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Mustafa NK, Ibrahim R, Awang Z, Aizuddin AN, Syed Junid SMA. Validation of a quantitative instrument measuring critical success factors and acceptance of Casemix system implementation in the total hospital information system in Malaysia. BMJ Open 2024; 14:e082547. [PMID: 39182935 DOI: 10.1136/bmjopen-2023-082547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
OBJECTIVES This study aims to address the significant knowledge gap in the literature on the implementation of Casemix system in total hospital information systems (THIS). The research focuses on validating a quantitative instrument to assess medical doctors' acceptance of the Casemix system in Ministry of Health (MOH) Malaysia facilities using THIS. DESIGNS A sequential explanatory mixed-methods study was conducted, starting with a cross-sectional quantitative phase using a self-administered online questionnaire that adapted previous instruments to the current setting based on Human, Organisation, Technology-Fit and Technology Acceptance Model frameworks, followed by a qualitative phase using in-depth interviews. However, this article explicitly emphasises the quantitative phase. SETTING The study was conducted in five MOH hospitals with THIS technology from five zones. PARTICIPANTS Prior to the quantitative field study, rigorous procedures including content, criterion and face validation, translation, pilot testing and exploratory factor analysis (EFA) were undertaken, resulting in a refined questionnaire consisting of 41 items. Confirmatory factor analysis (CFA) was then performed on data collected from 343 respondents selected via stratified random sampling to validate the measurement model. RESULTS The study found satisfactory Kaiser-Meyer-Olkin model levels, significant Bartlett's test of sphericity, satisfactory factor loadings (>0.6) and high internal reliability for each item. One item was eliminated during EFA, and organisational characteristics construct was refined into two components. The study confirms unidimensionality, construct validity, convergent validity, discriminant validity and composite reliability through CFA. After the instrument's validity, reliability and normality have been established, the questionnaire is validated and deemed operational. CONCLUSION By elucidating critical success factor and acceptance of Casemix, this research informs strategies for enhancing its implementation within the THIS environment. Moving forward, the validated instrument will serve as a valuable tool in future research endeavours aimed at evaluating the adoption of the Casemix system within THIS, addressing a notable gap in current literature.
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Affiliation(s)
- Noor Khairiyah Mustafa
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia Fakulti Perubatan, Cheras, Federal Territory of Kuala Lumpur, Malaysia
- Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Roszita Ibrahim
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia Fakulti Perubatan, Cheras, Federal Territory of Kuala Lumpur, Malaysia
| | - Zainudin Awang
- Faculty of Business Management, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Azimatun Noor Aizuddin
- Department of Public Health Medicine, Universiti Kebangsaan Malaysia Fakulti Perubatan, Cheras, Federal Territory of Kuala Lumpur, Malaysia
- International Casemix Centre (ITCC), Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid Syed Junid
- Department of Public Health and Community Medicine, International Medical University, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia
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Kakumanu S, Szefler S, Pappalardo AA, Sales AE, Baptist AP, Stern J, Nyenhuis SM. Applying the dissemination and implementation sciences to allergy and immunology: A Work Group Report from the AAAAI Quality, Adherence, and Outcomes Committee. J Allergy Clin Immunol 2024:S0091-6749(24)00745-0. [PMID: 39162669 DOI: 10.1016/j.jaci.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 06/04/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024]
Abstract
Translating evidence-based practice (EBP) into real-world clinical settings often takes a considerable amount of time and resources. In allergy and immunology, the dissemination and implementation (D&I) sciences facilitate the study of how variations in knowledge, resources, patient populations, and staffing models lead to differences in the clinical care of asthma, allergic disease, and primary immunodeficiency. Despite the need for validated approaches to study how to best apply EBP in the real world, the D&I sciences are underutilized. To address this gap, an American Academy of Allergy, Asthma & Immunology (AAAAI) work group was convened to provide an overview for the role of the D&I sciences in clinical care and future research within the field. For the D&I sciences to be leveraged effectively, teams should be multidisciplinary and inclusive of community and clinical partners, and multimethods approaches to data collection and analyses should be used. Used appropriately, the D&I sciences provide important tools to promote EBP and health equity as well as optimization of clinical practice in allergy and immunology.
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Affiliation(s)
- Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health, Madison, Wis; William S. Middleton Veterans Memorial Hospital, Madison, Wis.
| | - Stanley Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Andrea A Pappalardo
- Departments of Medicine and Pediatrics, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, Ill
| | - Anne E Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, Mo; Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Mich
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Mich
| | - Jessica Stern
- Division of Allergy, Immunology, and Rheumatology, Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy, Immunology, and Pulmonology, University of Chicago, Chicago, Ill
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Garner BR, Tueller SJ, Bradshaw M, Speck KJ, Satre D, Rash C, Donohoe T, Mungo J, Philbrick S, Ruwala R, Roosa MR, Zehner M, Ii JHF. Testing the incremental effectiveness of pay-for-performance to improve implementation of a motivational interviewing brief intervention for substance use disorders in HIV settings: Results of a parallel cluster-randomized type 3 hybrid trial. RESEARCH SQUARE 2024:rs.3.rs-4614222. [PMID: 39149465 PMCID: PMC11326404 DOI: 10.21203/rs.3.rs-4614222/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Background: Substance use disorders (SUDs) have a serious adverse impact on the physical and mental well-being of people with HIV. Previously, using a 39-site dual-randomized type 2 hybrid trial design, findings from the Substance Abuse Treatment to HIV Care Project supported the Implementation and Sustainment Facilitation (ISF) strategy to improve implementation and effectiveness of a motivational interviewing brief intervention (MIBI) for SUD within HIV service settings across the United States (US). Building on this trial, this parallel cluster-randomized type 3 hybrid trial aimed to test the incremental effectiveness of a pay-for-performance (P4P), a form of the "alter incentive/allowance structures" strategy. Methods: Twenty-six HIV service organizations, their staff participants (N=87), and their client participants (N=341) were cluster-randomized to one of two implementation conditions. The control condition included staff-focused training, feedback, and consultation (TFC) and team-focused implementation and sustainment (ISF). The experimental condition included TFC+ISF as well as P4P (TFC+ISF+P4P). P4P used financial incentives to reward MIBI implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined. Results: The addition of P4P had a large and significant effect on the number of MIBIs implemented ( d =1.30, p<.05) and reduction in anxiety ( d= -1.54), but there was no impact on days of substance use. P4P had large effects on MIBI quality ( d =1.24) and MIBI implementation effectiveness ( d =1.28), but these were not significant ( p <.10). Conclusions: P4P is a form of the "alter incentive/allowance structures" strategy. Its function is to reward the implementation of a clinical innovation. Rewarding implementation is consistent with the theory of implementation effectiveness, which suggests implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key antecedent of implementation effectiveness (i.e., the consistency and quality of implementation). We found that P4P had a significant, positive impact on MIBI implementation in HIV service settings, but client-level outcomes were mixed. Future research should examine the effectiveness of the P4P strategy to improve implementation and sustainment of other evidence-based innovations. Trial registration: ClinicalTrials.gov: NCT04687917. Registered 12/18/2020.
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McKay HA, Kennedy SG, Macdonald HM, Naylor PJ, Lubans DR. The Secret Sauce? Taking the Mystery Out of Scaling-Up School-Based Physical Activity Interventions. J Phys Act Health 2024; 21:731-740. [PMID: 38936808 DOI: 10.1123/jpah.2024-0274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 06/29/2024]
Abstract
Over the last 4 decades, physical activity researchers have invested heavily in determining "what works" to promote healthy behaviors in schools. Single and multicomponent school-based interventions that target physical education, active transportation, and/or classroom activity breaks effectively increased physical activity among children and youth. Yet, few of these interventions are ever scaled-up and implemented under real-world conditions and in diverse populations. To achieve population-level health benefits, there is a need to design school-based health-promoting interventions for scalability and to consider key aspects of the scale-up process. In this opinion piece, we aim to identify challenges and advance knowledge and action toward scaling-up school-based physical activity interventions. We highlight the key roles of planning for scale-up at the outset, scale-up pathways, trust among partners and program support, program adaptation, evaluation of scale-up, and barriers and facilitators to scaling-up. We draw upon our experience scaling-up effective school-based interventions and provide a solid foundation from which others can work toward bridging the implementation-to-scale-up gap.
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Affiliation(s)
- Heather A McKay
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Sarah G Kennedy
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Heather M Macdonald
- Active Aging Research Team, University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, BC, Canada
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Imel ZE, Pace B, Pendergraft B, Pruett J, Tanana M, Soma CS, Comtois KA, Atkins DC. Machine Learning-Based Evaluation of Suicide Risk Assessment in Crisis Counseling Calls. Psychiatr Serv 2024:appips20230648. [PMID: 39026467 DOI: 10.1176/appi.ps.20230648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Counselor assessment of suicide risk is one key component of crisis counseling, and standards require risk assessment in every crisis counseling conversation. Efforts to increase risk assessment frequency are limited by quality improvement tools that rely on human evaluation of conversations, which is labor intensive, slow, and impossible to scale. Advances in machine learning (ML) have made possible the development of tools that can automatically and immediately detect the presence of risk assessment in crisis counseling conversations. METHODS To train models, a coding team labeled every statement in 476 crisis counseling calls (193,257 statements) for a core element of risk assessment. The authors then fine-tuned a transformer-based ML model with the labeled data, utilizing separate training, validation, and test data sets. RESULTS Generally, the evaluated ML model was highly consistent with human raters. For detecting any risk assessment, ML model agreement with human ratings was 98% of human interrater agreement. Across specific labels, average F1 (the harmonic mean of precision and recall) was 0.86 at the call level and 0.66 at the statement level and often varied as a result of a low base rate for some risk labels. CONCLUSIONS ML models can reliably detect the presence of suicide risk assessment in crisis counseling conversations, presenting an opportunity to scale quality improvement efforts.
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Affiliation(s)
- Zac E Imel
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Brian Pace
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Brad Pendergraft
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Jordan Pruett
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Michael Tanana
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Christina S Soma
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - Kate A Comtois
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
| | - David C Atkins
- Lyssn.io, Seattle (Imel, Pace, Pruett, Tanana, Soma, Atkins); Protocall Services, Portland, Oregon (Pendergraft); Harborview Medical Center, University of Washington, Seattle (Comtois)
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Smith MY, Morrato EH, Mora N, Nguyen V, Pinnock H, Winterstein AG. The Reporting Recommendations Intended for Pharmaceutical Risk Minimization Evaluation Studies: Standards for Reporting of Implementation Studies Extension (RIMES-SE). Drug Saf 2024; 47:655-671. [PMID: 38478350 PMCID: PMC11182855 DOI: 10.1007/s40264-024-01417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The Reporting recommendations Intended for pharmaceutical risk Minimization Evaluation Studies (RIMES) was developed to improve the quality of reporting of risk minimization program evaluations. In light of continued inadequacies in study reporting, and high-profile program implementation failures, we updated the RIMES Checklist to incorporate additional concepts from the Standards for Reporting of Implementation studies (StaRI). METHODS The development of the updated checklist, the RIMES-StaRI Extension (RIMES-SE), entailed developing a study protocol and drafting an initial pool of items based on a mapping of the RIMES against the StaRI checklist. A modified e-Delphi exercise was then conducted to determine the importance and understandability of items for checklist inclusion. An expert workshop and an online commentary period for additional feedback followed. RESULTS The RIMES-SE contains 27 items. It includes two signature features of the StaRI Checklist: 1) a dual strand of items (represented in two columns) describing the risk minimization program (the 'intervention') and the corresponding implementation strategy; and 2) applicable to an array of different research methodologies. CONCLUSIONS The RIMES-SE Statement and Checklist extends the reporting guidelines set forth in the original RIMES Checklist via inclusion of key implementation science concepts. It is intended to improve the quality and transparency of reporting of risk minimization evaluation studies so as to advance drug safety science.
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Affiliation(s)
- Meredith Y Smith
- Implementation Science Group, Patient-Centered Research, Evidera, Inc., Bethesda, MD, USA.
