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Bearman SK, Rohde P, Pauling S, Gau JM, Shaw H, Stice E. Predictors of the sustainability for an evidence-based eating disorder prevention program delivered by college peer educators. Implement Sci 2024; 19:47. [PMID: 38965587 PMCID: PMC11225113 DOI: 10.1186/s13012-024-01373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/15/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Despite ongoing efforts to introduce evidence-based interventions (EBIs) into mental health care settings, little research has focused on the sustainability of EBIs in these settings. College campuses are a natural place to intervene with young adults who are at high risk for mental health disorders, including eating disorders. The current study tested the effect of three levels of implementation support on the sustainability of an evidence-based group eating disorder prevention program, the Body Project, delivered by peer educators. We also tested whether intervention, contextual, or implementation process factors predicted sustainability. METHODS We recruited 63 colleges with peer educator programs and randomly assigned them to (a) receive a 2-day Train-the-Trainer (TTT) training in which peer educators were trained to implement the Body Project and supervisors were taught how to train future peer educators (TTT), (b) TTT training plus a technical assistance (TA) workshop (TTT + TA), or (c) TTT plus the TA workshop and quality assurance (QA) consultations over 1-year (TTT + TA + QA). We tested whether implementation support strategies, perceived characteristics of the intervention and attitudes towards evidence-based interventions at baseline and the proportion of completed implementation activities during the implementation year predicted three school-level dichotomous sustainability outcomes (offering Body Project groups, training peer educators, training supervisors) over the subsequent two-year sustainability period using logistic regression models. RESULTS Implementation support strategies did not significantly predict any sustainability outcomes, although a trend suggested that colleges randomized to the TTT + TA + QA strategy were more likely to train new supervisors (OR = 5.46, 95% CI [0.89-33.38]). Colleges that completed a greater proportion of implementation activities were more likely to offer Body Project groups (OR = 1.53, 95% CI [1.19-1.98]) and train new peer educators during the sustainability phase (OR = 1.39, 95% CI [1.10-1.74]). Perceived positive characteristics of the Body Project predicted training new peer educators (OR = 18.42, 95% CI [1.48-299.66]), which may be critical for sustainability in routine settings with high provider turnover. CONCLUSIONS Helping schools complete more implementation activities and increasing the perceived positive characteristics of a prevention program may result in greater sustainment of prevention program implementation. TRIAL REGISTRATION This study was preregistered on 12/07/17 with ClinicalTrials.gov, ID NCT03409809, https://clinicaltrials.gov/ct2/show/NCT03409809 .
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Affiliation(s)
- Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Austin, TX, D580078712-0383, USA.
| | - Paul Rohde
- Oregon Research Institute, 3800 Sports Way, Springfield, OR, 97477, USA.
| | - Sydney Pauling
- Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Austin, TX, D580078712-0383, USA
| | - Jeff M Gau
- Oregon Research Institute, 3800 Sports Way, Springfield, OR, 97477, USA
| | - Heather Shaw
- Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Eric Stice
- Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA, 94305-5719, USA
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Brownson RC, Cabassa LJ, Drake BF, Shelton RC. Closing the gap: advancing implementation science through training and capacity building. Implement Sci 2024; 19:46. [PMID: 38961482 PMCID: PMC11223366 DOI: 10.1186/s13012-024-01371-x] [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: 04/04/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
In their article on "Navigating the Field of Implementation Science Towards Maturity: Challenges and Opportunities," Chambers and Emmons describe the rapid growth of implementation science along with remaining challenges. A significant gap remains in training and capacity building. Formats for capacity building include university degree programs, summer training institutes, workshops, and conferences. In this letter, we describe and amplify on five key areas, including the need to (1) identify advanced competencies, (2) increase the volume and reach of trainings, (3) sustain trainings, (4) build equity focused trainings, and (5) develop global capacity. We hope that the areas we highlight will aid in addressing several key challenges to prioritize in future efforts to build greater capacity in implementation science.
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Affiliation(s)
- Ross C Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, One Brookings Drive, Campus, Box 1196, St. Louis, MO, 63130, United States.
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, United States.
| | - Leopoldo J Cabassa
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, 63130 63130, United States
| | - Bettina F Drake
- Department of Surgery, Division of Public Health Sciences, and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, United States
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, 10032, United States
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Wright B, González I, Chen M, Aarons GA, Hunter SB, Godley MD, Purtle J, Dopp AR. Multi-level alignment processes in the sustainment of a youth substance use treatment model following a federal implementation initiative: A mixed method study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209445. [PMID: 38960147 DOI: 10.1016/j.josat.2024.209445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/30/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Government agencies have identified evidence-based practice (EBP) dissemination as a pathway to high-quality behavioral health care for youth. However, gaps remain about how to best sustain EBPs in treatment organizations in the U.S., especially in resource-constrained settings like publicly-funded youth substance use services. One important, but understudied, determinant of EBP sustainment is alignment: the extent to which multi-level factors that influence sustainment processes and outcomes are congruent, consistent, and/or coordinated. This study examined the role of alignment in U.S. states' efforts to sustain the Adolescent Community Reinforcement Approach (A-CRA), an EBP for youth substance use disorders, during the COVID-19 pandemic. METHODS In this mixed methods study, the qualitative investigation preceded and informed the quantitative investigation. We interviewed state administrators and providers (i.e., supervisors and clinicians) from 15 states that had completed a federal A-CRA implementation grant; providers also completed surveys. The sample included 50 providers from 35 treatment organizations that reported sustaining A-CRA when the COVID-19 pandemic began, and 20 state administrators. In qualitative thematic analyses, we applied the EPIS (Exploration, Preparation, Implementation, Sustainment) framework to characterize alignment processes that interviewees described as influential on sustainment. We then used survey items to quantitatively explore the associations described in qualitative themes, using bivariate linear regressions. RESULTS At the time of interview, staff from 80 % of the treatment organizations (n = 28), reported sustaining A-CRA. Providers from both sustainer and non-sustainer organizations, as well as state administrators, described major sources of misalignment when state agencies ceased technical assistance post-grant, and because limited staff capacity conflicted with A-CRA's training model, which was perceived as time-intensive. Participants described the pandemic as exacerbating preexisting challenges, including capacity issues. Sustainer organizations reported seeking new funding to help sustain A-CRA. Quantitative associations between self-rated extent of sustainment and other survey items largely followed the pattern predicted from the qualitative findings. CONCLUSIONS The COVID-19 pandemic amplified longstanding A-CRA sustainment challenges, but treatment organizations already successfully sustaining A-CRA pre-pandemic largely continued. There are missed opportunities for state-level actors to coordinate with providers on the shared goal of EBP sustainment. A greater focus on alignment processes in research and practice could help states and providers strengthen sustainability planning.
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Affiliation(s)
- Blanche Wright
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States of America; RAND, Santa Monica, CA, United States of America.
| | - Isabelle González
- Department of Psychology, Georgetown University, Washington, DC, United States of America
| | - Monica Chen
- RAND, Santa Monica, CA, United States of America; Department of Psychology, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States of America
| | | | - Mark D Godley
- Chestnut Health Systems, Normal, IL, United States of America
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, New York, NY, United States of America
| | - Alex R Dopp
- RAND, Santa Monica, CA, United States of America
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Mora Ringle VA, Calloway A, Reich D, Oziel R, Walzer A, O'Connor S, Venti A, Comeau C, Williams T, Creed TA. What Really Matters in the Implementation of Evidence-based Practices in Community Mental Health? Insight and Recommendations from Experts, Providers, and Clients. Community Ment Health J 2024:10.1007/s10597-024-01307-1. [PMID: 38907842 DOI: 10.1007/s10597-024-01307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/02/2024] [Indexed: 06/24/2024]
Abstract
Perceptions of evidence-based practices (EBPs) and implementation are inherent drivers of implementation outcomes. Most studies on implementation perceptions have focused on direct service providers, but clients and EBP experts may offer additional meaningful information about implementing EBPs in community settings. EBP providers (n = 21), EBP experts (n = 12), and clients who received EBPs (n = 6) participated in focus groups to ascertain their perceptions of and experiences with EBP implementation, as part of a program evaluation. Thematic analysis indicated that provider and expert perceptions of EBP implementation in community settings converged around themes of implementation supports and training and client outcomes, along with several subthemes. Client perceptions centered on themes regarding the importance of their personal experiences, their impressions of EBPs, as well as their recommendation for increasing public awareness and use of EBPs. Findings suggest that the perspectives of EBP providers and experts are closely aligned, focusing on system-level, individual-level, and training issues that impact EBP implementation within a public mental health system. The themes that were important to clients were primarily related to their experiences as recipients of an EBP which produced insightful recommendations for promoting EBPs in the community.
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Affiliation(s)
| | - Amber Calloway
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Reich
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Oziel
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- King's College London, London, UK
| | - Arielle Walzer
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sydne O'Connor
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuro-Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amberlee Venti
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Carrie Comeau
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Tamra Williams
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Torrey A Creed
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Shoesmith A, Nathan N, Lum M, Yoong S, Nolan E, Wolfenden L, Shelton RC, Cooper B, Lane C, Grady A, Imad N, Riley-Gibson E, McCarthy N, Pearson N, Hall A. Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C): development and psychometric evaluation of a measure of sustainability determinants in the early childhood education and care setting. Implement Sci 2024; 19:41. [PMID: 38902763 PMCID: PMC11188265 DOI: 10.1186/s13012-024-01372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND There is a need for valid and reliable measures of determinants of sustainability of public health interventions in early childhood education and care (ECEC) settings. This study aimed to develop and evaluate the psychometric and pragmatic properties of such a measure - the Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C). METHODS We undertook a two-phase process guided by the COnsensus-based Standards for the selection of health status Measurement INstruments checklist (COSMIN) and Psychometric and Pragmatic Evidence Rating Scale (PAPERS). Phase 1 involved measure development; i.e., determining items and scales through an iterative process and assessment of face and content validity. Phase 2 involved the evaluation of psychometric and pragmatic properties. The 29-item measure completed by service executives (directors and nominated supervisors) was embedded in a larger survey from a national sample of Australian ECEC services assessing their implementation of nutrition and physical activity programs. Structural validity, concurrent validity, known groups validity, internal consistency, floor and ceiling effects, norms, and pragmatic qualities of the measure were assessed according to the PAPERS criteria. RESULTS The final measure contained 26 items, with respondents reporting how strongly they agreed or disagreed on a five-point Likert scale. Phase 1 assessments confirmed the relevance, and face and content validity of the scale. In Phase 2, we obtained 482 completed surveys, of which 84% (n = 405) completed the entire measure across 405 ECEC settings (one executive per service). Three of the four fit indices for the confirmatory factor analysis met the pre-specified criteria (SRMR = 0.056, CFI = 0.993, RMSEA = 0.067) indicating 'good' structural validity. The IMPRESS-C illustrated: 'good' internal consistency, with Cronbach's alpha values from 0.53 to 0.92; 'emerging' concurrent validity; 'poor' known groups validity; 'good' norms; and 'good' overall pragmatic qualities (cost, readability, length, and assessor burden). CONCLUSIONS The IMPRESS-C possesses strong psychometric and pragmatic qualities for assessing service executive-level perceptions of determinants influencing sustainment of public health interventions within ECEC settings. To achieve a full range of perspectives in this setting, future work should be directed to also develop and test measures of sustainability determinants at the implementer level (e.g., among individual educators and staff).
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Affiliation(s)
- Adam Shoesmith
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Serene Yoong
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Brittany Cooper
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Cassandra Lane
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Noor Imad
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Faculty of Health, School of Health and Social Development, Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220, Australia
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Edward Riley-Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Nicole McCarthy
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Nicole Pearson
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2308, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, NSW, 2308, Australia
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Heitkemper E, Hulse S, Bekemeier B, Schultz M, Whitman G, Turner AM. The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation. JMIR Hum Factors 2024; 11:e51666. [PMID: 38837192 PMCID: PMC11187519 DOI: 10.2196/51666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 03/24/2024] [Accepted: 04/18/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. OBJECTIVE This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. METHODS Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. RESULTS Of the 9 participants, all were female and most worked at a local health department (7/9, 78%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting-89% (n=8) participants for task 1 and 67% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be "extremely useful" for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. CONCLUSIONS Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities.
