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Iwelunmor J, Ogedegbe G, Dulli L, Aifah A, Nwaozuru U, Obiezu-Umeh C, Onakomaiya D, Rakhra A, Mishra S, Colvin CL, Adeoti E, Badejo O, Murray K, Uguru H, Shedul G, Hade EM, Henry D, Igbong A, Lew D, Bansal GP, Ojji D. Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria. Implement Sci Commun 2023; 4:47. [PMID: 37143131 PMCID: PMC10157928 DOI: 10.1186/s43058-023-00425-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities' capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities' readiness to implement TASSH among PLHIV in Nigeria. METHODS This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. FINDINGS Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1-5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11-30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. CONCLUSION Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. TRIAL REGISTRATION NCT05031819.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA.
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa Dulli
- Family Health International 360, Durham, USA
| | - Angela Aifah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Ashlin Rakhra
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Shivani Mishra
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Calvin L Colvin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ebenezer Adeoti
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | | | - Kate Murray
- Family Health International 360, Durham, USA
| | - Henry Uguru
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Erinn M Hade
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Henry
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ayei Igbong
- Family Health International 360, Durham, USA
| | - Daphne Lew
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | | | - Dike Ojji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Abuja, Nigeria
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Niknam M, Omidvar N, Amiri P, Eini-Zinab H, kalantari N. Adapting the Community Readiness Model and Validating a Community Readiness Tool for Childhood Obesity Prevention Programs in Iran. J Prev Med Public Health 2023; 56:77-87. [PMID: 36746425 PMCID: PMC9925285 DOI: 10.3961/jpmph.22.409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES It is critical to assess community readiness (CR) when implementing childhood obesity prevention programs to ensure their eventual success and sustainability. Multiple tools have been developed based on various conceptions of readiness. One of the most widely used and flexible tools is based on the community readiness model (CRM). This study aimed to adapt the CRM and assess the validity of a community readiness tool (CRT) for childhood obesity prevention programs in Iran. METHODS A Delphi study that included 26 individuals with expertise in 8 different subject areas was conducted to adapt the CRM into a theoretical framework for developing a CRT. After linguistic validation was conducted for a 35-question CR interview guide, the modified interview guide was evaluated for its content and face validity. The quantitative and qualitative analyses were performed using Stata version 13 and MAXQDA 2010, respectively. RESULTS The Delphi panelists confirmed the necessity/appropriateness and adequacy of all 6 CRM dimensions. The Persian version of the interview guide was then modified based on the qualitative results of the Delphi study, and 2 more questions were added to the community climate dimension of the original CRT. All questions in the modified version had acceptable content and face validity. The final CR interview guide included 37 questions across 6 CRM dimensions. CONCLUSIONS By adapting the CRM and confirming linguistic, content, and face validity, the present study devised a CRT for childhood obesity prevention programs that can be used in relevant studies in Iran.
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Affiliation(s)
- Mahdieh Niknam
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Omidvar
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Corresponding author: Nasrin Omidvar, Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, West Arghavan Street, Shahrak Qods, Tehran 1981629573, Iran E-mail:
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Co-corresponding author: Parisa Amiri, Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Velenjak Street, Shahid Chamran Highway, Tehran 1985717413, Iran E-mail:
| | - Hassan Eini-Zinab
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Naser kalantari
- Department of Community Nutrition, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Walker JR, Anding JD, Dudensing RM, Lavinghouze SR, Jauregui V, Coats K. From Evidence-Based Implementation Guides to Meaningful Action: Public Health Practitioners Use Readiness Assessments to Build Bridges to Successful Community Prevention Implementation. Health Promot Pract 2022; 23:118S-127S. [PMID: 36374596 PMCID: PMC10861172 DOI: 10.1177/15248399221116308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Readiness has been cited as a determining factor in whether a community can effectively implement, support, and sustain an initiative. Through readiness assessments and technical assistance, public health practitioners can be the bridge between the gap of reaching goals outlined in Healthy People 2030, or another funder's guides, and actionable, successful, implementation. Readiness assessments are practical tools for implementing change in public health. Here we discuss three readiness assessment activities that we developed for four Texas counties: a partnership mapping tool, an Ease and Impact score, and a round table discussion. Through the assessments, we ascertained both readiness and the relevance of Policy, Systems and Environment opportunities. We used readiness assessments to translate our funder's implementation guide to meet the needs of four counties. Data allowed us to determine whether communities were ready to move forward with minimal technical assistance, needed further assessment to better understand relevance and feasibility within the community to implement the initiative, or whether this opportunity was not a good fit at the time. We adapted readiness tools based on components of the R = MC2 framework so we could assess the readiness (motivation [M]; general organizational capacity [C]; and innovation-specific capacities [C]) of the participant groups and based on that assessment, we provided appropriate, tailored technical assistance. Public health practitioners and local supporters can use readiness tools and technical assistance to build a bridge from implementation guide(s) to effective community program implementation.