- Department of Regulatory and Quality Sciences, School of Pharmacy, University of Southern California, Los Angeles, CA, USA.
| | - Elaine H Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Nallely Mora
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Viviana Nguyen
- Implementation Science Group, Patient-Centered Research, Evidera, Inc., Bethesda, MD, USA
| | | | - Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy and Center for Drug Evaluation and Safety, University of Florida, Gainesville, FL, USA
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Ulfa Y, Horiuchi S, Shishido E, Igarashi Y. Team-based learning in Indonesian midwifery education: Implementation research. Jpn J Nurs Sci 2024; 21:e12587. [PMID: 38308468 DOI: 10.1111/jjns.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/17/2023] [Accepted: 01/07/2024] [Indexed: 02/04/2024]
Abstract
AIM This study aims to implement team-based learning (TBL) and assess the impact on faculty members and students within midwifery education in Indonesia. METHODS Proctor's Framework for Implementation Research serves as the guiding approach in investigating the role of implementation strategies in implementing TBL within the context of midwifery education. The RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework was utilized to assess the outcome. RESULTS In this study, the implementation of TBL has demonstrated significant reach, with broad participation among both faculty and students in two schools. The efficacy of TBL is evident through enhanced student knowledge, engagement and active learning. Adoption of TBL was observed in both schools, with faculty and students expressing interest and active participation. High levels of implementation fidelity were maintained, even though with challenges related to preparation and implementation. These findings suggest that TBL can be successfully integrated into midwifery education, with positive implications. Regarding maintenance, faculty members have expressed their intention to continue using TBL in various topics for future lectures. CONCLUSIONS The implementation of TBL in Indonesian midwifery education has shown substantial reach and efficacy. Faculty and students are highly interested in adopting TBL for future use. Despite some implementation challenges, the study suggests that TBL can be effectively incorporated with minor adjustments, emphasizing its feasibility and potential impact. This research contributes to understanding TBL's applicability in various educational settings, especially in low-resource institutions.
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Affiliation(s)
- Yunefit Ulfa
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- National Research and Innovation Agency, Jakarta Pusat, Indonesia
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Eri Shishido
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yukari Igarashi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Lai AY, Wee KZ, Frimpong JA. Proactive behaviors and health care workers: A systematic review. Health Care Manage Rev 2024; 49:239-251. [PMID: 38757911 DOI: 10.1097/hmr.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Proactive behaviors at work refer to discretionary actions among workers that are self-starting, change oriented, and future focused. Proactive behaviors reflect the idiosyncratic actions by individual workers that shape the delivery and experience of professional services, highlight a bottom-up perspective on workers' agency and motivation that can influence organizational practices, and are associated with a variety of employee and organizational outcomes. PURPOSE This systematic review aims to understand the various forms of proactive behaviors in health care workers that have been studied, and how these proactive behaviors are associated with employee-level outcomes and quality of care. METHODS Systematic review of articles published to date on proactive behaviors in health care workers. RESULTS Based on the identification of 40 articles, we find that job crafting, active problem solving, voice, extra-role behaviors, and idiosyncratic deals have been investigated as proactive behaviors among health care workers. Among these, job crafting is the most commonly studied (35% of articles), and it has been conceptualized and measured in the most consistent way, including as individual- and group-level phenomena, and as organizational interventions. Studies on active problem solving, which refers to workers accepting responsibility, exercising control, and taking action around anticipated or experienced problems at work, have not been consistently investigated as a form of proactive behavior but represent 25% of the articles identified in this review. Overall, this review finds that proactive behaviors in health care is a burgeoning area of research, with the majority of studies being cross-sectional in design and published after 2010, and focused on workers' job satisfaction as the outcome. PRACTICE IMPLICATIONS Health care workers and managers should consider the distinct influences and contributions of proactive behaviors as ways to improve employee-level outcomes and quality of care.
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Mendieta MJ, Goderis G, Zeller A, Yip O, Siqeca F, Zúñiga F, Zullig LL, De Geest SM, Deschodt M, Flamaing J, Dhaini S. Mapping implementation strategies to reach community-dwelling older adults in Northwest Switzerland. Implement Sci 2024; 19:44. [PMID: 38926758 PMCID: PMC11210125 DOI: 10.1186/s13012-024-01374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In Northwestern Switzerland, recent legislation tackles the needs of community-dwelling older adults by creating Information and Advice Centers (IACs). IACs are a new service in the community that aims to assess the needs and provide information on age-related issues to community-dwelling older adults and their families. Previous studies reported difficulties in reaching community-dwelling older adults for community-based programs. We aimed to: 1) systematically identify implementation strategies to promote the IAC among community care providers, older adults and informal caregivers; 2) monitor the delivery of these strategies by the IAC management; and 3) describe the impact of those strategies on reach of community-dwelling older adults. This study was conducted as part of the TRANS-SENIOR project. METHODS As part of the INSPIRE feasibility assessment, we conducted a pre-test post-test study between March and September 2022. The sample included 8,840 older adults aged 65 + visiting/calling or being referred to the IAC for the first time. Implementation strategies were selected using implementation mapping and organized in bundles for each group of community care providers and older adults/caregivers. Our evaluation included: estimation of fidelity to the delivery of implementation strategies and bundles by the IAC management and their coverage; referral source of older adults to the IAC; and impact of the strategies on reach of the IAC on the 65 + population living in the care region. Adaptations to the strategies were documented using the FRAME-IS. Descriptive statistics were calculated and reported. RESULTS Seven implementation strategies were selected and organized in bundles for each community care provider and older adults and their caregivers. The lowest fidelity score was found in implementation strategies selected for nursing homes whereas the highest score corresponded to strategies targeting older adults and caregivers. "Informational visits" was the strategy with the lowest coverage (2.5% for nursing homes and 10.5% for hospitals and specialized clinics). The main referral sources were self-referrals and referrals by caregivers, followed by nursing homes. The IAC reach among the 65 + population was 5.4%. CONCLUSION We demonstrated the use of implementation mapping to select implementation strategies to reach community-dwelling older adults. The reach was low suggesting that higher fidelity to the delivery of the strategies, and reflection on the causal pathway of the implementation strategies might be needed.
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Affiliation(s)
- Maria Jose Mendieta
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium
| | - Geert Goderis
- Academic Center of General Practice, Department of Public Health and Primary Care, KU, Louvain, Belgium
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Olivia Yip
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Flaka Siqeca
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, UK
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, UK
| | - Sabina M De Geest
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.
| | - Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Louvain, Belgium
| | - Johan Flamaing
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium
| | - Suzanne Dhaini
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- University Children's Hospital Zurich, The Eleonore Foundation, Zurich, Switzerland
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Zomer L, van der Meer L, van Weeghel J, Widdershoven G, Voskes Y. From Model to Practice: A Qualitative Study on Factors Influencing the Implementation of the Active Recovery Triad (ART) Model in Long-Term Mental Health Care. J Clin Med 2024; 13:3488. [PMID: 38930017 PMCID: PMC11205107 DOI: 10.3390/jcm13123488] [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: 02/22/2024] [Revised: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The Active Recovery Triad (ART) model provides a framework for recovery-oriented care in the long-term mental health setting. The aim of this study is to gain insight into factors influencing the implementation process of the ART model. Methods: Focus groups were conducted with fourteen multidisciplinary teams that were in the process of implementing the ART model. Data were thematically analyzed. Results: Three phases of implementation were identified. In the first phase, getting started, support from both the top of the organization and the care workers, sufficient information to care workers, service users, and significant others, and creating momentum were considered crucial factors. In the second phase, during implementation, a stable team with a good team spirit, leadership and ambassadors, prioritizing goals, sufficient tools and training, and overcoming structural limitations in large organizations were seen as important factors. In the third phase, striving for sustainability, dealing with setbacks, maintaining attention to the ART model, and exchange with other teams and organizations were mentioned as core factors. Conclusions: The findings may support teams in making the shift from traditional care approaches towards recovery-oriented care in long-term mental health care.
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Affiliation(s)
- Lieke Zomer
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
- Altrecht GGZ, 3705 WC Zeist, The Netherlands
| | - Lisette van der Meer
- Department of Clinical & Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, 9470 AC Zuidlaren, The Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, 5037 DB Tilburg, The Netherlands
- Impact Care Group, GGz Breburg, 5017 JD Tilburg, The Netherlands
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Bartels SM, Phan HTT, Hutton HE, Nhan DT, Sripaipan T, Chen JS, Rossi SL, Ferguson O, Nong HTT, Nguyen NTK, Giang LM, Bui HTM, Chander G, Sohn H, Kim S, Tran HV, Nguyen MX, Powell BJ, Pence BW, Miller WC, Go VF. Scaling up a brief alcohol intervention to prevent HIV infection in Vietnam: a cluster randomized, implementation trial. Implement Sci 2024; 19:40. [PMID: 38867283 PMCID: PMC11170841 DOI: 10.1186/s13012-024-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/27/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) often address normative behaviors. If a behavior is also common among clinicians, they may be skeptical about the necessity or effectiveness of an EBI. Alternatively, clinicians' attitudes and behaviors may be misaligned, or they may lack the knowledge and self-efficacy to deliver the EBI. Several EBIs address unhealthy alcohol use, a common and often culturally acceptable behavior. But unhealthy alcohol use may be particularly harmful to people with HIV (PWH). Here, we present an implementation trial using an experiential implementation strategy to address clinicians' knowledge, attitudes, and behaviors. Clinicians receive the experiential intervention before they begin delivering an evidence-based brief alcohol intervention (BAI) to PWH with unhealthy alcohol use. METHODS Design: In this hybrid type 3 implementation-effectiveness cluster randomized controlled trial, ART clinics (n = 30) will be randomized 1:1 to facilitation, a flexible strategy to address implementation barriers, or facilitation plus the experiential brief alcohol intervention (EBAI). In the EBAI arm, clinicians, irrespective of their alcohol use, will be offered the BAI as experiential learning. EBAI will address clinicians' alcohol-related attitudes and behaviors and increase their knowledge and confidence to deliver the BAI. PARTICIPANTS ART clinic staff will be enrolled and assessed at pre-BAI training, post-BAI training, 3, 12, and 24 months. All PWH at the ART clinics who screen positive for unhealthy alcohol use will be offered the BAI. A subset of PWH (n = 810) will be enrolled and assessed at baseline, 3, and 12 months. OUTCOMES We will compare implementation outcomes (acceptability, fidelity, penetration, costs, and sustainability) and effectiveness outcomes (viral suppression and alcohol use) between the two arms. We will assess the impact of site-level characteristics on scaling-up the BAI. We will also evaluate how experiencing the BAI affected clinical staff's alcohol use and clinic-level alcohol expectations in the EBAI arm. DISCUSSION This trial contributes to implementation science by testing a novel strategy to implement a behavior change intervention in a setting in which clinicians themselves may engage in the behavior. Experiential learning may be useful to address normative and difficult to change lifestyle behaviors that contribute to chronic diseases. TRIAL REGISTRATION NCT06358885 (04/10/2024), https://clinicaltrials.gov/study/NCT06358885 .
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Affiliation(s)
- Sophia M Bartels
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Huong T T Phan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Heidi E Hutton
- Johns Hopkins Hospital University School of Medicine, Baltimore, MD, USA
| | - Do T Nhan
- Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam
| | - Teerada Sripaipan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jane S Chen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sarah L Rossi
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Olivia Ferguson
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | | | - Le Minh Giang
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Hao T M Bui
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Geetanjali Chander
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Hojoon Sohn
- Seoul National University College, Seoul, Korea
| | - Sol Kim
- Seoul National University College, Seoul, Korea
| | | | - Minh X Nguyen
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Department of Epidemiology, Hanoi Medical University, Hanoi, Vietnam
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MI, USA
| | - Brian W Pence
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Vivian F Go
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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Mirzadegan IA, Lewis EM, Cole SL, Meyer A. Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents. J Pediatr Psychol 2024:jsae040. [PMID: 38857450 DOI: 10.1093/jpepsy/jsae040] [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: 01/14/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. METHODS Parent-child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, "Making Mistakes", consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. RESULTS Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. CONCLUSIONS Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.
