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Adamu AA, Ndwandwe D, Jalo RI, Wiysonge CS. Positioning implementation science in national immunization programmes to improve coverage equity and advance progress toward Immunization Agenda 2030: An urgent global health imperative. Hum Vaccin Immunother 2024; 20:2331872. [PMID: 38556477 PMCID: PMC10984125 DOI: 10.1080/21645515.2024.2331872] [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: 02/14/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024] Open
Abstract
Despite the availability of effective vaccines for preventing common childhood infectious diseases, there is still significant disparities in access and utilization across many low- and middle-income countries (LMIC). The factors that drive these disparities are often multilevel, originating from individuals, health facilities, health systems and communities, and also multifaceted. Implementation science has emerged as a field to help address "know-do" gaps in health systems, and can play a significant role in strengthening immunization systems to understand and solve implementation barriers that limit access and uptake within their contexts. This article presents a reflexive perspective on how to position implementation research in immunization programmes to improve coverage equity. Furthermore, key points of synergy between implementation research and vaccination are highlighted, and some potential practice changes that can be applied within specific contexts were proposed. Using a human rights lens, it was concluded that the cost that is associated with implementation failure in immunization programmes is significant and unjust, and future directions for implementation research to optimize its application in practice settings have been recommended.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Wilmont I, Loeffen M, Hoogeboom T. A qualitative study on the facilitators and barriers to adopting the N-of-1 trial methodology as part of clinical practice: potential versus implementation challenges. Int J Qual Stud Health Well-being 2024; 19:2318810. [PMID: 38417032 PMCID: PMC10903748 DOI: 10.1080/17482631.2024.2318810] [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: 11/07/2023] [Accepted: 02/10/2024] [Indexed: 03/01/2024] Open
Abstract
PURPOSE To investigate opinions among healthcare stakeholders whether implementation of the N-of-1 trial approach in clinical practice is a feasible way to optimize evidence-based treatment results for unique patients. METHODS We interviewed clinicians, researchers, and a patient advocate (n = 13) with an interest in or experience with N-of-1 trials on the following topics: experience with N-of-1, measurement, validity and reliability, informally gathered data usability, and influence on physician-patient relationship. Interviews were analysed using qualitative, thematic analysis. RESULTS The N-of-1 approach has the potential to shift the current healthcare system towards embracing personalized medicine. However, its application in clinical practice carries significant challenges in terms of logistics, time investment and acceptability. New skills will be required from patients and healthcare providers, which may alter the patient-physician relationship. The rise of consumer technology enabling self-measurement may leverage the uptake of N-of-1 approaches in clinical practice. CONCLUSIONS There is a strong belief that the N-of-1 approach has the potential to play a prominent role in transitioning the current healthcare system towards embracing personalized medicine. However, there are many barriers deeply ingrained in our healthcare system that hamper the uptake of the N-of-1 approach, making it momentarily only interesting for research purposes.
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Affiliation(s)
- Ilona Wilmont
- Data & Knowledge Engineering, HAN University of Applied Sciences, Arnhem, the Netherlands
- Institute for Computing and Information Sciences, Data Science, Radboud University Nijmegen, Nijmegen, the Netherlands
| | | | - Thomas Hoogeboom
- IQ healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Hayvon JC. Systematic synthesis of intersectional best practices: knowledge translation for circumpolar indigenous disability. Int J Circumpolar Health 2024; 83:2333075. [PMID: 38590199 PMCID: PMC11005870 DOI: 10.1080/22423982.2024.2333075] [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: 01/17/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024] Open
Abstract
Numerous theories, models, and frameworks (TMFs) currently exist for knowledge translation (KT), with scholarship that is increasingly inclusive of populations experiencing health inequalities. This study proposes two objectives: 1) exploring a nine-step method for synthesising best practices, acknowledging existing syntheses in the form of tailored-databases and review-style publications; and 2) collating best practices to inform KT that is inclusive to indigenous individuals living with disabilities in circumpolar regions. The resulting synthesis emphasises 10 best practices: explicitly connect the accountability of stakeholders to the wellbeing of the people they serve; recognise entanglement with existing neoliberal systems; assess impacts of KT on indigenous treatment providers; employ personal outreach visits; rectify longstanding delegitimization; avoid assuming the target group to be homogeneous, critically examine inequitable distribution of benefits and risks; consider how emphasis on a KT initiative can distract from historical and systemic inequalities; target inequitable, systemic social and economic forces; consider how KT can also be mobilised to gain power and control; assess what is selected for KT, and how it intersects with power position of external stakeholders and internal champions; and, allow people access-to-knowledge which changes inequitable systems.
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Affiliation(s)
- John C. Hayvon
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Provvidenza CF, Al-Hakeem H, Ramirez E, Rusyn R, Kingsnorth S, Marshall S, Mallory K, Scratch SE. Exploring the adaptability of TeachABI as an online professional development module for high school educators. PEC INNOVATION 2024; 4:100299. [PMID: 38911021 PMCID: PMC11192793 DOI: 10.1016/j.pecinn.2024.100299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/25/2024]
Abstract
Objective Educators often lack the knowledge and resources to assist students with acquired brain injury (ABI). TeachABI, an education module, was created to help elementary school teachers support students with ABI in classrooms. This study examined the adaptability of TeachABI for high school educators. Methods A qualitative descriptive study explored high school educators' (n = 9) experiences reviewing TeachABI and its adaptability for high school through semi-structured interviews. The interview guide was informed by implementation and adaptation frameworks. Transcripts were examined using directed content analysis. Results Teachers felt TeachABI was a good foundation for creating a high school-based education module. Adaptations were highlighted, such as streamlining content (e.g., mental health) and strategies (e.g., supporting test taking), to better meet educator needs. Conclusions Using implementation science and adaptation frameworks provided a structured approach to explore the adaptive elements of TeachABI. The module was perceived as a suitable platform for teaching high school educators about ABI. Innovation TeachABI is an innovative, user informed education module, providing a multi-modal (e.g., case study, videos) and replicable approach to learning about ABI. Applying frameworks from different fields provides concepts to consider when tailoring resources to align with educator needs (e.g., grade, class environment) and facilitate innovation uptake.
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Affiliation(s)
- Christine F. Provvidenza
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Hiba Al-Hakeem
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Elizabeth Ramirez
- Department of Occupational Science & Occupational Therapy, University of Toronto, 60 – 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Rick Rusyn
- Department of Occupational Science & Occupational Therapy, University of Toronto, 60 – 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Shauna Kingsnorth
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
- Department of Occupational Science & Occupational Therapy, University of Toronto, 60 – 500 University Avenue, Toronto, ON M5G 1V7, Canada
| | - Sara Marshall
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Kylie Mallory
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
| | - Shannon E. Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada
- Department of Paediatrics, University of Toronto, 555 University Avenue, Black Wing Room 1436, Toronto, ON M5G 1X8, Canada
- Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7, Canada
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Scott S, Atkins B, D'Costa T, Rendle C, Murphy K, Taylor D, Smith C, Kellar I, Briggs A, Griffiths A, Hornak R, Spinewine A, Thompson W, Tsuyuki R, Bhattacharya D. Development of the Guide to Disseminating Research (GuiDiR): A consolidated framework. Res Social Adm Pharm 2024; 20:1047-1057. [PMID: 39183076 DOI: 10.1016/j.sapharm.2024.08.001] [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: 05/25/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Less than one third of research evidence is translated into policy or practice. Knowledge translation requires effective dissemination, adoption and finally implementation. These three stages are equally important, however, existing knowledge translation models and frameworks provide little and disparate information about the steps and activities required for effective dissemination. OBJECTIVE This study aimed to empirically develop a consolidated framework of evidence-based steps and activities for disseminating research evidence. METHODS We identified models and frameworks from a scoping review and dissemination and implementation webtool. We synthesised them into a prototype dissemination framework. Models and frameworks were eligible to inform steps in our framework if they fulfilled at least one of three elements of dissemination: intending to generate awareness of a message, incorporates targeting an audience: tailoring communication. An initial coding framework was created to organise data into dissemination steps. Drawing on 'co-approach' principles, authors of the included models and frameworks (dissemination experts) and health service researchers (end users) were invited to test and refine the prototype framework at a workshop. RESULTS From 48 models and frameworks reviewed, only 32 fulfilled one or more of the three dissemination elements. The initial coding framework, upon refinement, yielded the Guide to Disseminating Research (GuiDiR) comprising five steps. 1) Identify target audiences and dissemination partners. 2) Engage with dissemination partners. 3) Identify barriers and enablers to dissemination. 4) Create dissemination messages. 5) Disseminate and evaluate. Multiple activities were identified for each step and no single model or framework represents all steps and activities in GuiDiR. CONCLUSIONS GuiDiR unifies dissemination components from knowledge translation models and frameworks and harmonises language into a format accessible to non-experts. It outlines for researchers, funders and practitioners the expected structure of dissemination and details the activities for executing an evidence-based dissemination strategy.
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Affiliation(s)
- Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| | - Bethany Atkins
- School of Healthcare, University of Leicester, Leicester, UK
| | - Thomas D'Costa
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - Claire Rendle
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - David Taylor
- School of Healthcare, University of Leicester, Leicester, UK
| | - Caroline Smith
- School of Healthcare, University of Leicester, Leicester, UK
| | - Ian Kellar
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alys Griffiths
- School of Medicine and Population Health, University of Sheffield, UK
| | - Rebekah Hornak
- National Implementation Research Network, Frank-Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, USA
| | - Anne Spinewine
- Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium & CHU UCL Namur, Pharmacy Department, Yvoir, Belgium
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Ross Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta. Edmonton, AB., Canada
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Järnefelt H, Anttilainen J, Karhula K, Hublin C, Pehkonen I, Sallinen M. Factors facilitating and hindering the implementation of digital sleep coaching for bus drivers. APPLIED ERGONOMICS 2024; 121:104356. [PMID: 39033548 DOI: 10.1016/j.apergo.2024.104356] [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: 10/23/2023] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
Improving fatigue management is critical to the occupational safety of professional drivers. We aimed to identify the factors that facilitated or hindered the implementation of digital sleep coaching in bus companies and to explore bus drivers' experiences with it. Two bus companies implemented coaching for bus drivers. Using a mixed methods design, we collected data through two workshops (n = 30 and n = 27) attended by key personnel from the organisations and through questionnaires to the drivers (n = 30). Implementation was facilitated by, for example, the flexible participation and multichannel information of coaching, and hindered by restrictions on social support due to the COVID-19 pandemic, and lack of interest and inspiring examples. On average, the drivers rated the appropriateness and the feasibility of coaching as good. However, further development could lead to wider dissemination. It would also be important to involve the key people in the organisations and stakeholders more in supporting the implementation.
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Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland.
| | - Julia Anttilainen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland
| | - Kati Karhula
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland
| | - Irmeli Pehkonen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health, P.O. Box 40, FI-00032 Työterveyslaitos, Finland; University of Jyväskylä, P.O. Box 35, FI-40014, Finland
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Kanu FA, Freeland C, Nwokoro UU, Mohammed Y, Ikwe H, Uba B, Sandhu H, An Q, Asekun A, Akataobi C, Adewole A, Fadahunsi R, Wisdom M, Akudo OL, Ugbenyo G, Simple E, Waziri N, Vasumu JJ, Bahuli AU, Bashir SS, Isa A, Ugwu G, Obi EI, Binta H, Bassey BO, Shuaib F, Bolu O, Tohme RA. Evaluation of interventions to improve timely hepatitis B birth dose vaccination among infants and maternal tetanus vaccination among pregnant women in Nigeria. Vaccine 2024; 42:126222. [PMID: 39197221 DOI: 10.1016/j.vaccine.2024.126222] [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: 03/29/2024] [Revised: 08/07/2024] [Accepted: 08/09/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Nigeria has the largest number of children infected with hepatitis B virus (HBV) globally and has not yet achieved maternal and neonatal tetanus elimination. In Nigeria, maternal tetanus diphtheria (Td) vaccination is part of antenatal care and hepatitis B birth dose (HepB-BD) vaccination for newborns has been offered since 2004. We implemented interventions targeting healthcare workers (HCWs), community volunteers, and pregnant women attending antenatal care with the goal of improving timely (within 24 hours) HepB-BD vaccination among newborns and Td vaccination coverage among pregnant women. METHODS We selected 80 public health facilities in Adamawa and Enugu states, with half intervention facilities and half control. Interventions included HCW and community volunteer trainings, engagement of pregnant women, and supportive supervision at facilities. Timely HepB-BD coverage and at least two doses of Td (Td2+) coverage were assessed at baseline before project implementation (January-June 2021) and at endline, one year after implementation (January-June 2022). We held focus group discussions at intervention facilities to discuss intervention strengths, challenges, and improvement opportunities. RESULTS Compared to baseline, endline median vaccination coverage increased for timely HepB-BD from 2.6% to 61.8% and for Td2+ from 20.4% to 26.9% in intervention facilities (p < 0.05). In comparison, at endline in control facilities median vaccination coverage for timely HepB-BD was 7.9% (p < 0.0001) and Td2+ coverage was 22.2% (p = 0.14). Focus group discussions revealed that HCWs felt empowered to administer vaccination due to increased knowledge on hepatitis B and tetanus, pregnant women had increased knowledge that led to improved health seeking behaviors including Td vaccination, and transportation support was needed to reach those in far communities. CONCLUSION Targeted interventions significantly increased timely HepB-BD and Td vaccination rates in intervention facilities. Continued support of these successful interventions could help Nigeria reach hepatitis B and maternal and neonatal tetanus elimination goals.