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Affiliation(s)
| | - Jenna D. Anding
- Texas A&M AgriLife Extension Service, College Station, TX, USA
| | | | | | | | - Kelsey Coats
- Texas A&M AgriLife Extension Service, College Station, TX, USA
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Livet M, Blanchard C, Richard C. Readiness as a precursor of early implementation outcomes: an exploratory study in specialty clinics. Implement Sci Commun 2022; 3:94. [PMID: 36057722 PMCID: PMC9441080 DOI: 10.1186/s43058-022-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Readiness has been identified as an essential precursor of successful implementation. However, evidence supporting its value is sparse. Empirical studies exploring the relationship between the application of readiness interventions, readiness levels, and implementation outcomes are lacking. The purpose of this study was twofold: (1) to evaluate the effectiveness of a readiness intervention (based on increases in readiness levels, changes in early implementation outcomes (i.e., acceptability, appropriateness, feasibility, and intent to adopt), and qualitative insights into the types of perceived outcomes) and (2) to assess the role of readiness as a predictor of these early implementation outcomes.
Methods
Seven healthcare specialty clinics engaged in a structured process to assess and build readiness for implementing a comprehensive medication management (CMM) service over a 10-month period. A mixed methods approach, which included surveys with healthcare stakeholders at each clinic (N = 27) and interviews with the lead pharmacists (N = 7), was used to evaluate the effectiveness of the readiness intervention (aim 1). Survey data were also used to conduct multiple regression models to assess the role of readiness as a predictor of early acceptability, appropriateness, feasibility, and intent to adopt CMM (aim 2).
Results
Significantly higher readiness levels, as well as higher scores on acceptability, appropriateness, feasibility, and intent to adopt, were reported as a result of engaging in the readiness intervention. However, upon closer examination, the direction of this association seemed to be dependent on the type of clinic. Qualitative data on the types of perceived outcomes resulting from engaging in the readiness intervention provided further insights into the potential reasons for these findings. Furthermore, post-readiness levels predicted between 44 and 68% of the variance in the early implementation outcomes. When accounting for clinic membership, readiness remained critical for service acceptability, feasibility, and intent to adopt but not for appropriateness.
Conclusion
These findings provide insights into the relationship between use of a readiness intervention, readiness levels, and early implementation outcomes. Engaging healthcare settings in a readiness intervention was beneficial in ways more complex than a simple positive linear relationship, highlighting the opportunity to broaden its purpose and expand definitions of readiness success. In addition, the importance of readiness levels in predicting early implementation outcomes, while critical, also seems to be highly dependent on context, particularly for appropriateness (fit).
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Domlyn AM, Crowder C, Eisenson H, Pollak KI, Davis JM, Calhoun PS, Wilson SM. Implementation mapping for tobacco cessation in a federally qualified health center. Front Public Health 2022; 10:908646. [PMID: 36117603 PMCID: PMC9478793 DOI: 10.3389/fpubh.2022.908646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/04/2022] [Indexed: 01/22/2023] Open
Abstract
Background Implementation mapping (IM) is a promising five-step method for guiding planning, execution, and maintenance of an innovation. Case examples are valuable for implementation practitioners to understand considerations for applying IM. This pilot study aimed to determine the feasibility of using IM within a federally qualified health center (FQHC) with limited funds and a 1-year timeline. Methods An urban FQHC partnered with an academic team to employ IM for implementing a computerized strategy of tobacco cessation: the 5A's (Ask, Advise, Assess, Assist, Arrange). Each step of IM was supplemented with theory-driven methods and frameworks. Data collection included surveys and interviews with clinic staff, analyzed via rapid data analysis. Results Medical assistants and clinicians were identified as primary implementers of the 5A's intervention. Salient determinants of change included the perceived compatibility and relative priority of 5A's. Performance objectives and change objectives were derived to address these determinants, along with a suite of implementation strategies. Despite indicators of adoptability and acceptability of the 5A's, reductions in willingness to adopt the implementation package occurred over time and the intervention was not adopted by the FQHC within the study timeframe. This is likely due to the strain of the COVID-19 pandemic altering health clinic priorities. Conclusions Administratively, the five IM steps are feasible to conduct with FQHC staff within 1 year. However, this study did not obtain its intended outcomes. Lessons learned include the importance of re-assessing barriers over time and ensuring a longer timeframe to observe implementation outcomes.