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Affiliation(s)
- Isaac A Mirzadegan
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Ericka M Lewis
- School of Social Work, University of Maryland, Baltimore, MD, United States
| | - Sally L Cole
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alexandria Meyer
- School of Education and Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
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Mnyippembe A, Sheira LA, McCoy SI, Njau PF, Packel LJ, Hassan K, Solorzano-Barrera C, Maokola W, Kang Dufour MS, Sabasaba A, Liu J. Supporting young women's health through girl-friendly drug vendors in Lake Zone, Tanzania: protocol for the AmbassADDOrs for Health cluster-randomised controlled trial. BMJ Open 2024; 14:e078755. [PMID: 38851225 PMCID: PMC11163605 DOI: 10.1136/bmjopen-2023-078755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 05/15/2024] [Indexed: 06/10/2024] Open
Abstract
INTRODUCTION Adverse sexual and reproductive health (SRH) outcomes, such as unplanned pregnancies and HIV infection, disproportionately affect adolescent girls and young women (AGYW; aged 15-24 years) in east Africa. Increasing uptake of preventive SRH services via innovative, youth-centred interventions is imperative to addressing disparities in SRH outcomes. METHODS AND ANALYSIS From 2018 to 2019, we used human-centred design to co-develop a theoretically driven HIV and pregnancy prevention intervention for AGYW at private drug shops called Accredited Drug Dispensing Outlets (ADDOs) in Tanzania. The result, Malkia Klabu (Queen Club), was a customer loyalty programme designed to strengthen ADDOs' role as SRH providers while encouraging uptake of critical SRH prevention products among AGYW. Malkia Klabu members had access to free contraceptives and oral HIV self-test (HIVST) kits and earned punches on a loyalty card for other shop purchases; punches were redeemable for small prizes. Our pilot among 40 shops showed that intervention ADDOs had higher AGYW patronage and distributed more HIVST kits and contraceptives to AGYW relative to business-as-usual (ie, client purchasing) comparison shops. We will conduct a cluster-randomised controlled trial (c-RCT) among 120-140 ADDOs in 40 health catchment areas in Shinyanga and Mwanza Regions (Lake Zone), Tanzania. ADDO shop recruitment includes a 1-month run-in with a tablet-based electronic inventory management system for tracking shop transactions, followed by enrolment, randomisation and a 24-month trial period. Our c-RCT evaluating the human-centred design-derived intervention will assess population impact on the primary outcomes of HIV diagnoses and antenatal care registrations, measured with routine health facility data. We will also assess secondary outcomes focusing on mechanisms of action, evaluate programme exposure and AGYW behaviour change in interviews with AGYW, and assess shop-level implementation strategies and fidelity. ETHICS AND DISSEMINATION Ethical approval was granted from both the University of California, San Francisco and the Tanzanian National Institute for Medical Research. Study progress and final outcomes will be posted annually to the National Clinical Trials website; study dissemination will occur at conferences, peer-reviewed manuscripts and local convenings of stakeholders. TRIAL REGISTRATION NUMBER NCT05357144.
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Affiliation(s)
- Agatha Mnyippembe
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Lila A Sheira
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Prosper F Njau
- Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | - Laura J Packel
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Kassim Hassan
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Camila Solorzano-Barrera
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
| | - Werner Maokola
- Ministry of Health and Social Welfare, Dar es Salaam, United Republic of Tanzania
| | | | - Amon Sabasaba
- Health for a Prosperous Nation, Dar es Salaam, United Republic of Tanzania
| | - Jenny Liu
- Institute for Health Aging, Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, USA
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Sherwood KL, Smith MJ, Eldredge MA. The Need for Technology-Aided Instruction and Intervention Policy for Autistic Youth. JOURNAL OF DISABILITY POLICY STUDIES 2024; 35:54-64. [PMID: 38883993 PMCID: PMC11178338 DOI: 10.1177/10442073221150603] [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] [Indexed: 06/18/2024]
Abstract
This paper examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support or hinder the delivery of these interventions. Specifically, we focus on policies that might influence the delivery of TAII to autistic TAY. After a careful review of the literature, we observed that postsecondary policy guiding the delivery of TAII designed to support autistic TAY is lacking. TAII have demonstrated effectiveness, usability, sustainability, and cost-effectiveness, particularly with this population. We suggest possibilities for future policies to support the development, implementation, and evaluation of TAII for autistic TAY.
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Affiliation(s)
- Kari L Sherwood
- School of Social Work, University of Michigan; 1080 South University Avenue, Ann Arbor, MI 48109
- Department of Psychology, University of Michigan; 530 Church St., Ann Arbor, MI 48109
| | - Matthew J Smith
- School of Social Work, University of Michigan; 1080 South University Avenue, Ann Arbor, MI 48109
| | - Mary A Eldredge
- St. Mary Mercy Center for Family Care; 37595 W Seven Mile Rd, Livonia, MI 48152
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Rief W, Asmundson GJG, Bryant RA, Clark DM, Ehlers A, Holmes EA, McNally RJ, Neufeld CB, Wilhelm S, Jaroszewski AC, Berg M, Haberkamp A, Hofmann SG. The future of psychological treatments: The Marburg Declaration. Clin Psychol Rev 2024; 110:102417. [PMID: 38688158 DOI: 10.1016/j.cpr.2024.102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/02/2024]
Abstract
Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.
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Affiliation(s)
- Winfried Rief
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany.
| | | | - Richard A Bryant
- University of New South Wales, School of Psychology, Sydney, New South Wales, Australia
| | - David M Clark
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Anke Ehlers
- University of Oxford, Department of Experimental Psychology, Oxford, UK
| | - Emily A Holmes
- Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Solna, Sweden
| | | | - Carmem B Neufeld
- University of São Paulo, Department of Psychology, Ribeirão Preto, SP, Brazil
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Adam C Jaroszewski
- Massachusetts General Hospital and Harvard School of Medicine, Boston, USA
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Anke Haberkamp
- Philipps-University of Marburg, Department of Psychology, Clinical Psychology and Psychotherapy Group, Marburg, Germany
| | - Stefan G Hofmann
- Philipps-University of Marburg, Department of Psychology, Translational Clinical Psychology Group, Marburg, Germany
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16
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Akiba CF, Smith J, Wenger LD, Morris T, Patel SV, Bluthenthal RN, Tookes HE, LaKosky P, Kral AH, Lambdin BH. Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100421. [PMID: 38957482 PMCID: PMC11218888 DOI: 10.1016/j.ssmqr.2024.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Syringe Services Programs (SSPs) provide evidence-based services like drug use equipment to prevent infectious disease, overdose prevention education, and naloxone distribution to people who use drugs (PWUD). However, inadequate funding threatens provision of these interventions. This study aimed to document how the current funding landscape impacted determinants of SSP implementation, particularly describing financial and staffing barriers, facilitators, and proposed strategies, using qualitative methods informed by three implementation research frameworks. We interviewed 20 leaders of SSPs in the United States using a semi-structured interview guide. Participants described how structural stigma against PWUD led to insufficient and restrictive funding, and burdensome reporting for SSPs. This resulted in harming program implementation outcomes like reach, fidelity, and sustainability. Inadequate funding also led to insufficient staffing and subsequent staff stress, burnout, and turnover. Taken together, these barriers threatened the implementation of evidence-based interventions that SSPs provided, ultimately harming their ability to effectively address health outcomes like infectious disease transmission and opioid overdose mortality within their communities. Interviewees described how upstream policy strategies like political advocacy might address structural stigma at the federal level. Participants also highlighted state-level efforts like harm reduction-centered funding, technical assistance and capacity-building, and clearinghouse programs that may facilitate better implementation and health outcomes. A more robust understanding of the relationship between financial barriers, facilitators, and strategies on implementation and health outcomes represents a novel and vital area of research within harm reduction literature.
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Affiliation(s)
| | - Jessica Smith
- RTI International, Research Triangle Park, NC, United States
| | - Lynn D. Wenger
- RTI International, Research Triangle Park, NC, United States
| | - Terry Morris
- RTI International, Research Triangle Park, NC, United States
| | - Sheila V. Patel
- RTI International, Research Triangle Park, NC, United States
| | - Ricky N. Bluthenthal
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Hansel E. Tookes
- Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Paul LaKosky
- Dave Purchase Project, North American Syringe Exchange Network, Tacoma, WA, United States
| | - Alex H. Kral
- RTI International, Research Triangle Park, NC, United States
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Tantisattamo E. Implementation science: a tool to narrow know-do gap and widen equity in kidney diseases and transplantation. Kidney Int 2024; 105:1322-1323. [PMID: 38626880 DOI: 10.1016/j.kint.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 04/20/2024]
Affiliation(s)
- Ekamol Tantisattamo
- American Heart Association Comprehensive Hypertension Center at the University of California Irvine Medical Center, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange, California, USA; Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA; Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA.
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Starr LT, Washington KT, Jabbari J, Benson JJ, Oliver DP, Demiris G, Cagle JG. Pain Management Education for Rural Hospice Family Caregivers: A Pilot Study With Embedded Implementation Evaluation. Am J Hosp Palliat Care 2024; 41:619-633. [PMID: 37491002 PMCID: PMC11032627 DOI: 10.1177/10499091231191114] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Assessing and managing hospice patients' pain is a common source of anxiety among hospice family caregivers (HFCGs), especially caregivers in rural communities who face special challenges including distance, limited access, and concerns about opioid misuse. OBJECTIVE To pilot test Ready2Care, a pain management education intervention for rural HFCGs. We sought to determine whether there was a signal of benefit for clinically-relevant outcomes and to identify contextual factors pertinent to conducting a future randomized clinical trial of Ready2Care. METHODS We conducted a multi-method, single-arm study, enabling completion of paired t-tests comparing pre- and post-intervention measures of caregiver anxiety, pain management self-efficacy, barriers to pain management, and reports of patient pain intensity and corresponding patient and caregiver distress. We concurrently conducted an embedded implementation evaluation via calculation of descriptive statistics (recruitment and retention data) and directed content analysis of brief caregiver interviews. RESULTS Twenty-seven (n = 27) HFCGs participated; 15 completed the study. Among completers, significant improvement was observed in patient pain intensity (average 1.4 points decrease on 0-10 scale) and in overall pain experience. No statistically significant changes were detected in caregiver anxiety, barriers to pain management, or pain management self-efficacy. Facilitators to successful conduct of a future clinical trial included high acceptability of Ready2Care, driven by its perceived clarity and relevance to caregivers' concerns. Barriers included lower-than-anticipated accrual and an attrition rate of nearly 44%. CONCLUSION A multisite clinical trial of Ready2Care is warranted; however, its success may require more effective recruitment and retention strategies for rural caregiver participants.
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Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | | - JoAnn Jabbari
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | | | - Debra Parker Oliver
- Washington University in St Louis School of Medicine, St Louis, MO, USA
- Barnes-Jewish College, Goldfarb School of Nursing, St Louis, MO, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - John G. Cagle
- Center to Advance Chronic Pain Research, University of Maryland, School of Social Work, Baltimore, MD, USA
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Reed J, Hunn L, Smith T, Bosworth R, Gee B, Berry C, Clarke T. Barriers and facilitators in the implementation of youth and young adult models of mental health care. Early Interv Psychiatry 2024. [PMID: 38769737 DOI: 10.1111/eip.13555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/02/2024] [Accepted: 05/09/2024] [Indexed: 05/22/2024]
Abstract
AIM It is increasingly recognised that traditional models of mental health (MH) care, with a service transition at age 18 years, may not reflect best practice. The literature supports a move towards youth and young adult focused models of MH care, for young people up to the age of 25, which specifically cater to the unique psychosocial and developmental needs of this population. This service evaluation aimed to explore the facilitators and barriers to the implementation of youth models of MH care across England (UK). METHODS Six services participated in separate focus groups pertaining to their experience of implementing youth models of MH care. The interview guide for the focus groups was informed by the Consolidated Framework for Implementation Research (CFIR) and explored barriers and facilitators to implementation and sustainment. The focus groups were recorded, transcribed verbatim and analysed thematically. RESULTS Seven key themes relevant to the implementation of youth models of MH care were identified: a clear rationale for doing things differently, for young people by young people, "building those relationships is key", service identity development, resource and infrastructure, leadership at multiple levels, and valuing and developing staff. CONCLUSIONS The findings suggest effective communication and leadership, co-production and cross system collaboration contribute to successful implementation of youth models of MH care. The findings will be of interest to those involved in informing and supporting successful implementation and delivery of youth models of mental health care at local and national levels.
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Affiliation(s)
- Joanna Reed
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Lucy Hunn
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Tiffany Smith
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | - Brioney Gee
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Clio Berry
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK
| | - Timothy Clarke
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
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20
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Wende ME, Umstattd Meyer MR, Perry C, Prochnow T, Hamilton CNB, Abildso CG, Porter KMP. Implementation characteristics that may promote sustainability of a rural physical activity initiative: examination of Play Streets through the lens of community implementers. Implement Sci Commun 2024; 5:48. [PMID: 38698464 PMCID: PMC11064337 DOI: 10.1186/s43058-024-00571-2] [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: 04/16/2023] [Accepted: 03/14/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Play Streets, which are community-based environmental initiatives where public spaces/streets are temporarily closed to create safe, low-cost physical activity opportunities, have demonstrated feasibility and physical activity benefit in rural US areas. Yet, information is needed to identify implementation characteristics that may promote sustainability. This study examined rural Play Streets implementation characteristics that could impact sustainability from local partners' perspectives. METHODS Sixteen Play Streets implementation team members in rural Maryland, North Carolina, Oklahoma, and Texas, USA, participated in interviews. Semi-structured in-person individual and group interviews were conducted in the fall of 2018 (after Play Streets implementation in 2017 and 2018), recorded, and transcribed verbatim. Transcripts were analyzed using iterative, content analyses. Coding frameworks were based on the Public Health Program Capacity for Sustainability Framework, and emergent themes were also identified. RESULTS Interviewees' perceived characteristics for facilitating Play Streets implementation aligned with the Public Health Program Capacity for Sustainability Framework: funding stability, political support, partnerships, organizational capacity, program adaption, and communication. Interviewees also noted the importance of cultural alignment/support and the reciprocal impact of community connectedness/engagement. CONCLUSIONS Future research should examine the reciprocal role of public health impacts, as both outcomes and factors which may influence sustainability.
