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Holtrop K, Durtschi JA, Forgatch MS. Investigating active ingredients of the GenerationPMTO intervention: Predictors of postintervention change trajectories in parenting practices. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:212-224. [PMID: 34843323 PMCID: PMC9768796 DOI: 10.1037/fam0000925] [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: 06/13/2023]
Abstract
Empirically determining the active ingredients of evidence-based parenting interventions is a promising means for strengthening interventions and enhancing their public health impact. This study aimed to determine which distinct ingredients of the GenerationPMTO (GenPMTO) intervention were associated with subsequent changes in parenting practices. Using a sample of 153 participants randomly assigned to the GenPMTO condition, we employed multilevel modeling to identify intervention ingredients empirically linked with change trajectories in parenting practices observed across the 2 years following intervention exposure. Coercive parenting and positive parenting outcomes were examined. Study results indicated that emotion regulation, effective communication, problem solving, and monitoring each demonstrated a significant pattern of findings for coercive parenting. Differential exposure to each of these ingredients significantly predicted the level of coercive parenting immediately postintervention and/or trajectories of change in coercive parenting across the subsequent 2-year period, controlling for coercive parenting at baseline. No significant predictors were found for positive parenting trajectories. Our findings suggest four components as active ingredients of the GenPMTO intervention for coercive parenting. Identification of these active ingredients may lead to strengthening future iterations of GenPMTO by expanding the set of core components specified in the model, which may further improve public health benefits. Implications for further understanding change stemming from evidence-based parenting interventions are also discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Kendal Holtrop
- Department of Human Development and Family Studies, Michigan State University
| | - Jared A. Durtschi
- School of Family Studies and Human Services, Kansas State University
| | - Marion S. Forgatch
- Implementation Sciences International, Inc., Eugene, Oregon
- Oregon Social Learning Center, Eugene, Oregon
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Pinheiro-Carozzo NP, Murta SG, Vinha LGDA, da Silva IM, Fontaine AMGV. Beyond effectiveness of the Strengthening Families Program (10-14): a scoping RE-AIM-based review. PSICOLOGIA-REFLEXAO E CRITICA 2021; 34:16. [PMID: 34131838 PMCID: PMC8206301 DOI: 10.1186/s41155-021-00182-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
A scoping review, based on the RE-AIM framework, was conducted to analyze evidence of reach, effectiveness, adoption, implementation, and maintenance of the Strengthening Families Program (10-14), a preventive family-based substance abuse program for adolescents. Sixty-five articles were included. The results disclosed that effectiveness, implementation, and maintenance at the individual-level were the most evaluated aspects, while reach, maintenance at the setting-level, and adoption were the least investigated aspects. Positive effects on drug abuse prevention and protective parenting factors were found in the U.S. studies. Likewise, Latin American studies have shown the improvement of parenting practices. However, European studies have produced mixed results, with predominantly null effects on substance abuse. The implementation quality was high. There is no available evidence of adoption and maintenance at the setting-level by the organizations that implemented it. New studies must examine the reach, adoption, and sustainability of the program to lay foundations for its future use as an instrument of public policies.
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Affiliation(s)
- Nádia P Pinheiro-Carozzo
- Departamento de Psicologia, Centro de Ciências Humanas, Universidade Federal do Maranhão, Cidade Universitária Dom Delgado, Avenida dos Portugueses, 1966, Bacanga, São Luis, MA, 65080-805, Brazil.
| | - Sheila G Murta
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Luís Gustavo do A Vinha
- Departamento de Estatística, Instituto de Ciências Exatas, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Isabela M da Silva
- Departamento de Psicologia Clínica, Instituto de Psicologia, Universidade de Brasília, Campus Universitário Darcy Ribeiro, Brasília, DF, 70910-900, Brazil
| | - Anne Marie G V Fontaine
- Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Rua Alfredo Allen, 4200-135, Porto, Portugal
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To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084095. [PMID: 33924494 PMCID: PMC8069177 DOI: 10.3390/ijerph18084095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
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Hill LG, Cooper BR, Parker LA. Qualitative Comparative Analysis: A Mixed-Method Tool for Complex Implementation Questions. J Prim Prev 2019; 40:69-87. [DOI: 10.1007/s10935-019-00536-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Escoffery C, Lebow-Skelley E, Haardoerfer R, Boing E, Udelson H, Wood R, Hartman M, Fernandez ME, Mullen PD. A systematic review of adaptations of evidence-based public health interventions globally. Implement Sci 2018; 13:125. [PMID: 30257683 PMCID: PMC6158804 DOI: 10.1186/s13012-018-0815-9] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Adaptations of evidence-based interventions (EBIs) often occur. However, little is known about the reasons for adaptation, the adaptation process, and outcomes of adapted EBIs. To address this gap, we conducted a systematic review to answer the following questions: (1) What are the reasons for and common types of adaptations being made to EBIs in community settings as reported in the published literature? (2) What steps are described in making adaptations to EBIs? and (3) What outcomes are assessed in evaluations of adapted EBIs? METHODS We conducted a systematic review of English language publications that described adaptations of public health EBIs. We searched Ovid PubMed, PsycINFO, PsycNET, and CINAHL and citations of included studies for adapted