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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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Lizarondo L, McArthur A, Porche D, Corremans M, Perrenoud B, Rodrigues R, Lockwood C. Facilitation in evidence implementation - experiences, challenges, and determinants of perceived effectiveness: a qualitative systematic review. JBI Evid Implement 2023; 21:409-431. [PMID: 37975298 DOI: 10.1097/xeb.0000000000000399] [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: 11/19/2023]
Abstract
INTRODUCTION Facilitation is a key element of evidence implementation. Although quantitative systematic reviews have been undertaken to examine its components and effectiveness, no attempt has been made to synthesize qualitative evidence examining the experiences of facilitators on how facilitation is operationalized, the challenges associated with it, and the factors that can influence its perceived effectiveness. METHODS A systematic review of qualitative studies was conducted using the JBI methodology. RESULTS A total of 36 qualitative studies was included in the systematic review, with the majority being assessed as high quality following critical appraisal. The findings were extracted and further synthesized, highlighting that facilitation involves providing technical and non-technical support to health professionals, as well as high-intensity collaborations and relationship building. Determinants of perceived effectiveness of facilitation include facilitators' access to resources and learning support; their skills, traits/attitudes, and approach to facilitation; and the context of the organization where the implementation occurs. Work demands, emotional stress, and lack of clarity in roles and career development can pose challenges for facilitators. CONCLUSION To maximize the outcomes of facilitation in evidence implementation, the team of facilitators should be carefully selected to ensure they have the right skills, traits/attitudes, and approach to facilitation. They should also be provided with dedicated time to conduct the facilitation and have access to resources, training, and mentoring support. Future research should aim to examine the perspectives of the "implementers" who received support from facilitators to gain a better understanding of which facilitation strategies have an impact on clinical practice behavior. REVIEW REGISTRATION NUMBER PROSPERO CRD42023402496.
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Affiliation(s)
- Lucylynn Lizarondo
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Alexa McArthur
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Demetrius Porche
- School of Nursing, Louisiana State University Health Sciences Center New Orleans, New Orleans, LA, USA
- The Louisiana Centre for Promotion of Optimal Health Outcomes: A JBI Centre of Excellence, New Orleans, LA, USA
| | | | - Beatrice Perrenoud
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
- ELS School of Health Sciences, HES-SO University of Applied Sciences and Arts, Western Switzerland, Lausanne, Switzerland
| | - Rogério Rodrigues
- Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Harvey G, Collyer S, McRae P, Barrimore SE, Demmitt C, Lee-Steere K, Nolan B, Mudge AM. Navigating the facilitation journey: a qualitative, longitudinal evaluation of 'Eat Walk Engage' novice and experienced facilitators. BMC Health Serv Res 2023; 23:1132. [PMID: 37864161 PMCID: PMC10588033 DOI: 10.1186/s12913-023-10116-3] [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: 06/08/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) and integrated-PARIHS (i-PARIHS) frameworks position facilitation as an overarching strategy to enable implementation. In the revised i-PARIHS framework, facilitation is operationalised through a multi-level model with novice, experienced and expert facilitators working together in a network structure to build facilitation knowledge and skills along a continuum. To date, there has been limited evaluation of this facilitation model in practice, which is the aim of the study reported here. METHODS A descriptive, qualitative longitudinal study was undertaken to track a team of four novice and two experienced facilitators involved in facilitating the implementation of an intervention known as 'Eat Walk Engage' to improve multidisciplinary team delivery of age-friendly care principles in hospital. Over an 18-month period, repeat interviews were conducted to explore the learning, development, and evolving roles of novice facilitators and the roles of the experienced facilitators in providing support and mentoring. Interview data were analysed using a descriptive qualitative approach and findings were interpreted in collaboration with the participating facilitators. RESULTS The findings demonstrated experiential learning in both the novice and experienced facilitator groups as they enacted their roles in practice. The novice facilitators progressively transitioned to becoming more experienced facilitators and the experienced facilitators became increasingly expert, in line with the i-PARIHS concept of a facilitation journey from novice to expert. Strategies to support this development included a staggered approach to learning, regular meetings between the experienced and novice facilitators, reflective writing and informal peer support and networking. However, the roles were not without challenge and these challenges changed over time, from a more specific focus on the demands of the facilitator role to concerns about embedding and sustaining improvements in practice. CONCLUSIONS Within a network of peers and a mentored relationship with more experienced facilitators, individuals who are new to an implementation facilitator role can transition along a continuum to become experienced facilitators. Building implementation facilitation capability in this way takes time and requires tailored support and mentorship using a mix of structured and flexible approaches incorporating opportunities for reflection to support individual and group learning.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, Australia.