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Affiliation(s)
- Marilyn E Wende
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, USA.
| | - M Renée Umstattd Meyer
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, USA.
| | - Cynthia Perry
- School of Nursing, Oregon Health & Science University, Portland, USA
| | - Tyler Prochnow
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, USA
| | | | - Christiaan G Abildso
- Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, USA
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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21
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Ashcraft LE, Cabrera KI, Lane-Fall MB, South EC. Leveraging Implementation Science to Advance Environmental Justice Research and Achieve Health Equity through Neighborhood and Policy Interventions. Annu Rev Public Health 2024; 45:89-108. [PMID: 38166499 DOI: 10.1146/annurev-publhealth-060222-033003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Environmental justice research is increasingly focused on community-engaged, participatory investigations that test interventions to improve health. Such research is primed for the use of implementation science-informed approaches to optimize the uptake and use of interventions proven to be effective. This review identifies synergies between implementation science and environmental justice with the goal of advancing both disciplines. Specifically, the article synthesizes the literature on neighborhood-, community-, and policy-level interventions in environmental health that address underlying structural determinants (e.g., structural racism) and social determinants of health. Opportunities to facilitate and scale the equitable implementation of evidence-based environmental health interventions are highlighted, using urban greening as an illustrative example. An environmental justice-focused version of the implementation science subway is provided, which highlights these principles: Remember and Reflect, Restore and Reclaim, and Reinvest. The review concludes with existing gaps and future directions to advance the science of implementation to promote environmental justice.
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Affiliation(s)
- Laura Ellen Ashcraft
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
| | - Keven I Cabrera
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Meghan B Lane-Fall
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center (PISCE), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eugenia C South
- Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Youn SJ, Boswell JF, Douglas S, Harris BA, Aajmain S, Arnold KT, Creed TA, Gutner CA, Orengo-Aguayo R, Oswald JM, Stirman SW. Implementation Science and Practice-Oriented Research: Convergence and Complementarity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:336-347. [PMID: 37646966 DOI: 10.1007/s10488-023-01296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.
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Affiliation(s)
- Soo Jeong Youn
- Reliant Medical Group, OptumCare, Harvard Medical School, Worcester, MA, USA.
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Bethany A Harris
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Syed Aajmain
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Kimberly T Arnold
- Whole Health Equity Lab, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Torrey A Creed
- Penn Collaborative for CBT and Implementation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cassidy A Gutner
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rosaura Orengo-Aguayo
- Medical University of South Carolina (MUSC), National Crime Victims Research & Treatment Center, Charleston, SC, USA
| | | | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Department of Psychiatry and Behavioral Sciences, Stanford University, Menlo Park, CA, USA
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Arany S, Cavalcanti L, Phildor D, Watson GE, Kopycka-Kedzierawski DT, Eliav E, Medina-Walpole A, Caprio T. Implementation of a 4Ms approach in age-friendly oral health care at an Academic Specialty Care Dental Clinic. J Am Geriatr Soc 2024. [PMID: 38661080 DOI: 10.1111/jgs.18925] [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: 11/01/2023] [Revised: 03/17/2024] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Implementing the Age-Friendly Health System (AFHS) framework into dental care provides a significant opportunity to link oral health to healthy aging. This project aimed to implement the AFHS 4Ms (what matters, medications, mentation, and mobility) in the provision of oral health care. This article describes the planning, integration, training development, and outcome measurements supporting a 4Ms approach at an academic dental clinic. METHODS The Eastman Institute for Oral Health (EIOH) implemented screening instruments based on the 4Ms framework recommended for ambulatory care clinics by the Institute for Health Care Improvement (IHI). These ambulatory instruments were integrated into the workflows of a Specialty Care Clinic through the development of a plan-do-study-act cycle, utilization of available clinic resources, and creation of interdisciplinary collaborations. RESULTS This project demonstrated the feasibility of implementing an AFHS checklist and tracking forms in dental practice by integrating available resources and prioritizing the 4Ms elements. This effort necessitated interdisciplinary collaborations between dental, medical, and social service professionals. It also created a new age-friendly focused education and training curriculum for dental residents and faculty. CONCLUSIONS This pilot project is the first to establish dental standards for AFHS implementation, adapting the 4Ms assessment and metrics to oral health. This AFHS underscores key oral health processes, including assessment, planning, and personalized oral health care, adapted to the unique needs of the older adult population, especially those with cognitive impairment.
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Affiliation(s)
- Szilvia Arany
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Lia Cavalcanti
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
| | - Doris Phildor
- Alzheimer's Association Rochester New York Chapter, Rochester, New York, USA
| | - Gene E Watson
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester Medical Center, Rochester, New York, USA
- Department of Pharmacology and Physiology, University of Rochester, Rochester, New York, USA
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, New York, USA
- Department of Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Annette Medina-Walpole
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Thomas Caprio
- Medicine-Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Scanlon F, Morgan RD, Aceves D. Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01380-4. [PMID: 38662179 DOI: 10.1007/s10488-024-01380-4] [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] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.
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Klamert L, Craike M, Bedi G, Kidd S, Pascoe MC, Parker AG. Underreporting of implementation strategies and barriers in physical activity interventions for young people at risk of problematic substance use: a brief report. Implement Sci Commun 2024; 5:45. [PMID: 38649968 PMCID: PMC11036629 DOI: 10.1186/s43058-024-00578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Several studies have assessed whether physical activity interventions can reduce substance use in young people at risk of problematic substance use. This report identifies and describes the reporting of implementation characteristics within published studies of physical activity interventions for young people at risk of problematic substance use and provides recommendations for future reporting. METHODS Reported implementation strategies (including intervention manualization), barriers, implementation fidelity, and personnel acceptance were extracted from studies of physical activity interventions for young people aged 12-25 years at risk of problematic substance use that were included in a previous systematic review of intervention efficacy. RESULTS Implementation strategies were reported in less than half of the included studies (42.9%), implementation barriers in only 10.7% of studies, intervention fidelity in 21.4%, and personnel acceptance in a single study (3.6%). CONCLUSIONS Results indicate insufficient reporting of implementation strategies, barriers, fidelity, and personnel acceptance. Consideration of implementation characteristics is essential for implementing physical activity interventions in practice. Inadequate or limited reporting of these characteristics may contribute to delayed uptake and adoption of evidence-based interventions in clinical practice. Recommendations to improve the reporting of implementation information include integrating standards for reporting implementation characteristics into existing reporting guidelines, developing an international taxonomy of implementation strategies, and upskilling intervention researchers in the fundamentals of implementation science.
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Affiliation(s)
- Lisa Klamert
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Rd, Footscray, VIC, 3011, Australia.
- , Orygen, Parkville, VIC, 3052, Australia.
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, 3052, Australia.
| | - Melinda Craike
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Rd, Footscray, VIC, 3011, Australia
- Mitchell Institute for Education and Health Policy, Victoria University, Footscray, VIC, 3011, Australia
| | - Gillinder Bedi
- , Orygen, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Susan Kidd
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Rd, Footscray, VIC, 3011, Australia
- Acute Care Service, Tweed Byron Mental Health, Northern NSW Health District, Lismore, Australia
| | - Michaela C Pascoe
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Rd, Footscray, VIC, 3011, Australia
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, 70/104 Ballarat Rd, Footscray, VIC, 3011, Australia
- , Orygen, Parkville, VIC, 3052, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, 3052, Australia
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Bart G, Korthuis PT, Donohue JM, Hagedorn HJ, Gustafson DH, Bazzi AR, Enns E, McNeely J, Ghitza UE, Magane KM, Baukol P, Vena A, Harris J, Voronca D, Saitz R. Exemplar Hospital initiation trial to Enhance Treatment Engagement (EXHIT ENTRE): protocol for CTN-0098B a randomized implementation study to support hospitals in caring for patients with opioid use disorder. Addict Sci Clin Pract 2024; 19:29. [PMID: 38600571 PMCID: PMC11007900 DOI: 10.1186/s13722-024-00455-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Hospitalizations involving opioid use disorder (OUD) are increasing. Medications for opioid use disorder (MOUD) reduce mortality and acute care utilization. Hospitalization is a reachable moment for initiating MOUD and arranging for ongoing MOUD engagement following hospital discharge. Despite existing quality metrics for MOUD initiation and engagement, few hospitals provide hospital based opioid treatment (HBOT). This protocol describes a cluster-randomized hybrid type-2 implementation study comparing low-intensity and high-intensity implementation support strategies to help community hospitals implement HBOT. METHODS Four state implementation hubs with expertise in initiating HBOT programs will provide implementation support to 24 community hospitals (6 hospitals/hub) interested in starting HBOT. Community hospitals will be randomized to 24-months of either a low-intensity intervention (distribution of an HBOT best-practice manual, a lecture series based on the manual, referral to publicly available resources, and on-demand technical assistance) or a high-intensity intervention (the low-intensity intervention plus funding for a hospital HBOT champion and regular practice facilitation sessions with an expert hub). The primary efficacy outcome, adapted from the National Committee on Quality Assurance, is the proportion of patients engaged in MOUD 34-days following hospital discharge. Secondary and exploratory outcomes include acute care utilization, non-fatal overdose, death, MOUD engagement at various time points, hospital length of stay, and discharges against medical advice. Primary, secondary, and exploratory outcomes will be derived from state Medicaid data. Implementation outcomes, barriers, and facilitators are assessed via longitudinal surveys, qualitative interviews, practice facilitation contact logs, and HBOT sustainability metrics. We hypothesize that the proportion of patients receiving care at hospitals randomized to the high-intensity arm will have greater MOUD engagement following hospital discharge. DISCUSSION Initiation of MOUD during hospitalization improves MOUD engagement post hospitalization. Few studies, however, have tested different implementation strategies on HBOT uptake, outcome, and sustainability and only one to date has tested implementation of a specific type of HBOT (addiction consultation services). This cluster-randomized study comparing different intensities of HBOT implementation support will inform hospitals and policymakers in identifying effective strategies for promoting HBOT dissemination and adoption in community hospitals. TRIAL REGISTRATION NCT04921787.
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Affiliation(s)
- Gavin Bart
- Department of Medicine, Hennepin Healthcare and University of Minnesota, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - P Todd Korthuis
- Department of Medicine, Addiction Medicine Section, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, 97239-3098, Portland, OR, USA
| | - Julie M Donohue
- Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA, 15261, USA
| | - Hildi J Hagedorn
- Center for Care Delivery & Outcomes Research, Minneapolis VA Health Care System, University of Minnesota, 1 Veterans Drive, Minneapolis, MN, 55417, USA
| | - Dave H Gustafson
- Center for Health Enhancement Systems Studies, University of Wisconsin, 1513 University Ave., Madison, WI, 53706, USA
| | - Angela R Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego; La Jolla, CA, USA
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Eva Enns
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St. SE, Minneapolis, MN, 55408, USA
| | - Jennifer McNeely
- Department of Population Health, Section on Alcohol, Tobacco and Drug Use, NYU School of Medicine, 180 Madison Avenue, 17th floor, New York, NY, 10016, USA
- Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Udi E Ghitza
- National Institute on Drug Abuse (NIDA) Center for the Clinical Trials Network (CCTN), Bethesda, MD, 20892, USA
| | - Kara M Magane
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
| | - Paulette Baukol
- Berman Center for Outcomes & Clinical Research, 701 Park Ave, Ste. PP7.700, Minneapolis, MN, 55415, USA
| | - Ashley Vena
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Jacklyn Harris
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
| | - Delia Voronca
- The Emmes Company, LLC, 401 N. Washington St. #700, Rockville, MD, 20850, USA
- Currently: Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Rd, Tarrytown, Deceased, NY, 10591-6707, USA
| | - Richard Saitz
- Boston University School of Public Health, 801 Massachusetts Ave, Suite 431, Boston, MA, 02118, USA
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Dev S, Shidhaye R. Application of 'Readiness for Change' concept within implementation of evidence-based mental health interventions globally: protocol for a scoping review. Wellcome Open Res 2024; 7:293. [PMID: 37397434 PMCID: PMC10314182 DOI: 10.12688/wellcomeopenres.18602.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/14/2024] Open
Abstract
Background Concerning the growing burden of mental illnesses globally, there has been an increased investment into the implementation of evidence-based mental health interventions (EBmhIs) in routine care settings. However, the uptake and implementation of these EBmhIs has faced challenges in the real-world context. Among the many barriers and facilitators of implementation of EBmhIs identified by implementation science frameworks, evidence on the role of readiness for change (RFC) remains sparse. RFC constitutes the willingness and perceived capacity of stakeholders across an organization to implement a new practice. Theoretically, RFC has been defined at organizational, group, and individual levels, however, its conceptualization and operationalization across all these levels have differed in studies on the implementation of EBmhIs. By conducting a scoping review, we aim to examine the literature on RFC within the implementation of EBmhIs. Methods This scoping review will be conducted following the PRISMA-ScR guidelines. Iterative review stages will include a systematic and comprehensive search through four electronic databases (PubMed, Web of Science, Embase, and PsycINFO), selecting studies, charting data, and synthesizing the results. English-language studies meeting the inclusion criteria will be screened independently by two reviewers. Discussion This review will synthesize knowledge on the conceptualization of RFC across organizational, group, and individual levels within the implementation of EBmhIs. In addition, it will identify how RFC has been measured in these studies and summarize the reported evidence on its impact on the implementation of EBmhIs. Conclusions This review will assist mental health researchers, implementation scientists, and mental health care providers to gain a better understanding of the state of research on RFC within the implementation of EBmhIs. Registration The final protocol was registered with the Open Science Framework on October 21, 2022 ( https://osf.io/rs5n7).