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Affiliation(s)
| | - Scott Hulse
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, WA, United States
- School of Public Health, University of Washington, Seattle, WA, United States
| | - Melinda Schultz
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Greg Whitman
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Anne M Turner
- School of Public Health, University of Washington, Seattle, WA, United States
- School of Medicine, University of Washington, Seattle, WA, United States
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Ataman R, Ahmed S, Berta W, Thomas A. Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation. J Eval Clin Pract 2024; 30:559-574. [PMID: 38361260 DOI: 10.1111/jep.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024]
Abstract
RATIONALE Only half of newly implemented evidence-based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown. AIMS AND OBJECTIVES We aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome). METHODOLOGY Informed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo-Portland Adaptability Inventory - version 4 (MPAI-4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI-4. RESULTS We linked context, mechanisms and outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI-4 scoring: 77.7%) to low level (e.g., rate of MPAI-4 application to clinical decision-making: 3.7%)] and (4) the work of sustaining the MPAI-4 is shared amongst different stakeholders. CONCLUSION Implementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes.
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Affiliation(s)
- Rebecca Ataman
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Constance Lethbridge Rehabilitation Center, CIUSSS Centre-Ouest de l'Îile de Montreal, Montreal, Quebec, Canada
- Clinical Epidemiology, Center for Outcome Research and Evaluation (CORE), McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
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Tucker JD, Day S, Nwaozuru UC, Obiezu-Umeh C, Ezechi O, Chima K, Mukuka C, Iwelunmor J, Sturke R, Vorkoper S. Sustaining sexual health programs: practical considerations and lessons from the President's Emergency Plan for AIDS Relief. Sex Health 2024; 21:SH24064. [PMID: 38917298 DOI: 10.1071/sh24064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024]
Abstract
Enhancing the sustainability of sexual health programs is important, but there are few practical tools to facilitate this process. Drawing on a sustainability conceptual framework, this Editorial proposes four ideas to increase the sustainability of sexual health programs - early planning, equitable community engagement, return on investment, and partnerships to address social determinants. Early planning during the design of a sexual health program is important for sustainability because it provides an opportunity for the team to build factors relevant to sustainability into the program itself. Equitable community engagement can expand multi-sectoral partnerships for institutionalisation, identify allies for implementation, and strengthen relationships between beneficiaries and researchers. From a financial perspective, considering the return on investment could increase the likelihood of sustainability. Finally, partnerships to address social determinants can help to identify organisations with a similar vision. Existing sustainability frameworks can be used to measure each of these key elements. Several approaches can be used to enhance the sustainability of sexual health programs. The President's Emergency Plan for AIDS Relief provides potential lessons for increasing the sustainability of sexual health programs in diverse global settings.
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Affiliation(s)
- Joseph D Tucker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; and Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Day
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ucheoma C Nwaozuru
- Implementation Science, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Chisom Obiezu-Umeh
- Center for Dissemination & Implementation Science, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Oliver Ezechi
- Centre for Reproduction and Population Health Studies, Department of Clinical Sciences, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Kelechi Chima
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Juliet Iwelunmor
- Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Rachel Sturke
- Fogarty International Center, US National Institutes of Health, Bethesda, MD, USA
| | - Susan Vorkoper
- Fogarty International Center, US National Institutes of Health, Bethesda, MD, USA
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9
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Cash B, Lawless M, Robson K, Fealy S, Corboy D. Understanding the enablers to implementing sustainable health and well-being programs for older adults in rural Australia: A scoping review. Aust J Rural Health 2024; 32:419-432. [PMID: 38506524 DOI: 10.1111/ajr.13111] [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: 01/14/2024] [Revised: 03/06/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities. OBJECTIVE To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia. DESIGN A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest. FINDINGS Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models. DISCUSSION The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians. CONCLUSION Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities.
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Affiliation(s)
- Belinda Cash
- Manna Institute, Ageing Well in Rural and Regional Australia Research Group, School of Social Work and Arts, Charles Sturt University, Albury, New South Wales, Australia
| | - Michael Lawless
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Kristy Robson
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, New South Wales, Australia
| | - Shanna Fealy
- Ageing Well in Rural and Regional Australia Research Group, Charles Sturt University, Albury, New South Wales, Australia
| | - Denise Corboy
- Blue Sky Mind Research Consultancy, Ballarat, Victoria, Australia
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10
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Hirt J, Vetsch J, Weissenfels I, Heinrich S. Nurse-led physical activity interventions for people with dementia in nursing homes: A systematic review on intervention characteristics and implementation facilitators/barriers. Int J Nurs Stud 2024; 154:104756. [PMID: 38552471 DOI: 10.1016/j.ijnurstu.2024.104756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Physical activities are important to maintain and promote physical functioning and activities of daily living in people with dementia. Nurses are in a key position to deliver physical activity interventions in nursing homes. However, synthesized strategies for sustainable implementation of physical activity interventions in nursing homes for people with dementia are lacking. OBJECTIVE We aimed at synthesizing the evidence on nurse-led physical activity interventions and at identifying facilitators and barriers to sustainable implementation of physical activity interventions for people with dementia. DESIGN Systematic review. REVIEW METHODS We performed a comprehensive literature search combining database searches (MEDLINE, CINAHL, CENTRAL, Web of Science Core Collection; last search: September 27, 2023) and supplementary search methods (citation tracking, web searching, clinical guideline database searching). We considered studies on nurse-led physical activity interventions for people with dementia living in nursing homes for eligibility; published as journal articles and related material in English, French, German language, without restrictions on primary study design and publication year. Independently and in duplicate, we assessed the references' eligibility and the quality of the included studies. We used the Mixed Methods Appraisal Tool to appraise quality of included studies. We piloted and double-checked data extractions, and summarized the results narratively and graphically (harvest plot). We prospectively registered our review (PROSPERO CRD42021271833). RESULTS We identified 24 studies (of which eleven were randomized trials) assessing various interventions that we categorized into physical exercise (n = 8), care-integrated physical activity (n = 6), outdoor or walking activity (n = 5), technology-supported physical exercise (n = 3), and dancing (n = 2). Types of outcomes and length of follow-up varied widely. Effects were inconclusive, except for outdoor or walking activities showing an overall positive impact on physical outcomes. For eight interventions, we identified evidence on implementation barriers (b) and facilitators (f), including staff shortage (b), staff time resources (b), or ease of implementation for staff (f) and adaptability of interventions (f) or refusal to participate of people with dementia (b). CONCLUSIONS The results of our review provide a comprehensive overview on types, characteristics and effects of nurse-led physical activity interventions for people with dementia in nursing homes. Based on evidence from a range of study designs and sources, we came to the conclusion that all stakeholders involved considered physical activity interventions for people with dementia as useful and relevant. Outcome measures varied widely and a clear conclusion on effectiveness remains open.
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Affiliation(s)
- Julian Hirt
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Janine Vetsch
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland.
| | - Inga Weissenfels
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland.
| | - Steffen Heinrich
- Institute of Nursing Science, Department of Health, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland.
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11
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Kepper M, L'Hotta A, Shato T, Kwan BM, Glasgow RE, Luke D, Graham AK, Baumann AA, Brownson RC, Morse B. Supporting Teams with Designing for Dissemination and Sustainability: the Design, Development, and Usability of a Digital Interactive Platform. RESEARCH SQUARE 2024:rs.3.rs-4276919. [PMID: 38853949 PMCID: PMC11160915 DOI: 10.21203/rs.3.rs-4276919/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background The use of Designing for Dissemination and Sustainability (D4DS) principles and methods can support the development of research products (interventions, tools, findings) to match well with the needs and context of the intended audience and setting. D4DS principles and methods are not well-known or used during clinical and public health research; research teams would benefit from applying D4DS. This paper presents the development of a new digital platform for teams to learn and apply a D4DS process to their work. Methods A user-centered design (UCD) approach engaged users (n=14) and an expert panel (n=6) in an iterative design process from discovery to prototyping and testing. We led five design sessions using Zoom and Figma software over a 5-month period. Users (71% academics; 29% practitioners) participated in at least 2 sessions. Following design sessions, feedback from users were summarized and discussed to generate design decisions. A prototype was then built and heuristically tested with 11 users who were asked to complete multiple tasks within the platform while verbalizing their decision-making using the 'think aloud' procedure. The System Usability Scale (SUS) was administered at the end of each testing session. After refinements to the platform were made, usability was reassessed with 7 of 11 same users to examine changes. Results The interactive digital platform (the D4DS Planner) has two main components: 1) the Education Hub (e.g., searchable platform with literature, videos, websites) and 2) the Action Planner. The Action Planner includes 7 interactive steps that walk users through a set of activities to generate a downloadable D4DS action plan for their project. Participants reported that the prototype tool was moderately usable (SUS=66) but improved following refinements (SUS=71). Conclusions This is a first of its kind tool that supports research teams in learning about and explicitly applying D4DS to their work. The use of this publicly available tool may increase the adoption, impact, and sustainment of a wide range of research products. The use of UCD yielded a tool that is easy to use. The future use and impact of this tool will be evaluated, and the tool will continue to be refined and improved.
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Affiliation(s)
- Maura Kepper
- Washington University In St Louis: Washington University in St Louis
| | - Allison L'Hotta
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Thembekile Shato
- Washington University In St Louis: Washington University in St Louis
| | - Bethany M Kwan
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Russell E Glasgow
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
| | - Douglas Luke
- Washington University In St Louis: Washington University in St Louis
| | | | - Ana A Baumann
- Washington University in St Louis School of Medicine
| | - Ross C Brownson
- Washington University In St Louis: Washington University in St Louis
| | - Brad Morse
- University of Colorado School of Medicine: University of Colorado Anschutz Medical Campus School of Medicine
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12
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Huang A, Zhao Y, Cao C, Lyu M, Tang K. Integrating interventions supported by development assistance for health into local health system: evidence from a China-World Bank-UK rural health system strengthening project (1998-2007). BMJ Glob Health 2024; 9:e012853. [PMID: 38789275 PMCID: PMC11129031 DOI: 10.1136/bmjgh-2023-012853] [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: 05/15/2023] [Accepted: 02/28/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system. METHODS From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems. RESULTS Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions. CONCLUSION The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.
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Affiliation(s)
| | - Yingxi Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Nuffield Department of Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Chunkai Cao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Mohan Lyu
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Ishola OD, Holcombe SJ, Ferrand A, Ajijola L, Anieto NN, Igharo V. What Underlies State Government Performance in Scaling Family Planning Programming? A Study of The Challenge Initiative State Partnerships in Nigeria. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200228. [PMID: 38621820 PMCID: PMC11111101 DOI: 10.9745/ghsp-d-22-00228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/26/2022] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Relatively few studies rigorously examine the factors associated with health systems strengthening and scaling of interventions at subnational government levels. We aim to examine how The Challenge Initiative (TCI) coaches subnational (state government) actors to scale proven family planning and adolescent and youth sexual and reproductive health approaches rapidly and sustainably through public health systems to respond to unmet need among the urban poor. METHODS This mixed-methods comparative case study draws on 32 semistructured interviews with subnational government leaders and managers, nongovernmental organization leaders, and TCI Nigeria staff, triangulated with project records and government health management information system (HMIS) data. Adapting the Consolidated Framework for Implementation Research (CFIR), we contrast experience across 2 higher-performing states and 1 lower-performing state (identified through HMIS data and selected health systems strengthening criteria from 13 states) to identify modifiable factors linked with successful adoption and implementation of interventions and note lessons for supporting scale-up. RESULTS Informants reported that several TCI strategies overlapping with CFIR were critical to states' successful adoption and sustainment of interventions, most prominently external champions' contributions and strengthened state planning and coordination, especially in higher-performing states. Government stakeholders institutionalized new interventions through their annual operational plans. Higher-performing states incorporated mutually reinforcing interventions (including service delivery, demand generation, and advocacy). Although informants generally expressed confidence that newly introduced service delivery interventions would be sustained beyond donor support, they had concerns about government financing of demand-side social and behavior change work. CONCLUSION As political and managerial factors, even more than technical factors, were most linked with successful adoption and scale-up, these processes and systems should be assessed and prioritized from the start. Government leaders, TCI coaches, and other stakeholders can use these findings to shape similar initiatives to sustainably scale social service interventions.