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Affiliation(s)
- Florence A Kanu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; The U.S. Public Health Service Commissioned Corps, Atlanta, Georgia, United States.
| | | | - Ugochukwu Uzoechina Nwokoro
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria; African Field Epidemiology Network, Abuja, Nigeria
| | - Yahaya Mohammed
- African Field Epidemiology Network, Abuja, Nigeria; Department of Medical Microbiology and Parasitology, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Hadley Ikwe
- Global Immunization Division, CDC-Nigeria, Abuja, Nigeria
| | - Belinda Uba
- African Field Epidemiology Network, Abuja, Nigeria; National Emergency Routine Immunization Coordination Centre, Abuja, Nigeria
| | - Hardeep Sandhu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Qian An
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Adeyelu Asekun
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States; Global Immunization Division, CDC-Nigeria, Abuja, Nigeria
| | - Charles Akataobi
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Adefisoye Adewole
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Rhoda Fadahunsi
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Margeret Wisdom
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Okeke Lilian Akudo
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Gideon Ugbenyo
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Edwin Simple
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - Ndadilnasiya Waziri
- African Field Epidemiology Network, Abuja, Nigeria; National Stop Transmission of Poliomyelitis, Nigeria
| | - James Jacob Vasumu
- Adamawa State Primary Health Care Development Agency, Yola, Adamawa, Nigeria
| | | | | | - Abdullahi Isa
- Adamawa State Primary Health Care Development Agency, Yola, Adamawa, Nigeria
| | - George Ugwu
- Department of Obsterics and Gynaecology, College of Medicine, University of Nsukka, Nsukka, Enugu, Nigeria; Enugu State Primary Health Care Development Agency, Enugu, Nigeria
| | | | - Haj Binta
- National Emergency Routine Immunization Coordination Centre, Abuja, Nigeria; College of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Omotayo Bolu
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Rania A Tohme
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
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Brach JS, VanSwearingen JM, Freburger J, Weiner BJ, Zanardelli JJ, Perera S. On the Move in the community: Protocol for a hybrid 1 trial examining effectiveness and fidelity of a community-based group exercise program for older adults. Contemp Clin Trials 2024; 145:107666. [PMID: 39159805 DOI: 10.1016/j.cct.2024.107666] [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: 07/18/2023] [Revised: 04/23/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND On the Move (OTM), a group exercise program to improve mobility in older adults, is efficacious when delivered by research staff. The next step in the development of OTM as a fully implementable intervention is to conduct an effectiveness study in which the intervention is delivered in community settings by community providers. METHODS We describe the methods of a hybrid 1 cluster randomized, single-blind, intervention trial to compare the effectiveness of OTM to a delayed intervention control in 502 community-dwelling older adults across 44 sites. OTM classes are taught by certified instructors in the community twice a week for 12 weeks. Control centers receive no intervention for the first 12 weeks followed by 12-weeks of OTM classes. Participants are assessed at baseline, 12 and 24 weeks. The primary outcome is gait speed. Intervention fidelity, measured by adherence and competence in intervention delivery, is assessed by review of instructor intervention diaries and observation. Organizational, instructor, and participant-level factors which may impact fidelity are assessed using questionnaires, focus groups, and structured interviews. CONCLUSION The findings of this trial will 1) establish the effectiveness of OTM on improvements in walking and post-intervention persistence of benefits, 2) assess intervention fidelity and identify the impact of organizational, instructor, and participant level factors on fidelity, and 3) determine the extent to which fidelity moderates the effectiveness of OTM. The information derived from this project will provide valuable insight into the real-world effectiveness of OTM as a health promotion program for improving mobility in older adults.
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Affiliation(s)
- Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States of America.
| | - Jessie M VanSwearingen
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Janet Freburger
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - John J Zanardelli
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Subashan Perera
- Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
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Nataletti S, Banerjee A, Macaluso R, Prokup S, Jayaraman A, Wong AWK. Developing a mobile exercise program for individuals with Spinal Cord Injury: Stakeholder perceptions of app features and implementation determinants. Disabil Health J 2024; 17:101667. [PMID: 38964938 DOI: 10.1016/j.dhjo.2024.101667] [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: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Individuals with Spinal Cord Injury (SCI) often experience physical deconditioning, leading to long-term health challenges. While regular exercise can offer substantial health benefits, adherence to exercise guidelines among individuals with SCI is hindered by barriers such as inaccessibility. Exercise programs using the mobile application (App) tailored to individual needs present a promising solution for promoting exercise adherence among individuals with SCI. OBJECTIVE This study aimed to identify factors contributing to the successful implementation of an app-based home exercise program for individuals with SCI and gather user feedback on app preferences, functionality, and features. METHODS Guided by the Consolidated Framework for Implementation Research (CFIR), twenty-six clinicians completed an expert panel survey to rank factors influencing the implementation of an app-based intervention for increasing exercise adherence for individuals with SCI. CFIR-selected factors and app quality features obtained from the Mobile Application Rating Scale (MARS) framework were discussed in seven focus groups with 23 individuals with SCI, 6 caregivers, and 6 clinicians. RESULTS The expert survey identified adaptability, complexity, evidence strength/quality, relative advantage, knowledge/beliefs about the initiative, and execution as the key CFIR factors that affected the intervention's success. Major themes emerging from focus groups with individuals with SCI and caregivers included usability, instruction and guidelines, user-friendly interface, and clinician interaction. In contrast, clinicians mentioned themes such as the representation of the SCI population, time commitment, accessibility, and equipment. CONCLUSIONS The study highlights the significance of incorporating these determinants into future designs to develop app-based home exercise interventions for individuals with SCI.
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Affiliation(s)
- Sara Nataletti
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA.
| | - Anushua Banerjee
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Rebecca Macaluso
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Sara Prokup
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.
| | - Arun Jayaraman
- Max Näder Center for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, IL, 60611, USA.
| | - Alex W K Wong
- Department of Physical Medicine & Rehabilitation, Northwestern University, Chicago, IL, 60611, USA; Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
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10
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Thoonsen AC, van Schoten SM, Merten H, van Beusekom I, Schoonmade LJ, Delnoij DMJ, de Bruijne MC. Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review. Health Policy 2024; 148:105135. [PMID: 39128438 DOI: 10.1016/j.healthpol.2024.105135] [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: 07/31/2023] [Revised: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts. METHODS We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics. RESULTS Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements. CONCLUSION Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.
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Affiliation(s)
- Andrea C Thoonsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.
| | - Steffie M van Schoten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Hanneke Merten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Ilse van Beusekom
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands
| | - Linda J Schoonmade
- Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, NL-1081 HV Amsterdam, the Netherlands
| | - Diana M J Delnoij
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands; Erasmus Universiteit Rotterdam, Erasmus School of Health Policy & Management Health Care Governance, Burgemeester Oudlaan 50, NL-3062 PA Rotterdam, the Netherlands
| | - Martine C de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
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Aarons GA, Sklar M, Ehrhart MG, Roesch S, Moullin JC, Carandang K. Randomized trial of the leadership and organizational change for implementation (LOCI) strategy in substance use treatment clinics. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209437. [PMID: 38866139 DOI: 10.1016/j.josat.2024.209437] [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: 02/07/2024] [Revised: 04/28/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Evidence-based practice (EBP) implementation represents a strategic change that requires alignment of leadership and support throughout organizations. Leadership and Organizational Change for Implementation (LOCI) is a multifaceted implementation strategy that aims to improve implementation leadership and climate within organizations through iterative cycles of leadership and climate assessment and feedback, leadership training and coaching, and strategic planning with upper-level leaders. This study tested the effects of LOCI on transformational and implementation leadership, implementation climate, implementation citizenship behavior, and EBP reach. METHODS A multiple cohort, cluster randomized trial tests the effect of LOCI in 60 clinics across nine behavioral health organizations in California and Arizona, USA. The study randomized clinics within organizations to either LOCI or a leadership training webinar control condition in three consecutive cohorts. Repeated web-based surveys of direct service providers (nLOCI = 201, nControl = 179) assessed leadership, implementation climate, and implementation citizenship over time. Multilevel autoregressive modeling was the primary statistical analysis such that providers (level-1) were nested within clinics (level-2). The study predicted between-condition differences at 4-, 8-, and 12-month follow-up assessments. Provider engagement in a fidelity monitoring process assessed reach of motivational interviewing (i.e., number of sessions recorded/submitted for fidelity coding). An independent sample t-test explored between condition differences in motivational interviewing reach. RESULTS Results indicated between condition differences at 4 months for implementation leadership, implementation climate, and implementation citizenship behavior such that greater improvements were evidenced in the LOCI condition compared to the control condition. Reach of MI was significantly greater in the LOCI vs control condition such that LOCI providers were significantly more likely to engage in the fidelity monitoring process (chi-square (1, n = 370) = 5.59, p = .018). CONCLUSIONS LOCI was developed based on organizational theories of strategic leadership and climate to affect organizational change processes that communicate that innovation implementation is expected, supported, and recognized as a value of the organization. The LOCI implementation strategy resulted in more positive hypothesized outcomes compared to the control condition. Organizational change strategies have utility for implementing health innovations in complex, multilevel contexts and for greater sustainment of facilitative leader behaviors, strategic implementation climate, and improved implementation outcomes. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov gov (NCT03042832, 2 February 2017; retrospectively registered).
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Affiliation(s)
- Gregory A Aarons
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA 92093, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America.
| | - Marisa Sklar
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA 92093, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America.
| | - Mark G Ehrhart
- University of Central Florida, Department of Psychology, United States of America.
| | - Scott Roesch
- San Diego State University, Department of Psychology, 5500 Campanile Drive, San Diego, CA 92182-4611, United States of America.
| | - Joanna C Moullin
- Curtin University, School of Population Health, Kent Street, Bentley, Western Australia 6102, Australia
| | - Kristine Carandang
- University of California San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, United States of America; Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123, United States of America
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Nasca B, Reddy S, Furmanchuk A, Lundberg A, Kong N, Andrei AC, Theros J, Thomas A, Ingram M, Sanchez J, Slocum J, Stey AM. Hospital variation in adoption of balanced transfusion practices among injured patients requiring blood transfusions. Surgery 2024; 176:1273-1280. [PMID: 39069394 PMCID: PMC11381157 DOI: 10.1016/j.surg.2024.06.037] [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] [Received: 03/12/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND This study sought to measure hospital variability in adoption of balanced transfusion following the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) guidelines. We hypothesized hospital adoption rates of balanced transfusion would be low, and vary significantly among hospitals after controlling for patient, injury and hospital characteristics. STUDY DESIGN AND METHODS This was an observational cohort study of injured adult patients (≥16 years) in Trauma Quality Improvement Program hospitals 2016-2021. Inclusion criteria were hypotensive patients receiving one transfusion of packed red blood cells, fresh frozen plasma, platelets, or cryoprecipitate. Balanced transfusion was defined as ≥1 ratio of plasma to packed red blood cells or platelets to packed red blood cells or whole blood use at 4 hours. Hierarchical multivariable logistic regression quantified residual hospital-level variability in balanced transfusion rates after adjusting for patient and hospital characteristics. RESULTS Among 172,457 injured patients who received transfusions, 30,386 (17.6%) underwent balanced transfusion. Patient-level balanced transfusion rates were 11% in 2016, rose to 14.0% in 2019, and jumped up once whole blood transfusions were measured to 24.0% in 2020 and to 25.9% in 2021. Approximately 26% of the variability in balanced transfusion rates was attributable to the hospital. Verified level I hospitals had a 2.09 increased adjusted odds of balanced transfusion (95% CI 1.88-2.21) compared to nonverified hospitals. University teaching status had a 1.29 increased adjusted odds of balanced transfusion (95% CI 1.08-1.54) compared with community hospitals. Overall, 150 (23.5%) hospitals were high outliers (high performing) in balanced transfusion adoption and 124 (19.4%) hospitals were low outliers. CONCLUSION There was significant variability in hospital adoption of balanced transfusion.
