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Ahmad SZ, Ivers N, Zenlea I, Parsons JA, Shah BR, Mukerji G, Punthakee Z, Shulman R. An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada. Implement Sci Commun 2024; 5:25. [PMID: 38500183 PMCID: PMC10946155 DOI: 10.1186/s43058-024-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. METHODS An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. RESULTS Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. CONCLUSIONS We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
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Affiliation(s)
- Syed Zain Ahmad
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- SickKids Research Institute, Toronto, Canada
| | - Noah Ivers
- Women's College Institute for Health System Solutions and Virtual Care, Toronto, Canada
- Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada
- ICES, Toronto, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Rayzel Shulman
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- SickKids Research Institute, Toronto, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Canada.
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Neal WN, Moldavskiy M, Truax B, Ithurburn A, Ware M, Hebert JR, Opielinski L, Penko AL, Kern K, Palmer L, Backus D, Motl RW. Intervention fidelity and adaptation in a multi-site exercise training intervention for adults with multiple sclerosis. Contemp Clin Trials 2023; 133:107320. [PMID: 37633458 DOI: 10.1016/j.cct.2023.107320] [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: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Successful translation of evidence-based exercise training interventions from research to clinical practice depends on the balance of treatment fidelity and adaptability when delivering the exercise program across settings. The current paper summarizes fidelity of study design, provider training, and intervention delivery strategies from best practice recommendations, and reports challenges experienced and adaptations instrumented by behavioral coaches delivering the multi-site Supervised versus Telerehabilitation Exercise Programs for Multiple Sclerosis (STEP for MS) Trial. METHODS Using a reflexive thematic analysis approach, open-ended survey questions were analyzed to explore experiences of behavioral coaches, transcripts from team meetings among behavioral coaches, and notes from audits of one-on-one sessions between behavioral coaches and participants. RESULTS Themes related to the fidelity of study design and delivery of the STEP for MS Trial included adaptations to the intervention itself (e.g., completion of virtual supervised exercise sessions with behavioral coaches in place of face-to-face sessions during COVID-19 pandemic restrictions), modification of exercise equipment, and adjustments of program delivery. The adjustments of program delivery reported by behavioral coaches included increasing program fit, maintaining engagement, and addressing participant safety concerns; however, these adaptations did not jeopardize the content of the essential elements of the program model. CONCLUSIONS The current paper demonstrates that when best practice recommendations are implemented, it is possible to address challenges to study design and evidence-based intervention delivery in ways that adaptations to overcome real-world obstacles can be accomplished without compromising fidelity.
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Affiliation(s)
- Whitney N Neal
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Marina Moldavskiy
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA, United States of America
| | - Brendon Truax
- Department of Medicine, Division of Pulmonary/Allergy/Critical Care, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Ashlie Ithurburn
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Megan Ware
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States of America
| | - Jeffrey R Hebert
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Lauren Opielinski
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States of America
| | - Amanda L Penko
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, United States of America
| | - Kathryn Kern
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States of America
| | - Louise Palmer
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA, United States of America
| | - Deborah Backus
- Virginia C. Crawford Research Institute, Shepherd Center, Atlanta, GA, United States of America
| | - Robert W Motl
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States of America
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Corvin JA, Chan I, Aguado Loi CX, Dollman I, Gonzales J. Analytic hierarchy process: An innovative technique for culturally tailoring evidence-based interventions to reduce health disparities. Health Expect 2021; 24 Suppl 1:70-81. [PMID: 31908082 PMCID: PMC8137498 DOI: 10.1111/hex.13022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/09/2019] [Accepted: 12/14/2019] [Indexed: 12/02/2022] Open
Abstract
Latinos in the United States represent a disproportionate burden of illness and disease and face barriers to accessing health care and related resources. Culturally tailored, evidence-based interventions hold promise in addressing many of these challenges. Yet, ensuring patient voice is vital in the successful development and implementation of such interventions. Thus, this paper examines the application of analytic hierarchy process (AHP) to inform the augmentation and implementation of an evidence-based chronic disease self-management programme for underserved Latinos living with both minor depression and chronic illness. The process of AHP allows for direct input from the individuals that would utilize such a programme, including afflicted individuals, their family members and the health educators/promotores that would be responsible for implementation. Specifically, 45 participants, including 15 individuals with chronic disease, 15 family members/caregivers and 15 promotores, partook in the Stakeholder Values Questionnaire, which elicited preferences and values regarding major goals, processes and content for the intervention. AHP was employed to analyse pairwise comparison ratings and to determine differences and similarities across stakeholder groups. This analytical technique allowed for the adaptation of the EBI to stakeholders' specific priorities and preferences and facilitated complex decision-making. Findings not only shed light on similarities and differences between stakeholder groups, but also the magnitude of these priorities and preferences and allowed the intervention to be driven by the participants, themselves. Applying AHP was a unique opportunity to optimize the decision-making process to inform cultural adaptation of an EBI while considering multiple viewpoints systematically.