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Affiliation(s)
- Ariel M. Domlyn
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
| | | | - Howard Eisenson
- Lincoln Community Health Center, Durham, NC, United States
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
| | - Kathryn I. Pollak
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
| | - James M. Davis
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Patrick S. Calhoun
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Sarah M. Wilson
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Duke Cancer Institute, Duke University Health System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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Brown LD, Wells R, Chilenski SM. Initial conditions and functioning over time among community coalitions. EVALUATION AND PROGRAM PLANNING 2022; 92:102090. [PMID: 35462341 PMCID: PMC9340962 DOI: 10.1016/j.evalprogplan.2022.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/12/2022] [Accepted: 04/17/2022] [Indexed: 06/03/2023]
Abstract
Developing operationally strong community coalitions is critical to actualizing their potential for public health improvement. The purpose of this study was to measure how substance use prevention coalitions in Mexico functioned across their first 1.5 years, and to test associations between initial community contextual factors and subsequent coalition functioning and outcomes. Members of 19 coalitions participated in three waves of surveys about coalition context and functioning. We used paired t-tests to assess changes in coalition functioning and outcomes. Regression models estimated associations between coalition functioning and outcomes and initial community context. Among coalition functioning factors, over coalitions' first 1.5 years, member engagement increased, as did coordinator skill and participatory leadership style. Two initial community context factors - community support for prevention and community champions - predicted several measures of process competence, but only community champions predicted perceived community improvement. Thus, community champions may play a pivotal role in later coalition success. The observed increases in member engagement and process competence may support subsequent coalition sustainability, a crucial component to realizing their potential impact on public health.
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Affiliation(s)
- Louis D Brown
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston, School of Public Health, 5130 Gateway East Blvd., El Paso, TX 79903, USA.
| | - Rebecca Wells
- Department of Management, Policy, and Community Health, The University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Street, Houston, TX 77030, USA.
| | - Sarah Meyer Chilenski
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 314 Bio Behavioral Health Building, University Park, PA 16802, USA.
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Kenworthy T, Domlyn A, Scott VC, Schwartz R, Wandersman A. A Proactive, Systematic Approach to Building the Capacity of Technical Assistance Providers. Health Promot Pract 2022; 24:546-559. [PMID: 35301898 DOI: 10.1177/15248399221080096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technical assistance (TA) is a major capacity building strategy used by the government sector to promote health outcomes in the United States. However, there is minimal literature about how to develop TA provider capacities. This article describes a systematic and proactive approach for developing TA provider capacity, referred to as Technical Assistance for Technical Assistance Providers (TAFTAP), which draws on three implementation science frameworks (Interactive Systems Framework for Dissemination and Implementation, Getting To Outcomes, and R = MC2). We present an application of TAFTAP within a federal agency providing a readiness-informed TA approach to health departments of states, territories, and tribal areas implementing comprehensive tobacco prevention control programs. Pilot data suggest that TAFTAP is a promising approach for improving the quality of TA delivery. At the end of the 2-year project period, TAFTAP recipients provided generally positive qualitative feedback about the support they received. They chose to sustain the readiness-informed TA by incorporating it into a future funding announcement. Downstream state-level TA grantee recipients reported positive outcomes (e.g., accelerated progress, enjoying more one-on-one time with TA providers) from receiving the TA innovation from TAFTAP recipients. We suggest that funding agencies and training and TA centers consider this approach to bolster the capacity and motivation of TA providers for downstream benefit to health and human services staff and their clients. Practical steps for employing TAFTAP to advance health outcomes are included in this article.
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Affiliation(s)
- Tara Kenworthy
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
| | - Ariel Domlyn
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
| | - Victoria C Scott
- The University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Abraham Wandersman
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
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Woodward EN, Willging C, Landes SJ, Hausmann LRM, Drummond KL, Ounpraseuth S, Ball IA, Kirchner JE. Determining feasibility of incorporating consumer engagement into implementation activities: study protocol of a hybrid effectiveness-implementation type II pilot. BMJ Open 2022; 12:e050107. [PMID: 35042705 PMCID: PMC8768923 DOI: 10.1136/bmjopen-2021-050107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement in healthcare implementation, partially because no formal guidance exists. We will create and pilot a toolkit of methods to engage consumers from the US' Veterans Health Administration (VHA) in selecting and tailoring implementation strategies. This toolkit, Consumer Voice, will provide guidance on what, when, where, how and why an implementer might engage consumers in implementing treatments. We will pilot the toolkit by implementing Safety Planning Intervention for suicide prevention with rural veterans, a population with suicide disparities. Safety Planning Intervention is effective for reducing suicidal behaviours. METHODS AND ANALYSIS In Aim 1, we will use participatory approaches and user-centred design to develop Consumer Voice and its methods. In Aim 2, we will pilot Consumer Voice by implementing the Safety Planning Intervention in two clinics serving rural VHA patients. One site will receive a current implementation strategy (Implementation Facilitation) only; the second will receive Implementation Facilitation plus Consumer Voice. We will use mixed methods to assess feasibility and acceptability of Consumer Voice. We will compare sites on preliminary implementation (reach, adoption, fidelity) and clinical outcomes (depression severity, suicidal ideation, suicidal behaviour). In Aim 3, we will evaluate Aim 2 outcomes at 20 months to assess sustained impact. We will gather qualitative data on sustainability of the Safety Planning Intervention. ETHICS AND DISSEMINATION These studies are overseen by the Institutional Review Board at the Central Arkansas Veterans Healthcare System. We plan to use traditional academic modalities of dissemination (eg, conferences, publications). We plan to disseminate findings through meetings with other trainers in implementation practice so they may adopt Consumer Voice. We plan to share results with local community boards.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, New Mexico, USA