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Affiliation(s)
- Oluwayemisi Denike Ishola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria.
| | - Sarah Jane Holcombe
- The Challenge Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrea Ferrand
- The Challenge Initiative, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lekan Ajijola
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Nneoma Nonyelum Anieto
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
| | - Victor Igharo
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
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14
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Takens FE, Indyk I, Chinapaw MJM, Ujčič-Voortman JK, van Nassau F, Busch V. Qualitative multi-stakeholder evaluation of the adoption, implementation and sustainment of the school-based dietary intervention "Jump-in". BMC Public Health 2024; 24:1337. [PMID: 38760727 PMCID: PMC11102190 DOI: 10.1186/s12889-024-18814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Comprehensive school-based programs applying the WHO Health Promoting School Model have the potential to initiate and sustain behavior change and impact health. However, since they often include intervention efforts on a school's policies, physical environment, curriculum, health care and involving parents and communities, they significantly 'intrude' on a complex system that is aimed primarily at education, not health promotion. More insights into and concrete strategies are therefore needed regarding their adoption, implementation, and sustainment processes to address the challenge to sustainable implementation of HPS initiatives in a primarily educational setting. This study consequently evaluates adoption, implementation and sustainment processes of Amsterdam's Jump-in healthy nutrition HPS intervention from a multi-stakeholder perspective. METHODS We conducted semi-structured interviews and focus groups with all involved stakeholders (n = 131), i.e., Jump-in health promotion professionals (n = 5), school principals (n = 7), at-school Jump-in coordinators (n = 7), teachers (n = 20), parents (n = 50, 9 groups) and children (n = 42, 7 groups) from 10 primary schools that enrolled in Jump-in in the school year 2016-2017. Included schools had a higher prevalence of overweight and/or obesity than the Dutch average and they were all located in Amsterdam's low-SEP neighborhoods. Data were analyzed using a directed content analysis, in which the Determinants of Innovation Model was used for obtaining theory-based predetermined codes, supplemented with new codes emerging from the data. RESULTS During intervention adoption, all stakeholders emphasized the importance of parental support, and accompanying workshops and promotional materials. Additionally, parents and teachers indicated that a shared responsibility for children's health and nuanced framing of health messages were important. During implementation, all stakeholders needed clear guidelines and support structures. Teachers and children highlighted the importance of peer influence, social norms, and uniform application of guidelines. School staff also found further tailoring of the intervention and dealing with financial constraints important. For long-term intervention sustainment, incorporating the intervention policies into the school statutes was crucial according to health promotion professionals. CONCLUSIONS This qualitative evaluation provides valuable insights into factors influencing the adoption, implementation, and sustainment processes of dietary interventions, such as the importance of transparent and consistent intervention guidelines, clear communication regarding the rationale behind intervention guidelines, and, stakeholders' involvement in decision-making.
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Affiliation(s)
- Froukje E Takens
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands.
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Indira Indyk
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
| | - Mai J M Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Joanne K Ujčič-Voortman
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Health Behaviour and Chronic Diseases, Amsterdam, The Netherlands
| | - Vincent Busch
- Department Gezond Leven, Public Health Service of Amsterdam, Team Sarphati Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
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15
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Riley-Gibson E, Hall A, Shoesmith A, Wolfenden L, Shelton RC, Doherty E, Pollock E, Booth D, Salloum RG, Laur C, Powell BJ, Kingsland M, Lane C, Hailemariam M, Sutherland R, Nathan N. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Syst Rev 2024; 13:129. [PMID: 38725053 PMCID: PMC11084058 DOI: 10.1186/s13643-024-02541-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/23/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced-based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e. physical inactivity, poor diet, harmful alcohol use, and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such, this review will provide important evidence to advance the field of sustainability research. METHODS This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) checklist. Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team, data screening and extraction will be performed in duplicate, strategies will be coded using an adapted sustainability-explicit taxonomy, and evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or programme within any of the eligible settings will be included. Article screening, data extraction, risk of bias, and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random-effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include the following: time period, single or multi-strategy, type of setting, and type of intervention. Differences between sub-groups will be statistically compared. DISCUSSION/CONCLUSION This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022352333.
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Affiliation(s)
- Edward Riley-Gibson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia.
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Emma Pollock
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Debbie Booth
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, 76 Grenville StreetOntario, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Maji Hailemariam
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Local Health District, Hunter New England Population Health, Newcastle, NSW, 2287, Australia
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Alanazi MA. The Role of Physical Activity in Adjunctive Nursing Management of Neuro-Degenerative Diseases among Older Adults: A Systematic Review of Interventional Studies. Life (Basel) 2024; 14:597. [PMID: 38792618 PMCID: PMC11122640 DOI: 10.3390/life14050597] [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: 03/31/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Neurodegenerative diseases such as dementia and Parkinson's disease pose significant challenges to older adults globally. While pharmacological treatments remain primary, increasing evidence supports the role of non-pharmacological strategies like physical activity in managing these conditions. This systematic review critically evaluates the effectiveness of Nursing based physical activity interventions in improving cognitive function, physical functioning, mobility, and overall quality of life among older adults with neurodegenerative diseases. We conducted a comprehensive search across PubMed, EMBASE, Web of Science, CENTRAL, and other relevant databases, focusing on randomized controlled trials and observational studies that examined the impact of structured physical activity. Our findings from nineteen studies involving 1673 participants indicate that interventions ranging from aerobic exercises, resistance training, to mind-body exercises like Tai Chi and yoga have beneficial effects. Specifically, physical activity was consistently found to enhance cognitive performance, increase mobility, and improve balance and daily living activities, contributing to a better quality of life. However, these benefits vary depending on the type, intensity, and duration of the activity performed. Despite promising results, limitations such as small sample sizes, study heterogeneity, and short-term follow-up periods call for more robust, long-term studies to solidify these findings. This review underscores the potential of tailored physical activity programs as adjunctive therapy in the comprehensive management of neurodegenerative diseases among the elderly population.
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Affiliation(s)
- Majed Awad Alanazi
- Department of Medical Surgical Nursing, College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia
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17
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Deatrick JA. Adapting Psychosocial Interventions Using Participatory Methods: Lessons Learned for Family Nursing. JOURNAL OF FAMILY NURSING 2024; 30:87-93. [PMID: 38682440 DOI: 10.1177/10748407241232091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
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18
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Crane M, Lee K, Bohn-Goldbaum E, Nathan N, Bauman A. Sustaining health obesity prevention programs: Lessons from real-world population settings. EVALUATION AND PROGRAM PLANNING 2024; 103:102404. [PMID: 38244416 DOI: 10.1016/j.evalprogplan.2024.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/07/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
Current understanding of what sustains public health programs is derived primarily from evaluations of programs delivered for only a few years. To improve program planning and knowledge on program sustainment, we examined real-world population programs that have been delivered for >2 years. Our focus was physical activity and nutrition programs for obesity prevention. We identified programs through published literature and searched through publicly available information on the theoretical factors determining sustainment. We reviewed 90 programs and explored intervention characteristics, provider, delivery and process level factors, and the outer environment influences. Programs were sustained on average 15 years and more frequently characterised as behavioural change skills programs targeting children, funded by non-government organisations and delivered by community organisations. Most programs had undergone some modification (n = 55). Differences between programs were observed across key factors: Programs sustained 15+ years were mainly behaviour skills programs (n = 21); and characterised by interactive designs (i.e., face-to-face or digital) over static innovations (i.e., print material) compared with those sustained <15 years (p = 0.024). While government funding supported many of the programs (n = 45;), those sustained 15+ years were more likely to have been commercially funded (p = 0.044); and were less likely to have current community involvement (p = 0.013). Differences in ownership and funding were also observed across countries. While multiple factors may influence program sustainment, longer delivered programs where distinguished by their program characteristics and outer contextual factors, suggesting such factors may have an important role in sustaining programs in the longer-term.
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Affiliation(s)
- Melanie Crane
- Sydney School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW 2007, Australia.
| | - Karen Lee
- Sydney School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - Erika Bohn-Goldbaum
- Sydney School of Health Sciences, The University of Sydney, Sydney, NSW 2006, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia; Hunter Medical Research Institute, New Lambton, NSW, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; National Centre of Implementation Science, The University of Newcastle, Callaghan, NSW, Australia
| | - Adrian Bauman
- Sydney School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia; The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW 2007, Australia; National Centre of Implementation Science, The University of Newcastle, Callaghan, NSW, Australia
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Wong V, Franke T, McKay H, Tong C, Macdonald H, Sims-Gould J. Adapting an Effective Health-Promoting Intervention-Choose to Move-for Chinese Older Adults in Canada. J Aging Phys Act 2024; 32:151-162. [PMID: 37917970 DOI: 10.1123/japa.2023-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 11/04/2023]
Abstract
Evidence is sparse on how community-based health-promoting programs can be culturally adapted for racially minoritized, immigrant older adult populations. Choose to Move (CTM) is an evidence-based health-promoting program that enhances physical activity and mobility and diminished social isolation and loneliness in older adults in British Columbia, Canada. However, racially minoritized older adults were not reached in initial offerings. We purposively sampled CTM delivery staff (n = 8) from three not-for-profit organizations, in Metro Vancouver, British Columbia, that serve Chinese older adults. We used semistructured interviews, ethnographic observations, and meeting minutes to understand delivery staff's perspectives on factors that influence CTM adaptations for Chinese older adults. Deductive framework analysis guided by an adaptation framework, Framework for Reporting Adaptations and Modifications-Enhanced, found three dominant cultural- and immigration-related factors influenced CTM adaptations for Chinese older adults: (a) prioritizations, (b) familiarity, and (c) literacy. Findings may influence future program development and delivery to meet the needs of racially minoritized older adult populations.
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Affiliation(s)
- Venessa Wong
- Active Aging Research Team, Vancouver, BC,Canada
| | - Thea Franke
- Active Aging Research Team, Vancouver, BC,Canada
| | | | - Catherine Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON,Canada
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Teychenne M, Apostolopoulos M, France-Ratcliffe M, Chua E, Hall S, Opie RS, Blunden S, Duncan MJ, Olander EK, Koorts H. Factors relating to sustainability and scalability of the 'Food, Move, Sleep (FOMOS) for Postnatal Mental Health' program: Qualitative perspectives from key stakeholders across Australia. Health Promot J Austr 2024; 35:393-409. [PMID: 37384432 DOI: 10.1002/hpja.767] [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: 03/22/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023] Open
Abstract
ISSUE ADDRESSED Supporting healthy behaviours (quality diet, physical activity, sleep) through home-based interventions is feasible to improve postnatal mental health. Involving stakeholders in developing interventions is essential for maximising accessibility, implementation and scale-up. This study aimed to identify factors affecting the sustainable implementation and scalability of the Food, Move, Sleep (FOMOS) for Postnatal Mental Health program, including strategies to enhance research-practice translation. METHODS Stakeholders (n = 13) involved in promoting physical activity, healthy eating, postnatal and mental health, public health and/or policy participated in semi-structured interviews. Interviews, based on PRACTIS Guide recommendations for implementation and scale-up, explored perceptions of program design, implementation and scalability. Reflexive thematic analysis was undertaken. Identified implementation and scale-up strategies were mapped against the Expert Recommendations for Implementing Change compendium and PRACTIS Guide. RESULTS Individual-level: Targeting multiple systems (primary, tertiary, community-based care) and entry points (early, mid-postpartum) for uptake was important. For equity, screening women in public hospitals, engaging with community agencies and targeting most at-risk women, was suggested. Provider-level: Stakeholders identified strategies to enhance future roll-out (organisations assisting with recruitment). Factors impacting sustainability included high demand for the FOMOS program, and governance around screening and funding; online delivery, connecting with partners and providers and integration into existing services may enhance sustainability. Systems-level: Political support and community champions were perceived important for program dissemination. Nine strategies addressing program uptake, reach, implementation, potential scalability and sustainability were identified. CONCLUSIONS For sustainable implementation and potential scalability of a home-based multi-behaviour postnatal intervention, multi-level implementation and scale-up strategies, aligned with existing health systems, policies and initiatives to support postnatal mental health should be considered. SO WHAT?: This paper provides a comprehensive list of strategies that can be used to enhance sustainable implementation and scalability of healthy behaviour programs targeting postnatal mental health. Further, the interview schedule, systematically developed and aligned with the PRACTIS Guide, may serve as a useful resource for researchers conducting similar studies in future.