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Affiliation(s)
- Jaime A. Corvin
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
| | - Isabella Chan
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
| | | | - Ian Dollman
- Department of Global HealthCollege of Public HealthUniversity of South FloridaTampaFLUSA
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Everhart RS, Corona R, Mazzeo SE, Dempster KW, Schechter MS. School Nurses' Perspectives on Components of Asthma Programs to Address Pediatric Disparities. J Pediatr Psychol 2020; 45:900-909. [PMID: 32524136 PMCID: PMC7828575 DOI: 10.1093/jpepsy/jsaa039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/29/2020] [Accepted: 05/02/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To use a community engaged, collaborative approach with school nurses working within an urban community, to develop recommendations for future school-based interventions targeting pediatric asthma disparities. METHODS Open-ended survey data were collected from 33 nurses (77% of nurses in the school district) during a face-to-face monthly health services meeting. Questions asked nurses to estimate the proportion of students with asthma with the necessary forms and medications at school and to describe perceived barriers to having such forms and medications, and potential initiatives that could be implemented. A 30-min asthma education class was also piloted with school nurses, who then rated its acceptability and feasibility. Open-ended survey data were analyzed using thematic analysis. RESULTS Nurses estimated that 12% of students with asthma had an asthma action plan, 19% had a medication release form, and 15% had medications at school (i.e. inhalers). Four themes emerged regarding barriers to asthma management in schools and strategies for promoting asthma management in schools: coordination of care, asthma education, access to care, and medication adherence. Nurses noted the need for education focused specifically on teaching inhaler technique, and better communication between schools, providers, and families. CONCLUSIONS School nurses provided valuable information regarding specific barriers, as well as approaches to addressing these barriers in a future intervention. Findings suggest that a school-based intervention needs to address coordination among schools, parents, and medical providers, and will be optimally effective if it also addresses structural barriers.
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Affiliation(s)
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University and
| | | | | | - Michael S Schechter
- Division of Pulmonary Medicine, Department of Pediatrics, Children’s Hospital of Richmond at VCU
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Power J, Gilmore B, Vallières F, Toomey E, Mannan H, McAuliffe E. Adapting health interventions for local fit when scaling-up: a realist review protocol. BMJ Open 2019; 9:e022084. [PMID: 30679286 PMCID: PMC6347947 DOI: 10.1136/bmjopen-2018-022084] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Scaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up. METHODS AND ANALYSIS Given the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first completed stage of development of an initial programme theory framework, which identified potential actions, contexts, mechanisms and outcomes that could be used to make adaptations when scaling-up. It will then outline the methods for future stages of the review which will focus on identifying case examples of scale-up and adaptation in practice. This realist review consists of six stages: (i) clarifying scope and development of a theoretical framework, (ii) developing a search strategy, (iii) selection and appraisal, (iv) data extraction, (v) data synthesis and analysis and (vi) further theory refinement with stakeholders. ETHICS AND DISSEMINATION This review will develop theory on how adaptations can be made when scaling-up. Findings will be disseminated in a peer-reviewed journal and through stakeholder engagement as part of the research process. Ethical approval has been received through Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin.