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Affiliation(s)
- Saloni Dev
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, 02111, USA
| | - Rahul Shidhaye
- Care and Public Health Research Institute, Maastricht University, Maastricht, 6200, The Netherlands
- Department of Psychiatry, Pravara Institute of Medical Sciences, Loni, Maharashtra, 413736, India
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McGuire A, Amaro CM, Singh MN, Brown S. Targeting Caregiver Psychopathology in Parent Management Training for Adolescents: A Scoping Review of Commercially Available Treatment Resources. CHILD & YOUTH CARE FORUM 2024; 53:269-291. [PMID: 38601299 PMCID: PMC11003757 DOI: 10.1007/s10566-023-09754-9] [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] [Accepted: 05/04/2023] [Indexed: 04/12/2024]
Abstract
Background While parent management training (PMT) has been shown to be an effective treatment for adolescents with externalizing concerns, evidence suggests that effectiveness is not equitable across all types of families. Research suggests that caregiver psychopathology may adversely affect PMT success for adolescents. However, it remains unclear whether research on caregiver psychopathology is integrated within adolescent PMT resources (e.g., treatment manuals). Objective A scoping review of commercially available, clinician focused PMT resources was conducted to assess for information on caregiver psychopathology and clinical guidance for addressing caregiver psychopathology. Methods A search for commercially available resources was conducted among national treatment databases and book resource websites. Information on caregiver psychopathology was extracted from individual sessions of the PMT resources. Results Seven treatment resources met inclusion criteria. The majority of the treatment resources made at least one explicit comment that caregiver psychopathology may impact the course of treatment. There was very limited mention of caregiver psychopathology in skill building sections of the resources. Conclusions While most resources mentioned caregiver psychopathology, these comments lacked breadth and depth in providing clinicians with recommendations on how to tailor treatment to caregivers' needs. Recommendations are provided for how PMT programs might be improved in the future to support clinicians when faced with caregiver psychopathology by recognizing inequities and lack of diversity in resource development, using a transdiagnostic perspective (including a transdiagnostic approach to assessment of care-giver psychopathology), and integrating caregiver skill development.
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Affiliation(s)
- Austen McGuire
- Clinical Child Psychology Program, 2015 Dole Human Development Center, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7556, USA
| | - Christina M. Amaro
- Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Ave, Boston, MA 02215, USA
- Division of Behavioral Health and Center for Healthcare Delivery Science, Nemours Children’s Hospital, 1600 Rockland Road, Delaware, Wilmington, DE 19803, USA
| | - Mehar N. Singh
- Clinical Child Psychology Program, 2015 Dole Human Development Center, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045-7556, USA
| | - Shaquanna Brown
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI 02912, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Avenue, Providence, RI 02906, USA
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Huth D, Bräscher AK, Tholl S, Fiess J, Birke G, Herrmann C, Jöbges M, Mier D, Witthöft M. Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial. Psychol Med 2024; 54:1122-1132. [PMID: 37842765 DOI: 10.1017/s0033291723002921] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting. METHODS The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention. RESULTS The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33-0.49). CONCLUSIONS Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.
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Affiliation(s)
- Daniel Huth
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sarah Tholl
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Johanna Fiess
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Gunnar Birke
- Kliniken Schmieder Gailingen, Gailingen, Germany
| | | | | | - Daniela Mier
- Department of Clinical Psychology and Psychotherapy, University of Konstanz, Konstanz, Germany
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Finney Rutten LJ, Ridgeway JL, Griffin JM. Advancing Translation of Clinical Research Into Practice and Population Health Impact Through Implementation Science. Mayo Clin Proc 2024; 99:665-676. [PMID: 38569814 DOI: 10.1016/j.mayocp.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 04/05/2024]
Abstract
Translational and implementation sciences aim to prioritize and guide efforts to create greater efficiency and speed of scientific innovation across the translational science continuum to improve patient and population health. Key principles and practices rooted in translational and implementation science may be incorporated into clinical trials research, particularly pragmatic trials, to improve the relevance and impact of scientific innovation. This thematic review intends to raise awareness on the value of translational and implementation science in clinical research and to encourage its use in designing and implementing clinical trials across the translational research continuum. Herein, we describe the gap in translating research findings into clinical practice, introduce translational and implementation science, and describe the principles and practices from implementation science that can be used in clinical trial research across the translational continuum to inform clinical practice, to improve population health impact, and to address health care inequities.
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Affiliation(s)
| | - Jennifer L Ridgeway
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
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Bankole AO, Burse NR, Crowder V, Chan YN, Hirschey R, Jung A, Tan KR, Coppola S, Pergolotti M, Richardson DR, Bryant AL. "A strong reason why I enjoy coming to work": Clinician acceptability of a palliative and supportive care intervention (PACT) for older adults with acute myeloid leukemia and their care partners. J Geriatr Oncol 2024; 15:101740. [PMID: 38513534 PMCID: PMC11088930 DOI: 10.1016/j.jgo.2024.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/17/2023] [Accepted: 03/01/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Studies about clinician acceptability of integrative palliative care interventions in the inpatient and outpatient cancer settings are limited. In this study, we examined clinician acceptability of a NIH-funded interdisciplinary PAlliative and Supportive Care inTervention (PACT) for older adults with acute myeloid leukemia (AML) and their care partners that transcends both inpatient and outpatient settings. MATERIALS AND METHODS Data was collected using semi-structured interviews with clinicians who were directly involved in PACT. The domains of the Theoretical Framework of Acceptability were used to guide the qualitative analysis. RESULTS The clinicians consisted of occupational therapists (37%), physical therapists (25%), registered nurses (25%), and a clinical rehabilitation manager (13%). Five themes were identified in the thematic analysis: (1) Emotions and affect towards the intervention, (2) Intervention coherence and self-efficacy, (3) Barriers, burden, and opportunity costs of delivering the intervention, (4) Usefulness and effectiveness of the intervention, and (5) Recommendations to improve intervention delivery. DISCUSSION All clinicians found the PACT intervention highly acceptable and expressed the positive impact of the intervention on job fulfillment and satisfaction. Our findings provide evidence to inform the delivery and implementation of future large scale integrative palliative care intervention trials.
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Affiliation(s)
- Ayomide Okanlawon Bankole
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Natasha Renee Burse
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Victoria Crowder
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Ya-Ning Chan
- Department of Population Health Sciences, Duke University, Durham, NC, United States of America.
| | - Rachel Hirschey
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America.
| | - Ahrang Jung
- School of Nursing, The University of North Carolina at Greensboro, Greensboro, NC, United States of America.
| | - Kelly R Tan
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Susan Coppola
- Occupational Science and Occupational Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
| | - Mackenzi Pergolotti
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; ReVital Cancer Rehabilitation, Select Medical, Inc, Mechanicsburg, PA United States of America.
| | - Daniel R Richardson
- Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America.
| | - Ashley Leak Bryant
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States of America.
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Perez LG, Williams MV, Dopp AR, Ringel JS, Faherty LJ. Lessons From an Implementation Evaluation of a Real-World Multi-City Initiative to Address COVID-19 Vaccination Inequities. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:331-338. [PMID: 37451848 PMCID: PMC10350584 DOI: 10.1177/2752535x231189434] [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] [Indexed: 07/18/2023]
Abstract
Background: The COVID-19 pandemic shed light on stark racial and ethnic inequities in access to care and accurate health information in the U.S. When COVID-19 vaccines became available, communities of color faced multiple barriers that contributed to low vaccine rates. To address this gap, the Equity-First Vaccination Initiative supported community organizations in five demonstration cities to plan and implement hyper-local strategies to increase COVID-19 vaccine access and uptake among communities of color.Purpose: To draw learnings from the experiences of the participating organizations, we applied a framework that integrated implementation science and health equity principles.Design and sample: In this commentary, we describe how we used this framework to guide qualitative interviews with community organizations, focusing on insights across five implementation elements (reach, design, implementation, adaptation, implementation outcomes).Conclusions: Learnings from this evaluation may help guide future implementation of similarly complex initiatives involving multiple organizations and sites to advance health equity during a public health crisis.
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Affiliation(s)
- Lilian G. Perez
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, CA, USA
| | - Malcolm V. Williams
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, CA, USA
| | - Alex R. Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, CA, USA
| | - Jeanne S. Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, Santa Monica, CA, USA
| | - Laura J. Faherty
- Department of Behavioral and Policy Sciences, RAND Corporation, Boston, MA, USA
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
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Creasy SL, Sweet S, Myers JJ, Shumway M, Tolou-Shams M, McCaffrey N, Dauria EF. eHealth-Enhanced Peer Navigation for Substance Use Treatment and HIV Prevention Service Linkage for Young Adults Surveilled by the Criminal Legal System: Protocol for a Pilot Randomized Trial Study. JMIR Res Protoc 2024; 13:e54815. [PMID: 38530335 PMCID: PMC11005443 DOI: 10.2196/54815] [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: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND In the United States, the proportion of criminal legal-involved (CLI) adults with a substance use disorder reaches 72%, and ~150,000 persons with HIV pass through a carceral setting annually, which represents 16% of the HIV-infected population nationally. Despite the high need for substance use treatment and HIV prevention services, few carceral settings successfully link CLI individuals to treatment upon release. Young adults represent 41.9% of the adults incarcerated in the United States and have the highest HIV incidence rates nationally. Peer patient navigation has successfully increased community-based care linkage for people living with HIV leaving jail; yet, peer-led navigation for HIV prevention among HIV-negative CLI populations is undeveloped and untested. eHealth approaches to substance use and HIV prevention services hold promise because they improve access to effective intervention services, particularly for younger people. OBJECTIVE This paper describes a protocol for a pilot randomized controlled trial that aims to improve linkage to substance use treatment and HIV prevention services using peer navigation and a codeveloped eHealth technology adjunct. METHODS The three aims of this study are to (1) adapt an existing evidence-based navigator model and incorporate codeveloped eHealth technology to refer and link young adults (18 to 29 years) surveilled by the criminal legal system to substance use and pre-exposure prophylaxis (PrEP) services; (2) refine and test the intervention with criminal legal-involved young adults (CLI-YAs); and (3) assess the feasibility, acceptability, and impact of the intervention. Data to inform the intervention will be collected via system partner interviews (n=4) and focus groups with CLI-YAs (n=24). Next, an open trial (n=10) will be conducted. The intervention will be refined via interviews with participants and facilitators, and a randomized pilot trial (n=75) will be conducted to assess the feasibility, acceptability, and preliminary impact of the eHealth-enhanced navigation on substance use and PrEP services linkage. Exit interviews conducted with a subsample of intervention participants (n=10), the navigator (n=1), and system partners (n=4) will assess intervention acceptability and suggestions for improvement. A community of practice, a group of system partners with an interest in working toward solutions to common problems, will inform each phase of the study. RESULTS The project is currently ongoing. The project was funded in September 2022. Internal review board approval was received on March 21, 2022. The first results from early study aims are expected to be published in 2025. CONCLUSIONS This study provides an opportunity to reduce HIV acquisition and improve access to substance use treatment in a systemically marginalized group: young CLI-YAs. The results will contribute to the development and testing of a future multilevel randomized controlled trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54815.