| | - Sara J Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - Leslie R M Hausmann
- Department of Medicine, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Karen L Drummond
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Irenia A Ball
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas, USA
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Assessing Firm Readiness to Adopt Cluster-Based Innovative Projects: A Segmentation Analysis. SUSTAINABILITY 2022. [DOI: 10.3390/su14020947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As innovation has garnered substantial attention on corporate success and sustainability, organizations must evaluate internal contexts to determine potential innovative practices and benefits. Firms need to investigate the determining factors of innovation preparedness as organizational innovation practices are catalyzed through internal elements. This study evaluates small and medium firms’ readiness to adopt and execute collaborative innovative projects within a future cluster and its impacts on organizational advantages, intentions, and attributes. Thereby, three dimensions were considered in examining organizational preparedness, namely, climate, culture, and motivation. A total of 70 firms operating in the labeled agri-food sector in Morocco were interviewed and homogenously classified using integrated hierarchical and non-hierarchical algorithms, following a segmentation approach. Three segments were identified, stressing the degree of organizational readiness to undertake innovative projects within future service clusters. The segments varied according to the firm’s sub-sector, experience, and resources. Considering the association of readiness with benefits and practical aims, the results broaden firm preparedness understanding to adopt innovative projects. The results also illustrate the relevance of adapting both innovative and beneficial project arrangements for firms with minor to moderate experience while addressing current issues across different segments.
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Scheid JM, Sarinopoulos I, Cameron S, Tanner C. Learning Collaborative Events With Child Welfare and Health Care Providers Improve Systems Knowledge and Intent to Change. J Prim Care Community Health 2021; 12:21501327211048359. [PMID: 34632856 PMCID: PMC8512211 DOI: 10.1177/21501327211048359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Children in foster care are at higher risk of health problems. These risks
present challenges to achieving permanency, safety, and well-being. Despite
efforts to improve the systems serving children in foster care, gaps remain
in achieving timely and quality health services. Based on stakeholder
reports that health care provider knowledge about child welfare systems is a
barrier to care, the Fostering Health Partnerships project conducted
2-session learning collaborative events across Michigan. The project team
hypothesized that participants would increase knowledge of child welfare
policy and that physician participants would identify and commit to practice
change to improve health care services to children in foster care. Methods: Learning collaborative events included an in-person session followed by a
live webinar session. Participants included child welfare professionals,
physicians, and other health care representatives. Participants completed
surveys assessing knowledge about child welfare health policy. Physician
participants completed a post-event interview. The investigators used pre-
and post-intervention survey design and qualitative evaluation of physician
interview data to assess the impact of the learning collaborative events on
knowledge and practice. Results: A total of 781 individuals attended the initial session and 383 attended the
second session of 36 events for 80 counties in Michigan. 247 individuals
completed pre- and post-event surveys and 7 physicians completed interviews
after the events. Survey data showed that event participants demonstrated
increased knowledge of child welfare policy related to health
(P < .001). Interviewed physicians reported making
practice changes to improve health care services and indicated that the
events were valuable though time intensive. Conclusion: An abbreviated learning collaborative process is an effective tool to improve
knowledge and drive practice change. Future efforts will build on this
project to improve access, coordination, and quality health services for
children in foster care.
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Affiliation(s)
| | | | - Sierra Cameron
- Michigan Chapter, American Academy of Pediatrics, Lansing, MI, USA
| | - Clare Tanner
- Michigan Public Health Institute, Okemos, MI, USA
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Domlyn AM, Scott V, Livet M, Lamont A, Watson A, Kenworthy T, Talford M, Yannayon M, Wandersman A. R = MC 2 readiness building process: A practical approach to support implementation in local, state, and national settings. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1228-1248. [PMID: 33778968 DOI: 10.1002/jcop.22531] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
Effective implementation of evidence-based interventions is a persistent challenge across community settings. Organizational readiness - or, the motivation and collective capacity of an entity to adopt and sustain an innovation - is important to facilitate implementation. Drawing on the R = MC2 readiness framework, we developed a readiness building process to tailor support for implementation. The process is composed of the following stages: assessment, feedback and prioritization, and strategize. In this article, we describe the application of the readiness building process through three case examples representing interventions at different ecological levels: local, state, and national. The case examples illuminate challenges and practical considerations for using the readiness building process, including the significance of on-going leadership engagement and collaboration between support system and delivery system staff. To further the research and practice of implementation readiness, we suggest examining the impact of readiness building on implementation outcomes and developing an empirically-informed repository of change management strategies matched to readiness constructs.