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Sarah Collyer
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Prue McRae
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- Queensland University of Technology Institute of Health and Biomedical Innovation, Brisbane, Australia
| | | | - Camey Demmitt
- Caboolture Hospital, Caboolture, Queensland, Australia
| | - Karen Lee-Steere
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Health and Behavioural Sciences, Brisbane, Australia
| | | | - Alison M Mudge
- Royal Brisbane and Women's Hospital Department of Internal Medicine and Aged Care, Brisbane, Australia
- University of Queensland Faculty of Medicine, Brisbane, Australia
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Ritchie MJ, Parker LE, Kirchner JE. Facilitating implementation of primary care mental health over time and across organizational contexts: a qualitative study of role and process. BMC Health Serv Res 2023; 23:565. [PMID: 37259064 DOI: 10.1186/s12913-023-09598-y] [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: 10/12/2022] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Healthcare organizations have increasingly utilized facilitation to improve implementation of evidence-based practices and programs (e.g., primary care mental health integration). Facilitation is both a role, related to the purpose of facilitation, and a process, i.e., how a facilitator operationalizes the role. Scholars continue to call for a better understanding of this implementation strategy. Although facilitation is described as dynamic, activities are often framed within the context of a staged process. We explored two understudied characteristics of implementation facilitation: 1) how facilitation activities change over time and in response to context, and 2) how facilitators operationalize their role when the purpose of facilitation is both task-focused (i.e., to support implementation) and holistic (i.e., to build capacity for future implementation efforts). METHODS We conducted individual monthly debriefings over thirty months with facilitators who were supporting PCMHI implementation in two VA networks. We developed a list of facilitation activities based on a literature review and debriefing notes and conducted a content analysis of debriefing notes by coding what activities occurred and their intensity by quarter. We also coded whether facilitators were "doing" these activities for sites or "enabling" sites to perform them. RESULTS Implementation facilitation activities did not occur according to a defined series of ordered steps but in response to specific organizational contexts through a non-linear and incremental process. Amount and types of activities varied between the networks. Concordant with facilitators' planned role, the focus of some facilitation activities was primarily on doing them for the sites and others on enabling sites to do for themselves; a number of activities did not fit into one category and varied across networks. CONCLUSIONS Findings indicate that facilitation is a dynamic and fluid process, with facilitation activities, as well as their timing and intensity, occurring in response to specific organizational contexts. Understanding this process can help those planning and applying implementation facilitation to make conscious choices about the facilitation role and the activities that facilitators can use to operationalize this role. Additionally, this work provides the foundation from which future studies can identify potential mechanisms of action through which facilitation activities enhance implementation uptake.
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Affiliation(s)
- Mona J Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA.
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
| | - Louise E Parker
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA
- Department of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA, 02125, USA
| | - JoAnn E Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Dr, North Little Rock, AR, 72114, USA
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
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Ritchie MJ, Drummond KL, Smith BN, Sullivan JL, Landes SJ. Development of a qualitative data analysis codebook informed by the i-PARIHS framework. Implement Sci Commun 2022; 3:98. [PMID: 36104801 PMCID: PMC9476709 DOI: 10.1186/s43058-022-00344-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized in implementation studies. Although i-PARIHS developers have focused on creating tools to guide facilitators in its application in practice, tools are also needed for evaluation and research. Codebooks with clear and meaningful code labels and definitions are an important component of qualitative data analysis and have been developed for other widely used frameworks. There is no such codebook for i-PARIHS. Additionally, sub-constructs for the Innovation, Recipients, and Context constructs lack definitions, and there is no sub-classification of facilitation activities for the Facilitation construct. The lack of a standardized codebook hinders our ability to synthesize research findings across studies, explore and test the range of activities that are utilized in facilitation efforts, and potentially validate and further refine i-PARIHS. This paper describes a rigorous process of developing a detailed qualitative codebook informed by the i-PARIHS framework. Methods A workgroup of qualitative researchers conducted a rigorous four-phase process to develop a codebook informed by i-PARIHS. In phase 1, workgroup members reviewed and discussed literature, consulted an organizational scientist, and drafted and refined subcodes and definitions for i-PARIHS constructs. In phase 2, they obtained feedback from an expert panel and further refined subcodes and definitions. In phase 3, they obtained feedback from i-PARIHS developers/experts and incorporated it into the codebook. Finally, two studies piloted the application of the codebook which informed the final version. Results The resulting i-PARIHS-informed codebook includes definitions for the four main constructs of the framework: Innovation, Recipients, Context, and Facilitation; subcodes and definitions for characteristics of each of these constructs; and instructions for the suggested application of individual codes and use of the codebook generally. Conclusions The standardized codes and definitions in the codebook can facilitate data exploration, pattern identification, and insight development informed by the i-PARIHS framework. Qualitative analysts can also use them to explore interactions between i-PARIHS constructs, maximize the potential for comparing findings across studies, and support the refinement of the i-PARIHS framework using empirical findings from multiple studies. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00344-9.