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Affiliation(s)
- Stephanie L Creasy
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sheridan Sweet
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janet J Myers
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, CA, United States
| | - Marina Tolou-Shams
- Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, CA, United States
| | - Nicole McCaffrey
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Emily F Dauria
- Department of Behavioral and Community Health Sciences, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Woolf C, Kaplan L, Norrie LM, Burke D, Cunich M, Mowszowski L, Naismith SL. A feasibility, randomised controlled trial of Club Connect: a group-based healthy brain ageing cognitive training program for older adults with major depression within an older people's mental health service. BMC Psychiatry 2024; 24:208. [PMID: 38500095 PMCID: PMC10946102 DOI: 10.1186/s12888-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/21/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People's Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or 'reach'), tolerability (or 'implementation'), and acceptability (or 'adoption'). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. 'effectiveness') to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation. METHODS Using a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65-95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group. RESULTS Implementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2 = 0.115-0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50. CONCLUSIONS Our findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019).
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Affiliation(s)
- Claudia Woolf
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - L Kaplan
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW, Australia
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - M Cunich
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
| | - S L Naismith
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
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Chambers DA, Emmons KM. Navigating the field of implementation science towards maturity: challenges and opportunities. Implement Sci 2024; 19:26. [PMID: 38481286 PMCID: PMC10936041 DOI: 10.1186/s13012-024-01352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The field of implementation science has significantly expanded in size and scope over the past two decades, although work related to understanding implementation processes have of course long preceded the more systematic efforts to improve integration of evidence-based interventions into practice settings. While this growth has had significant benefits to research, practice, and policy, there are some clear challenges that this period of adolescence has uncovered. MAIN BODY This invited commentary reflects on the development of implementation science, its rapid growth, and milestones in its establishment as a viable component of the biomedical research enterprise. The authors reflect on progress in research and training, and then unpack some of the consequences of rapid growth, as the field has grappled with the competing challenges of legitimacy among the research community set against the necessary integration and engagement with practice and policy partners. The article then enumerates a set of principles for the field's next developmental stage and espouses the aspirational goal of a "big tent" to support the next generation of impactful science. CONCLUSION For implementation science to expand its relevance and impact to practice and policy, researchers must not lose sight of the original purpose of the field-to support improvements in health and health care at scale, the importance of building a community of research and practice among key partners, and the balance of rigor, relevance, and societal benefit.
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Affiliation(s)
- David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Room 3E-414, Rockville, Bethesda, MD, 20850, USA.
| | - Karen M Emmons
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Krisciunas GP, Scheel R, Slavin M. Implementing Dysphagia Outcome Assessments into Clinical Settings: Leveraging Principles of Implementation, Dissemination, and Psychometrics. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:707-715. [PMID: 38284938 DOI: 10.1044/2023_ajslp-23-00227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
PURPOSE Myriad dysphagia assessment tools have been designed, but their application is variable. This is partly due to a lack of implementation and dissemination strategy as well as to limited guidance regarding which instruments are optimally designed and best used for clinical and research applications. METHOD This tutorial provides a high-level overview of implementation and dissemination, their interaction with psychometrics and knowledge coproduction, and how these concepts relate to proper development and widespread application of contextually relevant, psychometrically optimized, evidence-based dysphagia assessment instruments. RESULTS A review of the literature identified two dysphagia assessment instruments that purposefully integrated implementation and dissemination processes after measurement development. Application of knowledge coproduction was not identified in any papers reporting development and testing of dysphagia assessment instruments. A better understanding of coproduction and psychometrics when developing measures, while simultaneously applying implementation science and dissemination strategies, can result in the development of optimal dysphagia assessment tools that are more consistently adopted into clinical practice. CONCLUSIONS Clinicians and researchers should promote the development of psychometrically sound measures, and employ principles of implementation science and effective dissemination strategies to advocate for, and promote the use of, well-designed instruments within their appropriate clinical contexts. Support from governing bodies and funding agencies could enhance future efforts to develop, and encourage widespread uptake of, optimally developed dysphagia assessment tools.
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Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Chobanian & Avedisian School of Medicine, MA
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
| | - Rebecca Scheel
- Department of Otolaryngology, Lahey Hospital & Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Mary Slavin
- Department of Health Law, Policy & Management, Boston University School of Public Health, MA
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Li J, Luo R, Guo P, Zhang D, Mo PKH, Wu AMS, Xin M, Shang M, Cai Y, Wang X, Chen M, He Y, Zheng L, Huang J, Xu RD, Lau JTF, Gu J, Hall BJ. Effectiveness of a WHO self-help psychological intervention to alleviate stress among healthcare workers in the context of COVID-19 in China: a randomised controlled trial. Epidemiol Psychiatr Sci 2024; 33:e11. [PMID: 38450478 PMCID: PMC10940054 DOI: 10.1017/s2045796024000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 09/19/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
AIMS To examine the effectiveness of Self-Help Plus (SH+) as an intervention for alleviating stress levels and mental health problems among healthcare workers. METHODS This was a prospective, two-arm, unblinded, parallel-designed randomised controlled trial. Participants were recruited at all levels of medical facilities within all municipal districts of Guangzhou. Eligible participants were adult healthcare workers experiencing psychological stress (10-item Perceived Stress Scale scores of ≥15) but without serious mental health problems or active suicidal ideation. A self-help psychological intervention developed by the World Health Organization in alleviating psychological stress and preventing the development of mental health problems. The primary outcome was psychological stress, assessed at the 3-month follow-up. Secondary outcomes were depression symptoms, anxiety symptoms, insomnia, positive affect (PA) and self-kindness assessed at the 3-month follow-up. RESULTS Between November 2021 and April 2022, 270 participants were enrolled and randomly assigned to either SH+ (n = 135) or the control group (n = 135). The SH+ group had significantly lower stress at the 3-month follow-up (b = -1.23, 95% CI = -2.36, -0.10, p = 0.033) compared to the control group. The interaction effect indicated that the intervention effect in reducing stress differed over time (b = -0.89, 95% CI = -1.50, -0.27, p = 0.005). Analysis of the secondary outcomes suggested that SH+ led to statistically significant improvements in most of the secondary outcomes, including depression, insomnia, PA and self-kindness. CONCLUSIONS This is the first known randomised controlled trial ever conducted to improve stress and mental health problems among healthcare workers experiencing psychological stress in a low-resource setting. SH+ was found to be an effective strategy for alleviating psychological stress and reducing symptoms of common mental problems. SH+ has the potential to be scaled-up as a public health strategy to reduce the burden of mental health problems in healthcare workers exposed to high levels of stress.
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Affiliation(s)
- Jinghua Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen University Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Guangdong Key Laboratory of Health Informatics, Guangzhou, China
- Research Center of Health Informatics, Sun Yat-sen University, Guangzhou, China
| | - Rui Luo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Pengyue Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Dexing Zhang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin District, Hong Kong, China
| | - Phoenix K. H. Mo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin District, Hong Kong, China
- The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China
| | - Anise M. S. Wu
- Department of Psychology, Faculty of Social Sciences, University of Macau, Taipa, Macao, China
| | - Meiqi Xin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Menglin Shang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuqi Cai
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xu Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Mingyu Chen
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yiling He
- Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Luxin Zheng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinying Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Roman Dong Xu
- Acacia Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Joseph T. F. Lau
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- Affiliated Kangning Hospital of Wenzhou Medical University, Wenzhou, China
- Centre for Health Behaviors Research, The Chinese University of Hong Kong, Shatin District, Hong Kong, China
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Jing Gu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Sun Yat-sen University Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China
- Guangdong Key Laboratory of Health Informatics, Guangzhou, China
- Research Center of Health Informatics, Sun Yat-sen University, Guangzhou, China
| | - Brian J. Hall
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People’s Republic of China
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Brochier A, Torres A, Tyrrell H, Paz KB, Wexler MG, Griffith M, Joiner T, Magardino A, Messmer E, Rogers S, Scheindlin B, Serwint JR, Sharif I, Shone LP, Stockwell MS, Tripodis Y, Garg A, Drainoni ML. Addressing adverse social determinants of health in pediatric primary care: Study protocol for a hybrid type 2 effectiveness-implementation randomized controlled trial in two national pediatric practice-based research networks. Contemp Clin Trials 2024; 138:107436. [PMID: 38199577 PMCID: PMC10922627 DOI: 10.1016/j.cct.2024.107436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 12/06/2023] [Accepted: 01/07/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Growing evidence linking social determinants of health (SDOH) to child health outcomes has prompted widespread recommendations for pediatricians to screen and refer for adverse SDOH at primary care visits. Yet there is little evidence to date demonstrating the effectiveness of practice-based SDOH screening and referral interventions on increasing family engagement with resources. This hybrid type 2 effectiveness-implementation trial aims to demonstrate the non-inferiority of a low-touch implementation strategy in order to facilitate dissemination of an existing SDOH screening and referral system (WE CARE) and demonstrate its effectiveness and sustainability in various pediatric practices. METHODS We recruited eighteen pediatric practices in fourteen US states through two pediatric practice-based research networks. For this stepped wedge cluster RCT, practices serve as their own controls during the Usual Care phase and implement WE CARE during the intervention phase via one of two randomized implementation strategies: self-directed, pre-recorded webinar vs. study team-facilitated, live webinar. We collect data at practice, clinician/staff, and parent levels to assess outcomes grounded in the Proctor Conceptual Model of Implementation Research. We use generalized mixed effects models and differences in proportions to compare rates of resource referrals by implementation strategy, and intention-to-treat analysis to compare odds of engagement with new resources among families enrolled in the Usual Care vs. WE CARE phases. DISCUSSION Findings from this trial may inform decisions about broader dissemination of SDOH screening systems into a diverse spectrum of pediatric practices across the US and potentially minimize the impact of adverse SDOH on children and families.
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Affiliation(s)
- Annelise Brochier
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Alessandra Torres
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America.
| | - Hollyce Tyrrell
- Academic Pediatric Association, McLean, VA, United States of America
| | - Katherine Barahona Paz
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America
| | | | - Miranda Griffith
- Primary Care Research, American Academy of Pediatrics, Itasca, IL, United States of America
| | - Terence Joiner
- Division of General Pediatrics, Department of Pediatrics, University of Michigan Medical School, and Ypsilanti Health Center, Ypsilanti, MI, United States of America
| | - Angela Magardino
- Department of Pediatrics, Boston Medical Center, Boston, MA, United States of America
| | - Emily Messmer
- Quality and Patient Experience, Mass General Brigham, Somerville, MA, United States of America
| | - Stephen Rogers
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Janet R Serwint
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Iman Sharif
- Harlem Hospital Center, New York, NY, United States of America; Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Laura P Shone
- Shone Sciences, DBA, Lowville, NY, United States of America
| | - Melissa S Stockwell
- Division of Child and Adolescent Health, Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Department of Population and Family Health, Mailman School of Public Health Columbia University, New York, NY, United States of America
| | - Yorghos Tripodis
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Arvin Garg
- Child Health Equity Center, Department of Pediatrics, UMass Chan Medical School, Worcester, MA, United States of America; UMass Memorial Children's Medical Center, Worcester, MA, United States of America
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, Boston, MA, United States of America; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States of America
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Younas A, Porr C, Maddigan J, Moore JE, Navarro P, Whitehead D. The Pathway Building Technique in Implementation Research Using Mixed Methods Design. Can J Nurs Res 2024; 56:5-15. [PMID: 37941336 PMCID: PMC10804687 DOI: 10.1177/08445621231213432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Data integration refers to combining quantitative and qualitative data in mixed methods. It can be achieved through several integration procedures. The building integration procedure can be used for developing quantitative instruments by integrating data from the qualitative phase. There are limited examples of data integration using the building procedure in mixed methods and implementation science. PURPOSE The purpose of this article is to illustrate how the pathway building technique can be used to integrate data in mixed methods research through concurrent use of implementation science models and frameworks. METHODS This two pathway building technique was developed based on a mixed methods implementation project of developing implementation strategies to promote compassionate nursing care of complex patients. RESULTS The first pathway is the integration of qualitative data from the first phase of mixed methods study with implementation models and frameworks to create a quantitative instrument (i.e., a Q-sort survey) for the subsequent phase. The second pathway is the operationalization of the Q-sort survey results (i.e., implementation strategies) using an implementation science specification framework. CONCLUSION The pathway technique is valuable for mixed methods research and implementation science as it offers a theory-based innovative method to tackle integration challenge.