public health EBIs. We abstracted characteristics of the original and adapted populations and settings, reasons for adaptation, types of modifications, use of an adaptation framework, adaptation steps, and evaluation outcomes. RESULTS Forty-two distinct EBIs were found focusing on HIV/AIDS, mental health, substance abuse, and chronic illnesses. More than half (62%) reported on adaptations in the USA. Frequent reasons for adaptation included the need for cultural appropriateness (64.3%), focusing on a new target population (59.5%), and implementing in a new setting (57.1%). Common adaptations were content (100%), context (95.2%), cultural modifications (73.8%), and delivery (61.9%). Most study authors conducted a community assessment, prepared new materials, implemented the adapted intervention, evaluated or planned to evaluate the intervention, determined needed changes, trained staff members, and consulted experts/stakeholders. Most studies that reported an evaluation (k = 36) included behavioral outcomes (71.4%), acceptability (66.7%), fidelity (52.4%), and feasibility (52.4%). Fewer measured adoption (47.6%) and changes in practice (21.4%). CONCLUSIONS These findings advance our understanding of the patterns and effects of modifications of EBIs that are reported in published studies and suggest areas of further research to understand and guide the adaptation process. Furthermore, findings can inform better reporting of adapted EBIs and inform capacity building efforts to assist health professionals in adapting EBIs.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - E. Lebow-Skelley
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - R. Haardoerfer
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - E. Boing
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - H. Udelson
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322 USA
| | - R. Wood
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - M. Hartman
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - M. E. Fernandez
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
| | - P. D. Mullen
- University of Texas School of Public Health, 7000 Fannin, Ste 2522, Houston, TX 77030 USA
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Shelton RC, Cooper BR, Stirman SW. The Sustainability of Evidence-Based Interventions and Practices in Public Health and Health Care. Annu Rev Public Health 2018; 39:55-76. [PMID: 29328872 DOI: 10.1146/annurev-publhealth-040617-014731] [Citation(s) in RCA: 343] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is strong interest in implementation science to address the gap between research and practice in public health. Research on the sustainability of evidence-based interventions has been growing rapidly. Sustainability has been defined as the continued use of program components at sufficient intensity for the sustained achievement of desirable program goals and population outcomes. This understudied area has been identified as one of the most significant translational research problems. Adding to this challenge is uncertainty regarding the extent to which intervention adaptation and evolution are necessary to address the needs of populations that differ from those in which interventions were originally tested or implemented. This review critically examines and discusses conceptual and methodological issues in studying sustainability, summarizes the multilevel factors that have been found to influence the sustainability of interventions in a range of public health and health care settings, and highlights key areas for future research.
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Affiliation(s)
- Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Brittany Rhoades Cooper
- Department of Human Development, Washington State University, Pullman, Washington 99164, USA;
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94024, USA;
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Kemp L. Adaptation and Fidelity: a Recipe Analogy for Achieving Both in Population Scale Implementation. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2016; 17:429-38. [PMID: 26969173 DOI: 10.1007/s11121-016-0642-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Balancing adherence to fidelity of evidence-based programs and adaptation to local context is one of the key debates in the adoption and implementation of effective programs. Concern about maintaining fidelity to achieve outcomes can result in replication of research-based models that can be a poor fit with the real world. Equally, unplanned adaptation can result in program drift away from the core elements needed to achieve outcomes. To support implementation of the Maternal Early Childhood Sustained Home-visiting (MECSH) program in multiple sites in three countries, an analogy was developed to identify how both fidelity and adaptation can be managed and successfully achieved. This article presents the Commonsense Cookery Book Basic Plain Cake with Variations recipe analogy to articulate the dual requirements of both fidelity and adaptation to achieve quality implementation of the MECSH program. Components classified by the analogy include identification of core ingredients, methods, and equipment that contribute to fundamental outcomes and fidelity to the evidence-based program, and a planned, collaborative approach to identification of needed variations to suit locally sourced capacity, needs, and tastes. Quality is achieved by identifying and measuring the core ingredients and the variations. Sourcing local ingredients and honoring of context support sustainability of quality practice. Using this analogy has assisted adopters of the MECSH program to understand that effective implementation requires uncompromised commitment to expectations of fidelity to the core components and methods; planned, proactive adaptation; systematic monitoring of both core program and agreed variations; and local ownership and sustainability.
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Affiliation(s)
- Lynn Kemp
- Centre for Health Equity Training Research and Evaluation (CHETRE), part of the Centre for Primary Health Care and Equity, Faculty of Medicine, UNSW Australia, Liverpool Hospital Locked Bag 7103, Liverpool BC, NSW, 1871, Australia. .,Translational Research and Social Innovation (TReSI), School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia.
