. Future work should involve stakeholders to address barriers and facilitators in Canada.

Physical Activity Counseling Education: The Use of Theory in Development, Implementation, and Evaluation

INTRODUCTION

Implementing evidence-based physical activity (PA) counseling for clients with spinal cord injury (SCI) may help address the decline in PA typically observed after discharge from rehabilitation. Engaging practitioners in educational intervention development may improve uptake of such a practice change. The purpose of this study is to (1) describe the theory-based development of a PA counseling education intervention and (2) evaluate the intervention's effects on PA counseling behavior and determinants (eg, knowledge, skills, confidence) among rehabilitation hospital physiotherapists and community SCI peers.

METHODS

The Knowledge to Action (KTA) Framework supplemented by the quality implementation framework was used to guide the engagement of physiotherapists and SCI peers in developing a PA counseling education intervention. A within-subjects, repeated measures design was used to evaluate the effects of the intervention. PA counseling behavior and determinants were evaluated using a survey guided by the theoretical domains framework, administered before and immediately after training, 2 months post, and 6 months post-training. Data were analyzed using one-way repeated-measures ANOVAs.

RESULTS

Physiotherapists and SCI peers (n = 10) demonstrated significant, medium-large-sized effects on PA counseling behaviors from baseline to 2 and 6 months (P's < 0.05). These behavioral improvements were supported by significant increases over time in all theoretical domains framework assessed (P's < 0.05), except intentions.

DISCUSSION

The combined use of the KTA and quality implementation framework provides a structure for engaging practitioners in education intervention design. This work shows promise for the use of theory to develop an education intervention that improves both PA counseling knowledge and behavior.

Evaluating for learning and sustainability (ELS) framework: a realist synthesis

BACKGROUND

Learning Health Systems (LHS), in which continuous and equitable improvements support optimization of healthcare practices, outcomes, experience, and costs, offer enormous potential for health system transformation. Within the LHS model, evaluation of health innovations assists in question identification, data collection, and targeted action, which facilitates continuous improvement. Evaluation that catalyzes learning may contribute to health innovation implementation, refinement, and sustainability, however, there is little consensus as to why certain evaluations support learning, while others impede it.

METHODS

Embedded in the implementation science literature, we conducted a realist synthesis to understand evaluative contextual factors and underlying mechanisms that best support health system learning and sustainable implementation of innovations. We sought to understand whether evaluations can 'work' to support learning and sustainability, in which contexts, for whom, and why. Working with an Expert Committee comprised of leaders in evaluation, innovation, sustainability, and realist methodology, we followed a five-stage process of: 1. Scoping the Review, 2. Building Theories, 3. Identifying the Evidence, 4. Evidence Selection and Appraisal, and 5.

DATA EXTRACTION AND SYNTHESIS

Our Review Team and Expert Committee participated in iterative cycles of results interpretation and feedback.

RESULTS

Our synthesis includes 60 articles capturing the mechanisms and contextual factors driving learning and sustainability through evaluation. We found that evaluations that support learning and sustainability incorporate favourable organizational preconditions and focus on implementing rapid cyclical feedback loops that contribute to a culture of innovation and evaluation sustainability. Our findings have been organized into 6 Context-Mechanism-Outcome Configurations (CMOCs): 1. Embracing Risk & Failure; 2. Increasing Capacity for Evaluation; 3. Co-Producing Evaluation; 4. Implementing Learning Feedback Loops; 5. Creating Sustainability Culture; and 6. Becoming a Learning Organization. We have also translated findings into a series of Action Strategies for evaluation implementation to support health systems learning and sustainability.

CONCLUSIONS

We identified key contextual factors and underlying mechanisms that make evaluations 'work' (or 'not work') to support learning and sustainability. Findings support the operationalization of LHS by translating CMOCs into Action Strategies for those tasked with completing evaluations with a view toward health system learning and innovation sustainability.

An emerging knowledge exchange framework: Leadership insight into a key capacity-building impact in a large urban, trauma-informed initiative supporting resiliency and promoting equity

BACKGROUND

Community capacity-building is the cornerstone of many public health initiatives, with increasing attention paid to community engagement, collective impact, and trauma-informed practices designed to support resiliency and promote health equity. Large-scale capacity-building projects proliferated during the global pandemic, highlighting the need for practical guidance and steps for efficiently responding to changing community needs and effectively communicating information across partnership and community members. The present qualitative longitudinal study provides a pragmatic framework for trauma-informed knowledge exchange across stakeholders in a large urban collective impact, capacity-building initiative designed to establish partnerships that engage community members, promote equity through tailored referrals and resource access, and address community needs and aspirations.

METHODS

Interviews were conducted with the leads of nine agencies funded to implement regionally responsive strategies addressing adverse childhood experience-driven health needs among their diverse subcommunities, while offsetting the impact of trauma, building capacities and improving resource access. We aimed to capture (1) the socioecological context of traumatic experiences and health barriers that propelled agencies to participate in a trauma-informed initiative; (2) agency leads' vision for community health; and (3) unfolding approaches to the initiatives' complex work, spanning pre-pandemic community needs and pandemic era challenges.

RESULTS

Agency leads' vision for healthy communities emerged from the strengths, adversity-driven challenges and health barriers of their communities; while focusing on relationship-building, trust-based engagement and equitable access to trauma-informed resources through knowledge exchange. Results support reflection-based learning practices that are characterized by a flexible mindset and action-oriented adaptability. Mechanisms that power multi-directional knowledge exchange included creative partnering; frameworks and trainings that address partnership and community needs; and actionable skill-building. Incorporating community members directly into the initiative's work exemplified the vision of an informed/resourced community, relationship-based engagement, use of adaptive practices and creative partnering. Lived experience staff provided a credibility bridge facilitating knowledge exchange between community and partnership members and creating power-sharing opportunities.

CONCLUSIONS

Engagement in public health initiatives is essential for community well-being and responsive public health initiatives. These data provide an emerging framework for thoughtful engagement and knowledge exchange among partnership and community members, while highlighting knowledge exchange as a key impact for outcome consideration.

Starting with the End in Mind: Recommendations to Optimize Implementation of a Novel TBI Classification from the 2024 NINDS TBI Classification and Nomenclature Workshop's Knowledge to Practice Working Group

The Knowledge to Practice Working Group (K2P WG) was one of six expert groups convened in early 2023 to plan the 2024 National Institute of Neurological Disorders and Stroke Traumatic brain injury (TBI) Classification and Nomenclature Workshop. Recognizing that implementation of revised classification systems is essential to achieve intended impact, the K2P WG's key aims were to foster shared understanding of knowledge translation (KT), build capacity for implementation of a revised TBI classification system, identify and prioritize KT actions, implementation steps and audiences; and make recommendations to advance implementation. The cornerstone of this work was a focused survey to identify "who needs to do what differently," while prioritizing potential implementation actions. Survey findings, dialogue with other working groups, stakeholder discussions, and public feedback were also utilized to support implementation of the revised Clinical, Biomarker, Imaging-Modifiers and retrospective TBI classification system. Forty researchers across five working groups responded to the survey (Response Rate = 59.7%). Fifty-two unique implementation actions were identified. The top 15 priorities across the five working groups comprised six pertaining to clinical practice (e.g., change Glasgow Coma Scale [GCS] assessment); seven focusing on research (e.g., develop tools for measuring psychological and environmental factors); and one each on lived experience (simplified language for patients and families) and other settings (insurance company support for biomarker testing). Twenty-seven stakeholder groups and 18 target settings were identified as being most impacted by the revised classification system. Key recommendations included: develop guidelines based on systematic reviews, clearly explain the rationale for the change, develop implementation toolkits with input from all stakeholders, and embed the new classification in a learning health system database to facilitate implementation strategies based on audits, feedback, and cost-effectiveness analyses.