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Affiliation(s)
- Ariel M Domlyn
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Wandersman Center, Columbia, South Carolina, USA
| | - Victoria Scott
- Wandersman Center, Columbia, South Carolina, USA
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Melanie Livet
- Wandersman Center, Columbia, South Carolina, USA
- Division of Practice Advancement and Clinical Education, Center for Medication Optimization (CMO), UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrea Lamont
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Wandersman Center, Columbia, South Carolina, USA
| | - Amber Watson
- Wandersman Center, Columbia, South Carolina, USA
| | - Tara Kenworthy
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Wandersman Center, Columbia, South Carolina, USA
| | | | - Mary Yannayon
- Division of Practice Advancement and Clinical Education, Center for Medication Optimization (CMO), UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abraham Wandersman
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
- Wandersman Center, Columbia, South Carolina, USA
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Vax S, Farkas M, Russinova Z, Mueser KT, Drainoni ML. Enhancing organizational readiness for implementation: constructing a typology of readiness-development strategies using a modified Delphi process. Implement Sci 2021; 16:61. [PMID: 34112191 PMCID: PMC8194182 DOI: 10.1186/s13012-021-01132-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Knowledge about the development of organizational readiness for implementation (ORI) is limited. ORI, referred to as the willingness and capacity of all relevant stakeholders to change practice, is critical for increasing the adoption rate of evidence-based practices and improving implementation outcomes. However, no methodology currently guides ORI's enhancement or addresses differences in readiness needs across an organization. This study used the transtheoretical model (TTM) as a framework for classifying a well-established compilation of implementation strategies into three readiness stages: pre-contemplation, contemplation, and preparation. METHODS A modified Delphi method was used to establish consensus among a panel of purposefully selected research and field implementation experts. The Delphi process involved three rounds of online questionnaires. The third round also included a live video discussion to clarify definitions in an effort to increase consensus among experts. RESULTS Of the 73 strategies reviewed, the experts identified 75% (n = 55) as relevant for pre-implementation and reached a high-level agreement on the assignment of 7% (n = 5) of the strategies to the pre-contemplation stage (ORI-1), 25% (n = 18) to the contemplation stage (ORI-2), and 52% (n = 38) to the preparation stage (ORI-3). Several strategies were identified as relevant to more than one stage. CONCLUSIONS Participating experts were able to reach high-level agreement on the relevance of specific sets of implementation strategies to each of the three ORI stages. The lowest number of strategies was assigned to ORI-1 and the highest number to ORI-3. Given the overlap of strategies across ORI stages, there is a need to better understand the specific utilization of such strategies at different stages. Future studies are needed to empirically evaluate the relevance and applicability of this expert-informed typology based on implementers' experiences in the field.
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Affiliation(s)
- Sigal Vax
- Rehabilitation Sciences Program, College of Health & Rehabilitation, Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA, 02215, USA.
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA.
| | - Marianne Farkas
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA
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Kolodny-Goetz J, Hamm DW, Cook BS, Wandersman A. The Readiness, Resilience and Recovery Tool: An Emerging Approach to Enhance Readiness Amidst Disruption. ACTA ACUST UNITED AC 2021; 1:135-146. [PMID: 34622213 PMCID: PMC8116638 DOI: 10.1007/s43477-021-00011-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/24/2021] [Indexed: 12/01/2022]
Abstract
Disruptions of varying severity often occur in the course of an organization’s work to implement new programs or projects. These disruptions may slow their progress or even derail the work altogether. Resilient organizations must be prepared to respond in a thoughtful and timely way to disruptions. Readiness, Resilience and Recovery is an adaptable readiness assessment tool that organizations can use to proceed with their work with insight about their readiness status and how their readiness has been impacted by a disruption. The resulting information can then be used to guide the development of solutions for recovery and build the organization’s overall capacity for resilience. Based on our early experience, the Readiness, Resilience and Recovery approach is emerging as a tool that can be useful when organizations face significant disruptions. We have found it to be adaptable to different types of projects, at various points in the implementation cycle, and with multiple types of disruptions. To demonstrate its use, this illustrative paper provides five examples from different projects and settings: Substance Abuse Treatment Services, Multi-Site Sexual Assault Prevention Initiative, Serve and Connect (a Police-Community Relationships Initiative), Carolina Family Engagement Center (family engagement in schools), and Action for Equity (an equity intervention). Practical uses of the tool and conceptualizing it within important implementation science concepts are discussed.