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Affiliation(s)
- Brian Nasca
- Department of surgery, Albany Medical College, New York, NY
| | - Susheel Reddy
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Alona Furmanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | | | - Jonathan Theros
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arielle Thomas
- Department of surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Martha Ingram
- Department of surgery, Emory University, Atlanta, GA
| | - Joseph Sanchez
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - John Slocum
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M Stey
- Feinberg School of Medicine, Northwestern University, Chicago, IL.
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Marchak JG, Beauchemin MP, Broglie L, Kelly KP, Seelisch J, Dupuis LL. Impact of the Children's Oncology Group's supportive care clinical practice guideline endorsement program: An institutional survey. Pediatr Blood Cancer 2024; 71:e31178. [PMID: 39010277 DOI: 10.1002/pbc.31178] [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: 03/27/2024] [Revised: 05/24/2024] [Accepted: 06/19/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Supportive care clinical practice guidelines (CPGs) facilitate the incorporation of the best available evidence into pediatric cancer care. We aimed to assess the impact of the work of the Children's Oncology Group (COG) Supportive Care Guideline Task Force on institutional supportive care practices. PROCEDURE An online survey was distributed to representatives at 209 COG sites to assess the awareness, use, and helpfulness of COG-endorsed supportive care CPGs. Availability of institutional policies regarding 13 topics addressed by current COG-endorsed CPGs was also assessed. Respondents described their institutional processes for developing supportive care policies. RESULTS Representatives from 92 COG sites responded to the survey, and 78% (72/92) were "very aware" of the COG-endorsed supportive care CPGs. On average, sites had policies that addressed seven COG-endorsed supportive care CPG topics (median = 7, range: 0-12). Only 45% (41/92) of sites reported having institutional processes for developing supportive care policies. Of these, most (76%, 31/41) reported that the COG-endorsed CPGs have a medium or large impact on policy development. Compared with sites without processes for supportive care policy development, sites with established processes had policies on a greater number of topics aligned with current COG-endorsed CPG topics (mean = 6.6, range: 0-12 vs mean = 7.9, range: 2-12; p = 0.027). CONCLUSIONS Most site respondents were aware of the COG-endorsed supportive care CPGs. Less than half of the COG sites represented in the survey have processes in place to implement supportive care policies. Improvement in local implementation is required to ensure that patients at COG sites receive evidence-based supportive care.
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Affiliation(s)
- Jordan Gilleland Marchak
- Emory University School of Medicine, Atlanta, Georgia, USA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Melissa P Beauchemin
- Columbia University School of Nursing, Columbia University Irving Medical Center, New York, New York, USA
| | - Larisa Broglie
- Department of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katherine Patterson Kelly
- Department of Nursing Science, Professional Practice, and Quality, Children's National Hospital, Washington, District of Columbia, USA
| | - Jennifer Seelisch
- Children's Hospital London Health Sciences Centre, Division of Hematology/Oncology, Western University, London, Ontario, Canada
| | - L Lee Dupuis
- Child Health Evaluative Sciences, Research Institute and Department of Pharmacy, The Hospital for Sick Children; Lesley Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Springgate B, Matta I, True G, Doran H, Torres WV, Stevens E, Holland E, Mott K, Ardoin TR, Nixdorff N, Haywood C, Meyers D, Johnson A, Tatum T, Palinkas LA. Implementation of medication for opioid use disorder treatment during a natural disaster: The PROUD-LA study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 165:209469. [PMID: 39094901 DOI: 10.1016/j.josat.2024.209469] [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: 01/17/2024] [Revised: 05/17/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The impacts of climate change-related extreme weather events (EWEs) on Medication for Opioid Use Disorders (MOUD) implementation for Medicaid beneficiaries are relatively unknown. Such information is critical to disaster planning and other implementation strategies. In this study we examined implementation determinants and strategies for MOUD during EWEs. METHODS The Louisiana-based Community Resilience Learning Collaborative and Research Network (C-LEARN) utilized Rapid Assessment Procedures-Informed Community Ethnography (RAPICE), involving community leaders in study design, execution, and data analysis. We conducted qualitative semi-structured interviews with 42 individuals, including MOUD Medicaid member patients and their caregivers, healthcare providers and administrators, and public health officials with experience with climate-related disasters. We mapped key themes onto updated Consolidated Framework for Implementation Research domains. RESULTS MOUD use is limited during EWEs by pharmacy closures, challenges to medication prescription and access across state lines, hospital and clinic service limits, overcrowded emergency departments, and disrupted communications with providers. MOUD demand simultaneously increases due to the stress associated with displacement, resource loss, the COVID-19 pandemic, and social determinants of health. Effective implementation strategies include healthcare system disaster plans with protocols for clear and regular patient-provider communication, community outreach, additional staffing, and virtual delivery of services. Providers can also increase MOUD access by having remote access to EHRs, laptops and contact information, resource lists, collaborative networks, and contact with patients via call centers and social media. Patients can retain access to MOUD via online patient portals, health apps, call centers, and provider calls and texts. The impact of EWEs on MOUD access and use is also influenced by individual characteristics of both patients and providers. CONCLUSIONS The increasing frequency and severity of climate-related EWEs poses a serious threat to MOUD for Medicaid beneficiaries. MOUD-specific disaster planning and use of telehealth for maintaining contact and providing care are effective strategies for MOUD implementation during EWEs. Potential considerations for policies and practices of Medicaid, providers, and others to benefit members during hurricanes or major community stressors, include changes in Medicaid policies to enable access to MOUD by interstate evacuees, improvement of medication refill flexibilities, and incentivization of telehealth services for more systematic use.
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Affiliation(s)
- Benjamin Springgate
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Isha Matta
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Gala True
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Hanna Doran
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | | | - Elyse Stevens
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Elizabeth Holland
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Karlee Mott
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Tiffany R Ardoin
- LSU Health Sciences Center - New Orleans, School of Medicine and School of Public Health, New Orleans, LA, USA.
| | - Neil Nixdorff
- Department of Internal Medicine, Division of Geriatric & Palliative Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Diana Meyers
- St. Anna's Episcopal Church, New Orleans, LA, USA.
| | - Arthur Johnson
- Lower Ninth Ward Center for Sustainable Engagement and Development, New Orleans, LA, USA.
| | - Thad Tatum
- Formerly Incarcerated Peers Support Group, New Orleans, LA, USA
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
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Kowalkowski M, Eaton T, Reeves KW, Kramer J, Murphy S, Hole C, Chou SH, Aneralla A, McWilliams A. Incorporating patient, caregiver, and provider perspectives in the co-design of an app to guide Hospital at Home admission decisions: a qualitative analysis. JAMIA Open 2024; 7:ooae079. [PMID: 39156047 PMCID: PMC11328531 DOI: 10.1093/jamiaopen/ooae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 04/23/2024] [Accepted: 08/02/2024] [Indexed: 08/20/2024] Open
Abstract
Objective Hospital at Home (HaH) programs currently lack decision support tools to help efficiently navigate the complex decision-making process surrounding HaH as a care option. We assessed user needs and perspectives to guide early prototyping and co-creation of 4PACS (Partnering Patients and Providers for Personalized Acute Care Selection), a decision support app to help patients make an informed decision when presented with discrete hospitalization options. Methods From December 2021 to January 2022, we conducted semi-structured interviews via telephone with patients and caregivers recruited from Atrium Health's HaH program and physicians and a nurse with experience referring patients to HaH. Interviews were evaluated using thematic analysis. The findings were synthesized to create illustrative user descriptions to aid 4PACS development. Results In total, 12 stakeholders participated (3 patients, 2 caregivers, 7 providers [physicians/nurse]). We identified 4 primary themes: attitudes about HaH; 4PACS app content and information needs; barriers to 4PACS implementation; and facilitators to 4PACS implementation. We characterized 3 user descriptions (one per stakeholder group) to support 4PACS design decisions. User needs included patient selection criteria, clear program details, and descriptions of HaH components to inform care expectations. Implementation barriers included conflict between app recommendations and clinical judgement, inability to adequately represent patient-risk profile, and provider burden. Implementation facilitators included ease of use, auto-populating features, and appropriate health literacy. Conclusions The findings indicate important information gaps and user needs to help inform 4PACS design and barriers and facilitators to implementing 4PACS in the decision-making process of choosing between hospital-level care options.
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Affiliation(s)
- Marc Kowalkowski
- Section on Hospital Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, United States
- Center for Health System Sciences, Atrium Health, Charlotte, NC 28204, United States
| | - Tara Eaton
- Center for Health System Sciences, Atrium Health, Charlotte, NC 28204, United States
| | - Kelly W Reeves
- Department of Family Medicine, Atrium Health, Charlotte, NC 28204, United States
| | - Justin Kramer
- Center for Health System Sciences, Atrium Health, Charlotte, NC 28204, United States
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27104, United States
| | - Stephanie Murphy
- Medically Home Group, Inc, Boston, MA 02118, United States
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC 28204, United States
| | - Colleen Hole
- Population Health, Clinical Integration, Atrium Health, Charlotte, NC 28204, United States
- Medical Group, Atrium Health, Charlotte, NC 28204, United States
| | - Shih-Hsiung Chou
- Information Technology, Data and Analytics, Atrium Health, Charlotte, NC 28204, United States
| | | | - Andrew McWilliams
- Division of Hospital Medicine, Department of Internal Medicine, Atrium Health, Charlotte, NC 28204, United States
- Information Technology, Medical Informatics, Atrium Health, Charlotte, NC 28204, United States
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Bridges EJ, Whitney JD, Walsh E, Christiansen P, Chu F, Kelly MJ, Lynch T, Marsh R, McCarthy M, Orn M, Poppe A, Selchow J, Unger N, White S, Wolkow C. Advancing a Nursing Culture of Inquiry: Strategies for the Community. AACN Adv Crit Care 2024; 35:265-271. [PMID: 39213630 DOI: 10.4037/aacnacc2024444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- Elizabeth J Bridges
- Elizabeth J. Bridges is Professor Emeritus, University of Washington School of Nursing and University of Washington Medical Center, 1959 NE Pacific, Box 357266, Seattle, WA 98195
| | - JoAnne D Whitney
- JoAnne D. Whitney is Professor Emeritus, University of Washington School of Nursing, and Research Scientist, Harborview Medical Center, Seattle, Washington
| | - Elaine Walsh
- Elaine Walsh is Nurse Scientist, Seattle Children's, and an Associate Professor, University of Washington School of Nursing, Seattle, Washington
| | - Pamela Christiansen
- Pamela Christiansen is Perianesthesia Clinical Nurse Specialist, Seattle Children's, Seattle, Washington
| | - Frances Chu
- Frances Chu is Medical Librarian, Providence Library Service, Providence Swedish First Hill Campus, Seattle, Washington
| | - Mary Jo Kelly
- Mary Jo Kelly is Procedural Clinical Nurse Specialist, Providence Swedish Medical Centers, Seattle, Washington
| | - Terry Lynch
- Terry Lynch is Critical Care Clinical Nurse Specialist/Educator, Valley Medical Center, Seattle, Washington
| | - Rebekah Marsh
- Rebekah Marsh is Clinical Nurse Educator-Acute Care/Telemetry, Harborview Medical Center, Seattle, Washington
| | - Mary McCarthy
- Mary McCarthy is Nurse Scientist, Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center, Tacoma, Washington
| | - Margaret Orn
- Margaret Orn is Nurse Educator, Virginia Mason Franciscan Health, Seattle, Washington
| | - Anne Poppe
- Anne Poppe is Director of Nursing for Education and Specialty Rehabilitation and Nurse Scientist, Veterans Affairs Puget Sound Health Care System, and Assistant Clinical Professor, University of Washington School of Nursing, Seattle, Washington
| | - Joy Selchow
- Joy Selchow is Nurse Manager, Virginia Mason Medical Center, Seattle, Washington
| | - Nancy Unger
- Nancy Unger is Clinical Teaching Associate, Division of General Surgery, University of Washington Medical Center, Seattle, Washington
| | - Suzanne White
- Suzanne White is President, Seattle Nursing Research Consortium Board of Directors, Seattle, Washington
| | - Cathy Wolkow
- Cathy Wolkow is Clinical Nurse 2, Intensive Care Unit, University of Washington Medical Center Northwest, Seattle, Washington
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Van der Roest HG, Christie HL, Franco-Martin MA, Dröes RM, de Vugt ME, Meiland F. Determinants of Successful Implementation of Assistive Technologies for Dementia: Exploratory Survey. JMIR Aging 2024; 7:e53640. [PMID: 39269371 DOI: 10.2196/53640] [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: 10/13/2023] [Revised: 05/16/2024] [Accepted: 06/19/2024] [Indexed: 09/15/2024] Open
Abstract
Background Despite positive results for the use of assistive technologies (ATs) in dementia, the uptake of ATs lags behind. It is considered important to assess determinants of successful or unsuccessful implementation of ATs. Objective We explored factors that influence the implementation of ATs for community-dwelling people with dementia, with the aim to better understand potentially effective implementation strategies. Methods A cross-sectional survey for researchers was developed and disseminated, exploring factors that influence either successful or unsuccessful implementation of ATs for dementia. The survey consisted of closed and open questions. Results The response rate was 10% (21/206); the 21 respondents who completed the survey were from 8 countries. Determinants of implementation were described for 21 ATs, of which 12 were successfully and 9 were unsuccessfully implemented. Various types of ATs were included, such as online platforms, sensors, or physical aids. The main determinants of implementation success were related to the AT itself, contextual factors, research activities, and implementation strategies. There was a lack of research data on some ethical issues and cost-effectiveness. Conclusions This study provided insight into some main barriers to and facilitators of implementation of ATs in dementia related to the AT itself, context, research-related activities, and applied implementation strategies. Lessons were formulated for various stakeholders to improve the implementation effectiveness of ATs in dementia.