Did a digital quality of life (QOL) assessment and practice support system in home health care improve the QOL of older adults living with life-limiting conditions and of their family caregivers? A mixed-methods pragmatic randomized controlled trial

We aimed to improve the quality of life (QOL) of homecare patients (≥ 55 years of age) who had chronic life-limiting conditions and that of their family caregivers by making QOL assessment data available via a digital QOL and practice support system (QPSS). We hypothesized that access to QPSS data in home health care would result in improved QOL for patients or their family caregivers. We further sought to understand how to integrate the use of QOL information into home health care. Our mixed-methods study, including a pragmatic randomized controlled trial (PrCT; registered at ClinicalTrials.gov #NCT02940951), was conducted with nine home healthcare teams in Canadian urban areas. The qualitative research included focus groups and interviews with home healthcare teams (N = 118) to determine how to integrate the QPSS into their practice. Participating homecare patients were assigned to an intervention group (N = 166), where home healthcare teams had access to patients' and their family caregivers' QOL data via the QPSS, or a usual care group (N = 165). Where possible, one family caregiver per patient was recruited (intervention N = 62; usual care N = 51). Primary outcomes, measured every two months for one year, were patients' and family caregivers' QOL trajectories. Longitudinal structural equation models were used to compare the trajectories. The home healthcare teams preferred to have QOL scores presented as tables and graphs, with family caregivers' data linked to each patient. Despite the enthusiasm expressed by the home healthcare teams, and efforts to satisfy their preferences, they infrequently accessed the QOL information. While we observed substantial individual-level variability in patients' and family caregivers' QOL trajectories, the average trajectories for the PrCT groups were similar. Making QOL assessment data available via a digital platform may not be sufficient to achieve measurable improvements for patients and family caregivers.

Approaches to Training Speech-Language Pathologists to Work With People With Aphasia: A Systematic Review

PURPOSE

The aim of this systematic review was to analyze the published research on training approaches for preparing current and future speech-language pathologists (SLPs) to work effectively with people with aphasia (PWA). The review addresses key questions regarding the described training approaches, their key features, research quality, and efficacy.

METHOD

The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with International Prospective Register of Systematic Reviews (CRD42024453742). The literature search spanned nine databases. Eligibility criteria included peer-reviewed publications in English that reported on training programs involving current or future SLPs working with PWA. Studies were assessed for research quality using the American Speech-Language-Hearing Association's (ASHA's) levels of evidence framework. Narrative synthesis was used to identify key features in the training programs.

RESULTS

A total of 920 citations were identified, with 50 studies meeting the inclusion criteria for analysis. Included studies represented a broad range of training approaches, research designs, and research quality. The 50 studies fell into ASHA levels of evidence Ib, IIa, IIb, III, and IV. Statistical meta-analysis was not possible because of variability in research design and outcome measures, but the studies revealed statistically significant findings relevant to the question of what makes training effective for preparing clinicians to work with people with aphasia.

CONCLUSIONS

The current literature related to training of clinicians to work with PWA is heterogeneous in approach, outcome metrics, and methodological quality. There is evidence supporting several recommendations for training clinicians including integrating direct interactions with PWA during training, combining didactic and experiential learning, and incorporating reflective practices. Overall, the review highlights the need for well-described evidence-based training standards for speech-language pathology students working with PWA. Future research should aim to develop and validate comprehensive training guidelines to improve care quality for individuals with aphasia.

What You Need to Know If You Want to Run an Aphasia Camp

BACKGROUND

Aphasia camps are an emerging psychosocial approach focusing on re-engaging people with aphasia in recreational and social activities. Current research highlights the positive impacts of aphasia camps on both attendees (people with aphasia and their loved ones) and facilitators (student and professional volunteers). However, the characteristics and facilitation of camps remain unknown due to a paucity of published research.

PURPOSE

The aim of this study was to explore the current scope of aphasia camps including their distribution, structure, and preparation requirements.

METHOD

A mixed-method, cross-sectional exploratory survey was employed to facilitate collection of various camp characteristics. Quantitative data were analyzed via descriptive statistics, and qualitative data were analyzed via inductive content analysis.

RESULTS

Who: The respondents (N = 14) predominantly identified as allied health professionals (n = 12) and were representative of 10 camps. Camps were commonly affiliated with a university or association. Where: Camps were located in the United States (n = 5), Canada (n = 3), Australia (n = 1), and one cruise ship. All camps were held annually, with most having been operating between 10 and 15 years. How: Camp preparations tended to commence 10-12 months before the event. The camps were predominantly funded by the attendees, with half utilizing community grants, and no camps received government support. The typical camp ran over 3 days/two nights and had over 20 people with aphasia attend; however, the schedule was highly varied in structure and types of activities.

CONCLUSIONS

Aphasia camps are highly diverse in structure, operation, and activities. Further research is needed to investigate stakeholder experiences and sustainable implementation practices to continue promoting the development of aphasia camps around the world.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28764962.

Healthcare professionals' perspectives on barriers and facilitators to implementing a warning signs intervention for older rural-dwelling medical patients at risk for hospital readmission

INTRODUCTION

Prior research has identified that older rural patients and their families view preparation for detecting and responding to worsening health after a hospital stay as their most pressing unmet need, and perceive an evidence-based warning signs intervention that prepares them to do so as highly likely to meet this need. Yet, little is known about healthcare professionals' perspectives about potential barriers and facilitators to implementing warning signs interventions, especially in rural communities.

AIM

This study aimed to identify potential barriers and facilitators to healthcare professionals' provision of a warning signs intervention in rural communities.

MATERIALS AND METHODS

In this qualitative descriptive study, we examined healthcare professionals' perspectives on potential barriers and facilitators to providing a warning signs intervention. A purposive, criterion-based sample of healthcare professionals, stratified by professional designation (three strata - nurses, physicians, and allied healthcare professionals) who provide health care to rural dwellers in Ontario, Canada participated in semi-structured telephone focus-group discussions or 1:1 interviews on barriers and facilitators to delivering the intervention. Data were analyzed using conventional qualitative content analysis.

RESULTS

Twenty-seven healthcare professionals participated in focus groups and 15 in 1:1 interviews for a total of 42 healthcare professionals. Analysis by healthcare professional stratum revealed nine categories of barriers and facilitators: material resources; human resources; healthcare professional communication; healthcare professional knowledge and skill; healthcare professional buy-in; context of rural practice; patient- and family-specific characteristics; risks and liabilities; and timing of intervention delivery. Seven of these categories converged across healthcare professional strata. However, the reasons why different healthcare professional strata perceived the categories as important, and the ways in which they saw them functioning as barriers and facilitators, varied. Our findings shed light on barriers and facilitators that should be considered to ensure successful implementation of the intervention in rural communities.

DISCUSSION

This study adds to the limited research on rural healthcare professionals' perspectives on barriers and facilitators to delivering a warning signs intervention.

How do we leverage implementation science to support and accelerate uptake of clinical practice guidelines in transfusion medicine

BACKGROUND

Developing and disseminating clinical practice guidelines is a common strategy used to inform practice and address evidence-to-practice gaps that are prominent in transfusion medicine. Despite a highly systematic method for synthesizing evidence into guideline recommendations, comparatively little attention is paid to the real-world implementation of the recommendations in routine practice. A more scientific approach drawing on learnings from the field of implementation science is therefore warranted.