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Affiliation(s)
- Ahtisham Younas
- Assistant Professor, Faculty of Nursing, Memorial University of Newfoundland, St. John's, Canada
| | - Caroline Porr
- Former Associate Professor, Faculty of Nursing, Memorial University of Newfoundland, St. John's, Canada
| | - Joy Maddigan
- Associate Professor, Faculty of Nursing, Memorial University of Newfoundland, St. John's, Canada
| | - Julia E Moore
- Director, The Center of Implementation, Toronto, Canada
| | - Pablo Navarro
- Senior Research Officer, The Newfoundland and Labrador Centre for Applied Health Research, St. John's, Newfoundland, Canada
| | - Dean Whitehead
- Senior Lecturer, Institute of Health and Wellbeing, Federation University Australia, Ballarat, Australia
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Brenner JM, Fulton TB, Kruidering M, Bird JB, Willey J, Qua K, Olvet DM. What have we learned about constructed response short-answer questions from students and faculty? A multi-institutional study. MEDICAL TEACHER 2024; 46:349-358. [PMID: 37688773 DOI: 10.1080/0142159x.2023.2249209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2023]
Abstract
PURPOSE The purpose of this study was to enrich understanding about the perceived benefits and drawbacks of constructed response short-answer questions (CR-SAQs) in preclerkship assessment using Norcini's criteria for good assessment as a framework. METHODS This multi-institutional study surveyed students and faculty at three institutions. A survey using Likert scale and open-ended questions was developed to evaluate faculty and student perceptions of CR-SAQs using the criteria of good assessment to determine the benefits and drawbacks. Descriptive statistics and Chi-square analyses are presented, and open responses were analyzed using directed content analysis to describe benefits and drawbacks of CR-SAQs. RESULTS A total of 260 students (19%) and 57 faculty (48%) completed the survey. Students and faculty report that the benefits of CR-SAQs are authenticity, deeper learning (educational effect), and receiving feedback (catalytic effect). Drawbacks included feasibility, construct validity, and scoring reproducibility. Students and faculty found CR-SAQs to be both acceptable (can show your reasoning, partial credit) and unacceptable (stressful, not USMLE format). CONCLUSIONS CR-SAQs are a method of aligning innovative curricula with assessment and could enrich the assessment toolkit for medical educators.
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Affiliation(s)
- Judith M Brenner
- Department of Science Education, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York, USA
| | - Tracy B Fulton
- Department of Biochemistry and Biophysics, University of California San Francisco, San Francisco, California, USA
| | - Marieke Kruidering
- Department of Cellular and Molecular Pharmacology, University of California San Francisco,San Francisco, California, USA
| | - Jeffrey B Bird
- Department of Science Education, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York, USA
| | - Joanne Willey
- Department of Science Education, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York, USA
| | - Kelli Qua
- Center for Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Doreen M Olvet
- Department of Science Education, Donald and Barbara Zucker School of Medicine, Hofstra/Northwell, Hempstead, New York, USA
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Du Plessis CD, Hampton LH, Harty M. Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines. SOUTH AFRICAN JOURNAL OF COMMUNICATION DISORDERS 2024; 71:e1-e10. [PMID: 38426737 PMCID: PMC10913137 DOI: 10.4102/sajcd.v71i1.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. OBJECTIVES To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit. METHOD We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. RESULTS Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. CONCLUSION Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution: This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.
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Affiliation(s)
- Chevonne D Du Plessis
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Patel-Syed Z, Becker S, Olson M, Rinella H, Scott K. What do you think it means? Using cognitive interviewing to improve measurement in implementation science: description and case example. Implement Sci Commun 2024; 5:14. [PMID: 38355677 PMCID: PMC10865651 DOI: 10.1186/s43058-024-00549-0] [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: 01/17/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Pragmatic measures are essential to evaluate the implementation of evidence-based interventions. Cognitive interviewing, a qualitative method that collects partner feedback throughout measure development, is particularly useful for developing pragmatic implementation measures. Measure developers can use cognitive interviewing to increase a measure's fit within a particular implementation context. However, cognitive interviewing is underused in implementation research, where most measures remain "homegrown" and used for single studies. We provide a rationale for using cognitive interviewing in implementation science studies and illustrate its use through a case example employing cognitive interviewing to inform development of a measurement-based care protocol for implementation in opioid treatment programs. Applications of cognitive interviewing, including developing a common language with partners and collecting multi-level feedback on assessment procedures, to improve measurement in implementation science are discussed.
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Affiliation(s)
- Zabin Patel-Syed
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA.
| | - Sara Becker
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Miranda Olson
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Hailey Rinella
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Kelli Scott
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
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Gannamani R, Castela Forte J, Folkertsma P, Hermans S, Kumaraswamy S, van Dam S, Chavannes N, van Os H, Pijl H, Wolffenbuttel BHR. A Digitally Enabled Combined Lifestyle Intervention for Weight Loss: Pilot Study in a Dutch General Population Cohort. JMIR Form Res 2024; 8:e38891. [PMID: 38329792 PMCID: PMC10884913 DOI: 10.2196/38891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 05/04/2023] [Accepted: 09/25/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Overweight and obesity rates among the general population of the Netherlands keep increasing. Combined lifestyle interventions (CLIs) focused on physical activity, nutrition, sleep, and stress management can be effective in reducing weight and improving health behaviors. Currently available CLIs for weight loss (CLI-WLs) in the Netherlands consist of face-to-face and community-based sessions, which face scalability challenges. A digitally enabled CLI-WL with digital and human components may provide a solution for this challenge; however, the feasibility of such an intervention has not yet been assessed in the Netherlands. OBJECTIVE The aim of this study was two-fold: (1) to determine how weight and other secondary cardiometabolic outcomes (lipids and blood pressure) change over time in a Dutch population with overweight or obesity and cardiometabolic risk participating in a pilot digitally enabled CLI-WL and (2) to collect feedback from participants to guide the further development of future iterations of the intervention. METHODS Participants followed a 16-week digitally enabled lifestyle coaching program rooted in the Fogg Behavior Model, focused on nutrition, physical activity, and other health behaviors, from January 2020 to December 2021. Participants could access the digital app to register and track health behaviors, weight, and anthropometrics data at any time. We retrospectively analyzed changes in weight, blood pressure, and lipids for remeasured users. Surveys and semistructured interviews were conducted to assess critical positive and improvement points reported by participants and health care professionals. RESULTS Of the 420 participants evaluated at baseline, 53 participated in the pilot. Of these, 37 (70%) were classified as overweight and 16 (30%) had obesity. Mean weight loss of 4.2% occurred at a median of 10 months postintervention. The subpopulation with obesity (n=16) showed a 5.6% weight loss on average. Total cholesterol decreased by 10.2% and low-density lipoprotein cholesterol decreased by 12.9% on average. Systolic and diastolic blood pressure decreased by 3.5% and 7.5%, respectively. Participants identified the possibility of setting clear action plans to work toward and the multiple weekly touch points with coaches as two of the most positive and distinctive components of the digitally enabled intervention. Surveys and interviews demonstrated that the digital implementation of a CLI-WL is feasible and well-received by both participants and health care professionals. CONCLUSIONS Albeit preliminary, these findings suggest that a behavioral lifestyle program with a digital component can achieve greater weight loss than reported for currently available offline CLI-WLs. Thus, a digitally enabled CLI-WL is feasible and may be a scalable alternative to offline CLI-WL programs. Evidence from future studies in a Dutch population may help elucidate the mechanisms behind the effectiveness of a digitally enabled CLI-WL.
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Affiliation(s)
- Rahul Gannamani
- Ancora Health BV, Groningen, Netherlands
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - José Castela Forte
- Ancora Health BV, Groningen, Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Pytrik Folkertsma
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | | | - Sipko van Dam
- Ancora Health BV, Groningen, Netherlands
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hendrikus van Os
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden University, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Hanno Pijl
- Department of Endocrinology, Leiden University Medical Center, Leiden University, Leiden, Netherlands
| | - Bruce H R Wolffenbuttel
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Tugnawat D, Singh A, Anand A, Bondre A, Chandke D, Dhurve P, Joshi U, Khan A, Muke S, Negi B, Nikhare K, Rathore D, Ramaswamy R, Haney JR, Sen Y, Sharma K, Shrivastava R, Verma N, Vishwakarma R, Vishwakarma D, Vorapanya V, Patel V, Bhan A, Naslund JA. ESSENCE: An Implementation Research Program to Scale Up Depression Care in Rural Communities. Psychiatr Serv 2024; 75:167-177. [PMID: 37904491 DOI: 10.1176/appi.ps.202100223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
BACKGROUND Task sharing may involve training nonspecialist health workers (NSHWs) to deliver brief mental health interventions. This approach is promising for reducing the global mental health treatment gap. However, capacity is limited for training large cadres of frontline workers in low- and middle-income countries, hindering uptake of these interventions at scale. METHODS The ESSENCE (enabling translation of science to service to enhance depression care) project in Madhya Pradesh, India, aims to address these challenges through two sequential randomized controlled trials. First, a training trial will evaluate the effectiveness and cost-effectiveness of digital training, compared with conventional face-to-face training, in achieving clinical competency of NSHWs in delivering an intervention for depression. This initial trial will be followed by an implementation trial aimed at evaluating the effectiveness of a remote enhanced implementation support, compared with routine implementation support, in addressing barriers to delivery of depression care in primary care facilities. RESULTS This project involved developing and pilot testing a scalable smartphone-based program for training NSHWs to deliver a brief psychological intervention for depression screening. This initial research guided a randomized trial of a digital training approach with NSHWs to evaluate the effectiveness of this approach. This trial will be followed by a cluster-randomized trial to evaluate the effectiveness of remote implementation support in ensuring efficient delivery of depression care in primary care facilities. NEXT STEPS Findings from these trials may inform sustainable training and implementation support models to integrate depression care into primary care for scale-up in resource-constrained settings.
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Affiliation(s)
- Deepak Tugnawat
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Abhishek Singh
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Aditya Anand
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ameya Bondre
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dinesh Chandke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Pooja Dhurve
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Udita Joshi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Azaz Khan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Shital Muke
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Babita Negi
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kalyani Nikhare
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Dharmendra Rathore
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Rohit Ramaswamy
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Juliana Restivo Haney
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Yogendra Sen
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Kamlesh Sharma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ritu Shrivastava
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Narendra Verma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Ram Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Deepali Vishwakarma
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vorapat Vorapanya
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Vikram Patel
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - Anant Bhan
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
| | - John A Naslund
- Sangath Bhopal Hub, Bhopal, Madhya Pradesh, India (Tugnawat, Singh, Anand, Bondre, Chandke, Dhurve, Joshi, Khan, Muke, Negi, Nikhare, Rathore, Sen, Sharma, Shrivastava, Verma, R. Vishwakarma, D. Vishwakarma, Bhan); James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati (Ramaswamy); Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Ramaswamy, Vorapanya); Department of Global Health and Social Medicine, Harvard Medical School, Boston (Haney, Patel, Naslund); Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston (Patel)
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Herkama S, Larose MP, Harjuniemi I, Pöyhönen V, Yanagida T, Kankaanpää E, Rissanen E, Salmivalli C. Improving the implementation of KiVa antibullying program with tailored support: Study protocol for a cluster randomized controlled trial. Contemp Clin Trials 2024; 137:107407. [PMID: 38104858 DOI: 10.1016/j.cct.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There are no evidence-based models to support the implementation of school-based bullying prevention programs. Our primary objective is to examine the impact of tailored support on the implementation of the KiVa antibullying program. Our second objective is to evaluate whether the offered support influences student outcomes (e.g., victimization, bullying perpetration). We also assess the cost-effectiveness of the provided support and conduct a process evaluation. METHODS In a cluster randomized control trial (cRCT), we compare program fidelity between schools that receive implementation support and those that do not. Twenty-four (N = 24) schools in Finland were randomized to either the IMPRES condition (receiving support, n = 12) or the control group (KiVa as usual, n = 12). In the IMPRES condition, pre-assessment and staff training were organized, and a selected team of staff members received four mentoring sessions during one academic year. Staff and students answer questionnaires at the end of school year 0, at post-intervention (year 1) and again at the 1-year follow-up (year 2). Our primary outcomes concern two main program components - universal and indicated actions - reflecting program fidelity. As secondary outcomes, we examine the level of bullying victimization and perpetration as well as students' perception of several program fidelity indicators. Finally, we assess several tertiary outcomes, collect resource data and conduct qualitative interviews to perform additional analyses. CONCLUSION This trial will inform us of whether implementation support can boost program fidelity and have a distal impact on bullying prevalence. TRIAL REGISTRATION ISRCTN15558617 https://doi.org/10.1186/ISRCTN15558617.