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Affiliation(s)
| | - Hannah Liane Christie
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | | | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam UMC (Vrije Universiteit Amsterdam location), Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marjolein Elizabeth de Vugt
- Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Franka Meiland
- Department of Medicine for Older People, Amsterdam UMC (Vrije Universiteit Amsterdam location), Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Larson EK, Ingram M, Dougherty E, Velasco M, Guzman V, Jackson A, Patel K, Carvajal SC, Wilkinson-Lee AM. Centering the role of community health workers in social risk screening, referral, and follow-up within the primary care setting. BMC PRIMARY CARE 2024; 25:338. [PMID: 39271996 PMCID: PMC11396075 DOI: 10.1186/s12875-024-02590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Community health workers (CHWs) remain an underutilized resource in social risk diagnostics in the primary care setting. This process evaluation study seeks to assess the role of CHWs in social risk screening, referral, and follow-up through process mapping to identify barriers to the process for future quality improvement efforts. METHODS Researchers at the Arizona Prevention Research Center (AzPRC) engaged with two Federally Qualified Health Centers (FQHCs) in two of Arizona's major urban areas to evaluate their internal processes for social risk screening and intervention. The Consolidated Framework for Implementation Research (CFIR) was used to direct a process mapping exercise to visually describe the workflow, gaps, and barriers to identifying and addressing social risk. RESULTS The process unveiled key areas for health system improvements in the community setting, the organizational setting, and in the implementation of social risk screening, referral, and follow-up. Further, process maps highlight the potential resources needed for effective CHW integration to address social risk in the primary care setting. CONCLUSIONS Our findings demonstrate the importance of organizational tools, such as process mapping, to assist primary care settings in evaluating internal processes for quality improvement in addressing social risk and in effectively integrating the CHW workforce. Subsequent research will evaluate rates of social risk screening, referral, and follow-up within all of Arizona's FQHCs and propose models for CHW integration to address social risk in primary care and strengthen social risk screening reach and effectiveness.
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Affiliation(s)
- Emily K Larson
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Maia Ingram
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Erin Dougherty
- El Rio Health Center, 839 W. Congress Street, Tucson, Arizona, 85745, USA
| | - Maria Velasco
- El Rio Health Center, 839 W. Congress Street, Tucson, Arizona, 85745, USA
| | - Vanessa Guzman
- Valle Del Sol Community Health Center, 3877 N 7th St, Phoenix, AZ, 85014, USA
| | - Azel Jackson
- Valle Del Sol Community Health Center, 3877 N 7th St, Phoenix, AZ, 85014, USA
| | - Kiran Patel
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Scott C Carvajal
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Ada M Wilkinson-Lee
- Arizona Prevention Research Center, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
- Department of Mexican American Studies, College of Social and Behavioral Sciences, University of Arizona, 1110 E. James Rogers Way, Tucson, AZ, 85721, USA
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Nikolovski J, Morton RL, Mercieca-Bebber R, Armstrong M, Hartas G, Rossiter B, Fagan M, Tinsley M, Snyder C, Aiyegbusi OL, Amin-Korim R, Sutherland K, Rutherford C. Acceptability and timing considerations when administering patient-reported outcome measures (PROMs) among people with chronic health conditions who are culturally and linguistically diverse (CALD): a qualitative study protocol. BMJ Open 2024; 14:e083346. [PMID: 39266310 DOI: 10.1136/bmjopen-2023-083346] [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: 09/14/2024] Open
Abstract
INTRODUCTION Patient-reported outcome measures (PROMs) are validated and standardised questionnaires that capture patients' own reports of their symptoms, functioning and well-being. PROMs can facilitate communication between patients and clinicians, reduce symptom burden, enhance quality of life and inform health service re-design. We aim to determine the acceptability of PROMs and the preferred timing of PROM completion in New South Wales (NSW) at the point of care, facilitated by the Health Outcomes and Patient Experiences (HOPE) platform. METHODS AND ANALYSIS Semi-structured interviews with patients (~50-75, sampling across seven language groups and seven clinical cohorts), carers (~10-20) and clinicians (~18) enrolled in HOPE will be conducted via videoconference, telephone or in person. Participants will be asked questions about (1) what makes PROMs acceptable for use in chronic disease management (2) when patients would prefer to complete PROMs and when clinicians would like to use PROMs for clinical decision-making and (3) factors that impede the acceptability of PROMs for culturally and linguistically diverse patients. Interviews will be analysed using a reflexive thematic approach, guided by Normalisation Process Theory. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Sydney Local Health District Human Research Ethics Committee (SLHD HREC, Study Protocol #X24-0138). Results will be published in appropriate peer-reviewed journals, presented at conferences, disseminated to participants in the form of a plain language summary, and widely disseminated to consumer groups and professional stakeholders.
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Affiliation(s)
- Jessica Nikolovski
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | | | - Matilda Armstrong
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Gill Hartas
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Brad Rossiter
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Margaret Fagan
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Melissa Tinsley
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Claire Snyder
- Departments of Medicine, Oncology, and Health Policy & Management, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research (CPROR), University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Rubina Amin-Korim
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Kim Sutherland
- Clinical Innovation and Research Division, New South Wales Office for Health and Medical Research, St Leonards, New South Wales, Australia
| | - Claudia Rutherford
- Sydney Quality of Life Office (SQOLO), The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
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20
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Santesson AHE, Holmberg R, Bäckström M, Gustafsson P, Perrin S, Jarbin H. Multilevel barriers to guideline implementation: a nationwide multi-professional cross-sectional study within child and adolescent psychiatry. Child Adolesc Psychiatry Ment Health 2024; 18:115. [PMID: 39267088 PMCID: PMC11397028 DOI: 10.1186/s13034-024-00803-2] [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: 02/27/2024] [Accepted: 08/27/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. METHODS 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. RESULTS Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. CONCLUSION This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research.
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Affiliation(s)
- Anna Helena Elisabeth Santesson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, BMC F12, Lund, 221 84, Sweden.
- Child and Adolescent Psychiatry, Region Halland, Halland, 30185, Sweden.
| | - Robert Holmberg
- Department of Psychology, Faculty of Social Sciences, Lund University, Box 213, Lund, 221 00, Sweden
| | - Martin Bäckström
- Department of Psychology, Faculty of Social Sciences, Lund University, Box 213, Lund, 221 00, Sweden
| | - Peik Gustafsson
- Department of Clinical Sciences, Faculty of Medicine, Lund University, BMC F12, Lund, 221 84, Sweden
| | - Sean Perrin
- Department of Psychology, Faculty of Social Sciences, Lund University, Box 213, Lund, 221 00, Sweden
| | - Håkan Jarbin
- Department of Clinical Sciences, Faculty of Medicine, Lund University, BMC F12, Lund, 221 84, Sweden
- Child and Adolescent Psychiatry, Region Halland, Halland, 30185, Sweden
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21
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Fernandez K, Hoetink A, Konrad-Martin D, Berndtson D, Clark K, Dreisbach L, Geller JI, Goffi-Gomez MV, Grosnik A, Jamis C, Knight K, Lee DS, Lee J, Liberman PHP, Milnes T, Meijer AJM, Ortiz CE, Rooker J, Sanchez VA, van den Heuvel-Eibrink MM, Brewer CC, Poling GL. Roadmap to a Global Template for Implementation of Ototoxicity Management for Cancer Treatment. Ear Hear 2024:00003446-990000000-00345. [PMID: 39261989 DOI: 10.1097/aud.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Ototoxicity is among the adverse events related to cancer treatment that can have far-reaching consequences and negative impacts on quality-of-life for cancer patients and survivors of all ages. Ototoxicity management (OtoM) comprises the prevention, diagnosis, monitoring, and treatment, including rehabilitation and therapeutic intervention, of individuals who experience hearing loss, tinnitus, or balance/vestibular difficulties following exposures to ototoxic agents, including platinum chemotherapy (cisplatin, carboplatin) and cranial radiation. Despite the well-established physical, socioeconomic, and psychological consequences of hearing and balance dysfunction, there are no widely adopted standards for clinical management of cancer treatment-related ototoxicity. Consensus recommendations and a roadmap are needed to guide development of effective and feasible OtoM programs, direct research efforts, address the needs of caregivers and patients at all stages of cancer care and survivorship. Here we review current evidence and propose near-term to longer-term goals to advance OtoM in five strategic areas: (1) beneficiary awareness, empowerment, and engagement, (2) workforce enhancement, (3) program development, (4) policy, funding, and sustainability, and (5) research and evaluation. The goal is to identify needs and establish a roadmap to guide worldwide adoption of standardized OtoM for cancer treatment and improved outcomes for patients and survivors.