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Kolko DJ, McGuier EA, Turchi R, Thompson E, Iyengar S, Smith SN, Hoagwood K, Liebrecht C, Bennett IM, Powell BJ, Kelleher K, Silva M, Kilbourne AM. Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial. Implement Sci 2022; 17:20. [PMID: 35193619 PMCID: PMC8862323 DOI: 10.1186/s13012-022-01195-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the "black box" of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. METHODS We will conduct a hybrid type 3 effectiveness-implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor-Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. DISCUSSION This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. TRIAL REGISTRATION ClinicalTrials.gov, NCT04946253 . Registered June 30, 2021.
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Affiliation(s)
- David J Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Elizabeth A McGuier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Eileen Thompson
- PA Medical Home Program, PA Chapter, American Academy of Pediatrics, Media, PA, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawna N Smith
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ian M Bennett
- Departments of Family Medicine and Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelly Kelleher
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital Research Institute, Columbus, OH, USA
| | - Maria Silva
- Allegheny Family Network, Pittsburgh, PA, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Paladino J, Sanders J, Kilpatrick LB, Prabhakar R, Kumar P, O'Connor N, Durieux B, Fromme EK, Benjamin E, Mitchell S. Serious Illness Care Programme-contextual factors and implementation strategies: a qualitative study. BMJ Support Palliat Care 2022:bmjspcare-2021-003401. [PMID: 35168931 DOI: 10.1136/bmjspcare-2021-003401] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The Serious Illness Care Programme (SICP) is a multicomponent evidence-based intervention that improves communication about patients' values and goals in serious illness. We aim to characterise implementation strategies for programme delivery and the contextual factors that influence implementation in three 'real-world' health system SICP initiatives. METHODS We employed a qualitative thematic framework analysis of field notes collected during the first 1.5 years of implementation and a fidelity survey. RESULTS Analysis revealed empiric evidence about implementation and institutional context. All teams successfully implemented clinician training and an electronic health record (EHR) template for documentation of serious illness conversations. When training was used as the primary strategy to engage clinicians, however, clinician receptivity to the programme and adoption of conversations remained limited due to clinical culture-related barriers (eg, clinicians' attitudes, motivations and practice environment). Visible leadership involvement, champion facilitation and automated EHR-based data feedback on documented conversations appeared to improve adoption. Implementing these strategies depended on contextual factors, including leadership support at the specialty level, champion resources and capacity, and EHR capabilities. CONCLUSIONS Health systems need multifaceted implementation strategies to move beyond the limited impact of clinician training in driving improvement in serious illness conversations. These include EHR-based data feedback, involvement of specialty leaders to message the programme and align incentives, and local champions to problem-solve frontline challenges longitudinally. Implementation of these strategies depended on a favourable institutional context. Greater attention to the influence of contextual factors and implementation strategies may enable sustained improvements in serious illness conversations at scale.
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Affiliation(s)
- Joanna Paladino
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Justin Sanders
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Family Medicine, Palliative Care, McGill University, Montreal, Québec, Canada
| | - Laurel B Kilpatrick
- Division of Supportive and Palliative Care, Baylor Scott and White Health, Temple, Texas, USA
| | | | | | | | | | - Erik K Fromme
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Evan Benjamin
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Suzanne Mitchell
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, USA
- UMass Memorial Health Care, Worcester, Massachusetts, USA
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Siden JY, Carver AR, Mmeje OO, Townsel CD. Reducing Implicit Bias in Maternity Care: A Framework for Action. Womens Health Issues 2021; 32:3-8. [PMID: 34774401 DOI: 10.1016/j.whi.2021.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/17/2023]
Affiliation(s)
- Jonathan Y Siden
- University of Michigan Medical School, Ann Arbor, Michigan; University of Michigan Ford School of Public Policy, Ann Arbor, Michigan.