STUDY DESIGN AND METHODS

In this article, we propose a methodological roadmap to embed implementation science principles, frameworks, and methods to facilitate the development and uptake of transfusion medicine guidelines. We draw upon research undertaken in partnership with the International Collaboration of Transfusion Medicine Guidelines (ICTMG) to illustrate the roadmap in action.

RESULTS

The methodological roadmap constitutes five steps which have been matched to existing processes for developing and implementing clinical practice guidelines: (1) environmental scan; (2) detailing who needs to do what differently, per guideline recommendation; (3) barriers and enablers assessment; (4) tailoring implementation strategies to identified barriers and enablers; and (5) implementation and evaluation of implementation strategies. For each step, we define the key concepts and methods involved, and share examples from work done with ICTMG to support transfusion medicine guideline implementation.

DISCUSSION

We intend this methodological roadmap for clinicians, researchers, and organizations involved in supporting clinical practice guideline use. Informed by principles, frameworks, and methods from implementation science, the roadmap can provide a more structured, transparent, and replicable approach to improve the implementation of guideline recommendations in transfusion medicine.

A stakeholder-involved adaptation of pathways and resources for engagement and participation (PREP) material with young adults with complex disability in Australia: an implementation feasibility study

PURPOSE

Pathways and Resources for Engagement and Participation (PREP) is an intervention to optimise individuals' participation by building problem-solving capacity and addressing environmental barriers. We investigated the feasibility of implementing PREP with young adults (18-30 years) with complex disability in Australia.

MATERIALS AND METHODS

Explanatory sequential mixed methods study in three stages. (i) PREP materials were collaboratively adapted by the research team and consumer research partners. (ii) Steps 1 and 2 of PREP (YA Supplement) were completed with three young adults with disability, and preliminary feasibility explored using qualitative methods. (iii) The feasibility of implementing adapted materials was examined using quantitative and qualitative methods involving four young adults with disability, six support people and two service providers.

RESULTS

Stage 1: PREP Young Adults Supplement (PREP (YA Supplement)) for use alongside PREP was developed. Stages 2 and 3: findings indicated PREP (YA Supplement) was acceptable, appropriate and feasible. Three themes were identified: setting and achieving goals were associated with challenges and benefits; finding the right time to implement the program was necessary; and PREP (YA Supplement) drives a shift to a participation-focused approach.

CONCLUSION

PREP delivered alongside PREP (YA Supplement) appears feasible with Australian young adults with complex disability.

Unravelling facilitation complexity in community pharmacy: A pragmatic tool for implementation strategy selection

INTRODUCTION

Pharmacy practice is becoming increasingly patient-centric with the development of community pharmacy services. Their implementation appears to be affected by causal relationships and interdependencies of determinants. To address these determinants, change agents need to select, operationalise strategies, and measure their impact. However, there is little real-world guidance on efficiently selecting strategies tailored to determinants.

OBJECTIVES

The aims of this study were to (1) explore the relationships between determinants and implementation strategies identified during the implementation of a Minor Ailment Service in Spanish community pharmacies and (2) develop a visual tool that links implementation strategies tailored to specific determinants for change agents to use during the facilitation process.

METHODS

The study employed a mixed methods approach within a three-year pragmatic type 3 hybrid effectiveness-implementation design. Data collection was facilitated by change agents, who utilised on-site and remote communication methods. The objectives of the change agents were to identify determinants, design and operationalise tailored implementation strategies. These data were documented and transformed into Sankey diagrams.

RESULTS

Ten change agents systematically documented 4236 determinant-strategy relationships in 92 pharmacies. The most common primary determinant domain they identified was "intervention characteristics" (n = 1843, 43.5 %). The most common secondary determinant domain was "characteristics of the individuals involved" (n = 3069, 72.5 %). The most common strategy category was "other" (n = 1808, 42.7 %). A Sankey diagram tool was developed to allow change agents to receive feedback on the effect of their strategies and select appropriate future implementation strategies.

CONCLUSIONS

The findings of this study inform the development of future visual tools for assisting change agents during the facilitation process. Sankey diagrams act as a generic and real-time tool, which will reduce the complexity inherent to the facilitation activity. This will facilitate prospective implementation researchers to plan implementation interventions and train change agents more efficiently, thereby optimising the change management process.

Increasing Olanzapine Prescribing for Patients Undergoing Highly Emetogenic Chemotherapy

Importance

Olanzapine as part of a 4-drug antiemetic regimen is highly effective at preventing nausea and vomiting in patients receiving highly emetogenic chemotherapy (HEC). National prescribing rates of olanzapine in eligible patients have, however, remained persistently low.

Objective

To describe efforts to increase the guideline-concordant use of olanzapine in patients receiving HEC in a statewide oncology collaborative.

Design, Setting, and Participants

The Michigan Oncology Quality Consortium (MOQC) is a collaborative of Michigan-based oncology practices whose mission is to advance the care of patients with cancer and their caregivers through comprehensive, patient- and practice-led quality improvement initiatives. Participants were patients receiving HEC at 38 MOQC member practices during an initiative from 2019 to 2023 to improve guideline-concordant inclusion of olanzapine as part of a 4-drug antiemetic regimen in HEC prophylaxis.

Interventions

Interventions included performance audit and feedback to practices along with peer comparison, learning collaboratives of practices, education by experts at collaborative meetings, creation of patient-facing materials, and the addition of value-based reimbursement beginning in 2021. Measure performance was assessed using the American Society of Clinical Oncology's Quality Oncology Practice Initiative.

Main Outcomes and Measures

Proportion of patients receiving olanzapine for the first cycle of HEC as part of a 4-drug antiemetic regimen for chemotherapy-induced nausea and vomiting.

Results

Between 2019 and 2024, data were manually collected from the medical records of 8662 patients treated with HEC at 38 medical oncology practices at 71 sites across the state. Individual patient-level demographic data are not available from the QOPI database. For patients from years 2021 through 2024, the median (IQR) age was 62 (52-69) years; 4434 were female (65.5%); 814 were Black or African American (12.0%), 121 were Hispanic or Latino (1.8%), and 5385 were White (79.7%). The use of olanzapine as part of a 4-drug antiemetic increased from 7.2% in 2019 to 63.4% in 2024 (χ21 = 553.61; P < .001).

Conclusions and Relevance

In this quality improvement study of olanzapine prescribing in eligible patients, MOQC deployed quality improvement methods to increase the prescribing of olanzapine as part of a 4-drug regimen in patients receiving HEC, well above both the baseline and national levels of prescribing. This work suggests that efforts to improve patient care can be effective across diverse practice types, locations, and sizes in a statewide collaborative. Ongoing efforts include supporting change in those practices with low rates of prescribing and demonstrating the importance of this work for patient outcomes.

Perspectives of key stakeholders on integrating wearable sensor technology into rehabilitation care: a mixed-methods analysis

Introduction

Rehabilitation is facing a critical practice gap: Patients seek out rehabilitation services to improve their activity in daily life, yet recent work demonstrates that rehabilitation may be having a limited impact on improving this outcome due to lack of objective data on patients' activity in daily life. Remote monitoring using wearable sensor technology is a promising solution to this address this gap. The purpose of this study was to understand patient and clinician awareness of the practice gap and preferences for integrating wearable sensor technology into rehabilitation care.