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Affiliation(s)
- Megan Teychenne
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Maria Apostolopoulos
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Madeleine France-Ratcliffe
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Elysha Chua
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sanae Hall
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Rachelle S Opie
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Sarah Blunden
- Appleton Institute of Behavioural Science, Central Queensland University, Adelaide, South Australia, Australia
| | - Mitch J Duncan
- School of Medicine & Public Health, College of Health, Medicine, and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ellinor K Olander
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, London, UK
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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Glasgow RE, Ford BS, Bradley CJ. Implementation science for cancer control: One center's experience addressing context, adaptation, equity, and sustainment. Transl Behav Med 2024; 14:215-224. [PMID: 38159246 PMCID: PMC10956964 DOI: 10.1093/tbm/ibad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Implementation science (IS) has great potential to enhance the frequency, speed, and quality of the translation of evidence-based programs, policies, products, and guidelines into practice. Progress has been made, but with some notable exceptions, this promise has not been achieved for cancer prevention and control. We discuss five interrelated but conceptually distinct, crosscutting issues important to accelerate IS for cancer prevention and control and how our Colorado Implementation Science Center in Cancer Control (COISC3) addressed these issues. These needs and opportunities include more fully addressing changing, multi-level context; guiding rapid, iterative adaptations; evaluating innovative approaches to engagement and health equity; greater attention to costs and economic issues; and sustainability. We summarize conceptual issues; evaluation needs and capacity building activities and then provide examples of how our IS center addressed these five needs for cancer prevention and control. We discuss changes made to address priorities of (i) guiding adaptations of implementation strategies to address changing context and (ii) working on issues identified and prioritized by our primary care partners rather than the research team. We conclude with discussion of lessons learned, limitations, and directions for future research and practice in IS to enhance cancer prevention and control as well as translational behavioral medicine more generally.
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Affiliation(s)
- Russell E Glasgow
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Bryan S Ford
- Colorado Implementation Science Center in Cancer Control, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Cathy J Bradley
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- University of Colorado Comprehensive Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Wolfenden L, Shoesmith A, Hall A, Bauman A, Nathan N. An initial typology of approaches used by policy and practice agencies to achieve sustained implementation of interventions to improve health. Implement Sci Commun 2024; 5:21. [PMID: 38443994 PMCID: PMC10913259 DOI: 10.1186/s43058-024-00555-2] [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: 07/10/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Scientific investigation of how to sustain the implementation of evidence-based interventions (EBI) is emerging. Sustaining the implementation of EBIs helps ensure their effects on improving health endure. External policy or practice agencies, such as government health departments, are often tasked with supporting individual organisations with sustaining their delivery of EBIs, for example, through financing, training or the provision of other supports. However, to our knowledge, the approaches taken by policy and practice agencies to support the sustainment of EBIs have not been consolidated, categorised and described as a typology. MAIN BODY To improve conceptual clarity and support both research and practice, we developed an initial working typology of the practical approaches to sustain implementation of EBIs (i.e. sustainment) in order to improve long term health from the perspective of these agencies. The working typology includes three broad approaches. The first, termed 'Self-Sustainment', is when implementation of the EBI by an organisation (e.g. hospital, clinic, school) is expected to continue (sustain) in the absence of external (agency) support. The second, termed 'Static Sustainment Support', involves the provision of pre-defined external (agency) support to assist organisations to continue implementation of an EBI. The final approach is termed 'Dynamic Sustainment Support', whereby support provided by an external agency is dynamic (continues to be adapted) overtime to assist organisations continue implementation of an intervention which may itself also evolve. CONCLUSIONS We describe the contexts and circumstances where each may be most appropriate in achieving sustained implementation and discuss their research and practice implications.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University of Drive, Callaghan, NSW, 2308, Australia.
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Wallsend, NSW, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia.
| | - Adam Shoesmith
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University of Drive, Callaghan, NSW, 2308, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Wallsend, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Alix Hall
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University of Drive, Callaghan, NSW, 2308, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Wallsend, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University of Drive, Callaghan, NSW, 2308, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Wallsend, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
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Beahm JD, McCall HC, Carleton RN, Jones N, Hadjistavropoulos HD. Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework. Internet Interv 2024; 35:100718. [PMID: 38318086 PMCID: PMC10840103 DOI: 10.1016/j.invent.2024.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
Background Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT. Methods In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance. Results The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support). Implications Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.
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Affiliation(s)
- Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nicholas Jones
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Department of Justice Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
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McKay V, Chen Y, Prewitt K, Malone S, Puerto-Torres M, Acuña-Aguirre C, Alfonso-Carreras Y, Alvarez-Arellano SY, Andrade-Sarmiento LA, Arce-Cabrera D, Argüello-Vargas D, Barragán-García MDC, Batista-Del-Cid R, Blasco-Arriaga EE, Cach-Castaneda MDC, Ceballo-Batista GI, Chávez-Rios M, Costa ME, Cuencio-Rodriguez ME, Diaz-Coronado R, Fing-Soto EA, García-Sarmiento TDJ, Gómez-García WC, Hernández-González CJ, Jimenez-Antolinez YV, Juarez-Tobias MS, León-López EM, Lopez-Facundo NA, Martínez Soria RA, Miralda-Méndez ST, Montalvo E, Pérez-Alvarado CM, Perez-Fermin CK, Quijano-Lievano ML, Salas-Mendoza B, Sanchez-Fuentes EE, Serrano-Landivar MX, Soto-Chavez V, Tejocote-Romero I, Valle S, Vasquez-Roman EA, Costa JT, Cardenas-Aguirre A, Devidas M, Luke DA, Agulnik A. Connecting Clinical Capacity and Intervention Sustainability in Resource-Variable Pediatric Oncology Centers in Latin America. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2024; 4:102-115. [PMID: 38566954 PMCID: PMC10987010 DOI: 10.1007/s43477-023-00106-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/10/2023] [Indexed: 04/04/2024]
Abstract
Clinical capacity for sustainability, or the clinical resources needed to sustain an evidence-based practice, represent proximal determinants that contribute to intervention sustainment. We examine the relationship between clinical capacity for sustainability and sustainment of PEWS, an evidence-based intervention to improve outcomes for pediatric oncology patients in resource-variable hospitals. We conducted a cross-sectional survey among Latin American pediatric oncology centers participating in Proyecto Escala de Valoración de Alerta Temprana (EVAT), an improvement collaborative to implement Pediatric Early Warning Systems (PEWS). Hospitals were eligible if they had completed PEWS implementation. Clinicians were eligible to participate if they were involved in PEWS implementation or used PEWS in clinical work. The Spanish language survey consisted of 56 close and open-ended questions about the respondent, hospital, participants' assessment of clinical capacity to sustain PEWS using the clinical sustainability assessment tool (CSAT), and perceptions about PEWS and its use as an intervention. Results were analyzed using a multi-level modeling approach to examine the relationship between individual, hospital, intervention, and clinical capacity determinants to PEWS sustainment. A total of 797 responses from 37 centers in 13 countries were included in the analysis. Eighty-seven percent of participants reported PEWS sustainment. After controlling for individual, hospital, and intervention factors, clinical capacity was significantly associated with PEWS sustainment (OR 3.27, p < .01). Marginal effects from the final model indicate that an increasing capacity score has a positive influence (11% for every additional CSAT point) of predicting PEWS sustainment. PEWS is a sustainable intervention and clinical capacity to sustain PEWS contributes meaningfully to PEWS sustainment.
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Affiliation(s)
- Virginia McKay
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Kim Prewitt
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Sara Malone
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
- Division of Population Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria E. Costa
- Hospital del Nino de la Santísima Trinidad, Cordoba, Argentina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Clara K. Perez-Fermin
- Hospital Infantil Regional Universitario Dr. Arturo Grullon, Santiago, Dominican Republic
| | | | | | | | | | | | | | - Sergio Valle
- Unidad Nacional de Oncologia Pediatrica (UNOP), Guatemala, Guatemala
| | | | - Juliana Texeira Costa
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Adolfo Cardenas-Aguirre
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Douglas A. Luke
- Brown School, Washington University, MSC 1196-251-46, 1 Brookings Drive, St. Louis, MO 63130, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN, USA
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Brooks SP, Alba C, Thomson D, Davison SN, Storey K. Partnership-building considerations for implementation science in learning health systems: a case study of the Implementation Science Collaborative in Alberta, Canada. FRONTIERS IN HEALTH SERVICES 2024; 4:1327395. [PMID: 38433991 PMCID: PMC10904619 DOI: 10.3389/frhs.2024.1327395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024]
Abstract
Introduction Implementation of health innovations is inherently collaborative, requiring trans-sectoral partnerships between implementation researchers, innovation teams, and implementation practitioners. Implementation science has been shown to improve implementation successes; however, challenges that hinder partnerships to advance implementation science continue to persist. Using a whole-system approach to assess and respond to implementation science partnership barriers may shed light on effective responses. Methods We conducted a case study of Alberta's learning health system, using semi-structured group and individual interviews to create a nuanced understanding of the considerations required for implementation research collaborations. We interviewed 53 participants representing 21 offices in the health system, academia, professional associations, and government who regularly plan, evaluate, and/or study health system implementation initiatives in Alberta. Using the Partnership Model for Research Capacity Building, we identified current facilitators and challenges for partnerships for conducting and using implementation science, at different levels of Alberta's health-research ecosystem. Results Alberta's healthcare system is well set up to readily embed intervention effectiveness and efficacy research. Infrastructure was also in place to strengthen implementation practice. However, weaknesses around exchanging knowledge and skills, providing feedback and mentoring, and accommodating diversity affected the ability of both individuals and teams to build implementation science capacity. Without this capacity, teams could not participate in embedded implementation research collaborations. We report the response of the Alberta Strategy for Patient-Oriented Research SUPPORT Unit to these barriers to provide practical guidance on various program options to strengthen individual- and organization-level implementation science capacity. Discussion This study applied a whole-system approach to assess factors across Alberta's health-research ecosystem, which affect partnerships to advance implementation science. Our findings illustrated that partnership considerations go beyond interpersonal factors and include system-wide considerations. With the results, health organization leaders have (1) a method for assessing organizational capability to readily embed implementation research and (2) a catalog of potential responses to create conditions to readily engage with implementation science in their day-to-day implementation processes.