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Affiliation(s)
- Katharine Fernandez
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Alex Hoetink
- Department of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Audiology, Utrecht Medical Center Utrecht Brain Center, Utrecht, the Netherlands
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Dawn Konrad-Martin
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Deborah Berndtson
- International Ototoxicity Management Group, Cancer Survivor and Advocate, Vienna, Virginia, USA
| | - Khaya Clark
- National Center for Rehabilitative Auditory Research, Veterans Affairs Rehabilitation Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon, USA
- Department of Otolaryngology/Head & Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
- Veterans Affairs Health Services Research & Development Center of Innovation, Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D 66), Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Laura Dreisbach
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California, USA
| | - James I Geller
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Amy Grosnik
- Division of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carmen Jamis
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kristin Knight
- Department of Audiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon, USA
| | - David S Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John Lee
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Trisha Milnes
- Department of Audiology, Veterans Affairs Augusta Health Care System, Augusta, Georgia, USA
| | - Annelot J M Meijer
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Candice E Ortiz
- Capital Institute of Hearing & Balance, Silver Spring, Maryland, USA
| | - Jennessa Rooker
- College of Nursing, University of South Florida, Tampa, Florida, USA
| | - Victoria A Sanchez
- Department of Otolaryngology-Head & Neck Surgery, University of South Florida, Tampa, Florida, USA
| | - Mary M van den Heuvel-Eibrink
- Audiology, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Audiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Carmen C Brewer
- Division of Intramural Research, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, USA
| | - Gayla L Poling
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Meddick-Dyson SA, Boland JW, Pearson M, Greenley S, Gambe R, Budding JR, Murtagh FEM. Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model. Intensive Care Med 2024:10.1007/s00134-024-07623-0. [PMID: 39266771 DOI: 10.1007/s00134-024-07623-0] [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: 05/21/2024] [Accepted: 08/20/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE The importance and effectiveness of palliative care (PC) in intensive care units (ICU) are known. Less is known about the implementation and integration of ICU-based PC interventions. This systematic review aims to use a modified implementation research logic model (IRLM) to identify, map, and synthesise evidence on implementation of ICU-PC (primary and/or specialist) interventions. METHODS This systematic review used an adapted Smith's IRLM to understand relationships between implementation factors-determinants (barriers and facilitators), strategies, and mechanisms-and report intervention characteristics and outcomes. Searches up to 2nd December 2023, of MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO, combined PC, intensive care, and implementation terms. RESULTS 84 studies (8 process evaluations, 76 effectiveness studies) were included. Published evidence on ICU-PC interventions is substantial, but reporting on implementation factors is variable and often lacking, especially for patient and family-related determinants and for all aspects of mechanisms. Main facilitators for implementation are adequate resources and collaboration between PC and ICU teams. Main barriers to implementation are lack of resources, negative perceptions of PC, and high ICU acuity. Implementation strategies include auditing resources, building stakeholder collaboratives, creating adaptable interventions, utilising champions, and supporting education. Mechanisms most commonly worked by facilitating collaborative working. CONCLUSION This review provides recommendations for ICUs when designing (stakeholder involvement, ICU-PC collaboration, assessment of culture and resources); implementing (targeted and adapted strategies, champions, and education); and evaluating/reporting (collect effectiveness and implementation data, including mechanisms) ICU-PC interventions. Use of implementation structures and patient/family involvement are both needed and important to be included.
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Affiliation(s)
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Cancer Awareness, Screening and Diagnostic Pathways Research Group (CASP), Hull York Medical School, University of Hull, Hull, UK
| | - Rutendo Gambe
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - John R Budding
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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23
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Harbin SG, Hugh ML, Tagavi D, Bravo A, Joshi M, Kiche S, Michael OG, Locke J. In an Imperfect World: Barriers and Facilitators to Educators' Evidence-Based Practice Use for Elementary-Aged Autistic Students in Inclusive Settings. J Autism Dev Disord 2024:10.1007/s10803-024-06531-y. [PMID: 39261394 DOI: 10.1007/s10803-024-06531-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] [Accepted: 08/14/2024] [Indexed: 09/13/2024]
Abstract
Educators' use of evidence-based practices (EBP) provides positive outcomes for autistic students in multiple areas of learning (e.g., peer interactions and academic skills) and may promote access and participation in general educational settings. However, many teachers report limited use of EBPs for their autistic students, with inconsistent fidelity. This study sought to understand barriers and facilitators educators identify to implementing EBPs with autistic students in general education classrooms. To understand educators' perspectives and experiences, we conducted a qualitative study with 81 educators who serve elementary-aged autistic students in one state. In response to interview questions based on the Consolidated Framework for Implementation Research framework, educators reported on multiple factors, including the general education environment, access to resources, training in EBPs, and professional collaboration. Implications for practice, training, and research are discussed. Specifically, we address educators' need for increased training and the availability of educator resources.
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Affiliation(s)
- Shawna G Harbin
- Department of Human Development and Family Science, Purdue University, Hanley Hall, Room 229, 1202 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA.
| | - Maria L Hugh
- Department of Special Education, University of Kansas, Lawrence, USA
| | - Daina Tagavi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Alice Bravo
- College of Education, University of Washington, Seattle, USA
| | - Mahima Joshi
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Sharon Kiche
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Olivia G Michael
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Jill Locke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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24
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Williams FS, Garofalo R, Karnik NS, Donenberg G, Centola H, Becker S, Welch S, Kuhns L. Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital. Addict Sci Clin Pract 2024; 19:67. [PMID: 39261950 PMCID: PMC11391670 DOI: 10.1186/s13722-024-00492-4] [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: 12/31/2023] [Accepted: 08/08/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity. METHOD This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions. DISCUSSION Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.
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Affiliation(s)
- Faith Summersett Williams
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA.
| | - Robert Garofalo
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Niranjan S Karnik
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Geri Donenberg
- Department of Medicine, Center for Dissemination and Implementation Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Hayley Centola
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Sara Becker
- Department of Psychiatry, Feinberg School of Medicine, The Center for Dissemination and Implementation Science (CDIS), Northwestern University, Chicago, IL, USA
| | - Sarah Welch
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lisa Kuhns
- Department of Pediatrics, Feinberg School of Medicine, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
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25
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Liao X, Yao C, Jin F, Zhang J, Liu L. Barriers and facilitators to implementing imaging-based diagnostic artificial intelligence-assisted decision-making software in hospitals in China: a qualitative study using the updated Consolidated Framework for Implementation Research. BMJ Open 2024; 14:e084398. [PMID: 39260855 DOI: 10.1136/bmjopen-2024-084398] [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: 09/13/2024] Open
Abstract
OBJECTIVES To identify the barriers and facilitators to the successful implementation of imaging-based diagnostic artificial intelligence (AI)-assisted decision-making software in China, using the updated Consolidated Framework for Implementation Research (CFIR) as a theoretical basis to develop strategies that promote effective implementation. DESIGN This qualitative study involved semistructured interviews with key stakeholders from both clinical settings and industry. Interview guide development, coding, analysis and reporting of findings were thoroughly informed by the updated CFIR. SETTING Four healthcare institutions in Beijing and Shanghai and two vendors of AI-assisted decision-making software for lung nodules detection and diabetic retinopathy screening were selected based on purposive sampling. PARTICIPANTS A total of 23 healthcare practitioners, 6 hospital informatics specialists, 4 hospital administrators and 7 vendors of the selected AI-assisted decision-making software were included in the study. RESULTS Within the 5 CFIR domains, 10 constructs were identified as barriers, 8 as facilitators and 3 as both barriers and facilitators. Major barriers included unsatisfactory clinical performance (Innovation); lack of collaborative network between primary and tertiary hospitals, lack of information security measures and certification (outer setting); suboptimal data quality, misalignment between software functions and goals of healthcare institutions (inner setting); unmet clinical needs (individuals). Key facilitators were strong empirical evidence of effectiveness, improved clinical efficiency (innovation); national guidelines related to AI, deployment of AI software in peer hospitals (outer setting); integration of AI software into existing hospital systems (inner setting) and involvement of clinicians (implementation process). CONCLUSIONS The study findings contributed to the ongoing exploration of AI integration in healthcare from the perspective of China, emphasising the need for a comprehensive approach considering both innovation-specific factors and the broader organisational and contextual dynamics. As China and other developing countries continue to advance in adopting AI technologies, the derived insights could further inform healthcare practitioners, industry stakeholders and policy-makers, guiding policies and practices that promote the successful implementation of imaging-based diagnostic AI-assisted decision-making software in healthcare for optimal patient care.
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Affiliation(s)
- Xiwen Liao
- Peking University First Hospital, Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Chen Yao
- Peking University First Hospital, Beijing, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, Beijing, China
| | - Feifei Jin
- Trauma Medicine Center, Peking University People's Hospital, Beijing, China
- Key Laboratory of Trauma treatment and Neural Regeneration, Peking University, Ministry of Education, Beijing, China
| | - Jun Zhang
- MSD R&D (China) Co., Ltd, Beijing, China
| | - Larry Liu
- Merck & Co Inc, Rahway, New Jersey, USA
- Weill Cornell Medical College, New York City, New York, USA
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26
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Johansen KK, Lerbæk B, Slade M, Castelein S, Jørgensen R. Paving the Road While Walking - Perspectives from Flexible Assertive Community Treatment Managers on Preparing the Implementation of Peer Support Work (PSW) in Outpatient Services. Issues Ment Health Nurs 2024:1-7. [PMID: 39250727 DOI: 10.1080/01612840.2024.2391848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
This qualitative study explored the perspectives of Flexible Assertive Community Treatment managers on preparation and employment of peer support workers. The study was based on semi-structured interviews with managers (n = 5) in Outpatient Services in the North Denmark Region. The analysis was based on an inductive approach to content analysis which led to three themes: (1) An exploratory but energy-loaded process-deciding to employ peer support workers, (2) Paving the road while walking-preparing employment of peer support workers, and (3) Uncertainty about the "how" and the "what"-preparing mental health professionals for collaborating with peer support workers. Together these themes describe an exploratory and unstructured implementation process, revealing a lack of structure during implementation. Such circumstances are known to potentially compromise staff wellbeing, feeling insecure about own professional role, and lack of readiness to embrace peer support workers as colleagues. Applying an implementation framework and addressing the literature on barriers and facilitators may promote successful implementation of peer support worker employment.
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Affiliation(s)
- Kirsten Kjær Johansen
- Unit for Psychiatric Research, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- Unit for Forensic Research, Mental Health Department Middelfart, Psychiatry Region of Southern, Denmark
| | - Birgitte Lerbæk
- Unit for Psychiatric Research, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
- Faculty of Nursing and Health Sciences, Health and Community Participation Division, Nord University, Namsos, Norway
| | - Stynke Castelein
- Lentis Psychiatric Institutr, Lentis Research, Groningen, The Netherlands
- Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, TS, The Netherlands
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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27
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Teede HJ, Best K, Bloomfield FH, Cass A, Cohen P, Crengle S, Harris-Brown T, Jan S, Johnson DW, Keogh S, McKenzie A, Middleton P, Peake S, Periyalil H, Scuffham PA, Scheppokat A, Sharplin GR, Webb S. Implementability and impact in clinical research and the role of clinical trial networks. Med J Aust 2024. [PMID: 39245965 DOI: 10.5694/mja2.52444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 05/29/2024] [Indexed: 09/10/2024]
Affiliation(s)
| | - Karen Best
- South Australian Health and Medical Research Institute, Adelaide, SA
| | | | - Alan Cass
- Menzies School of Health Research, Darwin, NT
| | - Paul Cohen
- University of Western Australia, Perth, WA
| | | | | | - Stephen Jan
- George Institute for Global Health, Sydney, NSW
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, QLD
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD
| | | | | | - Sandra Peake
- Basil Hetzel Institute for Translational Health Research, Adelaide, SA
| | | | - Paul A Scuffham
- Griffith Health Institute, Griffith University, Brisbane, QLD
| | - Angela Scheppokat
- National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Greg R Sharplin
- Rosemary Bryant AO Research Centre, Adelaide, SA
- University of South Australia, Adelaide, SA
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28
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Austin EJ, Briggs ES, Cheung A, LePoire E, Blanchard BE, Bauer AM, Al Achkar M, Powers DM. Understanding and Navigating the Unique Barriers Rural Primary Care Settings Face when Implementing Collaborative Care for Mental Health. Community Ment Health J 2024:10.1007/s10597-024-01348-6. [PMID: 39240482 DOI: 10.1007/s10597-024-01348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 08/17/2024] [Indexed: 09/07/2024]
Abstract
Rural primary care (RPC) clinics may face unique barriers to implementing the Collaborative Care Model (CoCM). We used mixed methods to explore RPC staff and practice facilitator (PF) perspectives on CoCM implementation. PFs reported on barriers and facilitators experienced after each monthly meeting with clinics (n = 459 surveys across 23 clinics). Data were analyzed descriptively and informed qualitative interviews with a purposive sample (n = 11) of clinic staff and PFs. Interviews were analyzed using Rapid Assessment Process and triangulated with quantitative data. The most prominent barriers experienced were: (1) the COVID-19 pandemic, (2) limited availability of site staff to participate in implementation activities, and (3) hiring of new CoCM staff. Qualitative data further characterized the ways these barriers uniquely influenced RPC settings and promising implementation strategies. RPC settings face unique challenges to CoCM implementation, but several promising implementation strategies - when tailored to RPC contexts - may help.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Box 351621, Seattle, WA, 98105, USA.