Methods

This study used a mixed-methods approach consisting of surveys and 1:1 interviews with clinicians (physical and occupational therapists or assistants) employed at an outpatient rehabilitation clinic within an academic medical center and patients seeking care at this clinic. Data were analyzed using descriptive statistics and thematic analysis.

Results

Data saturation was reached from nineteen clinicians and ten patients. Both clinicians and patients recognized the importance of measuring activity outside the clinic and viewed wearable sensor technology as an objective measurement tool. Most clinicians (63%) preferred continuous (vs. intermittent) monitoring within a care episode and most patients (60%) were willing to sync their sensor data as often as instructed by their provider. To maximize integration into clinical workflows, clinicians voiced a preference for availability of sensor data in the electronic health record.

Conclusions

Clinicians and patients value the use of wearable sensor technology to improve measurement of activity outside the clinic environment and expressed preferences for how this technology could best be integrated into routine rehabilitation care.

A Scoping Review on the Use of Infographics as a Health-Related Knowledge Translation Tool

Infographics are gaining in popularity as a promising knowledge translation (KT) tool to reach multiple health research users. This scoping review explores the depth and breadth of empirical evidence available on infographics' use and its effectiveness. A systematic search was conducted across MEDLINE, CINAHL, PsycInfo, Social Science Abstracts, ERIC, Cairn, Google Scholar, and Google Web. Articles were screened and abstracted independently by two reviewers. Among the 2173 sources identified, 21 met inclusion criteria. Of the included studies, 71% were published since 2018, 76% were conducted in North America, and 22% addressed cancer prevention. A great diversity in research designs and indicators is observed. Most studies used self-reported questionnaires often administered post-intervention. In general, infographics are appreciated, considered visually appealing, perceived as useful and easy to understand. According to experimental studies identified, infographics would not be more effective than other tools for information acquisition and retention, intention to act, and behavior change, except for specific subgroups. However, more studies are necessary to better understand the added value of infographics for knowledge translation compared to other dissemination tools, considering different target audiences and types of knowledge, and to identify characteristics (e.g., structure, message framing) that may influence their impact.

Advancing health equity in Nova Scotia by exploring gaps in healthcare delivery: a mixed methods protocol

Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing.

TRANSCENDENT (Transforming Research by Assessing Neuroinformatics across the Spectrum of Concussion by Embedding iNterdisciplinary Data-collection to Enable Novel Treatments): protocol for a prospective observational cohort study of concussion patients with embedded comparative effectiveness research within a network of learning health system concussion clinics in Canada

INTRODUCTION

Concussion affects over 400 000 Canadians annually, with a range of causes and impacts on health-related quality of life. Research to date has disproportionately focused on athletes, military personnel and level I trauma centre patients, and may not be applicable to the broader community. The TRANSCENDENT Concussion Research Program aims to address patient- and clinician-identified research priorities, through the integration of clinical data from patients of all ages and injury mechanisms, patient-reported outcomes and objective biomarkers across factors of intersectionality. Seeking guidance from our Community Advisory Committee will ensure meaningful patient partnership and research findings that are relevant to the wider concussion community.

METHODS AND ANALYSIS

This prospective observational cohort study will recruit 5500 participants over 5 years from three 360 Concussion Care clinic locations across Ontario, Canada, with a subset of participants enrolling in specific objective assessments including testing of autonomic function, exercise tolerance, vision, advanced neuroimaging and fluid biomarkers. Analysis will be predicated on pre-specified research questions, and data shared with the Ontario Brain Institute's Brain-CODE database. This work will represent one of the largest concussion databases to date, and by sharing it, we will advance the field of concussion and prevent siloing within brain health research.

ETHICS AND DISSEMINATION

This study was approved by the Children's Hospital of Eastern Ontario Research Ethics Board and preregistered on OSF (25 June 2024); https://doi.org/10.17605/OSF.IO/HYDZC. Dissemination of findings will be multifaceted, including conference presentations, peer-reviewed publications and sharing of adapted materials (eg, videos, infographics, plain language summaries) with community groups and key knowledge users.

Mixed-methods study on professionals' attitudes toward harm reduction in cannabis use and the development of a knowledge translation plan

Several factors limit the adoption of harm reduction in cannabis use (HR-c). A knowledge translation (KT) process can help optimize its adoption. This study aims to: (1) identify the attitudes toward HR-c of health and social services (HSS) practitioners working among young people in Quebec; and (2) develop a KT plan to enhance its adoption. Two conceptual frameworks guided the study: the Knowledge-to-Action model and the Consolidated Framework for Implementation Research. Managers and practitioners working among young people in difficulty in Quebec were recruited. Mixed methods tools were used, involving consultations (N = 14) and questionnaires (N = 167). Qualitative data underwent thematic analysis, while descriptive and inferential statistics were executed to analyze quantitative data. Participants presented positive attitudes toward HR-c (M = 44.79), negative attitudes toward abstinence-based treatments (M = 9.68), and moderate perceived levels of training in HR-c (M = 12.3). Their needs and contextual factors that might influence HR-c adoption were identified. Based on these findings, a KT plan was developed to optimize HR-c adoption by HSS practitioners. Despite some negative factors impacting its applicability, HR-c is generally accepted and implemented by practitioners. This study represents the pre-implementation phase of the KT plan, which will then guide the effective implementation of a KT process for HR-c adoption.

The integration of quality improvement and implementation science methods and frameworks in healthcare: a systematic review

OBJECTIVES

Quality Improvement (QI) and Implementation Science (IS) are both frequently utilised in health research. Little is known about how they are integrated within studies, and whether combined they add value. This systematic review sought to investigate how QI and IS theories and strategies are integrated within healthcare-based studies.

METHODS

A systematic search was conducted across five databases. Duplicates, studies published prior to 2014, systematic and scoping reviews, and study protocols were removed. The retrieved title abstracts were screened, and the full texts of eligible studies were reviewed in pairs using Covidence software. Of the included studies, data were extracted using a predefined template, and studies were critically appraised using the QI Minimum Quality Criteria Set. Frequency analysis of the use of QI or IS tools was conducted, as well as a narrative analysis of the integration of QI and IS in each study.

RESULTS

The database search returned 3,407 title abstracts, of which 1,618 were screened. Assessment for eligibility resulted in the identification of 149 studies, of which the full texts were reviewed, and 12 studies included in the final analysis. These 12 studies integrated QI and IS methods to implement an intervention in tertiary healthcare. The Plan-Do-Study-Act (PDSA) cycle was the most frequently used QI tool and the Theoretical Domains Framework, Behaviour Change Wheel (including Capabilities, Opportunity and Motivation) and the Consolidated Framework for Implementation Research were the most frequently used IS frameworks.

CONCLUSION

The study highlights a lack of consistent terminology across the QI and IS fields, as well as opportunities for greater integration of the two fields to enhance study design, implementation and sustainability, and to improve healthcare performance.

Developing a new pragmatic tool for assessing contextual fit and feasibility of evidence-based interventions towards effective implementation in global health

INTRODUCTION

Understanding the contextual fit and feasibility of evidence-based interventions (EBIs) constitutes an important aspect of implementation research to inform policy decisions for their uptake and sustainability in any given context (eg, setting, sector and population). Yet current methodologies, which attempt to assess contextual fit and feasibility of EBI as key preimplementation outcomes using a reductionist approach with summative scores, fall short in capturing the multiple forms of interactions and influences of constructs and contextual factors associated with EBI implementation in a real-world situation.