| | - Alissa R Carver
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Women's Hospital, Ann Arbor, Michigan
| | - Okeoma O Mmeje
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Women's Hospital, Ann Arbor, Michigan; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Women's Hospital, Ann Arbor, Michigan
| | - Courtney D Townsel
- Department of Obstetrics & Gynecology, University of Michigan Medical School, Women's Hospital, Ann Arbor, Michigan
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Ritchie MJ, Parker LE, Kirchner JE. From novice to expert: methods for transferring implementation facilitation skills to improve healthcare delivery. Implement Sci Commun 2021; 2:39. [PMID: 33832549 PMCID: PMC8033694 DOI: 10.1186/s43058-021-00138-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is substantial evidence that facilitation can address the challenges of implementing evidence-based innovations. However, facilitators need a wide variety of complex skills; lack of these can have a negative effect on implementation outcomes. Literature suggests that novice and less experienced facilitators need ongoing support from experts to develop these skills. Yet, no studies have investigated the transfer process. During a test of a facilitation strategy applied at 8 VA primary care clinics, we explored the techniques and processes an expert external facilitator utilized to transfer her skills to two initially novice internal facilitators who became experts. METHODS In this qualitative descriptive study, we conducted monthly debriefings with three facilitators over a 30-month period and documented these in detailed notes. Debriefings with the expert facilitator focused on how she trained and mentored facilitation trainees. We also conducted, recorded, and transcribed two semi-structured qualitative interviews with each facilitator and queried them about training content and process. We used a mix of inductive and deductive approaches to analyze data; our analysis was informed by a review of mentoring, coaching, and cognitive apprenticeship literature. We also used a case comparison approach to explore how the expert tailored her efforts. RESULTS The expert utilized 21 techniques to transfer implementation facilitation skills. Techniques included both active (providing information, modeling, and coaching) and participatory ones. She also used techniques to support learning, i.e., cognitive supports (making thinking visible, using heuristics, sharing experiences), psychosocial supports, strategies to promote self-learning, and structural supports. Additionally, she transferred responsibility for facilitation through a dynamic process of interaction with trainees and site stakeholders. Finally, the expert varied the level of focus on particular skills to tailor her efforts to trainee and local context. CONCLUSIONS This study viewed the journey from novice to expert facilitator through the lens of the expert who transferred facilitation skills to support implementation of an evidence-based program. It identified techniques and processes that may foster transfer of these skills and build organizational capacity for future implementation efforts. As the first study to document the implementation facilitation skills transfer process, findings have research and practical implications.
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Affiliation(s)
- Mona J. Ritchie
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
| | - Louise E. Parker
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Management, College of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA 02125 USA
| | - JoAnn E. Kirchner
- VA Behavioral Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
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Bergström A, Ehrenberg A, Eldh AC, Graham ID, Gustafsson K, Harvey G, Hunter S, Kitson A, Rycroft-Malone J, Wallin L. The use of the PARIHS framework in implementation research and practice-a citation analysis of the literature. Implement Sci 2020; 15:68. [PMID: 32854718 PMCID: PMC7450685 DOI: 10.1186/s13012-020-01003-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The Promoting Action on Research Implementation in Health Services (PARIHS) framework was developed two decades ago and conceptualizes successful implementation (SI) as a function (f) of the evidence (E) nature and type, context (C) quality, and the facilitation (F), [SI = f (E,C,F)]. Despite a growing number of citations of theoretical frameworks including PARIHS, details of how theoretical frameworks are used remains largely unknown. This review aimed to enhance the understanding of the breadth and depth of the use of the PARIHS framework. METHODS This citation analysis commenced from four core articles representing the key stages of the framework's development. The citation search was performed in Web of Science and Scopus. After exclusion, we undertook an initial assessment aimed to identify articles using PARIHS and not only referencing any of the core articles. To assess this, all articles were read in full. Further data extraction included capturing information about where (country/countries and setting/s) PARIHS had been used, as well as categorizing how the framework was applied. Also, strengths and weaknesses, as well as efforts to validate the framework, were explored in detail. RESULTS The citation search yielded 1613 articles. After applying exclusion criteria, 1475 articles were read in full, and the initial assessment yielded a total of 367 articles reported to have used the PARIHS framework. These articles were included for data extraction. The framework had been used in a variety of settings and in both high-, middle-, and low-income countries. With regard to types of use, 32% used PARIHS in planning and delivering an intervention, 50% in data analysis, 55% in the evaluation of study findings, and/or 37% in any other way. Further analysis showed that its actual application was frequently partial and generally not well elaborated. CONCLUSIONS In line with previous citation analysis of the use of theoretical frameworks in implementation science, we also found a rather superficial description of the use of PARIHS. Thus, we propose the development and adoption of reporting guidelines on how framework(s) are used in implementation studies, with the expectation that this will enhance the maturity of implementation science.