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Box 351621, Seattle, WA, 98105, USA
| | - Angel Cheung
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Erin LePoire
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Morhaf Al Achkar
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Diane M Powers
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
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Mir H, Cullen KJ, Mosleh K, Setrak R, Jolly S, Tsang M, Rutledge G, Ibrahim Q, Welsford M, Mercuri M, Schwalm JD, Natarajan MK. Smartphone App for Prehospital ECG Transmission in ST-Elevation Myocardial Infarction Activation: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e55506. [PMID: 39240681 DOI: 10.2196/55506] [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: 01/23/2024] [Revised: 06/17/2024] [Accepted: 07/09/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Timely diagnosis and treatment for ST-elevation myocardial infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reducing mortality and morbidity. Activation of the cardiac catheterization laboratory may occur through verbal communication and may also involve the secure sharing of electrocardiographic images between frontline health care providers and interventional cardiologists. To improve this response, we developed a quick, easy-to-use, privacy-compliant smartphone app, that is SMART AMI-ACS (Strategic Management of Acute Reperfusion and Therapies in Acute Myocardial Infarction Acute Coronary Syndromes), for real-time verbal communication and sharing of electrocardiographic images among health care providers in Ontario, Canada. The app further provides information about diagnosis, management, and risk calculators for patients presenting with acute coronary syndrome. OBJECTIVE This study aims to integrate the app into workflow processes to improve communication for STEMI activation, resulting in decreased treatment times, improved patient outcomes, and reduced unnecessary catheterization laboratory activation and transfer. METHODS Implementation of the app will be guided by the Reach, Effectiveness, Acceptability, Implementation, and Maintenance (RE-AIM) framework to measure impact. The study will use quantitative registry data already being collected through the SMART AMI project (STEMI registry), the use of the SMART AMI app, and quantitative and qualitative survey data from physicians. Survey questions will be based on the Consolidated Framework for Implementation Research. Descriptive quantitative analysis and thematic qualitative analysis of survey results will be conducted. Continuous variables will be described using either mean and SD or median and IQR values at pre- and postintervention periods by the study sites. Categorical variables, such as false activation, will be described as frequencies (percentages). For each outcome, an interrupted time series regression model will be fitted to evaluate the impact of the app. RESULTS The primary outcomes of this study include the usability, acceptability, and functionality of the app for physicians. This will be measured using electronic surveys to identify barriers and facilitators to app use. Other key outcomes will measure the implementation of the app by reviewing the timing-of-care intervals, false "avoidable" catheterization laboratory activation rates, and uptake and use of the app by physicians. Prospective evaluation will be conducted between April 1, 2022, and March 31, 2023. However, for the timing- and accuracy-of-care outcomes, registry data will be compared from January 1, 2019, to March 31, 2023. Data analysis is expected to be completed in Fall 2024, with the completion of a paper for publication anticipated by the end of 2024. CONCLUSIONS Smartphone technology is well integrated into clinical practice and widely accessible. The proposed solution being tested is secure and leverages the accessibility of smartphones. Emergency medicine physicians can use this app to quickly, securely, and accurately transmit information ensuring faster and more appropriate decision-making for STEMI activation. TRIAL REGISTRATION ClinicalTrials.gov NCT05290389; https://clinicaltrials.gov/study/NCT05290389. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55506.
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Affiliation(s)
- Hassan Mir
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Katelyn J Cullen
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen Mosleh
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rafi Setrak
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Sanjit Jolly
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Michael Tsang
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Gregory Rutledge
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- William Osler Health System, Brampton, ON, Canada
| | - Quazi Ibrahim
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle Welsford
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Mathew Mercuri
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J D Schwalm
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Madhu K Natarajan
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
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Chukwu OA, Adewole IF, Denburg A, Essue BM. Improving childhood cancer medicines access in developing countries: Towards an implementation framework to inform the Global Platform for Access to Childhood Cancer Medicines for Nigeria. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003275. [PMID: 39240943 PMCID: PMC11379258 DOI: 10.1371/journal.pgph.0003275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/29/2024] [Indexed: 09/08/2024]
Abstract
Children and adolescents in developing countries continue to be disproportionately affected by cancer and have significantly lower survival rates (30%) than their counterparts in high-income countries (80%). This disparity is driven by poor access to childhood cancer medicines. The World Health Organization and St. Jude Children's Research Hospital launched the Global Platform for Access to Childhood Cancer Medicines to provide continuous supply of quality childhood cancer medicines to developing countries. As much movement has not been seen with the platform, this research aimed to develop a stakeholder-informed guidance to support effective implementation of the platform and maximize opportunities to deliver on its intended goals. This study was guided by the Consolidated Framework for Implementation Research (CFIR). Participants were recruited based on the stakeholder categories framework and included policymakers from the Ministry of Health, organizations implementing access to medicines programs in Nigeria, medicines logistics providers, and health professionals and personnel at service delivery points such as oncologists and pharmacists. Data collection involved key informant interviews using a pilot-tested semi-structured interview guide. Data analysis was done by thematic content analysis. Ethical approval was obtained from the National Health Research Ethics Committee of Nigeria and the Ethics Review Board of University of Toronto. The findings reveal critical insights spanning five domains of the CFIR framework, each contributing uniquely to understanding the multifaceted issues of childhood cancer medicine access with a view to understanding pathways to implementation of the platform. Successfully implementing the platform could entail a partner-driven approach, integration with existing programs to avoid fragmentation, supporting capacity strengthening at the primary care level, and engaging patients and communities. This information was used to suggest a nuanced implementation framework for the platform in Nigeria and similar settings which could be beneficial for improving access for children who desperately need childhood cancer medicines to survive.
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Affiliation(s)
- Otuto Amarauche Chukwu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Folorunso Adewole
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan, Nigeria
- University College Hospital, Ibadan, Nigeria
| | - Avram Denburg
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beverley M Essue
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Straiton N, Moons P, Verstrael A, Liu M, Winter MM. Beyond validation: getting wearable activity trackers into cardiovascular care-a discussion paper. Eur J Cardiovasc Nurs 2024; 23:685-689. [PMID: 38345842 DOI: 10.1093/eurjcn/zvae019] [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: 01/15/2024] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 04/24/2024]
Abstract
This paper addresses the challenge of integrating wearable activity trackers (WATs) into cardiovascular disease care. Despite evidence supporting the use of trackers for monitoring and promoting physical activity, implementation challenges persist in clinical settings. The paper emphasizes the lack of systematic, evidence-based implementation approaches for integrating trackers. It underscores the urgent need for stakeholder collaboration between clinicians, patients, implementation scientists, researchers, health and technology partners, and the use of proven implementation science methodologies. This is crucial for bridging the gap and ensuring effective translation of WATs into cardiovascular care, meeting the increasing demand from patients and clinicians.
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Affiliation(s)
- Nicola Straiton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, Level 5, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Kapucijnenvoer 7 PB7001, 3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Arvid Wallgrens backe 1, 413 46 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Klipfontein Rd, Rondebosch, 7700 Cape Town, South Africa
| | - Axel Verstrael
- ESC Patient's Platform, European Society of Cardiology, Les Templiers, 2035 route des colles, CS 80179 Biot, 06903 Sophia Antipolis Cedex, France
| | - Mark Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, Level 5, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW 2010, Australia
- Faculty of Medicine and Health, University of Sydney, New South Wales 2006, Australia
| | - Michiel M Winter
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105 Amsterdam, The Netherlands
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Hussen SA, Byrd RN, Doraivelu K, Moore SJ, Camp DM, Wood-Palmer D, Kalokhe AS, Farber EW, Ali MK. Pre-implementation planning to enhance integration of HIV and behavioral health care services at two Ryan White-funded HIV care centers. Transl Behav Med 2024:ibae046. [PMID: 39236876 DOI: 10.1093/tbm/ibae046] [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] [Indexed: 09/07/2024] Open
Abstract
Behavioral health conditions are disproportionately experienced by people living with Human immunodeficiency virus (HIV), including young Black gay, bisexual, and other men who have sex with men (GBMSM). Left unaddressed, these symptoms can adversely impact HIV care outcomes. Improving the integration of behavioral health and HIV care services has been proposed as a strategy to address this challenge. To conduct a pre-implementation study exploring barriers and facilitators to improving HIV and behavioral health care integration at two HIV clinics in Atlanta, Georgia. We conducted a mixed-methods study guided by the Consolidated Framework for Implementation Research (CFIR). Sixty (60) HIV care providers, behavioral health care providers, and social service providers participated in cross-sectional surveys, and a subset of survey participants (15) also participated in a qualitative in-depth interview to explore CFIR constructs in greater depth. We focused on Intervention Characteristics, Outer Setting, and Inner Setting as the most relevant CFIR domains. Within each of these domains, we identified both facilitators and barriers to improving HIV and behavioral care integration in the two clinics. Participants agreed that enhancing integration would provide a relative advantage over current practice, would address young Black GBMSM and other patient needs, and would be compatible with the organizational mission. However, they also expressed concerns about complexity, resource availability, and priority relative to other clinic initiatives. Participants were enthusiastic about improving care integration but also invoked practical challenges to translating this idea into practice. Future research should test specific implementation strategies and their potential effectiveness for improving the integration of behavioral health and HIV care, as a strategy for improving well-being among young Black GBMSM and other people living with HIV.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Rosalind N Byrd
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Shamia J Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Daniel M Camp
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Drew Wood-Palmer
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Ameeta S Kalokhe
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, USA
| | - Eugene W Farber
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA
- Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, USA
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McCormack J, Noble C, Rutherford S, Ross LJ, Bialocerkowski A. Integrating the sustainable development goals into health professions' curricula: using the nominal group technique to guide their contextualisation. BMC MEDICAL EDUCATION 2024; 24:972. [PMID: 39237919 PMCID: PMC11378502 DOI: 10.1186/s12909-024-05968-0] [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: 01/08/2024] [Accepted: 08/28/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND To embed the Sustainable Development Goals in health profession education, educators must contextualise them to their profession and geographical region. This study used the nominal group technique to contextualise the SDGs for Australian nutrition and dietetics tertiary education programs by determining the specific knowledge, skills, and values required for graduating dietitians to practise sustainably. METHODS In 2022, 23 experts in food and sustainability attended a group session that employed the nominal group technique to discuss the Sustainable Development Goals knowledge, skills, and values Australian dietetic students should develop. After the group session, participants ranked the Sustainable Development Goals according to their perceived level of importance for student dietitians. These data were analysed using multi-methods, including a summation of the rankings, directed qualitative content analysis and reflexive thematic analysis. RESULTS The three highest-priority Sustainable Development Goals identified were (1) Zero Hunger, (2) Good Health and Well-Being, and (3) Responsible Consumption and Production, which were then considered with the qualitative findings. The main categories that were generated from the content analysis reflected the broad knowledge, skills, and values student dietitians should develop. The preliminary codes provided specific details for each of the main categories. The thematic analysis generated two additional themes: the importance of Indigenous ways of knowing, being and doing, and authentic experiential learning activities. CONCLUSIONS The method employed for this study provides a useful framework for health professions to contextualise the Sustainable Development Goals to their profession and geographical region. For this study, the ranking process and the qualitative data analysis enabled the Sustainable Development Goals to be reframed in a way that would be meaningful for dietetic educators and students and demonstrate the interrelatedness of the goals. The direct qualitative content analysis and reflexive thematic analysis identified the knowledge, skills, and values student dietitians should develop.
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Affiliation(s)
- Joanna McCormack
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia.
| | - Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, Australia
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Lynda J Ross
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
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Al Raiisi F, Cunningham S, Stewart D. A qualitative, theory-based exploration of facilitators and barriers for implementation of pharmacist prescribing in chronic kidney disease. Int J Clin Pharm 2024:10.1007/s11096-024-01794-y. [PMID: 39230784 DOI: 10.1007/s11096-024-01794-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 08/14/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND While there is an accumulation of evidence that pharmacist prescribing is safe and effective, there is a lack of research on processes of implementation into practice, particularly for patients with complex clinical conditions such as chronic kidney disease (CKD). AIM The aim was to explore the facilitators and barriers to the implementation of pharmacist prescribing for patients with CKD in the United Kingdom (UK). METHOD Semi-structured interviews were conducted with UK Renal Pharmacy Group members who were independent prescribers. The Consolidated Framework for Implementation Research (CFIR) underpinned the interview schedule. Interviews were recorded, transcribed, and independently coded by two researchers. A thematic approach was used for analysis, with data generation continuing until saturation of themes. Ethical approval was granted. RESULTS Data saturation was achieved following 14 interviews. Most interviewees were female (n = 11), all had secondary care as their main practice setting, and were highly experienced prescribers with 8 having 11 or more years of prescribing practice. Interviewees were positive regarding the development of their prescribing practice. Facilitators and barriers emerged across all 5 of the CFIR domains. Key facilitators were aspects of inner setting (e.g., organisational support and communication) while key barriers were also related to inner setting, specifically the need for adequate structural and financial resources. CONCLUSION This theory-based study has illuminated the facilitators and barriers for the implementation of pharmacist prescribing in CKD. There is a need to consider the resources required for implementation of prescribing practice at an early stage of planning and development.