METHODS

Between 18 February 2023 and 5 August 2023, we designed a novel tool through an ongoing collaborative effort of researchers, global health practitioners, policy makers and populations from low- and middle-income countries and high-income countries using a five-step sequential process. This process included step 1 (stakeholder envisioning), step 2 (evidence synthesis), step 3 (evidence deconstruction), step 4 (stakeholder consensus and conceptual framework development) and step 5 (tool development, deployment and standardisation).

RESULTS

Following this process, a pragmatic contextual fit and feasibility (PCoF) tool was developed with acceptability and preference derived as potentially stable constructs for contextual fit outcome and willingness to use and resource availability for feasibility outcome. The assessment of contextual fit and feasibility outcomes with strong, somewhat, and weak ratings was determined by a total of nine real-world scenarios of construct interactions in either case. Strong, somewhat and weak ratings of contextual fit or feasibility accounted for one, seven and one construct interaction(s), respectively.

CONCLUSION

This initial development of PCoF is a step in the right direction for addressing the complexity associated with EBI implementation that is in part posed by contextual factors and cannot be completely explained by summative scoring and arbitrary rating approaches of existing tools. The use of PCoF as a research and policy decision-support tool, once extensively refined, validated and standardised across multiple contexts, has the potential to generate robust evidence on the contextual fit and feasibility of EBI and to meaningfully support researchers, policy makers and other stakeholders in informing the prioritisation, adaptation and equity-focused uptake and scale-up of EBI for improved population health and social outcomes.

Knowledge Competence and Behavior of Learners: Social Determinants of Health for Pediatric Physical Therapists

PURPOSE

Pediatric physical therapists care for a diverse population for whom social determinants of health (SDOH) impact health outcomes. This study examines changes in knowledge and behavior following a continuing education course on SDOH.

METHODS

This mixed methods study design included participants from a convenience sample of pediatric physical therapists enrolled in a continuing education course in SDOH. Data were collected through surveys, cases, and interviews. Quantitative data were analyzed using descriptive frequencies and comparisons. Qualitative data were analyzed using a grounded theory approach.

RESULTS

Participants significantly improved their knowledge level in all content areas and increased the frequency in which they acted related to many content areas of the course.

CONCLUSIONS

This study highlights the ways physical therapists can potentially optimize health outcomes. The findings contribute to the Knowledge to Action framework.

Evaluating the Public Relationships of Registered Dietitians with Government, Food Industry, and Universities Regarding Knowledge Transfer

Purpose: The nutritional quality of the food supply is influenced by actions from the government, the food industry, and universities. Considering the potential of registered dietitians (RDs) to transfer nutrition knowledge, this study aimed to assess the positivity of the relationships between RDs and these actors to improve knowledge transfer initiatives for the benefit of food nutritional quality. Methods: Using a descriptive and correlation research design, 68 RDs, members of the Ordre des diététistes-nutritionnistes du Québec (dietitians in the Province of Québec, Canada), evaluated their relationships with the government, the food industry, and universities in a web-based survey. Results: Overall, RDs rated their relationships with universities more positively than with government or industry, which were similarly rated (p < 0.001). More specifically, RDs working in clinical nutrition rated all dimensions of their relationships with the actors in general less favourably than RDs in other sectors (p < 0.05). Conclusions: To support the successful transfer of knowledge regarding the nutritional quality of foods, these findings suggest that RDs should be encouraged to attempt to develop more positive relationships with government and industry, while maintaining their positive relationships with universities. Future research could further examine the clinical RD subgroup as well as the reasons for these results by conducting in-depth interviews or group discussions.

The road to successful implementation of innovation in radiotherapy: A research-based implementation protocol

BACKGROUND AND PURPOSE

Radiotherapy (RT) is rapidly advancing, yet only 50 % of innovations are implemented promptly. Despite the availability of Implementation Science (ImpSci) theories, models, and frameworks (TMFs), a theory-practice gap persists in effectively applying these insights in RT clinical practice. This study aims to develop a consensus-based implementation protocol for RT innovations using validated ImpSci knowledge.

MATERIAL AND METHODS

A literature review of TMFs (May-August 2023) and 20 semi-structured interviews with Dutch RT professionals (August-December 2023) identified key RT components for implementation. These insights informed a draft RT implementation protocol, which was refined through a three-round international Delphi study (March-September 2024) involving 11 RT and 5 ImpSci experts. Consensus was determined using a 5-point Likert scale, analysing medians, interquartile ranges (IQRs), and percentage scoring.

RESULTS

The Knowledge-to-Action (KTA) Framework and input from expert interviews were used to draft the protocol. Delphi response rates were 100 %, 93.8 %, and 88.9 % across rounds. In round 1, 88.9 % of elements achieved consensus (median = 4.0, IQR = 0.0-1.3); only the application of a prediction model for timely implementation (step 3c) needed revision after rounds 1 and 2. In round 3, also for step 3c consensus was reached (median = 4.0, IQR = 0.3). The protocol includes defining innovation types, stakeholder analysis, tailored implementation strategies, and a phased evaluation plan to ensure sustainability.

CONCLUSION

This is the first consensus-based RT innovation implementation protocol, addressing the theory-practice gap with a structured clinical approach. Future research should validate the protocol and assess the impact of preparation on implementation success.

Co-designing implementation strategies for social prescribing in Lancashire and South Cumbria: a qualitative study with a participatory approach

OBJECTIVES

Social Prescribing (SP) programmes hold significant promise, yet there is a critical need to identify the underlying causes of their challenges and develop evidence-based, co-designed solution ideas through a collaborative approach.

DESIGN

This study applied a multimethod participatory design using co-design workshops to generate solutions to root problems and a 2-day Citizen Jury (CJ) event to validate these solutions from different perspectives.

PARTICIPANTS

Four co-design workshops were conducted with different stakeholders, including experts-by-experience, community providers, SP link workers and other health and social care professionals who were responsible in SP coordination and leadership.

DATA ANALYSIS

Data were analysed using thematic analysis, identifying the root causes across several domains: human resources issues, social determinants of health), intrasectoral and intersectoral collaboration in health planning and service delivery, knowledge and awareness, financing, assessment systems for evaluating SP programme effectiveness, information systems and supportive policies/mechanisms.

RESULTS

11 solutions were proposed, including prioritising a human-centric approach, establishing sustainable funding mechanisms, providing sufficient training and knowledge for staff, fostering co-production and shared vision across sectors, adopting a preventive approach to healthcare, enhancing information system support and encouraging self-referrals. These strategies were proposed and refined during the 2-day CJ event.

CONCLUSIONS

Using a participatory method enabled a comprehensive understanding of different stakeholders' perspectives and facilitated the development of co-produced solutions based on the identified challenges. This approach has the potential to assist policymakers in developing realistic policies to enhance social care within integrated care systems.