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Affiliation(s)
- Stephanie P. Brooks
- Learning Health System Team, Alberta SPOR SUPPORT Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Cody Alba
- Learning Health System Team, Alberta SPOR SUPPORT Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Denise Thomson
- Learning Health System Team, Alberta SPOR SUPPORT Unit, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sara N. Davison
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Fathi LI, Yang D, Walker JL, Robinson M, Littlewood RA, Truby H. Exploring the long-term sustainability of school-based nutrition and food programs: What works, where and why? Health Promot J Austr 2024. [PMID: 38361362 DOI: 10.1002/hpja.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024] Open
Abstract
ISSUE ADDRESSED Most food and nutrition programs cease within 2 years. Understanding the determinants of program sustainability is crucial to maximise output from funding, whilst allowing sufficient time for program benefits to be achieved. This study applied the Consolidated Framework for Implementation Research (CFIR) to map the barriers and enablers of successful long-term implementation of school-based nutrition and food programs. METHODS Qualitative methods with purposive and snowball sampling were used to recruit experts who were identified as being influential in implementing and sustaining long-term (>2 years) school-based food and nutrition programs. Semi-structured interviews with global experts were conducted, transcribed verbatim and coded deductively (by applying the CFIR constructs) and inductively when required. Thematic analysis informed the development of themes. RESULTS Interviews were conducted with 11 experts including researchers, government employees, and a consultant of an international agency, from seven countries. Forty-eight deductive codes and eight inductive codes identified six main themes: (1) funding and integrity of its source; (2) political landscape; (3) nutrition policies and their monitoring; (4) involvement of community actors; (5) adaptability of the program and (6) effective program evaluation. Themes related mainly to the 'outer setting' domain of the CFIR. CONCLUSIONS The CFIR highlighted pertinent factors that influence the successful long-term implementation of school-based food and nutrition programs. SO WHAT?: The findings suggest that to sustain program implementation beyond its initial funding, relationships across government departments, local organisations and communities, need to be nurtured and prioritised from the outset.
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Affiliation(s)
- Leila I Fathi
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Danyu Yang
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Jacqueline L Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Health and Wellbeing Queensland, Brisbane, Queensland, Australia
| | - Mark Robinson
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robyn A Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Health and Wellbeing Queensland, Brisbane, Queensland, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Brandenburg H. [Innovative approaches in long-term care]. Z Gerontol Geriatr 2024; 57:3-6. [PMID: 38289474 DOI: 10.1007/s00391-023-02270-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Hermann Brandenburg
- Fakultät für Gesundheit (Department für Humanmedizin), assoziiert am Lehrstuhl für Soziologie (Prof. Dr. Werner Vogd), Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
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Mirbeth C. [Continuation of implementation processes in residential long-term care : Sustainability of the expert standard "Relationship management in the care of people with dementia"]. Z Gerontol Geriatr 2024; 57:21-26. [PMID: 38127135 PMCID: PMC10827942 DOI: 10.1007/s00391-023-02266-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Nursing institutions are facing many challenges due to evidence-based requirements. For example, they are required to introduce new interventions such as expert standards and thus adapt routine practices to new findings; however, if new interventions are continuously implemented in the facilities their sustainability is questionable. OBJECTIVE The aim was to find out how sustainably the expert standard "Relationship management in the care of people with dementia" is implemented in residential long-term care institutions. MATERIAL AND METHODS Qualitative, guideline-based interviews were conducted with persons from residential long-term care, oriented to the procedure of the problem-centered interview. The interviewees were involved in the model implementation of the expert standard "Relationship management in the care of people with dementia"'. The data were then analyzed using qualitative content analysis. RESULTS The participants assessed the sustainable implementation in different ways. Some rated the sustainability of the expert standard in their institution as successful, while others see potential for improvement. According to the participants, the sustainability of continuation of implementation processes is influenced by various factors. These relate to the institution, the external context, the intervention, the implementation process, and the people involved in the implementation. CONCLUSION On the basis of the factors identified, key needs can be derived for nursing practice, for science and research as well as for politics and legislation, so that the sustainability of expert standards and other evidence-based interventions can be ensured and, if necessary, optimized.
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Affiliation(s)
- Carolin Mirbeth
- Fakultät für Soziale Arbeit, Bereich Pflegewissenschaft, Katholische Universität Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Deutschland.
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Sarfan LD, Agnew ER, Diaz M, Cogan A, Spencer JM, Esteva Hache R, Wiltsey Stirman S, Lewis CC, Kilbourne AM, Harvey AG. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 3: study protocol to evaluate sustainment in a hybrid type 2 effectiveness-implementation cluster-randomized trial. Trials 2024; 25:54. [PMID: 38225677 PMCID: PMC10788981 DOI: 10.1186/s13063-023-07900-1] [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: 10/02/2023] [Accepted: 12/25/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Although research on the implementation of evidence-based psychological treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase-the Sustainment Phase-of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial-the Implementation Phase and Train-the-Trainer Phase-TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes. METHODS Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data. DISCUSSION The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT05956678 . Registered on July 21, 2023.
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Affiliation(s)
- Laurel D Sarfan
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Emma R Agnew
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Marlen Diaz
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Ashby Cogan
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Julia M Spencer
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Rafael Esteva Hache
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Amy M Kilbourne
- Quality Enhancement Research Initiative, U.S. Department of Veterans Affairs, Washington, D.C., USA
- Department of Learning Health Science, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA
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Lewis AK, Taylor NF, Carney PW, Bryson A, Sethi M, Ooi S, Tse GT, Harding KE. Sustainability of an intervention to reduce waiting for access to an epilepsy outpatient clinic. Heliyon 2024; 10:e23346. [PMID: 38169770 PMCID: PMC10758808 DOI: 10.1016/j.heliyon.2023.e23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 01/05/2024] Open
Abstract
Purpose Delays in outpatient specialist neurologist care for people with epilepsy are common despite recommendations for prompt access. There is evidence to suggest that there are interventions that can minimise waitlists and waiting time. However, little is known about whether such interventions can result in sustained improvements in waiting. The aim of this study was to determine the extent to which an intervention to reduce waiting in an epilepsy specialist outpatient clinic demonstrated sustained outcomes two years after the intervention was implemented. Methods This observational study analysed routinely collected epilepsy clinic data over three study periods: pre-intervention, post-intervention and at two-year follow-up. The intervention, Specific Timely Assessment and Triage (STAT), combined a short-term backlog reduction strategy and creation of protected appointments for new referrals based on analysis of demand. After the initial intervention, there was no further active intervention in the following two years. The primary outcome was waiting measured by 1.) waiting time for access to a clinic appointment, defined as the number of days between referral and first appointment for all patients referred to the epilepsy clinic during the three study periods; and 2.) a snapshot of the number of patients on the waitlist at two time points for each of the three study periods. Results Two years after implementing the STAT model in an epilepsy clinic, median waiting time from post-intervention to two-year follow-up was stable (52-51 days) and the interquartile range of days waited reduced from 37 to 77 days post-intervention to 45-57 days at two-year follow-up, with a reduction in the most lengthy wait times observed. After a dramatic reduction of the total number of patients on the waitlist immediately following the intervention, a small rise was seen at two years (n = 69) which remained well below the pre-intervention level (n = 582). Conclusion The STAT model is a promising intervention for reducing waiting in an epilepsy clinic. While there was a small increase in the waitlist after two years, the median waiting time was sustained.
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Affiliation(s)
- Annie K. Lewis
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Nicholas F. Taylor
- Eastern Health, Melbourne, Australia
- La Trobe University, Melbourne, Australia
| | - Patrick W. Carney
- Eastern Health, Melbourne, Australia
- Monash University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Alexander Bryson
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
| | - Moksh Sethi
- Eastern Health, Melbourne, Australia
- Northern Health, Melbourne, Australia
| | - Suyi Ooi
- Eastern Health, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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John DA, Adams EA, McGowan LJ, Joyes EC, Richmond C, Beyer FR, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review. BMJ Open 2024; 14:e080160. [PMID: 38216193 PMCID: PMC10806606 DOI: 10.1136/bmjopen-2023-080160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-methods systematic review aimed to synthesise evidence on the implementation and sustainability of interventions to improve oral health and related health behaviours among adults experiencing SMD. METHODS Bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to February 2023. Studies meeting the inclusion criteria were screened and extracted independently by two researchers. Quality appraisal was undertaken, and results were synthesised using narrative and thematic analyses. RESULTS Seventeen papers were included (published between 1995 and 2022). Studies were mostly of moderate quality and included views from SMD groups and service providers. From the qualitative synthesis, most findings were related to aspects such as trust, resources and motivation levels of SMD groups and service providers. None of the studies reported on diet and none included repeated offending (one of the aspects of SMD). From the quantitative synthesis, no difference was observed in programme attendance between the interventions and usual care, although there was some indication of sustained improvements in participation in the intervention group. CONCLUSION This review provides some evidence that trust, adequate resources and motivation levels are potentially important in implementing interventions to improve oral health and substance use among SMD groups. Further research is needed from high quality studies and focusing on diet in this population. PROSPERO REGISTRATION NUMBER CRD42020202416.
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Affiliation(s)
- Deepti A John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma C Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Landes
- NHS England and NHS Improvement, Newcastle upon Tyne, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, Plymouth University, Plymouth, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Dopp AR, North MN, Gilbert M, Ringel JS, Silovsky JF, Blythe M, Edwards D, Schmidt S, Funderburk B. Pilot evaluation of the Fiscal Mapping Process for sustainable financing of evidence-based youth mental health treatments: A comparative case study analysis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241249394. [PMID: 38737584 PMCID: PMC11084999 DOI: 10.1177/26334895241249394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies. Supports are needed that can guide service agencies in accessing sustainable funding for EBTs. We conducted a pilot evaluation of the Fiscal Mapping Process, an Excel-based strategic planning tool that helps service agency leaders identify and coordinate financing strategies for their EBT programs. Method Pilot testing of the Fiscal Mapping Process was completed with 10 youth mental health service agencies over a 12-month period, using trauma-focused cognitive-behavioral therapy or parent-child interaction therapy programs. Service agency representatives received initial training and monthly coaching in using the tool. We used case study methods to synthesize all available data (surveys, focus groups, coaching notes, document review) and contrast agency experiences to identify key findings through explanation building. Results Key evaluation findings related to the process and outcomes of using the Fiscal Mapping Process, as well as contextual influences. Process evaluation findings helped clarify the primary use case for the tool and identified the importance-and challenges-of engaging external collaborators. Outcome evaluation findings documented the impacts of the Fiscal Mapping Process on agency-reported sustainment capacities (strategic planning, funding stability), which fully explained reported improvements in outcomes (extent and likelihood)-although these impacts were incremental. Findings on contextual factors documented the influence of environmental and organizational capacities on engagement with the tool and concerns about equitable impacts, but also the view that the process could usefully generalize to other EBTs. Conclusions Our pilot evaluation of the Fiscal Mapping Process was promising. In future work, we plan to integrate the tool into EBT implementation initiatives and test its impact on long-term sustainment outcomes across various EBTs, while increasing attention to equity considerations.
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Affiliation(s)
| | | | | | | | - Jane F. Silovsky
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mellicent Blythe
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
- School of Social Work, University North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Susan Schmidt
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Beverly Funderburk
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Miller CJ, Sullivan JL, Connolly SL, Richardson EJ, Stolzmann KL, Brown M, Bailey HM, Weaver K, Sippel L, Kim B. Adaptation for sustainability in an implementation trial of team-based collaborative care. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231226197. [PMID: 38322803 PMCID: PMC10807389 DOI: 10.1177/26334895231226197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background Sustaining healthcare interventions once they have been implemented is a pivotal public health endeavor. Achieving sustainability requires context-sensitive adaptations to evidence-based practices (EBPs) or the implementation strategies used to ensure their adoption. For replicability of adaptations beyond the specific setting in question, the underlying logic needs to be clearly described, and adaptations themselves need to be plainly documented. The goal of this project was to describe the process by which implementation facilitation was adapted to improve the uptake of clinical care practices that are consistent with the collaborative chronic care model (CCM). Method Quantitative and qualitative data from a prior implementation trial found that CCM-consistent care practices were not fully sustained within outpatient general mental health teams that had received 1 year of implementation facilitation to support uptake. We undertook a multistep consensus process to identify adaptations to implementation facilitation based on these results, with the goal of enhancing the sustainability of CCM-based care in a subsequent trial. The logic for these adaptations, and the resulting adaptations themselves, were documented using two adaptation-oriented implementation frameworks (the iterative decision-making for evaluation of adaptations [IDEA] and the framework for reporting adaptations and modifications to evidence-based implementation strategies [FRAME-IS], respectively). Results Three adaptations emerged from this process and were documented using the FRAME-IS: (a) increasing the scope of implementation facilitation within the medical center, (b) having the internal facilitator take a greater role in the implementation process, and (c) shortening the implementation timeframe from 12 to 8 months, while increasing the intensity of facilitation support during that time. Conclusions EBP sustainability may require careful adaptation of EBPs or the implementation strategies used to get them into routine practice. Recently developed frameworks such as the IDEA and FRAME-IS may be used to guide decision-making and document resulting adaptations themselves. An ongoing funded study is investigating the utility of the resulting adaptations for improving healthcare.