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Cooper BR, Shrestha G, Hyman L, Hill L. Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes. J Prim Prev 2016; 37:33-52. [PMID: 26661413 DOI: 10.1007/s10935-015-0413-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although program adaptation is a reality in community-based implementations of evidence-based programs, much of the discussion about adaptation remains theoretical. The primary aim of this study was to replicate two coding systems to examine adaptations in large-scale, community-based disseminations of the Strengthening Families Program for Parents and Youth 10-14, a family-based substance use prevention program. Our second aim was to explore intersections between various dimensions of facilitator-reported adaptations from these two coding systems. Our results indicate that only a few types of adaptations and a few reasons accounted for a majority (over 70 %) of all reported adaptations. We also found that most adaptations were logistical, reactive, and not aligned with program's goals. In many ways, our findings replicate those of the original studies, suggesting the two coding systems are robust even when applied to self-reported data collected from community-based implementations. Our findings on the associations between adaptation dimensions can inform future studies assessing the relationship between adaptations and program outcomes. Studies of local adaptations, like the present one, should help researchers, program developers, and policymakers better understand the issues faced by implementers and guide efforts related to program development, transferability, and sustainability.
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Affiliation(s)
| | - Gitanjali Shrestha
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Leah Hyman
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Laura Hill
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
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Lyon AR, Koerner K. User-Centered Design for Psychosocial Intervention Development and Implementation. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016; 23:180-200. [PMID: 29456295 PMCID: PMC5812700 DOI: 10.1111/cpsp.12154] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current paper articulates how common difficulties encountered when attempting to implement or scale-up evidence-based treatments are exacerbated by fundamental design problems, which may be addressed by a set of principles and methods drawn from the contemporary field of user-centered design. User-centered design is an approach to product development that grounds the process in information collected about the individuals and settings where products will ultimately be used. To demonstrate the utility of this perspective, we present four design concepts and methods: (a) clear identification of end users and their needs, (b) prototyping/rapid iteration, (c) simplifying existing intervention parameters/procedures, and (d) exploiting natural constraints. We conclude with a brief design-focused research agenda for the developers and implementers of evidence-based treatments.
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Schinckus L, Van den Broucke S, Housiaux M. Assessment of implementation fidelity in diabetes self-management education programs: a systematic review. PATIENT EDUCATION AND COUNSELING 2014; 96:13-21. [PMID: 24795074 DOI: 10.1016/j.pec.2014.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/19/2014] [Accepted: 04/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE As diabetes requires extensive self-care, self-management education is widely recommended to enhance the effectiveness and reduce the costs of treatment. While a variety of diabetes self-management (DSM) programs are available, the conditions for their effective implementation are not well documented. This paper reviews the literature on implementation fidelity (IF), the degree to which programs are delivered as intended, as a factor influencing the effectiveness of diabetes education. METHODS Medical, psychological and educational research databases were searched to identify published studies on diabetes education describing the implementation process. Studies detailing the intervention adherence/fidelity/integrity were included to assess the way key elements of IF were addressed. RESULTS From an initial 418 abstracts, 20 published papers were retained for an in-depth analysis focusing on the components of IF. Intervention content was mainly assessed through observation, whereas intervention dose was more often assessed through self-report measures. Only one study addressed the relationship between IF and intervention effectiveness. CONCLUSION Despite the importance of IF to achieve program outcomes, IF of DSM programs remains largely under-investigated. PRACTICE IMPLICATIONS The results of this review suggest that reports on DSM education should systematically describe how the program was implemented. The impact of IF on program outcomes needs further investigation.
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Affiliation(s)
- Louise Schinckus
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium.
| | - Stephan Van den Broucke
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Marie Housiaux
- Psychological Sciences Research Institute, Catholic University of Louvain, Louvain-la-Neuve, Belgium
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Ahlmark N, Reynolds Whyte S, Curtis T, Tjørnhøj-Thomsen T. Positionings in healthcare: diabetes training for Arabic-speaking immigrants. HEALTH EDUCATION 2014. [DOI: 10.1108/he-04-2013-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose– The purpose of this study is to explore how healthcare professionals in Denmark perceived and enacted their role as diabetes trainers for Arabic-speaking immigrants in three new local authority settings. The paper used positioning theory, which is a dynamic alternative to the more static concept of role in that it seeks to capture the variable, situationally specific, multiple and shifting character of social interaction, as the analytical tool to examine how people situationally produce and explain behaviour of themselves and others.Design/methodology/approach– The paper generated data through observation of diabetes training and of introductory interviews with training participants in three local authority healthcare centres over a total of five months. The authors conducted 12 individual interviews and two group interviews with healthcare professionals.Findings– Healthcare professionals shifted between three positionings – caregiver, educator and expert. The caregiver was dominant in professionals’ ideals but less in their practice. Healthcare professionals other-positioned participants correspondingly as: vulnerable, difficult students and chronically ill. The two first other-positionings drew on dominant images of an ethnic other as different and problematic.Practical implications– Becoming more reflexive and explicit about one's positionings offer the potential for a more conscious, confident, flexible and open-ended teaching practice. Such reflexivity may also reduce the perception that teaching challenges are rooted in participants’ ethnic background.Originality/value– The paper provides a new understanding of healthcare practice by showing professionals’ multiple and reciprocal positionings and the potential and risks in this regard. The paper demonstrates the need for healthcare workers to reflect on their positionings not only in relation to immigrants, but to all patients.
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