An integrated knowledge mobilization approach to substance use health

The Canadian Centre on Substance Use and Addiction (CCSA) has a mandate to provide national leadership in evidence-informed analysis and knowledge mobilization to advance solutions that reduce substance-related harms. Doing this work effectively requires an understanding of the needs, priorities, perspectives and ideologies of multiple groups. Partnerships across various sectors support a full understanding and acknowledgement of the systems that create differential health outcomes for individuals and communities. CCSA has developed an integrated knowledge mobilization model to guide our work in supporting better substance use health outcomes. Our model begins by understanding the context a particular need (for example, research question and practice improvement) is occurring within. This involves engaging key partners with multiple viewpoints to understand the current situation, constraints and opportunities, including barriers to care, social and structural determinates of health and community strengths and assets. Based on this, the steps that follow involve determining the appropriate action and CCSA's unique role to respond in alignment with partner and community priorities to advance solutions within the given context. This leads to an iterative process of generating and mobilizing knowledge. This integrated and collaborative approach ensures that responses are relevant to the identified knowledge gap, that recommendations reflect partners' realities and that our efforts will achieve impact while minimizing the risk of harm. Through an iterative process of generating and mobilizing knowledge (for example, supporting the scale and spread of innovations, developing new tools and generating or tailoring evidence for a specific audience/context/substance/setting, among others), outputs such as increased awareness, knowledge, use of information and strengthened capacity occur. Together, these efforts contribute to the outcome of a healthier society for people living in Canada, where multiple forms of evidence advance substance use health. Meaningful engagement of partners and evaluation of our efforts are ingrained throughout the model to ensure our work has the intended effects. We share our approach for the consideration of other organizations (in the space of substance use health and otherwise) to engage partners in the development of evidence and other resources that can drive impactful programs, practice and policy.

Exploring the utilisation and effectiveness of implementation science strategies by cystic fibrosis registries for healthcare improvement: a systematic review

BACKGROUND

Cystic fibrosis (CF) registries capture important information in high-burden health domains to support improvement in health outcomes, although a number of unanswered questions persist, as follows. 1) Do CF registries utilise implementation science strategies to improve patient outcomes? 2) Which implementation strategies have been engaged? 3) Has the engagement of these strategies been effective in improving clinical outcomes?

METHODS

We undertook a systematic review to exploring the use of implementation science strategies by CF registries for healthcare improvement. We searched MEDLINE, Embase, Scopus, Emcare and Web of Science databases for use of Expert Recommendations for Implementing Change (ERIC) implementations and use of the Knowledge to Action framework for improvement. We used the Risk of Bias in Non-randomised Studies - of Interventions tool for risk-of-bias assessment.

RESULTS

1974 citations were identified and 12 studies included. Included studies described 45 ERIC implementation strategies from nine categories. Strategies included "use evaluative and iterative strategies" (n=9) and "develop stakeholder interrelationships" (n=10). Least-used strategies were "utilise financial strategies" (n=1), "support clinicians" category (n=3) and "provide interactive assistance" (n=2). All 12 studies utilised monitoring of knowledge use, and assessing barriers and facilitators of knowledge use. Only seven studies utilised mechanisms to sustain knowledge use.

DISCUSSION

Reported studies describe significant benefits in important CF outcomes for people with CF reported at site-specific and population levels. Studies highlighted the importance of governance, leadership, patient and family engagement, multidisciplinary engagement, quality improvement, data and analytics and research. The ready availability of clinical performance data feedback to clinicians and patients by CF registries is likely to strengthen the effectiveness of CF registries in driving healthcare improvement within a learning health system.

Effects of DELIMA education programme on nurses' knowledge, confidence, attitude, and screening accuracy for delirium in paediatric intensive care units

OBJECTIVE

To evaluate the effects of a 4-week Delirium Introduction and Maintenance programme based on the knowledge-to-action framework on nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium in the paediatric intensive care unit (PICU).

RESEARCH METHODOLOGY/DESIGN

A quasi-experimental study with a pretest-posttest design.

SETTING

This study was conducted between January and February 2024 with nurses in two Indonesian PICUs.

MAIN OUTCOME MEASURES

Nursing knowledge, self-confidence and attitudes were measured at baseline and the third and fourth weeks (maintenance period) after the intervention was implemented. The Cornell Assessment of Pediatric Delirium (CAPD) was used to evaluate the screening accuracy for delirium at the third and fourth weeks postintervention.

RESULTS

A total of 44 nurses with a mean age of 28 years participated in the intervention. At weeks 3 and 4 after the intervention, the intervention group exhibited substantial improvements in knowledge (B = 1.35 and 1.39), self-confidence and attitudes (B = 1.26 and 1.29), and screening accuracy (B = 0.25 and 0.27) compared with the control group (all P < 0.05). The nurses' screening accuracy for delirium by using the CAPD improved from 50 % (week 1) to 86 % (week 3) and 100 % (week 4) in the intervention group, whereas the nurses' screening accuracy for delirium in the control group modestly increased from 17 % to 33 % (week 3) and 37 % (week 4).

CONCLUSIONS

The theory-driven, multimodal intervention improved the nurses' knowledge of delirium, self-confidence and attitudes, and screening accuracy for delirium. Implementing comprehensive delirium education programmes can enhance delirium recognition and management in PICUs. Future studies should investigate the long-term effects of delirium education programmes on patient outcomes.

IMPLICATIONS FOR CLINICAL PRACTICE

An integrated instructional approach was employed to improve nurses' knowledge, self-confidence, attitudes, and screening accuracy for delirium.

Harnessing delegation and technology to identify and manage malnutrition in a digital hospital: An implementation study

AIMS

Delegation of nutrition care activities to Dietetic Assistants in hospitals has been identified as one innovative malnutrition model of care, but there has been limited evaluation of their roles. This study aimed to develop, implement and evaluate a new Malnutrition Model of Care embracing automated delegation and digital systems.

METHODS

The Malnutrition Model of Care was created to detect patients at risk of malnutrition (using the Malnutrition Screening Tool) and nutritional decline (via routine intake tracking at all meals and snacks). Digital systems generated automated referrals to dietetics, with protocols to support Dietetic Assistants to action these to direct care escalation to the ward dietitian. Dietetic Assistant training included simulations and clinical task instructions. Implementation evaluation was guided by the Donabedian model of quality and included a review of inpatient dietetics occasions of service, survey of Dietetic Assistant role satisfaction and task confidence, and hospital-wide cross-sectional malnutrition audit. Data was descriptively analysed.

RESULTS

During the first year of implementation, 60% of Dietetics inpatient occasions of service were completed by Dietetic Assistants, with 26% of Dietetic Assistant inpatient tasks initiated from nursing malnutrition risk screening. Most Dietetic Assistants reported adequate training and confidence in completing delegated tasks. Malnutrition prevalence was 14% with no hospital-acquired malnutrition identified. No clinical incidents were reported.

CONCLUSIONS

The Dietetic Assistant workforce and technology were harnessed to implement an innovative delegated Malnutrition Model of Care that appears to be safe and effective at managing malnutrition from preliminary evaluation. Work continues to formally assess service efficiencies, cost and patient experience.

Sharing knowledge on implementing mental health and wellbeing projects for veterans and first responders

PURPOSE

The aim of this study was to describe the knowledge to action and knowledge transfer approaches used in an international mental health research funding program and its outcomes. A key goal of the evaluation was to maximise organisational learning and knowledge sharing to inform future implementation projects.

METHODS

A series of interactive knowledge sharing workshops focused on five key themes: peer support; psychoeducation; the involvement of family, friends, and significant others; retreat, residential, or group-based programs; and organisational change. Qualitative descriptive analysis was used to code, summarise and describe themes.

FINDINGS

Key learnings that influenced the success of mental health initiatives include building relationships across all organisational levels, involving Veterans and First Responders with lived experience in the design and implementation process, and understanding the unique workplace culture and operations.

CONCLUSION

Our findings highlight the need for collaborative, informed approaches tailored to the culture, organisation and mental health support needs of Veteran and First Responder. These insights enhance understanding of the factors that impact the successful implementation of mental health prevention and support programs for those exposed to work-related trauma.

