1
|
Van Houtven CH, Drake C, Malo TL, Decosimo K, Tucker M, Sullivan C, D'Adolf J, Hughes JM, Christensen L, Grubber JM, Coffman CJ, Sperber NR, Wang V, Allen KD, Hastings SN, Shea CM, Zullig LL. Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory. Implement Sci Commun 2023; 4:69. [PMID: 37337208 DOI: 10.1186/s43058-023-00447-x] [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: 12/28/2022] [Accepted: 05/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST. METHODS In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters." RESULTS Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption. CONCLUSIONS To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption. TRIAL REGISTRATION ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.
Collapse
Affiliation(s)
- Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Connor Drake
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Teri L Malo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA.
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Caitlin Sullivan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Josh D'Adolf
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Division of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Leah Christensen
- Veteran's Health Administration Central Office, Washington, DC, USA
| | - Janet M Grubber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Cooperative Studies Program Coordinating Center, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Cynthia J Coffman
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Virginia Wang
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Medicine & Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Nicole Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, NC, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher M Shea
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System (152), 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
| |
Collapse
|
2
|
Kaufman CE, Keane EM, Shangreau C, Arthur-Asmah R, Morse B, Whitesell NR. Dissemination and uptake of HIV/STD preventive interventions in American Indian and Alaska Native communities: a case study. ETHNICITY & HEALTH 2021; 26:352-363. [PMID: 30146899 DOI: 10.1080/13557858.2018.1514456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/23/2018] [Indexed: 06/08/2023]
Abstract
Objectives: HIV and sexually transmitted diseases (STDs) are serious health conditions among American Indian and Alaska Native (AIAN) populations, especially youth. However, few sexual risk reduction evidence-based interventions (EBIs) have been implemented by AIAN-serving organizations. This project sought to identify and assess the parameters facilitating the uptake and use of EBIs in order to strengthen opportunities for sustainability and improved sexual health among AIANs.Design: Guided by Rogers' theory of diffusion of innovation, we conducted a survey with a national sample of stakeholders involved with sexual health and well-being of AIAN youth (N = 142). We collected surveys for nine months beginning September 2010 and analyzed data in 2014 and 2015. We assessed respondents' perceptions of factors that might facilitate or hinder the use of a sexual risk reduction EBI, called RESPECT, in their communities. We regressed the scale of likely program uptake (alpha = 0.88) on each of five measures of perception of diffusion and uptake: trialability (extent new program can be altered), relative advantage (more advantageous than current program), observability (impact of program), complexity (difficulty of implementation), and compatibility (consistent with community values and practices).Results: Trialability (p = .009), observability (p = .003), and compatibility (p = .005) were found to be significantly related to program uptake in the adjusted model. Standardized betas showed that compatibility ranked highest of the three, followed by trialability and observability.Conclusions: For AIAN-serving organizations and AIAN communities, demonstrating trialability, compatibility, and observability of a sexual risk reduction EBI in specific cultural settings may increase likelihood of implementation and sustainability.
Collapse
Affiliation(s)
- Carol E Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Ellen M Keane
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| | - Carly Shangreau
- Great Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's Health Board, Rapid City, SD, USA
| | - Ruth Arthur-Asmah
- Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Bradley Morse
- The Butler Institute, University of Denver, Denver, CO, USA
| | - Nancy R Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health - Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
3
|
Dryden-Palmer KD, Parshuram CS, Berta WB. Context, complexity and process in the implementation of evidence-based innovation: a realist informed review. BMC Health Serv Res 2020; 20:81. [PMID: 32013977 PMCID: PMC6998254 DOI: 10.1186/s12913-020-4935-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. Methods Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers’ Diffusion of Innovations theory (DOI) and Harvey and Kitson’s integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. Results A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. Conclusions The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.