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Affiliation(s)
- Fatma Al Raiisi
- Oman College of Health Sciences - Pharmacy programme, Muscat, Oman.
| | - Scott Cunningham
- Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland
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Wilcox S, Saunders RP, Kaczynski AT, Rudisill AC, Stucker J, Kinnard D, McKeever BW, Day KR, Parker-Brown J, Kim YS. Constructs from the Consolidated Framework for Implementation Research associated with church enrollment and intervention adoption in a national implementation study of a faith-based organizational change intervention. BMC Public Health 2024; 24:2401. [PMID: 39232686 PMCID: PMC11373172 DOI: 10.1186/s12889-024-19832-9] [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: 02/02/2024] [Accepted: 08/19/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Organizational adoption is a key but understudied step in translating evidence-based interventions into practice. The purpose of this study was to report recruitment strategies and factors associated with church enrollment and intervention adoption in a national implementation study of the Faith, Activity, and Nutrition (FAN) program. METHODS We worked with partners using multiple strategies to disseminate intervention availability. Interested churches completed an online form. To enroll, the church coordinator (FAN coordinator) and pastor completed baseline surveys and then received intervention online training access. We compared enrolled vs. non-enrolled churches on how they heard about the study and church characteristics. We compared intervention-adopting vs. non-adopting churches on Consolidated Framework for Implementation Research (CFIR) constructs using Fisher's exact tests, χ2, or independent sample t-tests and reported differences where p < 0.10, d≥|0.35|, or the difference in percentage points was ≥ 10. RESULTS We received 226 interest forms; 107 churches enrolled, and 85 churches adopted the intervention. Faith-based sources were the most, and paid media the least, effective in reaching churches, which were largely from the southeast with a Methodist or Baptist tradition (no differences by enrollment status). Enrolled churches were less likely to have 500 + worshipers and more likely to have attended a study information session than non-enrolled churches. Church (CFIR inner setting) and FAN coordinator characteristics, but not intervention characteristics, were related to intervention adoption. CONCLUSION Partnerships, relationships, and "face time" are important for enrolling churches in evidence-based interventions. Church and church coordinator characteristics are related to intervention adoption. Further work on adoption conceptualization and operationalization is needed.
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Affiliation(s)
- Sara Wilcox
- Prevention Research Center and Department of Exercise Science, University of South Carolina, Columbia, SC, 29208, USA.
| | - Ruth P Saunders
- Prevention Research Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, USA
| | - A Caroline Rudisill
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, USA
| | - Jessica Stucker
- Prevention Research Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Deborah Kinnard
- Prevention Research Center, University of South Carolina, Columbia, SC, 29208, USA
| | - Brooke W McKeever
- Department of Advertising and Public Relations, University of Alabama, Tuscaloosa, AL, 35487, USA
| | - Kelsey R Day
- University of Virginia School of Medicine, Charlottesville, VA, 22903, USA
| | - Jasmin Parker-Brown
- Prevention Research Center and Department of Exercise Science, University of South Carolina, Columbia, SC, 29208, USA
| | - Ye Sil Kim
- Prevention Research Center, University of South Carolina, Columbia, SC, 29208, USA
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Schaefers A, Xin L, Butler P, Gardner J, MacMillan Uribe AL, Rethorst CD, Rolke L, Seguin-Fowler RA, Szeszulski J. Relationship between the inner setting of CFIR and the delivery of the Healthy School Recognized Campus initiative: a mixed-methods analysis. Implement Sci Commun 2024; 5:96. [PMID: 39232800 PMCID: PMC11375957 DOI: 10.1186/s43058-024-00627-3] [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: 01/29/2024] [Accepted: 08/01/2024] [Indexed: 09/06/2024] Open
Abstract
INTRODUCTION Healthy School Recognized Campus (HSRC) is a Texas A&M AgriLife Extension initiative that promotes the delivery of multiple evidence-based physical activity and nutrition programs in schools. Simultaneous delivery of programs as part of HSRC can result in critical implementation challenges. The study examines how the inner setting constructs from the Consolidated Framework for Implementation Research (CFIR) impact HSRC program delivery. METHODS We surveyed (n = 26) and interviewed (n = 20) HSRC implementers (n = 28) to identify CFIR inner setting constructs related to program acceptability, appropriateness, and feasibility. Using a concurrent mixed-methods design, we coded interviews using the CFIR codebook, administered an inner setting survey, tested for relationships between constructs and implementation outcomes via chi-square tests, and compared quantitative and qualitative results. RESULTS Stakeholders at schools that implemented one program vs. more than one program reported no differences in acceptability, appropriateness, or feasibility outcomes (p > .05); however, there was a substantial difference in reported program minutes (1118.4 ± 951.5 vs. 2674.5 ± 1940.8; p = .036). Available resources and leadership engagement were related to HSRC acceptability (r = .41; p = .038 and r = .48; p = .012, respectively) and appropriateness (r = .39; p = .046 and r = 0.63; p = .001, respectively). Qualitative analyses revealed that tangible resources (e.g., curriculum, a garden) enabled implementation, whereas intangible resources (e.g., lack of time) hindered implementation. Participants also stressed the value of buy-in from many different stakeholders. Quantitative results revealed that implementation climate was related to HSRC acceptability (r = .46; p = .018), appropriateness (r = .50; p = .009), and feasibility (r = .55; p = .004). Learning climate was related to HSRC appropriateness (r = .50; p = .009). However, qualitative assessment of implementation climate subconstructs showed mixed perspectives about their relationship with implementation, possibly due to differences in the compatibility/priority of different programs following COVID-19. Networks/communication analysis showed that schools have inner and outer circles of communication that can either benefit or hinder implementation. CONCLUSION Few differences were found by the number of programs delivered. Implementation climate (i.e., compatibility, priority) and readiness for implementation (i.e., resources and leadership engagement) were important to HSRC implementation. Strategies that focus on reducing time-related burdens and engaging stakeholders may support HSRC's delivery. Other constructs (e.g., communication, access to knowledge) may be important to the implementation of HSRC but need further exploration.
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Affiliation(s)
- Allyson Schaefers
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA
| | - Lucy Xin
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA
| | - Paula Butler
- Texas A&M AgriLife Extension, 600 John Kimbrough Boulevard, College Station, TX, 77843, USA
| | - Julie Gardner
- Texas A&M AgriLife Extension, 600 John Kimbrough Boulevard, College Station, TX, 77843, USA
- Texas 4-H Youth Development, 1470 William D Fitch Parkway, College Station, TX, 77845, USA
| | - Alexandra L MacMillan Uribe
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA
| | - Chad D Rethorst
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA
| | - Laura Rolke
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA
- Department of Population and Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC, 27701, USA
| | - Rebecca A Seguin-Fowler
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 1500 Research Parkway, Centeq Building B, College Station, TX, 77845, USA
| | - Jacob Szeszulski
- Institute for Advancing Health Through Agriculture (IHA), Texas A&M University, 17360 Coit Rd, Dallas, TX, 75252, USA.
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Siegling C, Mertins E, Wefer F, Bolte C, Krüger L. [Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01175-3. [PMID: 39231839 DOI: 10.1007/s00063-024-01175-3] [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: 04/29/2024] [Revised: 07/04/2024] [Accepted: 07/27/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND In the Federal Republic of Germany, it has been possible for some years to study (intensive) nursing care alongside further training in intensive care and anaesthesia. This results in a nursing skill-grade mix in the intensive care unit (ICU), which nursing management must consider. OBJECTIVES The aim is to show the development and implementation of a new nursing management structure in the ICU and also provide an overview of the parallel role development with preliminary results at a university hospital. MATERIALS AND METHODS Within a working group of nursing management, a narrative analysis of the current situation was carried out with close involvement of the ICU ward managers and the staff units for nursing development, further education and nursing education. The content was organized into subject areas and a new management model was subsequently developed. The evaluation took place narratively within the context of employee interviews. RESULTS The management model in the ICU was divided into the areas of nursing management, nursing education, and nursing science as a management triangle. Nursing management is staffed by at least two people as ward managers and deputies, while the nursing education and science team leaders have equal decision-making powers in terms of shared governance. The respective specialist departments work together within the hospital in networks with other ICUs. Other specialist roles such as primary nurses, advanced practice nurses, heart failure nurses or practical instructors are given specific contact persons in the management team to match their tasks, which was viewed positively. CONCLUSIONS The development of nursing practice can be promoted through close co-operation within the management team.
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Affiliation(s)
- Christian Siegling
- Pflegedirektor, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Georgstraße 11, 32345, Bad Oeynhausen, Deutschland.
| | - Esther Mertins
- Stv. Pflegedirektorin/Pflegedienstleiterin, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Franziska Wefer
- Stabsstelle Pflegeentwicklung, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
- Institut für Pflegewissenschaft, Medizinische Fakultät und Universitätsklinik Köln, Universität zu Köln, Köln, Deutschland
| | - Christina Bolte
- Stabsstelle Fort- und Weiterbildung, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Lars Krüger
- Stabsstelle Projekt- und Wissensmanagement/Pflegeentwicklung Intensivpflege, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinikum der Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
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Nguyen OT, Vo SD, Lee T, Cato KD, Cho H. Implementation and delivery of electronic health records training programs for nurses working in inpatient settings: a scoping review. J Am Med Inform Assoc 2024:ocae228. [PMID: 39225789 DOI: 10.1093/jamia/ocae228] [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: 04/15/2024] [Revised: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES Well-designed electronic health records (EHRs) training programs for clinical practice are known to be valuable. Training programs should be role-specific and there is a need to identify key implementation factors of EHR training programs for nurses. This scoping review (1) characterizes the EHR training programs used and (2) identifies their implementation facilitators and barriers. MATERIALS AND METHODS We searched MEDLINE, CINAHL, PsycINFO, and Web of Science on September 3, 2023, for peer-reviewed articles that described EHR training program implementation or delivery to nurses in inpatient settings without any date restrictions. We mapped implementation factors to the Consolidated Framework for Implementation Research. Additional themes were inductively identified by reviewing these findings. RESULTS This review included 30 articles. Healthcare systems' approaches to implementing and delivering EHR training programs were highly varied. For implementation factors, we observed themes in innovation (eg, ability to practice EHR skills after training is over, personalizing training, training pace), inner setting (eg, availability of computers, clear documentation requirements and expectations), individual (eg, computer literacy, learning preferences), and implementation process (eg, trainers and support staff hold nursing backgrounds, establishing process for dissemination of EHR updates). No themes in the outer setting were observed. DISCUSSION We found that multilevel factors can influence the implementation and delivery of EHR training programs for inpatient nurses. Several areas for future research were identified, such as evaluating nurse preceptorship models and developing training programs for ongoing EHR training (eg, in response to new EHR workflows or features). CONCLUSIONS This scoping review highlighted numerous factors pertaining to training interventions, healthcare systems, and implementation approaches. Meanwhile, it is unclear how external factors outside of a healthcare system influence EHR training programs. Additional studies are needed that focus on EHR retraining programs, comparing outcomes of different training models, and how to effectively disseminate updates with the EHR to nurses.