Use of multimedia shared decision-making aids (EATING program) for improving advance care planning engagement among community-dwelling older adults with chronic diseases: A cluster randomized controlled trial

BACKGROUND

Discussing advance care planning (ACP) preferences for nasogastric tube (NG) insertion remains challenging among older adults. Multimedia decision-making aids have demonstrated potential to enhance understanding and support informed decision-making.

AIM

To evaluate the effectiveness of the EATING program (multimedia decision-making aids + traditional educational module) compared to usual care (traditional educational module alone) in improving ACP readiness on NG insertion for community older adults with chronic illness.

METHODS

A single blind, two-arm parallel cluster randomized controlled trial was conducted across four community villages in Northern Taiwan. Participants from two villages received the EATING program, while the other two villages received the usual care. Eligible criteria included community older adults aged ≥65 with at least one chronic disease who were able to provide informed consent. Exclusion criteria included hearing or visual impairments or a history of mental illness. Pre- and post-intervention outcomes, along with one-month follow-up data, were analyzed using descriptive statistics and generalized estimating equations.

RESULTS

Both groups showed significant immediate improvements in knowledge (p < 0.001), belief/behavior (p < 0.001), decision confidence (p < 0.001), and readiness for ACP (p < 0.001). The experimental group showed greater improvement, particularly in emotional response and preferences (Z = -5.51, p < 0.001), observed only in this group. Sustained effect on knowledge (B = 35.029, p < 0.001), emotional response and preferences (B = 9.342, p < 0.001), refusal NG tube insertion (Z = -2.770, p = 0.006), and likelihood of signing official documents (p = 0.035) were observed after one month.

CONCLUSION

The study highlights the potential of multimedia program to enhance NG insertion discussions among community older adults. Further qualitative investigations and cultural adaptation are recommended.

Promoting provider adherence to American Diabetes Association guidelines with a diabetes care bundle: A DNP quality improvement project

ABSTRACT

Type 2 diabetes mellitus (T2DM) is a common and expensive health condition. Patients are at increased risk for cardiorenal complications when metabolic targets for hemoglobin A1C, BP, and low-density lipoprotein cholesterol are unmet. Many providers do not fully adhere to the latest diabetes guidelines. This quality improvement project aimed to achieve adherence to all components of a diabetes care bundle (DCB) based on the American Diabetes Association (ADA) Standards of Care in Diabetes-2023 for at least 30% of patient visits for T2DM among providers at two primary care clinics. The DCB successfully assisted providers in adhering to ADA guidelines during patient visits while not greatly increasing visit cycle time.

Evaluation of the implementation of an insulin patient decision aid for patients with type 2 diabetes in an academic primary care clinic in Malaysia: a mixed method study

BACKGROUND

Literature surrounding patient decision aid (PDA) focus on testing effectiveness such as measuring patient or practice outcomes, while few studies looked into evaluation of implementation outcomes. It is important to assess implementation outcomes because in order for PDA to deliver its intended effects, they should first be effectively implemented. This study aimed to evaluate the implementation of an insulin PDA in an academic primary care clinic specifically measuring implementation outcomes.

METHODS

A mixed-methods sequential explanatory design was used. This study was conducted at a primary care clinic in an academic hospital from April - November 2018. The insulin PDA was implemented using a tailored implementation intervention, which comprised of 11 strategies aiming to overcome 13 prioritised implementation barriers. Evaluation data were collected from: healthcare administrators such as the head of department, the clinic coordinator, and the nursing officer who oversees the clinic operations, doctors whose tasks were to deliver the insulin PDA to patients, nurses who were responsible for making sure the insulin PDAs were available, and patients with type 2 diabetes who were offered the insulin PDA. The study commenced with the quantitative approach to assess 'Reach', 'Adoption', 'Implementation' and 'Maintenance'of the insulin PDA. Subsequently, qualitative approach was employed and qualitative interviews were conducted with the relevant stakeholders to explain the quantitative outcomes. A total of six IDIs and six FGDs were conducted with healthcare providers (healthcare policymakers: 3, doctors: 35, and staff nurses: 5), and 62 IDIs were conducted with patients.

RESULTS

For 'Reach', 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors' 'Adoption' of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of 'Implementation' of the PDA varied for different tasks (ranged from 19.2 to 84.9%) and was challenged by patient and system barriers. For 'Maintenance', 80% of the doctors were willing to continue using the PDA due to its benefits.

CONCLUSION

This study highlighted that the implementation of an insulin PDA in a primary care setting is promising. Addressing the issues of social hierarchy, and healthcare providers' roles and responsibilities can further improve implementation outcomes.

Implementation Science Competencies for Policy Transformation Framework (ISCPT)

Implementation science (IS) models play a crucial role in translating evidence-based practice (EBP) into sustainable policy reforms. However, the competencies required for nurses to lead these transformations remain poorly defined. Objective: This study develops a framework for implementation lead (IL) nurses, identifying the core competencies needed to drive evidence-based policy transformation within healthcare systems. Method: A secondary data analysis (SDA) was conducted using qualitative data from focus group interviews originally collected, recorded, and transcribed as part of the EQUIP (Evidence-based Quality Improvement Project). The dataset includes insights from 12 IL nurses who participated in PEACE-based training, addressing real-world clinical challenges. Their perspectives were thematically analyzed to generate a competency framework for policy leadership. Findings: The study developed the Implementation Science Competencies for Policy Transformation (ISCPT) framework, which highlights three pillars: (1) evidence appraisal and guideline development, (2) collaborative leadership for policy advocacy, and (3) continuous improvement through data-driven decision-making. Conclusions: Grounded in IL nurses' perspectives, the ISCPT framework provides a nurse-centric roadmap for policy transformation, integrating interdisciplinary collaboration, adaptive leadership, and evidence-based decision-making into nursing education and practice. While the findings reflect a single healthcare context, the framework offers actionable guidance for preparing nurses to lead policy-driven healthcare improvements.

A scoping review of how behavioural theories, models and frameworks have been applied to the design, conduct, analysis or reporting of clinical trials

BACKGROUND

Clinical trials provide much of the evidence that guides decision making about treatment and care but are often complicated to deliver. Trials can be thought of as complex systems with interacting individuals, as such behavioural science is a useful lens to investigate how trial processes may be improved. To guide selection of an appropriate behavioural theory, model, or framework to further enhance trial processes, we sought to map their past application within the design, conduct, analysis and reporting of clinical trials.

METHODS

A scoping review to investigate the breadth of trials methods research that has utilised a behavioural theory, model, or framework was conducted through a database search and citation analysis. Publications investigating any part of the trial lifecycle (from design to reporting) through a behavioural lens were included. Data were extracted from each study and organised thematically to summarise trends in behavioural approach application within different trial-related behaviours and contexts.

RESULTS

A total of 96 studies were included. A majority of these (n = 93, 97%) investigated trial conduct processes, such as recruitment and retention. A total of 23 unique theories, models or frameworks were identified. Three behavioural theories, models or frameworks, the Theory of Planned Behaviour (n = 23, 24%), Social Cognitive Theory (n = 12, 13%) and the Theoretical Domains Framework (n = 30, 31%), accounted for more than two-thirds of those utilised. When compared to key stages of the Knowledge to Action cycle, approaches reported in included studies were most often utilised to "Identify a problem" within trials (n = 40, 42%).