Collapse
Affiliation(s)
- K D Dryden-Palmer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Critical Care Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada. .,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada.
| | - C S Parshuram
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Critical Care Program, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - W B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
4
|
LaJeunesse S, Thompson S, Pullen-Seufert N, Kolbe MB, Heiny S, Thomas C, Johnson ER. Diverse school community engagement with the North Carolina active routes to school project: a diffusion study. Int J Behav Nutr Phys Act 2019; 16:118. [PMID: 31783871 PMCID: PMC6884761 DOI: 10.1186/s12966-019-0889-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Schools located in rural parts of the United States and North Carolina have benefited proportionally less from the federal Safe Routes to School (SRTS) program than their more urban counterparts. We investigated whether and how diverse elementary and middle school communities throughout North Carolina have engaged in a SRTS-inspired, multi-sectoral initiative called the Active Routes to School (ARTS) project over the course of 5 years (2013 through 2017). Methods Analyses included a study sample of 2602 elementary and middle schools in North Carolina, 853 that participated in the ARTS project over the five-year study period and 1749 that had not. Statistical models controlling for county- and school-level confounders predicted schools’ involvement in walking and bicycling-promotive events, programs, and policies over time. Results Schools’ engagement with ARTS Project programming increased significantly over the study period, with 33% of eligible schools participating with the project by the end of 2017. Participation was most common in promotional events. Such event participation predicted engagement with regularly recurring programming and school- and district-level establishment of biking- and walking-facilitative policies. Lower income schools were more likely to establish recurring bike and walk programs than wealthier schools, whereas rural schools were less likely than city schools to participate in promotional events, yet equally as likely as other schools to participate in recurring bike and walk programs. Conclusions Schools’ engagement with the North Carolina ARTS Project diffused despite many schools’ rural geographies and lower socioeconomic status. Further, participation in one-time promotional events can portend schools’ establishment of recurring walking and biking programs and supportive policies.
Collapse
Affiliation(s)
- Seth LaJeunesse
- Highway Safety Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sam Thompson
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Nancy Pullen-Seufert
- Highway Safety Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Bea Kolbe
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Stephen Heiny
- Highway Safety Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cathy Thomas
- Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Edward R Johnson
- Division of Bicycle and Pedestrian Transportation, North Carolina Department of Transportation, Raleigh, NC, USA
| |
Collapse
|
5
|
The coaching on lifestyle (CooL) intervention for obesity, a study protocol for an action-oriented mixed-methods study. BMC Public Health 2018; 18:117. [PMID: 29310640 PMCID: PMC5759228 DOI: 10.1186/s12889-017-5010-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 12/20/2017] [Indexed: 12/16/2022] Open
Abstract
Background Combined lifestyle interventions (CLIs) have proved to be effective in changing and maintaining behavioural lifestyle changes and reducing overweight and obesity, in clinical and real-world settings. In this CLI, lifestyle coaches are expected to promote lifestyle changes of participants regarding physical activity and diet. In the Coaching on Lifestyle (CooL) intervention, which takes a period of 8 to 10 months, lifestyle coaches counsel adults and children aged 4 years and older (and their parents) who are obese or are overweight with an increased risk of developing cardiovascular diseases or type II diabetes. In group and individual sessions, themes such as physical activity, dietary behaviours, sleep and stress are addressed. The aim of the present study is to monitor the implementation process of the CooL intervention and to examine how the lifestyle coaches contribute to a healthier lifestyle of the participants. Methods This action-oriented study involves monitoring the implementation process of the CooL intervention and examining the lifestyle changes achieved by participants over time, in a one-group pre-post design using mixed methods. Methods include semi-structured interviews, observations, document analysis, biomedical parameters and questionnaires. Discussion The added value of the CooL study lies in its action-oriented approach and the use of mixed methods, including both qualitative and quantitative research methods. The long-term coaching used in the CooL intervention is expected to have beneficial effects on sustained lifestyle changes. Trial registration NTR6208; date registered: 13–01-2017.
Collapse
|
6
|
van de Glind I, Heinen M, Geense W, Mesters I, Wensing M, van Achterberg T. Making the connection-factors influencing implementation of evidence supported and non-evaluated lifestyle interventions in healthcare: a multiple case study. HEALTH EDUCATION RESEARCH 2015; 30:521-541. [PMID: 26025211 DOI: 10.1093/her/cyv020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
Many implementation barriers relate to lifestyle interventions (LIs) being developed by scientists. Exploring whether implementation of non-evaluated LIs is less complicated, might offer insight how to improve the use of effective interventions. This study aimed to identify influencing factors for implementation and compare factors between evidence supported and non-evaluated LIs. Evidence-supported (n = 7) and non-evaluated LIs (n = 7) in hospitals, general practices and community care organizations were included as cases. Semi-structured interviews (n = 46) were conducted. Additionally, documents (n = 207) were collected describing intervention, implementation process, and policy. We used a stepwise approach to inductively identify factors, organize them by diffusion phase, and an existing framework. A total of 37 factors were identified. 'Dissemination' factors were mainly observed in evidence-supported LIs. 'Compatibility to existing structures' ('adoption'), 'funding' and 'connection to existing care processes' ('implementation') was factors identified in all cases. 'Quality control' and 'ongoing innovation' ('maintenance') were reported in evidence-supported interventions. In all domains of the framework factors were observed. Factors identified in this study are in line with the literature. The findings do not support the assumption that implementation of non-evaluated LIs is perceived as less complex.