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Affiliation(s)
- Jessica Power
- Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brynne Gilmore
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hasheem Mannan
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Zullig LL, McCant F, Silberberg M, Johnson F, Granger BB, Bosworth HB. Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention. Transl Behav Med 2018; 8:225-232. [PMID: 29432589 DOI: 10.1093/tbm/ibx030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina. CHANGE 3 was available to low-income patients receiving care in three geographical areas with multiple chronic conditions at low or moderate risk for developing cardiovascular disease. Adaptations were made to ensure fit with available organizational resources and the patient population's health needs. Data available for evaluation are presented. For CHANGE 2, we evaluated improvement in A1c control using paired t test. For both studies, we describe feasibility measured by percentage of patients who completed the curriculum. CHANGE 2 involved 125 participants. CHANGE 3 had 127 participants. In CHANGE 2, 69 participants had A1c measurements at baseline and 12-month follow-up; A1c improved from 8.4 to 7.8 (p = .008). In CHANGE 3, interventionists completed 47% (n = 45) of calls to enroll participants at the 4-month encounter, and among those eligible for a 12-month call (n = 52), 21% of 12-month calls were completed with participants. In CHANGE 2, 40% of participants (n = 50) completed all 12 encounters. Thoughtful adaptation is critical to translate clinical trials into community-based clinic settings. Successful implementation of adapted evidence-based interventions may be feasible and can positively affect patients' disease control.
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Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA
| | - Felicia McCant
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, USA
| | - Mina Silberberg
- Community and Family Medicine, Duke University, Durham, NC, USA
| | - Fred Johnson
- Community and Family Medicine, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, USA.,Department of Population Health Sciences, Duke University, Durham, NC, USA.,School of Nursing, Duke University, Durham, NC, USA.,Center for Population Health Sciences, Duke University, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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7
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Cooper BR, Shrestha G, Hyman L, Hill L. Adaptations in a Community-Based Family Intervention: Replication of Two Coding Schemes. J Prim Prev 2016; 37:33-52. [PMID: 26661413 DOI: 10.1007/s10935-015-0413-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although program adaptation is a reality in community-based implementations of evidence-based programs, much of the discussion about adaptation remains theoretical. The primary aim of this study was to replicate two coding systems to examine adaptations in large-scale, community-based disseminations of the Strengthening Families Program for Parents and Youth 10-14, a family-based substance use prevention program. Our second aim was to explore intersections between various dimensions of facilitator-reported adaptations from these two coding systems. Our results indicate that only a few types of adaptations and a few reasons accounted for a majority (over 70 %) of all reported adaptations. We also found that most adaptations were logistical, reactive, and not aligned with program's goals. In many ways, our findings replicate those of the original studies, suggesting the two coding systems are robust even when applied to self-reported data collected from community-based implementations. Our findings on the associations between adaptation dimensions can inform future studies assessing the relationship between adaptations and program outcomes. Studies of local adaptations, like the present one, should help researchers, program developers, and policymakers better understand the issues faced by implementers and guide efforts related to program development, transferability, and sustainability.