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Zlateva I, Schiessl A, Khalid N, Bamrick K, Flinter M. Development and validation of the Readiness to Train Assessment Tool (RTAT). BMC Health Serv Res 2021; 21:396. [PMID: 33910561 PMCID: PMC8082650 DOI: 10.1186/s12913-021-06406-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, health centers in the United States have embraced the opportunity to train the next generation of health professionals. The uniqueness of the health centers as teaching settings emphasizes the need to determine if health professions training programs align with health center priorities and the nature of any adjustments that would be needed to successfully implement a training program. We sought to address this need by developing and validating a new survey that measures organizational readiness constructs important for the implementation of health professions training programs at health centers where the primary role of the organizations and individuals is healthcare delivery. METHODS The study incorporated several methodological steps for developing and validating a measure for assessing health center readiness to engage with health professions programs. A conceptual framework was developed based on literature review and later validated by 20 experts in two focus groups. A survey-item pool was generated and mapped to the conceptual framework and further refined and validated by 13 experts in three modified Delphi rounds. The survey items were pilot-tested with 212 health center employees. The final survey structure was derived through exploratory factor analysis. The internal consistency reliability of the scale and subscales was evaluated using Chronbach's alpha. RESULTS The exploratory factor analysis revealed a 41-item, 7-subscale solution for the survey structure, with 72% of total variance explained. Cronbach's alphas (.79-.97) indicated high internal consistency reliability. The survey measures: readiness to engage, evidence strength and quality of the health professions training program, relative advantage of the program, financial resources, additional resources, implementation team, and implementation plan. CONCLUSIONS The final survey, the Readiness to Train Assessment Tool (RTAT), is theoretically-based, valid and reliable. It provides an opportunity to evaluate health centers' readiness to implement health professions programs. When followed with appropriate change strategies, the readiness evaluations could make the implementation of health professions training programs, and their spread across the United States, more efficient and cost-effective. While developed specifically for health centers, the survey may be useful to other healthcare organizations willing to assess their readiness to implement education and training programs.
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Affiliation(s)
- Ianita Zlateva
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA.
| | - Amanda Schiessl
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA
| | - Nashwa Khalid
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA
| | - Kerry Bamrick
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA
| | - Margaret Flinter
- Weitzman Institute, Community Health Center, Inc., Middletown, CT, USA
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Bast LS, Andersen HB, Andersen A, Lauemøller SG, Bonnesen CT, Krølner RF. School Coordinators' Perceptions of Organizational Readiness Is Associated with Implementation Fidelity in a Smoking Prevention Program: Findings from the X:IT II Study. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:312-323. [PMID: 33404969 PMCID: PMC8032573 DOI: 10.1007/s11121-020-01197-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
School organizational readiness to implement interventions may play an important role for the actual obtained implementation level, and knowledge about organizational readiness prior to intervention start can help pinpoint how to optimize support to the schools. In this study, we applied a novel heuristic, R = MC2 to assess school organizational readiness prior to implementation of a multicomponent smoking prevention program. Furthermore, we examined the association to actual implementation after the first year of study. We used questionnaire data from school coordinators at 40 schools in Denmark who had accepted to implement the multi-component smoking prevention intervention-X:IT II-in the school year 2017-2018 including three main components: (1) Rules on smoke-free school time, (2) A smoke-free curriculum, and (3) Parental involvement. On behalf of the school, a school coordinator answered a baseline questionnaire about the organizational readiness and a follow-up questionnaire about implementation of the three components after first year of study. Readiness was measured by summing aspects of motivation (relative advantage, compatibility, complexity, and priority), general capacity (culture, climate, and staff capacity), and innovation-specific capacity (knowledge, skills, and abilities). Based on school coordinators' perceptions, almost all schools had good general capacity while the other two areas of readiness varied across schools; overall, 56.8% of schools (N = 25) had good motivation for implementing the X:IT II intervention and 61.3% (N = 27) had high innovation-specific capacity. Half of the schools had high overall readiness defined as high motivation and high innovation-specific capacity. Schools with high overall readiness implemented the rules on smoke-free school time, smoke-free curriculum, and parental involvement to a higher degree than schools with low overall readiness. All participating schools possessed sufficient levels of general capacity, e.g., a well-functioning organizational culture and sufficient staff capacity. High levels of motivation and innovation-specific capacity were positively associated with the schools' actual implementation of the main intervention components. This way of conceptualizing and measuring organizational readiness may be useful in future studies, i.e., in studies where enhancing readiness is a main objective.