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Affiliation(s)
- Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System Capt. Jonathan H. Harwood Jr. Center for Research, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eric J. Richardson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelly L. Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Madisen Brown
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Hannah M. Bailey
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Kendra Weaver
- U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Lauren Sippel
- U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention, Washington, DC, USA
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Niang M, Alami H, Gagnon MP, Dupéré S. A conceptualisation of scale-up and sustainability of social innovations in global health: a narrative review and integrative framework for action. Glob Health Action 2023; 16:2230813. [PMID: 37459240 DOI: 10.1080/16549716.2023.2230813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The scale-up and sustainability of social innovations for health have received increased interest in global health research in recent years; however, these ambiguous concepts are poorly defined and insufficiently theorised and studied. Researchers, policymakers, and practitioners lack conceptual clarity and integrated frameworks for the scale-up and sustainability of global health innovations. Often, the frameworks developed are conceived in a linear and deterministic or consequentialist vision of the diffusion of innovations. This approach limits the consideration of complexity in scaling up and sustaining innovations. OBJECTIVE By using a systems theory lens and conducting a narrative review, this manuscript aims to produce an evidence-based integrative conceptual framework for the scale-up and sustainability of global health innovations. METHOD We conducted a hermeneutic narrative review to synthetise different definitions of scale-up and sustainability to model an integrative definition of these concepts for global health. We have summarised the literature on the determinants that influence the conditions for innovation success or failure while noting the interconnections between internal and external innovation environments. RESULTS The internal innovation environment includes innovation characteristics (effectiveness and testability, monitoring and evaluation systems, simplification processes, resource requirements) and organisational characteristics (leadership and governance, organisational change, and organisational viability). The external innovation environment refers to receptive and transformative environments; the values, cultures, norms, and practices of individuals, communities, organisations, and systems; and other contextual characteristics relevant to innovation development. CONCLUSION From these syntheses, we proposed an interconnected framework for action to better guide innovation researchers, practitioners, and policymakers in incorporating complexity and systemic interactions between internal and external innovation environments in global health.
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Affiliation(s)
- Marietou Niang
- Department of Social Work and Psychosociology, Université du Québec à Rimouski, Lévis, QC, Canada
| | - Hassane Alami
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | | | - Sophie Dupéré
- Faculty of Nursing Science, Université Laval, Québec, QC, Canada
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Della Bona M, Crawford G, Royce B, Jancey J, Leavy JE. Using ERIC to Assess Implementation Science in Drowning Prevention Interventions in High-Income Countries: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:45. [PMID: 38248510 PMCID: PMC10815182 DOI: 10.3390/ijerph21010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024]
Abstract
This systematic review identifies and describes the use of the Expert Recommendation for Implementing Change (ERIC) concepts and strategies using public health approaches to drowning prevention interventions as a case study. International calls for action have identified the need to better understand the implementation of drowning prevention interventions so that intervention design and implementation is improved. In high-income countries (HICs), interventions are sophisticated but still little is known or written about their implementation. The review was registered on PROSPERO (number CRD42022347789) and followed the PRISMA guidelines. Eight databases were searched. Articles were assessed using the Public Health Ontario Meta-tool for quality appraisal of public health evidence. Forty-nine articles were included. Where ERIC strategies were reported, the focus was on evaluative and iterative strategies, developing partnerships and engaging the target group. The review identified few articles that discussed intervention development and implementation sufficiently for strategies to be replicated. Findings will inform further research into the use and measurement of implementation strategies by practitioners and researchers undertaking work in drowning prevention in HICs and supports a call to action for better documentation of implementation in public health interventions.
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Affiliation(s)
- Malena Della Bona
- Collaboration for Evidence, Research and Impact in Public Health (CERIPH), School of Population Health, Curtin University, Perth 6000, Australia
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Rudel RK, Byhoff E, Strombotne KL, Drainoni ML, Greece JA. Healthcare-based food assistance programmes in the United States: a scoping review and typology. J Nutr Sci 2023; 12:e128. [PMID: 38155805 PMCID: PMC10753472 DOI: 10.1017/jns.2023.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
This scoping review aimed to identify the breadth of healthcare-based food assistance programmes in the United States and organize them into a typology of programmes to provide implementation guidance to aspiring food assistance programmers in healthcare settings. We searched PubMed, Cochrane, and CINAHL databases for peer-reviewed articles published between 1 January 2010 and 31 December 2021, and mined reference lists. We used content analysis to extract programmatic details from each intervention and to qualitatively analyse intervention components to develop a typology for healthcare institutions in the United States. Eligible articles included descriptions of patient populations served and programmatic details. Articles were not required to include formal evaluations for inclusion in this scoping review. Our search resulted in 8706 abstracts, which yielded forty-three articles from thirty-five interventions. We identified three distinct programme types: direct food provision, referral, and voucher programmes. Programme type was influenced by programme goals, logistical considerations, such as staffing, food storage or refrigeration space, and existence of willing partner CBOs. Food provision programmes (n 13) were frequently permanent and leveraged partnerships with community-based organisations (CBOs) that provide food. Referral programmes (n 8) connected patients to CBOs for federal or local food assistance enrollment. Voucher programmes (n 14) prioritised provision of fruits and vegetables (n 10) and relied on a variety of clinic staff to refer patients to months-long programmes. Healthcare-based implementers can use this typology to design and maintain programmes that align with the needs of their sites and patient populations.
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Affiliation(s)
- Rebecca K. Rudel
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, Massachusetts 02118
- Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, Massachusetts 02118
| | - Elena Byhoff
- Department of Medicine, University of Massachusetts Chan Medical School, 55 Lake Avenue, North Worcester, Massachusetts 01655
| | - Kiersten L. Strombotne
- Department of Health, Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston Massachusetts 02118
| | - Mari-Lynn Drainoni
- Department of Medicine, Section of Infectious Diseases, Boston University Chobanian & Avedisian School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, Massachusetts 02118
- Department of Health, Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston Massachusetts 02118
- Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 801 Massachusetts Avenue, 2nd Floor, Boston, Massachusetts 02118
| | - Jacey A. Greece
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, Massachusetts 02118
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Criter RE, Sheperd M, Northrup D, Shuster L. Perceptions of the Scope of Practice of Audiology. Am J Audiol 2023; 32:930-940. [PMID: 37783210 DOI: 10.1044/2023_aja-23-00027] [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: 10/04/2023] Open
Abstract
PURPOSE The primary purpose of this study was to determine which scope of practice roles and responsibilities are attributed to the profession of audiology (AUD) relative to other health care disciplines by a group of health and human services faculty and students. METHOD An online survey inquiring about participant knowledge of different health professions' scopes of practice, and experience with and attitude toward the profession of AUD, was sent to faculty and students in the Western Michigan University College of Health and Human Services. Students also completed two subscales of the Interprofessional Attitudes Scale. Descriptive statistics and chi-square and Kruskal-Wallis analyses evaluating response differences between groups are presented. RESULTS Thirty-six faculty and 118 students (48 graduate and 70 undergraduate) completed the survey. AUD was the profession most often associated with all hearing-related scope of practice activities. Speech-language pathology was often associated with hearing-related scope of practice activities. Audiologists were less commonly associated with vestibular, balance, and mobility scope of practice activities. Group was significant for four scope of practice activities. About half of respondents indicated they knew nothing or a little about AUD, and a majority had no or rare interactions with audiologists in class or clinic. Only about half of participants responded they were likely or very likely to refer patients to an audiologist. CONCLUSION Increased knowledge of the scope of practice and exposure to the profession of AUD may benefit other health care professionals and patients, possibly leading to increased interprofessional practice and an increased number of appropriate referrals.
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Affiliation(s)
- Robin E Criter
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
| | - Melanie Sheperd
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
| | | | - Linda Shuster
- Department of Speech, Language and Hearing Sciences, Western Michigan University, Kalamazoo
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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Hall A, Wolfenden L, Gardner C, McEvoy B, Lane C, Shelton RC, McFadyen T, Lee DC, Shoesmith A, Austin K, Nathan N. A bibliographic review of sustainability research output and investment in 10 leading public health journals across three time periods. PUBLIC HEALTH IN PRACTICE 2023; 6:100444. [PMID: 38028253 PMCID: PMC10654021 DOI: 10.1016/j.puhip.2023.100444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives Long-term delivery, or sustainability, of evidence-based interventions is necessary for public health benefits to be realised. However, sustainment of effective interventions is poor. Understanding the evidence-base and identifying potential gaps is necessary to inform where future research efforts are most warranted. Study design We undertook a repeat cross-sectional bibliographic review of research published in 10 public health journals across three time periods (2010, 2015 and 2020/2021). Methods Studies were eligible if they were a data-based study or review article. Studies were assessed as to whether they focused on sustainability. The percentage of public health research studies assessing sustainability overall and by the three time periods was calculated. The association between time period and the proportion of sustainability articles was assessed using logistic regression. Descriptive statistics were used to summarise study characteristics overall and by time period. Results 10,588 data-based articles were identified, of which 1.3 % (n = 136) focused on sustainability. There was a statistically significant association between time period and the proportion of sustainability research, with a slight increase across the three time periods: 0.3 % (95 % CI: 0.1 %, 0.7 %) in 2010, 1.4 % (95 % CI: 1.0 %, 1.9 %) in 2015 and 1.6 % (95 % CI: 1.3 %, 1.9 %) in 2020/2021. Most research was descriptive/epidemiological (n = 69, 51 %), few focused on measurement (n = 2, 1.5 %) and none on cost effectiveness. Only one intervention study assessed the effect of specific sustainability strategies. Conclusions This bibliographic review highlights the need for more public health research on sustainability, particularly in the areas of measurement, sustainability interventions, and cost effectiveness.
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Affiliation(s)
- Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Carly Gardner
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Brydie McEvoy
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Rachel C. Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Tameka McFadyen
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Daniel C.W. Lee
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Karly Austin
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
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Vo V, Chen G, Aquino YSJ, Carter SM, Do QN, Woode ME. Multi-stakeholder preferences for the use of artificial intelligence in healthcare: A systematic review and thematic analysis. Soc Sci Med 2023; 338:116357. [PMID: 37949020 DOI: 10.1016/j.socscimed.2023.116357] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Despite the proliferation of Artificial Intelligence (AI) technology over the last decade, clinician, patient, and public perceptions of its use in healthcare raise a number of ethical, legal and social questions. We systematically review the literature on attitudes towards the use of AI in healthcare from patients, the general public and health professionals' perspectives to understand these issues from multiple perspectives. METHODOLOGY A search for original research articles using qualitative, quantitative, and mixed methods published between 1 Jan 2001 to 24 Aug 2021 was conducted on six bibliographic databases. Data were extracted and classified into different themes representing views on: (i) knowledge and familiarity of AI, (ii) AI benefits, risks, and challenges, (iii) AI acceptability, (iv) AI development, (v) AI implementation, (vi) AI regulations, and (vii) Human - AI relationship. RESULTS The final search identified 7,490 different records of which 105 publications were selected based on predefined inclusion/exclusion criteria. While the majority of patients, the general public and health professionals generally had a positive attitude towards the use of AI in healthcare, all groups indicated some perceived risks and challenges. Commonly perceived risks included data privacy; reduced professional autonomy; algorithmic bias; healthcare inequities; and greater burnout to acquire AI-related skills. While patients had mixed opinions on whether healthcare workers suffer from job loss due to the use of AI, health professionals strongly indicated that AI would not be able to completely replace them in their professions. Both groups shared similar doubts about AI's ability to deliver empathic care. The need for AI validation, transparency, explainability, and patient and clinical involvement in the development of AI was emphasised. To help successfully implement AI in health care, most participants envisioned that an investment in training and education campaigns was necessary, especially for health professionals. Lack of familiarity, lack of trust, and regulatory uncertainties were identified as factors hindering AI implementation. Regarding AI regulations, key themes included data access and data privacy. While the general public and patients exhibited a willingness to share anonymised data for AI development, there remained concerns about sharing data with insurance or technology companies. One key domain under this theme was the question of who should be held accountable in the case of adverse events arising from using AI. CONCLUSIONS While overall positivity persists in attitudes and preferences toward AI use in healthcare, some prevalent problems require more attention. There is a need to go beyond addressing algorithm-related issues to look at the translation of legislation and guidelines into practice to ensure fairness, accountability, transparency, and ethics in AI.