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Affiliation(s)
| | - Gitanjali Shrestha
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Leah Hyman
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
| | - Laura Hill
- Department of Human Development, Washington State University, Pullman, WA, 99164, USA
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Janevic MR, Stoll S, Wilkin M, Song PXK, Baptist A, Lara M, Ramos-Valencia G, Bryant-Stephens T, Persky V, Uyeda K, Lesch JK, Wang W, Malveaux FJ. Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study. Am J Public Health 2016; 106:2012-2018. [PMID: 27631740 DOI: 10.2105/ajph.2016.303373] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of care coordination on asthma outcomes among children in underserved urban communities. METHODS We enrolled children, most of whom had very poorly or not well-controlled asthma, in medical-social care coordination programs in Los Angeles, California; Chicago, Illinois; Philadelphia, Pennsylvania; and San Juan, Puerto Rico in 2011 to 2014. Participants (n = 805; mean age = 7 years) were 60% male, 50% African American, and 42% Latino. We assessed asthma symptoms and health care utilization via parent interview at baseline and 12 months. To prevent overestimation of intervention effects, we constructed a comparison group using bootstrap resampling of matched control cases from previous pediatric asthma trials. RESULTS At follow-up, intervention participants had 2.2 fewer symptom days per month (SD = 0.3; P < .01) and 1.9 fewer symptom nights per month (SD = 0.35; P < .01) than did the comparison group. The relative risk in the past year associated with the intervention was 0.63 (95% confidence interval [CI] = 0.45, 0.89) for an emergency department visit and 0.69 (95% CI = 0.47, 1.01) for hospitalization. CONCLUSIONS Care coordination may improve pediatric asthma symptom control and reduce emergency department visits. POLICY IMPLICATIONS Expanding third-party reimbursement for care coordination services may help reduce pediatric asthma disparities.
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Affiliation(s)
- Mary R Janevic
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Shelley Stoll
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Margaret Wilkin
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Peter X K Song
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Alan Baptist
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Marielena Lara
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Gilberto Ramos-Valencia
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Tyra Bryant-Stephens
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Victoria Persky
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Kimberly Uyeda
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Julie Kennedy Lesch
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Wen Wang
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
| | - Floyd J Malveaux
- At the time of the study, Mary R. Janevic, Shelley Stoll, and Margaret Wilkin were with the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor. Peter X. K. Song and Wen Wang are with the Department of Epidemiology, University of Michigan School of Public Health. Alan Baptist is with the Division of Allergy and Clinical Immunology, University of Michigan Medical School, Ann Arbor. Marielena Lara was with the Children's Hospital of Los Angeles, University of Southern California, Los Angeles. Gilberto Ramos-Valencia is with the Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico. Tyra Bryant-Stephens is with the Children's Hospital of Philadelphia, Philadelphia, PA. Victoria Persky is with the Division of Epidemiology and Biostatistics, University of Illinois, Chicago School of Public Health, Chicago, IL. Kimberly Uyeda is with the Los Angeles Unified School District, Los Angeles. Julie Kennedy Lesch and Floyd J. Malveaux were with the Merck Childhood Asthma Network, Inc., Washington, DC
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Janevic MR, Stoll SC, Lara M, Ramos-Valencia G, Bryant-Stephens T, Persky V, Uyeda K, Lesch JK, Malveaux FJ. The "Retrofitting" Approach to Adapting Evidence-Based Interventions: A Case Study of Pediatric Asthma Care Coordination, United States, 2010-2014. Prev Chronic Dis 2016; 13:E114. [PMID: 27560722 PMCID: PMC5003528 DOI: 10.5888/pcd13.160129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Adaptation of evidence-based interventions upon implementation into new practice settings is universal, yet poorly understood. During a cross-site evaluation of the implementation of a proven intervention for pediatric asthma care coordination into 4 resource-challenged settings, we conducted in-depth interviews with site representatives, who reported how and why they modified intervention components. Interview notes were coded for themes. We focused on a single theme from a respondent who described the adaptation process as "backing" the intervention into ongoing services; we found evidence of a similar process at other sites. We labeled this process "retrofitting" to signify adaptation that consists of altering existing services to align with intervention components, rather than modifying the intervention to fit a new setting. Advantages of retrofitting may include allowing organizations to keep what works, capitalizing on existing support for program activities, elevating the role of local knowledge, and potentially promoting the sustainability of effective innovations.
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Affiliation(s)
- Mary R Janevic
- University of Michigan School of Public Health, 1425 Washington Heights, Ann Arbor, MI 48109-2029.
| | - Shelley C Stoll
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | | | | | - Victoria Persky
- University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Kimberly Uyeda
- Los Angeles Unified School District, Los Angeles, California
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Pérez D, Van der Stuyft P, Zabala MC, Castro M, Lefèvre P. A modified theoretical framework to assess implementation fidelity of adaptive public health interventions. Implement Sci 2016; 11:91. [PMID: 27391959 PMCID: PMC4939032 DOI: 10.1186/s13012-016-0457-8] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 05/14/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND One of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness. DISCUSSION We support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention's effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment-implemented, not-implemented, modified, or added components of the strategy-also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation. The modified Carroll et al.'s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it.