Collapse
Affiliation(s)
- Irene van de Glind
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse Mesters
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo van Achterberg
- Radboud Institute for Health Sciences, Department of IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
7
|
Naik AD, Lawrence B, Kiefer L, Ramos K, Utech A, Masozera N, Rao R, Petersen NJ, Kunik ME, Cully JA. Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression. Fam Pract 2015; 32:216-23. [PMID: 25552674 DOI: 10.1093/fampra/cmu084] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Evidence-based interventions are often poorly translated into primary care settings due to inadequate integration into organizational cultures and clinical workflows. Study designs that blend evaluation of effectiveness and implementation may enhance uptake of interventions into primary care settings. Community-Based Participatory Research (CBPR) models are useful for developing partnerships between research teams and primary care clinical partners to test blended study designs. METHODS We conducted a formative evaluation of partnership building between a health services research team and a primary care community in US Veterans Affairs Health System to conduct a randomized effectiveness trial of an intervention embedded in routine primary care. The formative evaluation used qualitative data drawn from research/clinical partnership meetings. Data were coded and analysed using qualitative framework analysis. RESULTS The CBPR model guided development of a research/clinical partnership based on a facilitation team consisting of 'external facilitators' (research team), 'internal facilitators' (primary care leadership) and a 'clinical advisory committee' drawn from the primary care community. Qualitative themes focused on: how the intervention components ('evidence') aligned with local clinical cultures, barriers and facilitators to acceptance and adoption of the intervention processes within the context of clinical workflows and identified 'facilitators' of intervention uptake and sustainability. CONCLUSION A CBPR model can guide the development of research/clinical partnerships. Partnerships can identify barriers and craft modifications to intervention procedures that promote integration and into primary care workflows. Formative research/clinical partnerships are critical for designing and testing interventions focused on implementation and sustainability of new evidence within routine primary care.
Collapse
Affiliation(s)
- Aanand D Naik
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health,
| | - Briana Lawrence
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Susan G. Komen Cancer Disparities Trainee, The University of Texas School of Public Health
| | - Lea Kiefer
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine
| | - Katherine Ramos
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine, Department of Counseling Psychology, University of Houston
| | - Anne Utech
- Department of Medicine, Baylor College of Medicine, Primary Care Line, Michael E. DeBakey VA Medical Center
| | | | - Radha Rao
- Primary Care Line, Michael E. DeBakey VA Medical Center
| | - Nancy J Petersen
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Department of Medicine, Baylor College of Medicine
| | - Mark E Kunik
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine and VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| | - Jeffrey A Cully
- VA HSR&D Houston Center of Innovation, Michael E. DeBakey VA Medical Center, Menninger Department of Psychiatry and Behavioral Science, Baylor College of Medicine and VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
| |
Collapse
|
8
|
Abell CH, Keaster R. Change and administrative barriers: nurse educators' perceptions concerning the use of simulators. Nurs Educ Perspect 2013; 33:395-8. [PMID: 23346789 DOI: 10.5480/1536-5026-33.6.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The purpose of this descriptive correlational research study was twofold: to examine the adoption of simulators in the nursing classroom and the relationship between adoption and nurse educators' perceptions of established change strategies as followed by program administrators. BACKGROUND The use of simulators in education is important and requires many nurse educators to change their current teaching strategies. METHOD Data were collected from a purposive population using a demographic questionnaire, the nursing practice questionnaire (NPQ), and the change process survey. RESULTS The overall diffusion score, as measured by the NPQ, was 2.6. A statistically significant correlation was noted between level of use and the perception of established change strategies being followed (r = .340, p < .01). CONCLUSION Findings indicate that nurse educators adopt simulators sometimes when appropriate. Administrators of nursing programs can enhance this change by using established change strategies.