CONCLUSION

A wide variety of behavioural approaches to investigate trial conduct were identified. However, the trial processes studied were focused within trial recruitment and largely used a select number approaches. Future research should assess whether these approaches are fit for purpose, as well as prioritising other trial areas for methods research.

JUMPSTART: evaluation of an early mobilization program following transcatheter aortic valve replacement

BACKGROUND

Patients with aortic stenosis undergoing a transcatheter aortic valve replacement (TAVR) are typically discharged from hospital the next day, leaving little time to support their mobilization needs. Therefore, to improve the early mobilization of post-TAVR patients, we investigated the adoption and acceptability of a self-directed, tailored and home-based exercise program (JUMPSTART), which consists of four exercise modules, available in virtual and paper formats.

METHODS

This prospective, observational, non-randomized and comparative study was conducted at one regional cardiac centre in Ontario, Canada. The development of the JUMPSTART program was informed by the Knowledge-to-Action Cycle and the choice of study outcomes were guided by the RE-AIM Framework. Program adoption and acceptability were captured through two follow-up surveys, 14-days and three-months post-TAVR; survey questions were informed by the Consolidated Framework for Implementation Research. The target program adoption rate was 70% by three-months post-TAVR. Impact of program participation on quality-of-life scores, and study participants' cardiac rehabilitation attendance, were also assessed.

RESULTS

There were 144 study participants. Survey response rates were 86% at 14-days post-TAVR, and 78% at three-months post-TAVR. The program adoption rate was 75% while the cardiac rehabilitation attendance rate was 30%. Approximately 70% of participants preferred the paper-based program format. The technological requirement was the most common barrier to engaging with virtual formats. Most (70%) rated the exercises as being the right level of difficulty. There were no reports of major health or safety concerns while exercising. Quality-of-life scores significantly increased from baseline to three-months post-TAVR; however, this could not be attributed to frequency of program participation. Furthermore, 73% of program participants felt that their recovery was improved because of their participation in the program, and 96% reported that they would recommend it to others. The study team regularly reviewed preliminary findings and took action to improve the program and the implementation process.

CONCLUSIONS

Participants were satisfied with the JUMPSTART program, which will continue to be offered to post-TAVR patients. Despite the increasing use of virtual technologies, most of this patient population prefers paper-based resources. Future planning will involve developing additional modules and exploring ways to increase program adoption, as well as cardiac rehabilitation attendance.

CLINICAL TRIAL NUMBER

Not applicable.

Rapid review method series: interim guidance for the reporting of rapid reviews

Rapid reviews (RRs) are produced using abbreviated methods compared with standard systematic reviews (SR) to expedite the process for decision-making. This paper provides interim guidance to support the complete reporting of RRs. Recommendations emerged from a survey informed by empirical studies of RR reporting, in addition to collective experience. RR producers should use existing, robustly developed reporting guidelines as the foundation for writing RRs: notably Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA 2020; reporting for SRs), but also preferred reporting items for overviews of reviews (PRIOR) items (reporting for overviews of SRs) where SRs are included in the RR. In addition, a minimum set of six items were identified for RRs: three items pertaining to methods and three addressing publication ethics. Authors should be reporting what a priori-defined iterative methods were used during conduct, what distinguishes their RR from an SR, and knowledge user (eg, policymaker) involvement in the process. Explicitly reporting deviations from standard SR methods, including omitted steps, is important. The inclusion of publication ethics items reflects the predominance of non-journal published RRs: reporting an authorship byline and corresponding author, acknowledging other contributors, and reporting the use of expert peer review. As various formats may be used when packaging and presenting information to decision-makers, it is practical to think of complete reporting as across a set of explicitly linked documents made available in an open-access journal or repository that is barrier-free. We encourage feedback from the RR community of the use of these items as we look to develop a consolidated list in the development of PRISMA-RR.

Codesign and evaluation of advanced therapeutic information resources for and with families of children with neurological conditions: a mixed methods cross-sectional study

OBJECTIVE

Parents and caregivers of children with neurological conditions express interest in new and developing treatments and trials; however, they have limited knowledge of, and access to, reliable information. This study aims to empower and equip decision-making and support communication in the application of advanced neurotherapeutics and personalised medicine, covering gene therapy, stem cell therapy, neurostimulation and neuroimmunotherapies.

DESIGN

A suite of online psychoeducational resources has been created and evaluated to establish implementation success. A codesign approach was incorporated in this mixed methods cross-sectional study.

SETTING

Quaternary children's hospital network.

PATIENTS

Across three phases, 105 parents of children with neurological conditions, clinicians and advocacy group representatives participated.

INTERVENTIONS

A suite of psychoeducational resources about advanced therapeutics in clinical trials was codeveloped with parents and evaluated.

MAIN OUTCOME MEASURES

Acceptability, Appropriateness, and Feasibility of Intervention Measures, Preparedness for Decision-Making Scale, Decision Self-efficacy Scale and open-ended qualitative feedback.

RESULTS

The resources provide an acceptable, appropriate, credible and feasible source of information. Parents also established they help with preparedness and confidence in decision-making regarding the applications of neurotherapeutics.

CONCLUSIONS

This study and its results are aligned with, and supports, the needs and preferences of caregivers of children with neurological conditions, promoting information provision, healthcare engagement and clinical decision-making. These resources will form a foundation for accurate and contemporary scientific knowledge that is distilled and available to a wide range of stakeholders.

Combined use of the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework with other implementation frameworks: a systematic review

BACKGROUND

Appropriately and comprehensive applying implementation frameworks is one of the key challenges in implementation science resulting in increased use of multiple implementation frameworks within projects. This is particularly true for frameworks such as PARIHS/i-PARIHS. Therefore, this systematic review aimed to examine if and why the PARIHS/i-PARIHS framework has been applied in research with other implementation frameworks.

METHODS

We searched six databases from 2016 (the year following i-PARIHS' publication) to April 2024 and supplemented this with a citation search of the seminal i-PARIHS paper. We included studies that 1) were peer-reviewed with a protocol or empirical study design, 2) have applied the PARIHS or i-PARIHS framework for implementation planning, delivery, analysis, or evaluation and 3) also used at least one other implementation framework. Descriptive statistics were conducted to report on study characteristics and frequency for each implementation framework used with PARIHS/i-PARIHS. A qualitative, content analysis was used to analyse the answers to open-ended extraction questions.

RESULTS

Thirty-six articles met criteria for inclusion and included 16 protocols and 20 empirical articles (twelve intervention and eight cross-sectional studies). Thirty-four of the studies used one additional implementation framework and two studies used two additional implementation frameworks. In total, nine implementation frameworks were applied with PARIHS/i-PARIHS, including: 1) RE-AIM, 2) CFIR, 3) NPT, 4) REP, 5) TDF, 6), DSF, 7) KTA, 8) Stetler's Model, and 9) SIF. Thirty-four reported a rationale for using PARIHS/i-PARIHS and 34 reported a rationale for using the other implementation framework. Only eleven reported a rationale for using more than one implementation framework. Only three reported strengths of combining implementation frameworks.

CONCLUSIONS

Overall, this review identified that implementation researchers are using PARIHS/i-PARIHS in combination with other implementation frameworks and providing little to no rationale for why. Use of multiple implementation frameworks without detailed rationales compromises our ability to evaluate mechanisms of effectiveness. Implementation researchers and practitioners need to be more explicit about their framework selection, detailing the complementary strengths of the frameworks that are being used in combination, including why using one is not sufficient.

TRIAL REGISTRATION

This systematic review was registered with PROSPERO: ID: 392147.