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Affiliation(s)
- Dennis Pérez
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Marta Castro
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Pierre Lefèvre
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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11
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Neamah HH, Sebert Kuhlmann AK, Tabak RG. Effectiveness of Program Modification Strategies of the Diabetes Prevention Program: A Systematic Review. DIABETES EDUCATOR 2016; 42:153-65. [PMID: 26879459 DOI: 10.1177/0145721716630386] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study is to review the effectiveness of commonly used program modifications classified under cultural adaptation and program translational strategies for the Diabetes Prevention Program (DPP) in terms of risk reduction for type 2 diabetes. METHODS Authors extracted data about weight, body mass index (BMI), and 5 areas of program modification strategies from 28 interventions and analyzed them in SPSS software. Bivariate analyses examined the odds of achieving a significant reduction in outcomes by each modification of the DPP and by presence of a maintenance component, as well as the mean reduction of weight and BMI by more versus fewer modifications and by the presence of a maintenance component. RESULTS There were no statistically significant differences in achieving a significant reduction in weight or BMI by any type of modification or by the presence of a maintenance component. Programs with fewer modifications reported significantly greater reduction in mean weight at 12 months postintervention and the furthest time point extracted. Programs with a maintenance component achieved significantly greater reduction in mean weight measured at the furthest time point extracted. CONCLUSIONS The DPP appears to be programmatically robust to a variety of cultural adaptation and translational strategies. Potentially cost-saving modifications do not seem to reduce effectiveness, which should encourage implementation on a broader scale. Program planners should, however, make efforts to include maintenance components because they appear to significantly reduce risk for acquiring type 2 diabetes.
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Affiliation(s)
- Hind H Neamah
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann)
| | - Anne K Sebert Kuhlmann
- Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Neamah, Dr Sebert Kuhlmann),Behavioral Sciences and Health Education, College for Public Health and Social Justice, Saint Louis University, St Louis, Missouri, USA (Dr Sebert Kuhlmann)
| | - Rachel G Tabak
- Prevention Research Center in St Louis, Brown School, Washington University in St Louis, St Louis, Missouri, USA (Dr Tabak)
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12
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Kelly RP, Stoll SC, Bryant-Stephens T, Janevic MR, Lara M, Ohadike YU, Persky V, Ramos-Valencia G, Uyeda K, Malveaux FJ. The Influence of Setting on Care Coordination for Childhood Asthma. Health Promot Pract 2015; 16:867-77. [PMID: 26232778 PMCID: PMC4655362 DOI: 10.1177/1524839915598499] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings-school district, clinic or health care system, and community-and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team.