Collapse
Affiliation(s)
- Cathy H Abell
- Western Kentucky University School of Nursing, Bowling Green, USA.
| | | |
Collapse
|
9
|
Roughead EE. Enhancing early uptake of drug evidence into primary care. Expert Rev Pharmacoecon Outcomes Res 2012; 6:661-71. [PMID: 20528492 DOI: 10.1586/14737167.6.6.661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Closing the gap between evidence and healthcare practice is critical for improving health outcomes for consumers. This is particularly critical for medicines, which are the most commonly used healthcare intervention. This paper describes relevant communication, persuasion, behavior change theories, diffusion of innovation and health promotion models, and considers how they apply to enhance the uptake of evidence in primary care. The implementation of new evidence into practice requires a change in behavior. This is complex and requires multistrategic interventions. The understanding and application of the communication and behavioral theories examined in this paper can assist in maximizing the impact of interventions to enhance uptake of evidence concerning medicines.
Collapse
Affiliation(s)
- Elizabeth E Roughead
- Associate Professor, University of South Australia, Sansom Institute, Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, GPO Box 2471, Adelaide 5001, South Australia.
| |
Collapse
|
10
|
Helmink JHM, Kremers SPJ, van Boekel LC, van Brussel-Visser FN, de Vries NK. Factors determining the motivation of primary health care professionals to implement and continue the 'Beweegkuur' lifestyle intervention programme. J Eval Clin Pract 2012; 18:682-8. [PMID: 21438965 DOI: 10.1111/j.1365-2753.2011.01654.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine factors explaining motivation among health care professionals to implement and continue a multidisciplinary primary care-based lifestyle intervention, called BeweegKuur, to support prevention and treatment of type 2 diabetes mellitus. METHODS Questionnaire research with two measurements among Dutch general practitioners, practice nurses and physiotherapists participating in a pilot study. At baseline, professionals were generally preparing to start the implementation. At second measurement, all practices were implementing BeweegKuur. RESULTS The results reveal a positive motivation among professionals to implement and continue the intervention. The motivation of practice nurses to continue implementation was lower compared with other professionals. Social support by colleagues, compatibility and perceived relative advantage of the intervention for the professionals were associates of the baseline motivation to implement it. High-baseline self-efficacy and profession (i.e. not being practice nurse) positively predicted the motivation to continue the intervention at second measurement. CONCLUSIONS Professionals in our study can be characterized as innovators or early adopters, and inclusion of BeweegKuur in the basic health insurance package may persuade other adoption categories to implement the intervention. An intensified focus on skills building (e.g. motivational interviewing skills, general lifestyle counselling skills) is expected to contribute to sustained high-quality implementation of the intervention.
Collapse
Affiliation(s)
- Judith H M Helmink
- Department of Health Promotion, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands.
| | | | | | | | | |
Collapse
|
11
|
Helmink JHM, Kremers SPJ, Van Boekel LC, Van Brussel-Visser FN, Preller L, De Vries NK. The BeweegKuur programme: a qualitative study of promoting and impeding factors for successful implementation of a primary health care lifestyle intervention for overweight and obese people. Fam Pract 2012; 29 Suppl 1:i68-i74. [PMID: 22399560 DOI: 10.1093/fampra/cmr056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of the study was to identify promoting and impeding factors for successful implementation of a Dutch primary health care-based lifestyle programme called 'BeweegKuur'. BeweegKuur aims to increase the physical activity and change the diet of people at increased health risk due to overweight or obesity. OBJECTIVE To determine perceived promoting and impeding factors in the implementation of the BeweegKuur programme for overweight and obese people. METHODS This study consisted of 3 focus group meetings with intervention participants, 15 interviews with health care professionals (HCPs) and 1 focus group session with dieticians. The interviews and focus groups were recorded and transcribed verbatim. The data were analysed with the Nvivo qualitative research software package. RESULTS For some intervention participants, the invitation to participate in BeweegKuur came unexpectedly, as they had not been diagnosed with an illness. HCPs were aware of this and took time to explain to participants that the programme was appropriate and safe for them. Participants as well as professionals were generally positive about the feasibility of the programme for overweight and obese people. CONCLUSIONS HCPs as well as intervention participants were motivated to participate in the programme, and generally indicated that the intervention was in accordance with their needs. The multidisciplinary approach and the combination of physical activity and dietary behaviour change can make the BeweegKuur programme a success if potential impeding factors like those identified in the present study are overcome.