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Affiliation(s)
- Anna Bergström
- Department of Women’s and Children’s health, Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Uppsala, Sweden
- Institute for Global Health, University College London, London, UK
| | - Anna Ehrenberg
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Ann Catrine Eldh
- Department of Medicine and Health, Linköping University, Linköping, Sweden
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kazuko Gustafsson
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- University Library, Uppsala University, Uppsala, Sweden
| | - Gillian Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Green Templeton College, University of Oxford, Oxford, UK
| | - Jo Rycroft-Malone
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancashire, UK
| | - Lars Wallin
- School of Education, Health, and Social Studies, Dalarna University, Falun, Sweden
- Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ritchie MJ, Parker LE, Kirchner JE. From novice to expert: a qualitative study of implementation facilitation skills. Implement Sci Commun 2020; 1:25. [PMID: 32885184 PMCID: PMC7427882 DOI: 10.1186/s43058-020-00006-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is widely reported that facilitation can aid implementation of evidence-based practices. Although scholars agree that facilitators need a diverse range of skills, only a few retrospective studies have identified some of these. During the test of a facilitation strategy within the context of a VA initiative to implement evidence-based care delivery models, we documented the skills an expert external facilitator transferred to two initially novice internal regional facilitators. Ours is the first study to explore facilitation skills as they are being applied and transferred. METHODS Facilitators applied the strategy at eight primary care clinics that lacked implementation capacity in two VA networks. We conducted monthly debriefing interviews over a 30-month period and documented these in detailed notes. External facilitator interviews focused specifically on training and mentoring internal facilitators and the skills that she transferred. We also conducted, recorded, and transcribed two qualitative interviews with each facilitator and queried them about training content and process. We conducted a content analysis of the data, using deductive and inductive methods, to identify skills the external facilitator helped internal facilitators learn. We also explored the complexity of facilitation skills and grouped them into overarching skillsets. RESULTS The external facilitator helped internal facilitators learn 22 complex skills; with few exceptions, these skills were not unique but overlapped with one another. We clustered 21 of these into 5 groups of overarching skillsets: (1) building relationships and creating a supportive environment, (2) changing the system of care and the structure and processes that support it, (3) transferring knowledge and skills and creating infrastructure support for ongoing learning, (4) planning and leading change efforts, and (5) assessing people, processes, and outcomes and creating infrastructure for program monitoring. CONCLUSIONS This study documented a broad range of implementation facilitation skills that are complex and overlapping. Findings suggest that studies and initiatives planning or applying facilitation as an implementation strategy should ensure that facilitators have or have the opportunity to learn the skills they need. Because facilitation skills are complex, the use of didactic methods alone may not be sufficient for transferring skills; future work should explore other methods and techniques.
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Affiliation(s)
- Mona J. Ritchie
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
| | - Louise E. Parker
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Management and Marketing, College of Management, University of Massachusetts, 100 Morrissey Blvd, Boston, MA 02125 USA
| | - JoAnn E. Kirchner
- VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, Department of Veterans Affairs, 2200 Ft Roots Dr, Building 58, North Little Rock, AR 72114 USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, #755, Little Rock, AR 72205 USA
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Baloh J, Zhu X, Ward MM. What Influences Sustainment and Nonsustainment of Facilitation Activities in Implementation? Analysis of Organizational Factors in Hospitals Implementing TeamSTEPPS. Med Care Res Rev 2019; 78:146-156. [PMID: 31092101 DOI: 10.1177/1077558719848267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Implementation processes are often long and complex, requiring sustained facilitation efforts. Drawing on organizational and implementation literature, we examined the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME) and team continuity (CONTINUITY) on sustainment of internal facilitation activities. For 2 years, we followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program, and conducted quarterly interviews with key informants. We coded, calibrated, and analyzed the data using the fuzzy-set qualitative comparative analysis. We found that five hospitals sustained facilitation activities and the combination of SMS, MMS, and CONTINUITY (i.e., presence of all three factors) was a sufficient condition for sustainment. Five other hospitals did not sustain facilitation activities and they either lacked MMS or lacked both TIME and CONTINUITY. In follow-up analyses, we found that team leadership continuity also influenced sustainment patterns. We discussed the implications for research and practice.
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Affiliation(s)
- Jure Baloh
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xi Zhu
- University of Iowa, Iowa City, Iowa, USA
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