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Kamp K, Yang PL, Friedman E, Lopez A, Iribarren S, Barney P, Munson S, Heitkemper M, Levy R. Formative Evaluation of a Comprehensive Self-Management Intervention for Irritable Bowel Syndrome, Comorbid Anxiety, and Depression: Mixed Methods Study. JMIR Form Res 2024; 8:e43286. [PMID: 38294871 PMCID: PMC10867748 DOI: 10.2196/43286] [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: 10/13/2022] [Revised: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a disorder of the gut-brain interaction that is associated with abdominal pain, altered bowel patterns, and reduced quality of life. Up to 50% of patients with IBS also report anxiety or depressive symptoms. Although effective self-management interventions exist for individuals with IBS, few have been effectively implemented, and most do not consider the unique needs of patients with comorbid IBS and anxiety or depression. OBJECTIVE This study aimed to determine the anticipated acceptability, appropriateness, feasibility, and usability of a comprehensive self-management intervention using an implementation science and human-centered design approach among individuals with comorbid IBS and anxiety or depression and health care providers. METHODS A convergent mixed methods design was used to elicit feedback on the comprehensive self-management intervention outline and content to identify refinement needs before testing. Patients with IBS and moderate to severe anxiety or depression and health care providers were purposefully sampled from primary care and gastroenterology settings. Participants completed semistructured interviews and surveys on anticipated acceptability, appropriateness, feasibility, and usability. RESULTS Patient participants (n=12) were on average 36.8 (SD 12.2) years of age, and 42% (5/12) were currently receiving psychological therapy. Health care providers (n=14) were from primary care (n=7) and gastroenterology (n=7) settings. The mean usability scores (out of 100) were 52.5 (SD 14.5) for patients and 45.6 (SD 11.6) for providers. For patients and providers, qualitative data expanded the quantitative findings for acceptability and appropriateness. Acceptability findings were the comprehensive nature of the intervention and discussion of the gut-brain interaction. For appropriateness, participants reported that the intervention provided structure, accountability, and support. Feasibility was confirmed for patients, but there was a divergence of findings between quantitative and qualitative measures for providers. Patients focused on intervention feasibility, while providers focused on implementation feasibility in the clinic. Identified usability issues to address before implementation included the intervention delivery format, length, and lack of integration into health care settings that, if not addressed, may limit the reach of the intervention. CONCLUSIONS Patients and health care providers found the intervention acceptable and appropriate. Several feasibility and usability issues were identified, including intervention delivery methods, length of intervention, and the best methods to implement in the clinic setting. The next steps are to refine the intervention to address the identified issues and test in a pilot study whether addressing usability issues leads to the anticipated improvements in implementation and uptake.
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Affiliation(s)
- Kendra Kamp
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | | | - Emily Friedman
- Alacrity Center, University of Washington, Seattle, WA, United States
| | - Alejandra Lopez
- Alacrity Center, University of Washington, Seattle, WA, United States
| | - Sarah Iribarren
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Pamela Barney
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Sean Munson
- Human Centered Design and Engineering, University of Washington, Seattle, WA, United States
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, WA, United States
| | - Rona Levy
- School of Social Work, University of Washington, Seattle, WA, United States
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Drmic I, Brian J, Roncadin C, Shaver C, Pase M, Rugajs N, Tofano K, Dowds E, Zwaigenbaum L, Smith IM, Bryson SE. Community implementation of a brief parent mediated intervention for toddlers with probable or confirmed autism spectrum disorder: feasibility, acceptability, and drivers of success (IE Drmic et al.). Front Pediatr 2024; 11:1295294. [PMID: 38322245 PMCID: PMC10844426 DOI: 10.3389/fped.2023.1295294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/27/2023] [Indexed: 02/08/2024] Open
Abstract
Background Social ABCs is a caregiver-mediated Naturalistic Developmental Behavioral Intervention for toddlers with confirmed/suspected Autism Spectrum Disorder (ASD), with evidence in controlled research settings. Information is lacking on implementation in community settings. We reported on the treatment effectiveness of this program within a community setting, and the current paper describes the implementation phase of this work. Distinguishing between treatment and implementation effectiveness is critical for transporting interventions from laboratory to community. Objectives Describe the implementation of Social ABCs through a large public autism service, supported by a research-community partnership. Methods We describe this project through the Exploration, Preparation, Implementation, Sustainment (EPIS) framework as it focuses on implementation of evidence-based practices in publicly funded services. We apply this framework to the reporting stage. This project took place in the context of a 3-year government-funded pilot at a hospital-based publicly funded autism service. Participants: Program developers; Autism Service team; toddlers with suspected/confirmed ASD aged 14-34 months (M = 25.18 months) and their caregivers. Training/supervision: Provided by program developers at tapering intensity. Evaluation: Caregivers completed the Caregiver Diary and satisfaction surveys. We explored training processes, intervention uptake, acceptability, adaptations to fit community context, appropriateness, perceived impact, and facilitators/barriers. Results Six coaches were trained to fidelity, and three of these were further trained as Site Trainers. 183 clinically referred families enrolled and 89.4% completed the 12-week program. Caregivers reported increases in adherence and competence, high satisfaction and perceived benefits for their children. Coaches reported high satisfaction. Toddlers were appropriately identified to receive the intervention. Referral processes improved, including decreased referral age, and increased family readiness for diagnostic assessment and subsequent services. Conclusions Social ABCs was successfully implemented in a community service through a research-community partnership. The program was feasible, acceptable, and appropriate within a community context. Drivers of success included funding, institutional support, shared decision-making, adaptations to fit context, leadership support, perceived positive impact, and commitment to evaluation.
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Affiliation(s)
- Irene Drmic
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Jessica Brian
- Autism Research Centre, Bloorview Research Institute, Toronto, ON, Canada
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Chantelle Shaver
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Marlene Pase
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Natalie Rugajs
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Kristina Tofano
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | - Erin Dowds
- McMaster Children’s Hospital, Autism Program, Hamilton, ON, Canada
| | | | - Isabel M. Smith
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Susan E. Bryson
- Department of Pediatrics and Department of Psychology & Neuroscience, Autism Research Centre, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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Tembo TA, Mollan K, Simon K, Rutstein S, Chitani MJ, Saha PT, Mbeya-Munkhondya T, Jean-Baptiste M, Meek C, Mwapasa V, Go V, Bekker LG, Kim MH, Rosenberg NE. Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial. BMJ Open 2024; 14:e077706. [PMID: 38253452 PMCID: PMC10806658 DOI: 10.1136/bmjopen-2023-077706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Index case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to limited technical capacity of healthcare workers (HCWs) and clinical coordination. Digitisation of training and quality improvement processes presents an opportunity to address these challenges. We developed an implementation package that combines digital and face-to-face modalities (blended learning) to strengthen HCWs ICT skills and enhance quality improvement mechanisms. This cluster randomised controlled trial will assess the impact of the blended learning implementation package compared with the standard of care (SOC) on implementation, effectiveness and cost-effectiveness outcomes. METHODS AND ANALYSIS The study was conducted in 33 clusters in Machinga and Balaka districts, in Southern Malawi from November 2021 to November 2023. Clusters are randomised in a 2:1 ratio to the SOC versus blended learning implementation package. The SOC is composed of: brief face-to-face HCW ICT training and routine face-to-face facility mentorship for HCWs. The blended learning implementation package consists of blended teaching, role-modelling, practising, and providing feedback, and blended quality improvement processes. The primary implementation outcome is HCW fidelity to ICT over 1 year of follow-up. Primary service uptake outcomes include (a) index clients who participate in ICT, (b) contacts elicited, (c) HIV self-test kits provided for secondary distribution, (d) contacts tested and (e) contacts identified as HIV-positive. Service uptake analyses will use a negative binomial mixed-effects model to account for repeated measures within each cluster. Cost-effectiveness will be assessed through incremental cost-effectiveness ratios examining the incremental cost of each person tested. ETHICS AND DISSEMINATION The Malawi National Health Science Research Committee, the University of North Carolina and the Baylor College of Medicine Institutional Review Boards approved the trial. Study findings will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT05343390.
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Affiliation(s)
- Tapiwa A Tembo
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Katie Mollan
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Katherine Simon
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sarah Rutstein
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Mike Jones Chitani
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Pooja T Saha
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Milenka Jean-Baptiste
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Caroline Meek
- The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | | | - Vivian Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Linda Gail Bekker
- Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Maria H Kim
- Research, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Nora E Rosenberg
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Terrana A, Viglione C, Rhee K, Rabin B, Godino J, Aarons GA, Chapman J, Melendrez B, Holguin M, Osorio L, Gidwani P, Juarez Nunez C, Firestein G, Hekler E. The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity. FRONTIERS IN HEALTH SERVICES 2024; 3:1281690. [PMID: 38292916 PMCID: PMC10826509 DOI: 10.3389/frhs.2023.1281690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
There are numerous frameworks for implementing evidence-based practices (EBPs) in novel settings to achieve "fidelity." However, identifying appropriate referents for fidelity poses a challenge. The Core Functions and Forms paradigm offers a model that can inform adaptation decisions throughout all phases of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We applied the Core Functions-Forms paradigm throughout the Exploration and Preparation phases of EPIS in the design of two EBPs targeting family protective factors among Latinos in San Diego, as well as describe plans for its use in Implementation and Sustainment. We employed a distinct approach for each intervention element to contrast adaptation decisions that prioritize adherence to either form or function fidelity. We describe our application of the functions-forms paradigm within the EPIS framework, focusing on the Preparation phase. We also provide functions-forms matrices that map out the relationship between individual intervention components (forms) and the essential processes (functions) by which components are theorized to exert their impact. This case study of how the core functions-forms framework can be mapped onto EPIS can support a conceptual shift from prioritizing form fidelity to also focusing on function fidelity. This might allow interventionists to target appropriate fidelity referents when adapting an EBP, rather than defaulting to maintaining fidelity to forms as described in the protocol. We see great promise for using this framework for guiding actions throughout all EPIS phases and informing future applications of this paradigm to foster more robust fidelity to function.
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Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Clare Viglione
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Kyung Rhee
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Borsika Rabin
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Job Godino
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Gregory A. Aarons
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Jessica Chapman
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Blanca Melendrez
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | - Liliana Osorio
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | | | - Gary Firestein
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
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Imel ZE, Tanana MJ, Soma CS, Hull TD, Pace BT, Stanco SC, Creed TA, Moyers TB, Atkins DC. Mental Health Counseling From Conversational Content With Transformer-Based Machine Learning. JAMA Netw Open 2024; 7:e2352590. [PMID: 38252437 PMCID: PMC10804269 DOI: 10.1001/jamanetworkopen.2023.52590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/28/2023] [Indexed: 01/23/2024] Open
Abstract
Importance Use of asynchronous text-based counseling is rapidly growing as an easy-to-access approach to behavioral health care. Similar to in-person treatment, it is challenging to reliably assess as measures of process and content do not scale. Objective To use machine learning to evaluate clinical content and client-reported outcomes in a large sample of text-based counseling episodes of care. Design, Setting, and Participants In this quality improvement study, participants received text-based counseling between 2014 and 2019; data analysis was conducted from September 22, 2022, to November 28, 2023. The deidentified content of messages was retained as a part of ongoing quality assurance. Treatment was asynchronous text-based counseling via an online and mobile therapy app (Talkspace). Therapists were licensed to provide mental health treatment and were either independent contractors or employees of the product company. Participants were self-referred via online sign-up and received services via their insurance or self-pay and were assigned a diagnosis from their health care professional. Exposure All clients received counseling services from a licensed mental health clinician. Main Outcomes and Measures The primary outcomes were client engagement in counseling (number of weeks), treatment satisfaction, and changes in client symptoms, measured via the 8-item version of Patient Health Questionnaire (PHQ-8). A previously trained, transformer-based, deep learning model automatically categorized messages into types of therapist interventions and summaries of clinical content. Results The total sample included 166 644 clients treated by 4973 therapists (20 600 274 messages). Participating clients were predominantly female (75.23%), aged 26 to 35 years (55.4%), single (37.88%), earned a bachelor's degree (59.13%), and were White (61.8%). There was substantial variability in intervention use and treatment content across therapists. A series of mixed-effects regressions indicated that collectively, interventions and clinical content were associated with key outcomes: engagement (multiple R = 0.43), satisfaction (multiple R = 0.46), and change in PHQ-8 score (multiple R = 0.13). Conclusions and Relevance This quality improvement study found associations between therapist interventions, clinical content, and client-reported outcomes. Consistent with traditional forms of counseling, higher amounts of supportive counseling were associated with improved outcomes. These findings suggest that machine learning-based evaluations of content may increase the scale and specificity of psychotherapy research.
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Affiliation(s)
| | | | | | | | | | | | - Torrey A. Creed
- Beck Community Initiative, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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