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Walker TJ, Brandt HM, Wandersman A, Scaccia J, Lamont A, Workman L, Dias E, Diamond PM, Craig DW, Fernandez ME. Development of a comprehensive measure of organizational readiness (motivation × capacity) for implementation: a study protocol. Implement Sci Commun 2020; 1:103. [PMID: 33292840 PMCID: PMC7656510 DOI: 10.1186/s43058-020-00088-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/19/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Organizational readiness is important for the implementation of evidence-based interventions. Currently, there is a critical need for a comprehensive, valid, reliable, and pragmatic measure of organizational readiness that can be used throughout the implementation process. This study aims to develop a readiness measure that can be used to support implementation in two critical public health settings: federally qualified health centers (FQHCs) and schools. The measure is informed by the Interactive Systems Framework for Dissemination and Implementation and R = MC2 heuristic (readiness = motivation × innovation-specific capacity × general capacity). The study aims are to adapt and further develop the readiness measure in FQHCs implementing evidence-based interventions for colorectal cancer screening, to test the validity and reliability of the developed readiness measure in FQHCs, and to adapt and assess the usability and validity of the readiness measure in schools implementing a nutrition-based program. METHODS For aim 1, we will conduct a series of qualitative interviews to adapt the readiness measure for use in FQHCs. We will then distribute the readiness measure to a developmental sample of 100 health center sites (up to 10 staff members per site). We will use a multilevel factor analysis approach to refine the readiness measure. For aim 2, we will distribute the measure to a different sample of 100 health center sites. We will use multilevel confirmatory factor analysis models to examine the structural validity. We will also conduct tests for scale reliability, test-retest reliability, and inter-rater reliability. For aim 3, we will use a qualitative approach to adapt the measure for use in schools and conduct reliability and validity tests similar to what is described in aim 2. DISCUSSION This study will rigorously develop a readiness measure that will be applicable across two settings: FQHCs and schools. Information gained from the readiness measure can inform planning and implementation efforts by identifying priority areas. These priority areas can inform the selection and tailoring of support strategies that can be used throughout the implementation process to further improve implementation efforts and, in turn, program effectiveness.
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Affiliation(s)
- Timothy J. Walker
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Heather M. Brandt
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208 USA
| | | | | | - Andrea Lamont
- Wandersman Center, 1512 Laurel St., Columbia, SC 29201 USA
| | - Lauren Workman
- Core for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 103, Columbia, SC 29210 USA
| | - Emanuelle Dias
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Pamela M. Diamond
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Derek W. Craig
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Maria E. Fernandez
- Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
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Livet M, Yannayon M, Richard C, Sorge L, Scanlon P. Ready, set, go!: exploring use of a readiness process to implement pharmacy services. Implement Sci Commun 2020; 1:52. [PMID: 32885208 PMCID: PMC7427920 DOI: 10.1186/s43058-020-00036-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background Readiness is an essential precursor of successful implementation; however, its conceptualization and application has proved elusive. R = MC2 operationalizes readiness for use in practice. The purpose of this study was to (1) describe the application of R = MC2 to assess and build readiness in nine healthcare sites responsible for implementing medication management services and (2) gain insights into the sites’ experience. Methods This mixed methods exploratory study used data collected as part of a process evaluation. Understanding application of the readiness process (Aim 1) involved examining team members’ involvement (who?), readiness challenges and readiness building strategies (what?), strategy execution (how much?), and resulting changes (for what purpose?). To understand the sites’ experience with the R = MC2 system (Aim 2), interviews were conducted with six of the sites to identify facilitators, barriers, and lessons learned. Data sources included a document review (e.g., sites’ action plans), survey results, and interview data. Results Sites included primary care and specialty clinics, pharmacies within health systems, and community pharmacies. Teams consisted of 4–11 members, including a lead pharmacist. The teams’ readiness activities clustered into five broad categories of readiness building strategies (e.g., building the operational infrastructure for service integration). Of the 34 strategies identified across sites, 68% were still in progress after 4 months. Engaging in the readiness process resulted in a number of outputs (e.g., data management systems) and benefits (e.g., an opportunity to ensure alignment of priorities and fit of the intervention). Based on the interviews, facilitators of the readiness process included assistance from a coach, internal support, and access to the readiness tools. Competing priorities and lack of resources, timely decision-making, and the timing of the readiness process were cited as barriers. The importance of service fit, stakeholder engagement, access to a structured approach, and rightsizing the readiness process emerged as lessons learned. Conclusions These findings provide valuable insights into the application of a readiness process. If readiness is to be integrated into routine practice as part of any implementation effort, it is critical to gain a better understanding of its application and value.