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Affiliation(s)
- Vinh Vo
- Centre for Health Economics, Monash University, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash University, Australia
| | - Yves Saint James Aquino
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Soceity, University of Wollongong, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, School of Health and Soceity, University of Wollongong, Australia
| | - Quynh Nga Do
- Department of Economics, Monash University, Australia
| | - Maame Esi Woode
- Centre for Health Economics, Monash University, Australia; Monash Data Futures Research Institute, Australia
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McKay V, Carothers B, Graetz D, Malone S, Puerto-Torres M, Prewitt K, Cardenas A, Chen Y, Devidas M, Luke DA, Agulnik A. Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol. Implement Sci Commun 2023; 4:141. [PMID: 37978404 PMCID: PMC10657009 DOI: 10.1186/s43058-023-00519-y] [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: 09/18/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND More than 90% of children with cancer live in low-resourced settings, where survival is only 20%. Sustainable evidence-based (EB) interventions yielding ongoing beneficial patient outcomes are critical to improve childhood cancer survival. A better understanding of factors promoting intervention sustainability in these settings is urgently needed. The aim of this study is to provide an empirical understanding of how clinical capacity for sustainability, or the resources needed to sustain an intervention, impacts the sustainment of Pediatric Early Warning System (PEWS), an EB intervention that improves pediatric oncology outcomes in low-resource hospitals by detecting clinical deterioration and preventing the need for more intense treatment. METHODS We will conduct a prospective, longitudinal study of approximately 100 resource-variable hospitals implementing and sustaining PEWS participating in Proyecto EVAT, a quality improvement collaborative of Latin American pediatric oncology centers. Aim 1: We will evaluate how clinical capacity for sustainability changes over time through 5 to 9 prospective measurements of capacity via survey of clinical staff using PEWS (approximately n = 13 per center) during the phases of PEWS adoption, implementation, and sustainability using the Clinical Sustainability Assessment Tool (CSAT). Aim 2: We will determine the relationship between capacity and a) PEWS sustainment and b) clinical deterioration mortality among pediatric oncology patients at centers sustaining PEWS for 2 to 10 years using chart review and an existing patient outcomes registry. Aim 3: We will develop novel strategies to promote sustainability by gaining a deeper understanding of perceived challenges to building capacity and PEWS sustainment. In combination with quantitative outcomes, we will conduct 24 focus groups with staff (doctors, nurses, and administrators) from hospitals with both high (n = 4) and low capacity (n = 4). We will then use implementation mapping to generate theoretically driven, empirically-supported sustainability strategies. DISCUSSION This study will advance implementation science by providing a theoretically driven, foundational understanding of factors that predict sustainability among a large, diverse cohort of hospitals. We will then use this knowledge to develop sustainability evidence-informed strategies that optimize capacity and promote long-term sustainment of PEWS and improvements in patient outcomes, thus promoting equity in childhood cancer care globally.
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Affiliation(s)
- Virginia McKay
- Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Bobbi Carothers
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Dylan Graetz
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Sara Malone
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Population Health Science, Washington University in St. Louis School of Medicine, St Louis, MO, United States
| | - Maria Puerto-Torres
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Kim Prewitt
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Adolfo Cardenas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Yichen Chen
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meenakshi Devidas
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Douglas A Luke
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Asya Agulnik
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Division of Critical Care, St. Jude Children's Research Hospital, Memphis, TN, USA
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Ramaswamy R, Bogdewic S, Williams CR, Deganus S, Bonzi GA, Boakye J, Koranteng E, Mensah R, Amanor A, Bryce F, Owen MD. Implementation matters: assessing the effectiveness and sustainment of an obstetric triage program at a high-volume facility in Ghana. Implement Sci Commun 2023; 4:138. [PMID: 37968768 PMCID: PMC10647175 DOI: 10.1186/s43058-023-00527-y] [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: 06/13/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Maternal mortality remains stubbornly high in Ghana. Current national efforts are focused on improving the quality of care offered in health facilities. Obstetric triage is one intervention that has been proposed to improve the timeliness and appropriateness of care, two key elements of quality. In this study, we describe and evaluate a theory-based implementation approach to introduce obstetric triage into Tema General Hospital, a high-volume maternity hospital in Greater Accra, that blends concepts from implementation science and quality improvement. This implementation project was a first attempt to scale this intervention into a new facility, following initial development in the Greater Accra Regional Hospital (formerly Ridge Hospital) in Accra. METHODS This was a retrospective mixed-methods evaluation of two stages of implementation: active implementation and sustainment. We triangulated monitoring data captured during active implementation with clinical outcome data (timeliness of first assessment, accuracy of diagnosis, and appropriateness of care plan) from direct observation or patient obstetric triage assessment forms at baseline, at the completion of the active implementation stage, and following a 12-month "washout" period with no contact between hospital staff and the purveyor organization. Finally, we assessed embeddedness of the new triage procedures using the NoMad, a quantitative assessment of constructs from normalization process theory (NPT). RESULTS Patient waiting time decreased substantially during the study. At baseline, the median arrival-to-assessment waiting time was 70.5 min (IQR: 30.0-443.0 min). Waiting time decreased to 6.0 min (IQR: 3.0-15.0 min) following active implementation and to 5.0 min (IQR: 2.0-10.0 min) during the sustainment period. Accuracy of diagnosis was high at the end of active implementation (75.7% correct) and improved during the sustainment period (to 77.9%). The appropriateness of care plans also improved during the sustainment period (from 66.0 to 78.9%). Per NoMad data, hospital staff generally perceive obstetric triage to be well integrated into the facility. CONCLUSIONS This theory-based implementation approach proved to be successful in introducing a novel obstetric triage concept to a busy high-volume hospital, despite resource constraints and a short implementation window. Results proved long-lasting, suggesting this approach has high potential for engendering sustainability in other facilities as well. Our approach will be useful to other initiatives that aim to utilize program data to create and test implementation theories.
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Affiliation(s)
- Rohit Ramaswamy
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stephanie Bogdewic
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Caitllin R Williams
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sylvia Deganus
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Joana Boakye
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | | | - Alice Amanor
- Tema General Hospital, Ghana Health Service, Tema, Ghana
| | | | - Medge D Owen
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Zurynski Y, Ludlow K, Testa L, Augustsson H, Herkes-Deane J, Hutchinson K, Lamprell G, McPherson E, Carrigan A, Ellis LA, Dharmayani PNA, Smith CL, Richardson L, Dammery G, Singh N, Braithwaite J. Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review. Implement Sci 2023; 18:62. [PMID: 37957669 PMCID: PMC10641997 DOI: 10.1186/s13012-023-01315-x] [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: 06/04/2023] [Accepted: 10/08/2023] [Indexed: 11/15/2023] Open
Abstract
OBJECTIVE To identify barriers and facilitators associated with the sustainability of implemented and evaluated improvement programs in healthcare delivery systems. DATA SOURCES AND STUDY SETTING Six academic databases were searched to identify relevant peer-reviewed journal articles published in English between July 2011 and June 2022. Studies were included if they reported on healthcare program sustainability and explicitly identified barriers to, and facilitators of, sustainability. STUDY DESIGN A systematic integrative review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Study quality was appraised using Hawker's Quality Assessment Tool. DATA COLLECTION/EXTRACTION METHODS A team of reviewers screened eligible studies against the inclusion criteria and extracted the data independently using a purpose-designed Excel spreadsheet. Barriers and facilitators were extracted and mapped to the Integrated Sustainability Framework (ISF). Frequency counts of reported barriers/facilitators were performed across the included studies. RESULTS Of the 124 studies included in this review, almost half utilised qualitative designs (n = 52; 41.9%) and roughly one third were conducted in the USA (n = 43; 34.7%). Few studies (n = 29; 23.4%) reported on program sustainability beyond 5 years of program implementation and only 16 of them (55.2%) defined sustainability. Factors related to the ISF categories of inner setting (n = 99; 79.8%), process (n = 99; 79.8%) and intervention characteristics (n = 72; 58.1%) were most frequently reported. Leadership/support (n = 61; 49.2%), training/support/supervision (n = 54; 43.5%) and staffing/turnover (n = 50; 40.3%) were commonly identified barriers or facilitators of sustainability across included studies. Forty-six (37.1%) studies reported on the outer setting category: funding (n = 26; 56.5%), external leadership by stakeholders (n = 16; 34.8%), and socio-political context (n = 14; 30.4%). Eight studies (6.5%) reported on discontinued programs, with factors including funding and resourcing, poor fit, limited planning, and intervention complexity contributing to discontinuation. CONCLUSIONS This review highlights the importance of taking into consideration the inner setting, processes, intervention characteristics and outer setting factors when sustaining healthcare programs, and the need for long-term program evaluations. There is a need to apply consistent definitions and implementation frameworks across studies to strengthen evidence in this area. TRIAL REGISTRATION https://bmjopen.bmj.com/content/7/11/e018568 .
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Affiliation(s)
- Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109.
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia.
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
| | - Jessica Herkes-Deane
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Karen Hutchinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Gina Lamprell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Elise McPherson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Putu Novi Arfirsta Dharmayani
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Carolynn L Smith
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Lieke Richardson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Genevieve Dammery
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia, Level 6, 75 Talavera Rd, NSW, 2109
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Sarfan LD, Agnew ER, Diaz M, Cogan A, Spencer JM, Hache RE, Stirman SW, Lewis CC, Kilbourne AM, Harvey A. The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for serious mental illness in community mental health part 3: Study protocol to evaluate sustainment in a hybrid type 2 effectiveness-implementation cluster-randomized trial. RESEARCH SQUARE 2023:rs.3.rs-3328993. [PMID: 37961426 PMCID: PMC10635358 DOI: 10.21203/rs.3.rs-3328993/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
treatments (EBPTs) has advanced rapidly, research on the sustainment of implemented EBPTs remains limited. This is concerning, given that EBPT activities and benefits regularly decline post-implementation. To advance research on sustainment, the present protocol focuses on the third and final phase - the Sustainment Phase - of a hybrid type 2 cluster-randomized controlled trial investigating the implementation and sustainment of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) for patients with serious mental illness and sleep and circadian problems in community mental health centers (CMHCs). Prior to the first two phases of the trial - the Implementation Phase and Train-the-Trainer Phase - TranS-C was adapted to fit the CMHC context. Then, 10 CMHCs were cluster-randomized to implement Standard or Adapted TranS-C via facilitation and train-the-trainer. The primary goal of the Sustainment Phase is to investigate whether adapting TranS-C to fit the CMHC context predicts improved sustainment outcomes. Methods Data collection for the Sustainment Phase will commence at least three months after implementation efforts in partnering CMHCs have ended and may continue for up to one year. CMHC providers will be recruited to complete surveys (N = 154) and a semi-structured interview (N = 40) on sustainment outcomes and mechanisms. Aim 1 is to report the sustainment outcomes of TranS-C. Aim 2 is to evaluate whether manipulating EBPT fit to context (i.e., Standard versus Adapted TranS-C) predicts sustainment outcomes. Aim 3 is to test whether provider perceptions of fit mediate the relation between treatment condition (i.e., Standard versus Adapted TranS-C) and sustainment outcomes. Mixed methods will be used to analyze the data. Discussion The present study seeks to advance our understanding of sustainment predictors, mechanisms, and outcomes by investigating (a) whether the implementation strategy of adapting an EBPT (i.e., TranS-C) to the CMHC context predicts improved sustainment outcomes and (b) whether this relation is mediated by improved provider perceptions of treatment fit. Together, the findings may help inform more precise implementation efforts that contribute to lasting change. Trial Registration ClinicalTrials.gov identifier: NCT05956678. Registered on July 21, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05956678?term=NCT05956678&draw=2&rank=1.