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Affiliation(s)
- R Patrick Kelly
- University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA
| | - Shelley C Stoll
- University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA
| | | | - Mary R Janevic
- University of Michigan Center for Managing Chronic Disease, Ann Arbor, MI, USA
| | | | | | - Victoria Persky
- University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | | | - Kimberly Uyeda
- Los Angeles Unified School District, Los Angeles, CA, USA
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13
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Martin MA, Mosnaim GS, Olson D, Swider S, Karavolos K, Rothschild S. Results from a community-based trial testing a community health worker asthma intervention in Puerto Rican youth in Chicago. J Asthma 2015; 52:59-70. [PMID: 25162304 PMCID: PMC8341398 DOI: 10.3109/02770903.2014.950426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
UNLABELLED Abstract Objective: Puerto Rican children suffer disproportionately from asthma. Project CURA tested the efficacy of a community health worker (CHW) intervention to improve use of inhaled corticosteroids (ICS) and reduce home asthma triggers in Puerto Rican youth in Chicago. METHODS This study employed a behavioral randomized controlled trial design with a community-based participatory research approach. Medications and technique were visually assessed; adherence was determined using dose counters. Home triggers were assessed via self-report, visual inspection and salivary cotinine. All participants received education on core asthma topics and self-management skills. Participants in the CHW arm were offered home education by the CHW in four visits over four months. The attention control arm received four newsletters covering the same topics. RESULTS While most of the participants had uncontrolled persistent asthma, <50% had ICS at baseline. In the CHW arms, 67% of participants received the full four-visit intervention. In the Elementary school cohort (n=51), the CHW arm had lower odds of having an ICS (OR=0.2; p=0.02) at 12-months; no differences were seen in other outcomes between arms at any time point. The only significant treatment arm difference in the high school cohort (n=50) was in inhaler technique where the CHW arm performed 18.0% more steps correct at five months (p<0.01) and 14.2% more steps correct at 12 months (p<0.01). CONCLUSIONS While this CHW intervention did not increase the number of participants with ICS or reduce home asthma triggers, important lessons were learned including challenges to CHW intervention fidelity and the need for CHWs to partner with clinical providers.
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Affiliation(s)
- Molly A Martin
- University of Illinois at Chicago, Department of Pediatrics. 840 S Wood St, Chicago, IL, 60612
| | - Giselle S. Mosnaim
- Rush University Medical Center, Department of Preventive Medicine. 1700 W Van Buren, Suite 470, Chicago, IL, 60612
| | - Daniel Olson
- Rush University Medical Center, Rush Medical College. 600 S. Paulina Street, Suite 202, Chicago, IL, 60612
| | - Susan Swider
- Rush University Medical Center, College of Nursing. 600 S. Paulina Street, Suite 1080, Chicago, IL, 60612
| | - Kelly Karavolos
- Rush University Medical Center, Department of Preventive Medicine. 1700 W Van Buren, Suite 470, Chicago, IL, 60612
| | - Steven Rothschild
- Rush University Medical Center, Department of Preventive Medicine. 1700 W Van Buren, Suite 470, Chicago, IL, 60612
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Doyle K, Hungerford C. Adapting evidence-based interventions to accommodate cultural differences: where does this leave effectiveness? Issues Ment Health Nurs 2014; 35:739-44. [PMID: 25259636 DOI: 10.3109/01612840.2014.901452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Evidence-based interventions are an essential part of delivering contemporary mental health services. Many such interventions, however, are developed with and for mainstream population groups. Practitioners and researchers alike will often adapt tools, practices, processes or programmes to meet the needs of culturally diverse populations groups, but wonder if and how such adaptations will affect outcomes. This paper considers the processes by which evidence-based interventions can be adapted by health professionals in any context; and includes an example of a successful cultural adaptation to an evidence-based intervention. The successful implementation of the Aboriginal Mental Health First Aid programme in Australia illustrates the potential for adapted interventions to support improvements in the health outcomes of people from culturally diverse backgrounds. The paper concludes by outlining the steps mental health professionals can take when adapting evidence-based interventions for use in their own workplace settings.
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Affiliation(s)
- Kerrie Doyle
- Disciplines of Nursing and Midwifery, Faculty of Health, University of Canberra, Canberra, Australia
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Quasi-experimental pilot study of intervention to increase participant retention and completed home visits in the nurse-family partnership. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 14:525-34. [PMID: 23832657 DOI: 10.1007/s11121-013-0410-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We evaluated an intervention to increase participant retention and engagement in community practice settings of the Nurse-Family Partnership (NFP), an evidence-based program of nurse home visiting for low-income, first-time parents. Using a quasi-experimental design (6 intervention and 11 control sites that delivered the NFP), we compared intervention and control sites on retention and number of completed home visits during a 10-month period after the intervention was initiated. Nurses at the five intervention sites were guided in tailoring the frequency, duration, and content of the visits to participants' needs. NFP nurses at the control sites delivered the program as usual. At the intervention sites, participant retention and completed home visits increased from the pre-intervention to intervention periods, while at the control sites, these outcomes decreased from the pre-intervention to intervention periods, leading to a significant intervention-control difference in change in participant retention (hazard ratio, 0.42; p = 0.015) and a 1.4 visit difference in change in completed home visits (p < 0.001, ES = 0.36). We conclude that training nurse home visitors to promote adaptation of program dosage and content to meet families' needs shows promise as a way to improve participant retention and completed home visits.