Collapse
Affiliation(s)
- J H M Helmink
- Department of Health Promotion, School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|
12
|
Jansen M, Harting J, Ebben N, Kroon B, Stappers J, Van Engelshoven E, de Vries N. The concept of sustainability and the use of outcome indicators. A case study to continue a successful health counselling intervention. Fam Pract 2008; 25 Suppl 1:i32-7. [PMID: 18836093 DOI: 10.1093/fampra/cmn066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To ensure the continuation of a successful pilot programme, the change process and the concept of sustainability need to be elaborated. So far, there are different theories on organizational change and sustainability but its practical application stay far behind. OBJECTIVES To test the practical application of a theory-based concept of sustainability and to assess the role of the change agent. A health counselling programme for high-risk cardiovascular patients, called Heartbeat 2, was used as a case study. METHODS Outcome indicators were assessed based on the questions: Why should health counselling be sustained? How should this be done and by whom? How much needs to occur and by when? Data were derived from registrations, reports and focus group interviews. RESULTS The results indicate a need for a linkage system in the final stages of change so that the programme is maintained. Limitations of the external change agent are described. The outcome indicators appeared to be an adequate operationalization to monitor sustainability. The change process leading up to sustainability appeared to be highly complex due to unpredictable and unforeseen external factors. CONCLUSIONS Our concept of sustainability appeared to be an adequate tool for the change agent to assess the extent of sustainability. An external change agent has limited influence on the management's decision-making processes during the sustainability stage. As long as the context is changing, definite choices to sustain the innovative service of health counselling in hospitals will not be made, which inherently means an ongoing change process to sustainability.
Collapse
Affiliation(s)
- Maria Jansen
- Department of Academic Collaboration for Public Health Limburg, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
13
|
Harting J, van Assema P, van Limpt P, Gorgels T, van Ree J, Ruland E, Vermeer F, de Vries NK. Cardiovascular prevention in the Hartslag Limburg project: effects of a high-risk approach on behavioral risk factors in a general practice population. Prev Med 2006; 43:372-8. [PMID: 16905181 DOI: 10.1016/j.ypmed.2006.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2005] [Revised: 05/23/2006] [Accepted: 06/03/2006] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study describes a general-practice-based high-risk cardiovascular prevention approach in Maastricht, The Netherlands (1999-2003). The intervention consisted of a complete registration of risk factors, optimization of medical treatment and health counseling on high fat consumption, smoking and physical inactivity. METHODS Behavioral effects were assessed in a trial, randomization by practice and usual care as control. Validated questionnaires were completed by 1300 patients at baseline, 1174 after 4 months (90.3%) and 1046 (80.5%) after 18 months. RESULTS After 4 months, intention-to-treat analyses revealed a decrease in saturated fat intake of 1.3 points (scale ranging from 7 to 30 points, p=0.000). This was partly sustained after 18 months (-0.5 points, p=0.014). After 18 months, obese intervention patients were more likely to be sufficiently physically active than their control counterparts (OR=1.90, p=0.023). No intervention effects were found for smoking. CONCLUSION Given the multiple factor and multiple component high-risk approach, the intervention had modest effects on only some of the behavioral risk factors addressed. Process data showed that the registration of risk factors and the optimization of medical treatment were only partly implemented, that the health counseling component could be further improved and that the intervention could benefit from additional health promoting strategies.
Collapse
Affiliation(s)
- Janneke Harting
- Department of Health Education and Promotion, Maastricht University, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Kwak L, Kremers SPJ, van Baak MA, Brug J. Participation rates in worksite-based intervention studies: health promotion context as a crucial quality criterion. Health Promot Int 2005; 21:66-9. [PMID: 16339773 DOI: 10.1093/heapro/dai033] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recently, a set of specific quality evaluation criteria for health promotion research has been proposed in this journal. One of the quality criteria identified is the 'health promotion context'. With this paper we would like to contribute to the dialogue by specifying the importance of this criterion on the basis of our on experience with worksite-based obesity prevention interventions. We advocate the reporting of participation rates among approached worksites in publications on worksite intervention effects. Such information will help to draw conclusions on the practical relevance of the shown effectiveness of the intervention. Health promotion practice is advised to adopt and disseminate evidence-based interventions, accompanied by a diffusion study with a minimal research burden for participants.
Collapse
|