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Affiliation(s)
| | | | - Marlen Diaz
- UC Berkeley: University of California Berkeley
| | - Ashby Cogan
- UC Berkeley: University of California Berkeley
| | | | | | | | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute
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Laur C, Ladak Z, Hall A, Solbak NM, Nathan N, Buzuayne S, Curran JA, Shelton RC, Ivers N. Sustainability, spread, and scale in trials using audit and feedback: a theory-informed, secondary analysis of a systematic review. Implement Sci 2023; 18:54. [PMID: 37885018 PMCID: PMC10604689 DOI: 10.1186/s13012-023-01312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a widely used implementation strategy to influence health professionals' behavior that is often tested in implementation trials. This study examines how A&F trials describe sustainability, spread, and scale. METHODS This is a theory-informed, descriptive, secondary analysis of an update of the Cochrane systematic review of A&F trials, including all trials published since 2011. Keyword searches related to sustainability, spread, and scale were conducted. Trials with at least one keyword, and those identified from a forward citation search, were extracted to examine how they described sustainability, spread, and scale. Results were qualitatively analyzed using the Integrated Sustainability Framework (ISF) and the Framework for Going to Full Scale (FGFS). RESULTS From the larger review, n = 161 studies met eligibility criteria. Seventy-eight percent (n = 126) of trials included at least one keyword on sustainability, and 49% (n = 62) of those studies (39% overall) frequently mentioned sustainability based on inclusion of relevant text in multiple sections of the paper. For spread/scale, 62% (n = 100) of trials included at least one relevant keyword and 51% (n = 51) of those studies (31% overall) frequently mentioned spread/scale. A total of n = 38 studies from the forward citation search were included in the qualitative analysis. Although many studies mentioned the need to consider sustainability, there was limited detail on how this was planned, implemented, or assessed. The most frequent sustainability period duration was 12 months. Qualitative results mapped to the ISF, but not all determinants were represented. Strong alignment was found with the FGFS for phases of scale-up and support systems (infrastructure), but not for adoption mechanisms. New spread/scale themes included (1) aligning affordability and scalability; (2) balancing fidelity and scalability; and (3) balancing effect size and scalability. CONCLUSION A&F trials should plan for sustainability, spread, and scale so that if the trial is effective, the benefits can continue. A deeper empirical understanding of the factors impacting A&F sustainability is needed. Scalability planning should go beyond cost and infrastructure to consider other adoption mechanisms, such as leadership, policy, and communication, that may support further scalability. TRIAL REGISTRATION Registered with Prospero in May 2022. CRD42022332606.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.
| | - Zeenat Ladak
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, Toronto, ON, M5S 1V6, Canada
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Nathan M Solbak
- Physician Learning Program, Continuing Medical Education and Professional Development, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Health Quality Programs, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Shewit Buzuayne
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Noah Ivers
- Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
- Institute of Health Policy, Management and Evaluation, Health Sciences Building, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, M5G 1V7, Canada
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Madrigal L, Haardörfer R, Kegler MC, Piper S, Blais LM, Weber MB, Escoffery C. Patterns of Sustainability Capacity Among Organizations That Deliver the National Diabetes Prevention Program: A Latent Profile Analysis. Prev Chronic Dis 2023; 20:E91. [PMID: 37824699 PMCID: PMC10599327 DOI: 10.5888/pcd20.230067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Since the launch of the National Diabetes Prevention Program (DPP) in 2010, more than 3,000 organizations have registered with the Centers for Disease and Control and Prevention to deliver the program; today, however, only approximately 2,000 organizations are registered, indicating challenges with sustainability. We used the Program Sustainability Assessment Tool (PSAT) to explore patterns of sustainability capacity among National DPP delivery organizations. METHODS We used data from a cross-sectional online survey conducted in August and September 2021 of staff members (N = 440) at National DPP delivery organizations. We conducted a latent profile analysis to identify latent subpopulations on the basis of respondent PSAT domain scores. Regression analyses were used to estimate associations between derived latent classes, PSAT scores, and respondent characteristics. RESULTS The 4-class model included 4 groups of capacity for program sustainability, ranging from low to high: low (class 1) with 8.0% of the sample, medium-low (class 2) with 22.0%, medium-high (class 3) with 41.6%, and high (class 4) with 28.4%. Program evaluation (mean score = 5.1 [SD = 1.4]) and adaptation (mean score = 5.3 [SD = 1.3]) were the domains with the highest scores, while funding stability (mean score = 4.0 [SD = 1.6]) and Partnerships (mean score = 4.0 [SD = 1.7]) had the lowest scores. In our sample of National DPP delivery organizations, most reported relatively high capacity for program sustainability, and key indicators associated with sustainability capacity were virtual delivery, location of delivery, funding sources, and organization type. DISCUSSION Similar to sustainability capacity findings from other PSAT studies, our study found that funding stability and partnerships are areas to strengthen. This insight is useful in sustainability planning at organizational and national levels across multiple programs.
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Affiliation(s)
- Lillian Madrigal
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322
| | | | | | - Sarah Piper
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Linelle M Blais
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mary Beth Weber
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cam Escoffery
- Rollins School of Public Health, Emory University, Atlanta, Georgia
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Nathan N, Hall A, Shoesmith A, Bauman AE, Peden B, Duggan B, Gardner C, Lane C, Lecathelinais C, Oldmeadow C, Duncan C, Groombridge D, Riley-Gibson E, Pollock E, Boyer J, Wiggers J, Gillham K, Pattinson M, Mattingly M, McCarthy N, Naylor PJ, Reeves P, Budgen P, Sutherland R, Jackson R, Croft T, Pascoe W, Wolfenden L. A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers' sustained implementation of classroom physical activity breaks (energisers): study protocol. BMC Public Health 2023; 23:1942. [PMID: 37805480 PMCID: PMC10559446 DOI: 10.1186/s12889-023-16810-5] [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: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers' sustainment of energisers (short 3-5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up. METHODS A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods. DISCUSSION This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools' sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally. TRIAL REGISTRATION ACTRN12620000372987 version 1 registered 17th March 2020. Version 3 (current version) updated 4th August 2023.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Adam Shoesmith
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW 2287 Australia
| | - Adrian E. Bauman
- Prevention Research Collaboration, Sydney School of Public Health, Sydney, Australia
- Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW 2006 Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Belinda Peden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
| | - Bernadette Duggan
- Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, NSW Australia
| | - Carly Gardner
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | | | - Craig Duncan
- Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, NSW Australia
| | - Daniel Groombridge
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Edward Riley-Gibson
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Emma Pollock
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - James Boyer
- The NSW Department of Education, Sydney, NSW Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Martina Pattinson
- Health Promotion, Northern NSW Local Health District, Lismore, NSW Australia
| | - Megan Mattingly
- Health Promotion, Murrumbidgee Local Health District, Suite 1B/620 Macauley Street, Albury, NSW 2640 Australia
| | - Nicole McCarthy
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC Canada
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Philippa Budgen
- Health Promotion Service, Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Rebecca Jackson
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Thomas Croft
- Aboriginal Health Unit, Hunter New England Local Health District, Wallsend, NSW Australia
| | - William Pascoe
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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Fathi LI, Walker J, Dix CF, Cartwright JR, Joubert S, Carmichael KA, Huang YS, Littlewood R, Truby H. Applying the Integrated Sustainability Framework to explore the long-term sustainability of nutrition education programmes in schools: a systematic review. Public Health Nutr 2023; 26:2165-2179. [PMID: 37548226 PMCID: PMC10564612 DOI: 10.1017/s1368980023001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/27/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE This review aimed to identify and synthesise the enablers and barriers that influence the long-term (≥ 2 years) sustainment of school-based nutrition programmes. DESIGN Four databases (PubMed, Cochrane Library, Embase and Scopus) were searched to identify studies reporting on the international literature relating to food and nutrition programmes aimed at school-age (5-14 years) children that had been running for ≥ 2 years (combined intervention and follow-up period). Eligible studies were analysed using the Integrated Sustainability Framework (ISF), which involved deductive coding of programme enablers and barriers. A quality assessment was completed, using the Mixed-Methods Appraisal Tool and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. SETTING International school-based nutrition programmes. SUBJECTS Individuals involved with the implementation of school-based nutrition programmes. RESULTS From the 7366 articles identified, thirteen studies (seven qualitative, five mixed methods and one quantitative descriptive) were included, from which the enablers and barriers of eleven different nutrition-related programmes were analysed. Thirty-four factors across the five domains of the ISF were identified that influenced the sustained implementation of programmes. The most common barrier was a lack of organisational readiness and resources, whereas the most common enabler was having adequate external partnerships and a supportive environment. CONCLUSIONS These findings have application during the initiation and implementation phases of school-based nutrition programmes. Paying attention to the 'outer contextual factors' of the ISF including the establishment and maintenance of robust relationships across whole of government systems, local institutions and funding bodies are crucial for programme sustainment.
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Affiliation(s)
- Leila Isabella Fathi
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jacqueline Walker
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Clare Frances Dix
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Jessica Rose Cartwright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Suné Joubert
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Kerri Amelia Carmichael
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Yu-Shan Huang
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
| | - Robyn Littlewood
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
- Health and Wellbeing Queensland, Brisbane, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD4067, Australia
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Plever S, Kisely S, Bonevski B, McCarthy I, Emmerson B, Ballard E, Anzolin M, Siskind D, Allan J, Gartner C. Can improvement in delivery of smoking cessation care be sustained in psychiatry inpatient settings through a system change intervention? An analysis of statewide administrative health data. Aust N Z J Psychiatry 2023; 57:1375-1383. [PMID: 37038343 DOI: 10.1177/00048674231164566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This study evaluated maintenance of improved delivery of smoking cessation assistance in adult acute psychiatry inpatient units 3 years post statewide implementation of a system change intervention through analysis of a statewide administrative health dataset. METHOD Rates of documenting smoking status and providing a brief smoking cessation intervention (the Smoking Cessation Clinical Pathway) in all eligible Queensland public adult acute psychiatry inpatient units (N = 57) during the implementation phase (October 2015-September 2017) of a system change intervention were compared to the maintenance phase (October 2017-October 2020) using interrupted time series analysis. RESULTS Across implementation and maintenance phases, the percentage of discharges from psychiatry inpatient units that had a smoking status recorded remained high with the statewide average exceeding 90% (implementation phase 93.2%, 95% confidence interval = [92.4, 93.9]; and maintenance phase 94.6%, 95% confidence interval = [94.0, 95.2]). The percentage of discharges statewide with a completed Pathway stabilised during the maintenance phase (change in slope -3.7%, 95% confidence interval = [-5.2, -2.3]; change in level 0.4%, 95% confidence interval = [-7.0, 7.9]). CONCLUSION An evidence-based smoking cessation intervention implemented with a system change intervention resulted in sustained improvement in addressing smoking in adult inpatient psychiatry units up to 3 years post implementation.
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Affiliation(s)
- Sally Plever
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Billie Bonevski
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Irene McCarthy
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Brett Emmerson
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Melissa Anzolin
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Dan Siskind
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John Allan
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
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Shelton RC, Hailemariam M, Iwelunmor J. Making the connection between health equity and sustainability. Front Public Health 2023; 11:1226175. [PMID: 37822544 PMCID: PMC10562623 DOI: 10.3389/fpubh.2023.1226175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Maji Hailemariam
- C. S. Mott Department of Public Health and Department of OBGYN and Reproductive Biology, Michigan State University, Flint, MI, United States
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, MO, United States
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