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Lara M, Ramos-Valencia G, González-Gavillán JA, López-Malpica F, Morales-Reyes B, Marín H, Rodríguez-Sánchez MH, Mitchell H. Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico. Pediatrics 2013; 131 Suppl 1:S26-37. [PMID: 23457147 DOI: 10.1542/peds.2012-1427d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. METHODS We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. RESULTS Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. CONCLUSIONS Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.
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Affiliation(s)
- Marielena Lara
- RAND Corporation, 1776 Main St, PO Box 2138, Santa Monica, CA 90407-2138, USA.
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Bringing Evidence-Based Interventions to the Field. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 19:1-3. [DOI: 10.1097/phh.0b013e318249bc06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Home visitation program effectiveness and the influence of community behavioral norms: a propensity score matched analysis of prenatal smoking cessation. BMC Public Health 2012; 12:1016. [PMID: 23170927 PMCID: PMC3533912 DOI: 10.1186/1471-2458-12-1016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 11/17/2012] [Indexed: 11/24/2022] Open
Abstract
Background The influence of community context on the effectiveness of evidence-based maternal and child home visitation programs following implementation is poorly understood. This study compared prenatal smoking cessation between home visitation program recipients and local-area comparison women across 24 implementation sites within one state, while also estimating the independent effect of community smoking norms on smoking cessation behavior. Methods Retrospective cohort design using propensity score matching of Nurse-Family Partnership (NFP) clients and local-area matched comparison women who smoked cigarettes in the first trimester of pregnancy. Birth certificate data were used to classify smoking status. The main outcome measure was smoking cessation in the third trimester of pregnancy. Multivariable logistic regression analysis examined, over two time periods, the association of NFP exposure and the association of baseline county prenatal smoking rate on prenatal smoking cessation. Results The association of NFP participation and prenatal smoking cessation was stronger in a later implementation period (35.5% for NFP clients vs. 27.5% for comparison women, p < 0.001) than in an earlier implementation period (28.4% vs. 25.8%, p = 0.114). Cessation was also negatively associated with county prenatal smoking rate, controlling for NFP program effect, (OR = 0.84 per 5 percentage point change in county smoking rate, p = 0.002). Conclusions Following a statewide implementation, program recipients of NFP demonstrated increased smoking cessation compared to comparison women, with a stronger program effect in later years. The significant association of county smoking rate with cessation suggests that community behavioral norms may present a challenge for evidence-based programs as models are translated into diverse communities.
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Childhood asthma: considerations for primary care practice and chronic disease management in the village of care. Prim Care 2012; 39:381-91. [PMID: 22608872 DOI: 10.1016/j.pop.2012.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Childhood asthma is at historically high levels, with significant morbidity and mortality. Despite more than two decades of improved understanding of childhood asthma care and the evolution of beneficial medications, widespread control remains poor, leading to suboptimal patient outcomes and quality of life. This lack of control results in excessive emergency department use, hospitalizations, and inappropriate and/or unnecessary costs to the health care system. Advanced practice models that incorporate community-based approaches and services for childhood asthma are needed. Innovative, community-included methods of care to address the burden of childhood asthma may provide examples for care of other chronic diseases.