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Affiliation(s)
- Melanie Livet
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Mary Yannayon
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Chloe Richard
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Lindsay Sorge
- Alliance for Integrated Medication Management, Minneapolis, MN USA.,Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN USA
| | - Paul Scanlon
- Alliance for Integrated Medication Management, Minneapolis, MN USA.,Financial Transformations Inc., Fairfax, VA USA
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Williams CR, Bogdewic S, Owen MD, Srofenyoh EK, Ramaswamy R. A protocol for evaluating a multi-level implementation theory to scale-up obstetric triage in referral hospitals in Ghana. Implement Sci 2020; 15:31. [PMID: 32398109 PMCID: PMC7218616 DOI: 10.1186/s13012-020-00992-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/16/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Ghana significantly reduced maternal and newborn mortality between 1990 and 2015, largely through efforts focused on improving access to care. Yet achieving further progress requires improving the quality and timeliness of care. Beginning in 2013, Ghana Health Service and Kybele, a US-based non-governmental organization, developed an innovative obstetric triage system to help midwives assess, diagnosis, and determine appropriate care plans more quickly and accurately. In 2019, efforts began to scale this successful intervention into six additional hospitals. This protocol describes the theory-based implementation approach guiding scale-up and presents the proposed mixed-methods evaluation plan. METHODS An implementation theory was developed to describe how complementary implementation strategies would be bundled into a multi-level implementation approach. Drawing on the Interactive Systems Framework and Evidenced Based System for Implementation Support, the proposed implementation approach is designed to help individual facilities develop implementation capacity and also build a learning network across facilities to support the implementation of evidence-based interventions. A convergent design mixed methods approach will be used to evaluate implementation with relevant data drawn from tailored assessments, routinely collected process and quality monitoring data, textual analysis of relevant documents and WhatsApp group messages, and key informant interviews. Implementation outcomes of interest are acceptability, adoption, and sustainability. DISCUSSION The past decade has seen a rapid growth in the development of frameworks, models, and theories of implementation, yet there remains little guidance on how to use these to operationalize implementation practice. This study proposes one method for using implementation theory, paired with other kinds of mid-level and program theory, to guide the replication and evaluation of a clinical intervention in a complex, real-world setting. The results of this study should help to provide evidence of how implementation theory can be used to help close the "know-do" gap. Every woman and every newborn deserves a safe and positive birth experience. Yet in many parts of the world, this goal is often more aspiration than reality. In 2006, Kybele, a US-based non-governmental organization, began working with the Ghanaian government to improve the quality of obstetric and newborn care in a large hospital in Greater Accra. One successful program was the development of a triage system that would help midwives rapidly assess pregnant women to determine who needed what kind of care and develop risk-based care plans. The program was then replicated in another large hospital in the Greater Accra region, where a systematic theory to inform triage implementation was developed. This paper describes the extension of this approach to scale-up the triage program implementation in six additional hospitals. The scale-up is guided by a multi-level theory that extends the facility level theory to include cross-facility learning networks and oversight by the health system. We explain the process of theory development to implement interventions and demonstrate how these require the combination of local contextual knowledge with evidence from the implementation science literature. We also describe our approach for evaluating the theory to assess its effectiveness in achieving key implementation outcomes. This paper provides an example of how to use implementation theories to guide the development and evaluation of complex programs in real-world settings.
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Affiliation(s)
- Caitlin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephanie Bogdewic
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Medge D Owen
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Kybele, Inc., Lewisville, North Carolina, USA
| | | | - Rohit Ramaswamy
- Public Health Leadership and Maternal and Child Health, UNC/RTI Consortium for Implementation Science, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Hajjar L, Cook BS, Domlyn A, Ray KA, Laird D, Wandersman A. Readiness and Relationships Are Crucial for Coalitions and Collaboratives: Concepts and Evaluation Tools. ACTA ACUST UNITED AC 2020. [DOI: 10.1002/ev.20399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Carr T, Turner MW, Ramaswamy R. Scoping review study to identify how communities in the USA, Australia, New Zealand and Canada use quality improvement (QI) approaches to address community health and well-being. BMJ Open 2019; 9:e034302. [PMID: 31831551 PMCID: PMC6924873 DOI: 10.1136/bmjopen-2019-034302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Both US and global communities lag on key health indicators. There has been limited progress in building capacity to improve health beyond the healthcare field. Yet, communities also need to engage in health improvement initiatives. A substantial body of literature describes standards and core components for quality improvement (QI) approaches in clinical settings. This study aims to determine how communities in the USA, Australia, New Zealand and Canada use QI approaches for health and well-being improvement and how such approaches compare to those in clinical settings. METHODS AND ANALYSIS We developed a study protocol based on scoping review framework by Arksey and O'Malley, methodological advancements for scoping studies (Levac et al ) and other published protocols. We developed research questions in an iterative process and used the Population, Intervention, Comparison, Outcomes strategy to determine eligibility criteria. Electronic databases deemed appropriate (Web of Science, Scopus, and Proquest Health Management) will be searched for studies that meet inclusion criteria. References of included studies will be included when relevant. Two reviewers will independently screen all abstracts and full-text studies for inclusion. A third reviewer will adjudicate disagreements that arise. An instrument will be developed to extract data from included studies. Quantitative and qualitative results will be reported. ETHICS AND DISSEMINATION We developed this protocol to systematically conduct a scoping review of how US communities use QI approaches to address community health and well-being. Results will benefit multiple stakeholders by informing how to better support, design and evaluate community well-being improvement interventions. Results will be distributed through peer-reviewed journals, conferences, presentations and a public health graduate course.
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Affiliation(s)
- Tara Carr
- Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mallory Wolfe Turner
- Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Rohit Ramaswamy
- Public Health Leadership and Maternal and Child Health, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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