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Mansfield C, Viswanathan M, Woodell C, Nourani V, Ohadike YU, Lesch JK, Malveaux FJ, Bryant-Stephens T, Findley S, Lara M, Matiz A, Valencia GR, Rosenthal M, Persky VW, Uyeda K, Williams R, Banda E, Ramirez-Diaz E, Reyes BM, Montoya J, West C. Outcomes from a cross-site evaluation of a comprehensive pediatric asthma initiative incorporating translation of evidence-based interventions. Health Promot Pract 2012; 12:34S-51S. [PMID: 22068359 DOI: 10.1177/1524839911415665] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reports on an evaluation of the Merck Childhood Asthma Network, Inc. (MCAN) initiative using pooled cross-site data on patient-reported outcomes pre- and postintervention to quantify the changes experienced by children in five program sites supported by the network. The results show a consistent pattern of improvement across all measured outcomes, including symptoms, hospital and emergency department use, school absences, and caregiver confidence. Children who started with uncontrolled asthma experienced larger improvements than children with controlled asthma at baseline. However, even considering the significant gains made by children with uncontrolled asthma at baseline, after 12 months, most of the outcomes for these children were significantly worse than the 12-month outcomes for children with controlled asthma at baseline. The evaluation of the MCAN initiative offers a model that can be used in cases where resources must be balanced between evaluation and delivering services to children. The design process and results from the common survey instrument provide information for future initiatives seeking to translate evidence-based interventions in a community-based setting.
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Williams R, Woodell C, McCarville E, Damitz M, Banks T, Montoya J, Lesch JK, Peretz P, Lara M. Desired attributes and skills of program managers in translation of evidence-based interventions. Health Promot Pract 2012; 12:82S-90S. [PMID: 22068364 DOI: 10.1177/1524839911412593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Successful chronic disease project management, especially of multiyear initiatives using evidence-based interventions (EBIs), is of great importance to funders, health care decision makers, and researchers, particularly in light of limited funding. However, a gap in knowledge may exist regarding which attributes and skills are most desirable in a program manager to help him or her ensure successful implementation of EBIs. Although some literature examines the dynamics contributing to the success of community coalitions, public health leadership, and community health education, there is minimal literature exploring the significance of a program manager's role in the conceptualization, implementation, and sustainability of initiatives to improve patient and community health. The authors present their experiences as participants in a large-scale asthma initiative implemented in priority communities, as well as results of a survey distributed among all personnel of the program sites. The survey aimed to assess the key skills and attributes, in addition to contextual factors, that contribute to the strength of a program manager overseeing EBIs in asthma initiatives. The results suggest that certain attributes and skills are desirable in recruiting and hiring of a program manager, especially when augmented by ongoing skill-building training, and can help ensure program and research success.
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Affiliation(s)
- Rhonda Williams
- Respiratory Health Association of Metropolitan Chicago, Chicago, IL, USA
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Viswanathan M, Lux L, Lohr KN, Evans TS, Smith LR, Woodell C, Mansfield C, Darcy N, Ohadike YU, Lesch JK, Malveaux FJ. Translating evidence-based interventions into practice: the design and development of the Merck Childhood Asthma Network, Inc. (MCAN). Health Promot Pract 2012; 12:9S-19S. [PMID: 22068366 DOI: 10.1177/1524839911412594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric asthma is a multifactorial disease, requiring complex, interrelated interventions addressing children, families, schools, and communities. The Merck Childhood Asthma Network, Inc. (MCAN) is a nonprofit organization that provides support to translate evidence-based interventions from research to practice. MCAN developed the rationale and vision for the program through a phased approach, including an extensive literature review, stakeholder engagement, and evaluation of funding gaps. The analysis pointed to the need to identify pediatric asthma interventions implemented in urban U.S. settings that have demonstrated efficacy and materials for replication and to translate the interventions into wider practice. In addition to this overall MCAN objective, specific goals included service and system integration through linkages among health care providers, schools, community-based organizations, patients, parents, and other caregivers. MCAN selected sites based on demonstrated ability to implement effective interventions and to address multiple contexts of pediatric asthma prevention and management. Selected MCAN program sites were mature institutions or organizations with significant infrastructure, existing funding, and the ability to provide services without requiring a lengthy planning period. Program sites were located in communities with high asthma morbidity and intended to integrate new elements into existing programs to create comprehensive care approaches.
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