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Affiliation(s)
- Oliver T Nguyen
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, FL 32611, United States
- Department of Industrial and Systems Engineering, University of Wisconsin at Madison, Madison, WI 53706, United States
| | - Steven D Vo
- Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL 33612, United States
| | - Taeheon Lee
- Department of Biotechnology, Ghent University Global Campus, Incheon 21985, South Korea
| | - Kenrick D Cato
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, United States
- Department of Pediatric Data and Analytics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Hwayoung Cho
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, Gainesville, FL 32611, United States
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Bjørbak Alnæs M, Skodvin B, Anker Jahnsen J, Kalleklev Velure G, Oppegaard O, Reiakvam Kittang B, Storaas T, Aase Schaufel M. "What if the patient has a severe reaction, and it is my fault?" A qualitative study exploring factors for sustainable implementation of penicillin allergy delabelling. Antimicrob Resist Infect Control 2024; 13:97. [PMID: 39218954 PMCID: PMC11368001 DOI: 10.1186/s13756-024-01456-8] [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: 06/17/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Penicillin allergy delabelling (PAD), the process of evaluating penicillin allergy labels, is a key target in antibiotic stewardship, but uptake of the procedure outside clinical studies is limited. We aimed to explore factors that need to be addressed to sustainably implement a clinical pathway for PAD. METHODS We conducted a qualitative study based on semi-structured interviews with focus groups consisting of a purposive sample of twenty-five nurses and physicians working in four different hospitals in Western Norway. Systematic text condensation was applied for analysis. RESULTS Psychological safety was reported as crucial for clinicians to perform PAD. A narrative of uncertainty and anticipated negative outcomes were negatively associated with PAD performance. Education, guidelines, and colleague- and leadership support could together create psychological safety and empower health personnel to perform PAD. Key factors for sustainable implementation of PAD were facilitating the informant's profound motivation for providing optimal health care and for reducing antimicrobial resistance. Informants were motivated by the prospect of a simplified PAD procedure. We identified three main needs for implementation of PAD: (1) creating psychological safety; (2) utilising clinicians' inherent motivation and (3) optimal organisational structures. CONCLUSION A planned implementation of PAD must acknowledge clinicians' need for psychological safety and aid reassurance through training, leadership, and guidelines. To implement PAD as an everyday practice it must be minimally disruptive and provide a contextually adaptive logistic chain. Also, the clinician's motivation for providing the best possible healthcare should be utilised to aid implementation. The results of this study will aid sustainable implementation of PAD in Norway. ETHICS The study was approved by the Western Norway Regional Committee for Medical Research Ethics (Study No:199210).
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Affiliation(s)
- Marie Bjørbak Alnæs
- Section of Clinical Allergy, Department of Occupational Medicine, Haukeland University Hospital, Bergen, 5020, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway.
| | - Brita Skodvin
- The Norwegian Advisory Unit for Antibiotic use in Hospitals, 5020, Bergen, Norway
| | - Jan Anker Jahnsen
- Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
- Regional Medicines Information and Pharmacovigilance Centre (RELIS Vest), University Hospital, Haukeland, Bergen, Norway
| | - Grete Kalleklev Velure
- Section of Clinical Allergy, Department of Occupational Medicine, Haukeland University Hospital, Bergen, 5020, Norway
| | - Oddvar Oppegaard
- Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, 5020, Norway
| | - Bård Reiakvam Kittang
- Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
- Haraldsplass Deaconess Hospital, Bergen, 5009, Norway
- Department of Nursing Home Medicine, Fyllingsdalen, 5145, Norway
| | - Torgeir Storaas
- Section of Clinical Allergy, Department of Occupational Medicine, Haukeland University Hospital, Bergen, 5020, Norway
| | - Margrethe Aase Schaufel
- Department of Clinical Medicine, University of Bergen, Bergen, 5021, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, 5020, Norway
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Kagwanja N, Molyneux S, Whyle E, Tsofa B, Leli H, Gilson L. Power and positionality in the practice of health system responsiveness at sub-national level: insights from the Kenyan coast. Int J Equity Health 2024; 23:177. [PMID: 39223623 PMCID: PMC11367973 DOI: 10.1186/s12939-024-02258-5] [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: 05/16/2024] [Accepted: 08/21/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Health system responsiveness to public priorities and needs is a broad, multi-faceted and complex health system goal thought to be important in promoting inclusivity and reducing system inequity in participation. Power dynamics underlie the complexity of responsiveness but are rarely considered. This paper presents an analysis of various manifestations of power within the responsiveness practices of Health Facility Committees (HFCs) and Sub-county Health Management Teams (SCHMTs) operating at the subnational level in Kenya. Kenyan policy documents identify responsiveness as an important policy goal. METHODS Our analysis draws on qualitative data (35 interviews with health managers and local politicians, four focus group discussions with HFC members, observations of SCHMT meetings, and document review) from a study conducted at the Kenyan Coast. We applied a combination of two power frameworks to interpret our findings: Gaventa's power cube and Long's actor interface analysis. RESULTS We observed a weakly responsive health system in which system-wide and equity in responsiveness were frequently undermined by varied forms and practices of power. The public were commonly dominated in their interactions with other health system actors: invisible and hidden power interacted to limit their sharing of feedback; while the visible power of organisational hierarchy constrained HFCs' and SCHMTs' capacity both to support public feedback mechanisms and to respond to concerns raised. These power practices were underpinned by positional power relationships, personal characteristics, and world views. Nonetheless, HFCs, SCHMTs and the public creatively exercised some power to influence responsiveness, for example through collaborations with political actors. However, most resulting responses were unsustainable, and sometimes undermined equity as politicians sought unfair advantage for their constituents. CONCLUSION Our findings illuminate the structures and mechanisms that contribute to weak health system responsiveness even in contexts where it is prioritised in policy documents. Supporting inclusion and participation of the public in feedback mechanisms can strengthen receipt of public feedback; however, measures to enhance public agency to participate are also needed. In addition, an organisational environment and culture that empowers health managers to respond to public inputs is required.
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Affiliation(s)
- Nancy Kagwanja
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Eleanor Whyle
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Benjamin Tsofa
- Health Systems and Research Ethics Department, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Hassan Leli
- County Department of Health, Kilifi County Government, Kilifi, Kenya
| | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, Western Cape, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Gonzalez CJ, Kapadia SN, Niederdeppe J, Dharia A, Talal AH, Lloyd AR, Franco R, Labossiere S, Shapiro MF, Wethington E. The State of Hepatitis C Elimination from the Front Lines: A Qualitative Study of Provider-Perceived Gaps to Treatment Initiation. J Gen Intern Med 2024; 39:2268-2276. [PMID: 38782810 PMCID: PMC11347520 DOI: 10.1007/s11606-024-08807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Hepatitis C (HCV) is a curable chronic infection, but lack of treatment uptake contributes to ongoing morbidity and mortality. State and national strategies for HCV elimination emphasize the pressing need for people with HCV to receive treatment. OBJECTIVE To identify provider-perceived barriers that hinder the initiation of curative HCV treatment and elimination of HCV in the USA. APPROACH Qualitative semi-structured interviews with 36 healthcare providers who have evaluated patients with HCV in New York City, Western/Central New York, and Alabama. Interviews, conducted between 9/2021 and 9/2022, explored providers' experiences, perceptions, and approaches to HCV treatment initiation. Transcripts were analyzed using hybrid inductive and deductive thematic analysis informed by established health services and implementation frameworks. KEY RESULTS We revealed four major themes: (1) Providers encounter professional challenges with treatment provision, including limited experience with treatment and perceptions that it is beyond their scope, but are also motivated to learn to provide treatment; (2) providers work toward building streamlined and inclusive practice settings-leveraging partnerships with experts, optimizing efficiency through increased access, adopting inclusive cultures, and advocating for integrated care; (3) although at times overwhelmed by patients facing socioeconomic adversity, increases in public awareness and improvements in treatment policies create a favorable context for providers to treat; and (4) providers are familiar with the relative advantages of improved HCV treatments, but the reputation of past treatments continues to deter elimination. CONCLUSIONS To address the remaining barriers and facilitators providers experience in initiating HCV treatment, strategies will need to expand educational initiatives for primary care providers, further support local infrastructures and integrated care systems, promote public awareness campaigns, remove prior authorization requirements and treatment limitations, and address the negative reputation of outdated HCV treatments. Addressing these issues should be considered priorities for HCV elimination approaches at the state and national levels.
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Affiliation(s)
- Christopher J Gonzalez
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Jeff Niederdeppe
- Cornell Jeb E. Brooks School of Public Policy and Department of Communication, Cornell University, Ithaca, NY, USA
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrew H Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Audrey R Lloyd
- Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ricardo Franco
- Department of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephane Labossiere
- Department of Health Studies & Applied Educational Psychology, Columbia University, New York, NY, USA
| | - Martin F Shapiro
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Elaine Wethington
- Department of Psychology, College of Human Ecology, Cornell University, Ithaca, NY, USA
- Department of Sociology, College of Arts and Sciences, Cornell University, Ithaca, NY, USA
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Rigler N, Averbach S, Sandoval S, Hildebrand M, Mody SK. Barriers and Facilitators of Extended Use of the Contraceptive Implant: A Cross-Sectional Survey of Clinicians. Womens Health Issues 2024; 34:480-487. [PMID: 38811280 DOI: 10.1016/j.whi.2024.04.003] [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: 08/25/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND The U.S. Food and Drug Administration (FDA) approved the etonogestrel contraceptive implant for 3 years of use. Evidence suggests that it may be used for up to 5 years for pregnancy prevention, also known as extended use. METHODS We conducted a national cross-sectional survey among a group of reproductive health clinicians. We developed an online survey using the Consolidated Framework for Implementation Research (CFIR) and distributed it through e-mail listservs and social media groups from May to June 2021. We analyzed results using multivariable logistical regression. RESULTS Among the 300 respondents, 195 (65.0%) reported that they always offer extended use, and 50 (16.7%) reported that they sometimes offer extended use. Fifty-five respondents (18.3%) reported that they never offer extended use. After adjusting for age, gender, and clinical setting, we found that complex family planning sub-specialists (adjusted odds ratio [aOR] = 9.32; 95% confidence interval [CI] [1.81, 48.03]) and family medicine physicians (aOR = 4.37, 95% CI [1.58, 12.10]) were significantly more likely to recommend extended use compared with general obstetrics and gynecology (OBGYN) physicians. Clinicians from private practices or health maintenance organizations were significantly less likely to offer extended use than those from academic centers (aOR = 0.19, 95% CI [0.07, 0.51]; aOR = 0.06, 95% CI [0.01, 0.31]). The most common barriers to offering extended use were concerns about pregnancy risk, bleeding, and lack of FDA approval past 3 years. Meanwhile, clinicians identified strong published evidence supporting extended use as a key facilitator for offering it, and they perceived that prior counseling on extended use from a past clinician was a key facilitator for patients to adopt it. CONCLUSIONS One-third of clinicians in this study did not consistently offer extended use of the contraceptive implant. An opportunity exists to expand access to extended use by focusing on education interventions for clinicians and seeking FDA approval for 5 years of use.
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Affiliation(s)
- Nicole Rigler
- School of Medicine, University of California San Diego, San Diego, California
| | - Sarah Averbach
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California; Center on Gender Equity and Health, University of California, San Diego, San Diego, California
| | - Selina Sandoval
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Marisa Hildebrand
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California
| | - Sheila K Mody
- Division of Complex Family Planning, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, California.
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Mercier AM, Allison MK, Greulich J, Alston A, Racher ML. Occupational Exposure to Aerosolized Human Papillomavirus: Assessing and Addressing Perceptions of and Barriers to Vaccination of at-Risk Health Care Workers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:681-687. [PMID: 39041764 DOI: 10.1097/phh.0000000000001908] [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: 07/24/2024]
Abstract
OBJECTIVES This study aimed to assess current vaccination rates among health care workers at risk for occupational human papillomavirus (HPV) exposure and explore factors that influence decisions about HPV vaccination. DESIGN Using a mixed-methods design, this study included a questionnaire and qualitative focus groups. SETTING The study took place at an academic medical center. PARTICIPANTS Participants were 37 health care professionals in occupations at risk for workplace HPV exposure. MAIN OUTCOME MEASURES The primary qualitative outcome measured was HPV vaccination status. The primary qualitative outcomes assessed were perceptions of occupational HPV exposure risk, protective measures, and HPV vaccination. RESULTS Most participants were female (86.5%, n = 32) and younger than 35 years (51.4%; n = 19) and therefore would have been eligible to receive the HPV vaccine series as a teenager or young adult. Nearly two-thirds (67.6%; n = 25) of participants had received the HPV vaccine; of those, half were vaccinated as teenagers (52%; n = 13). One-third (n = 4) of those vaccinated as adults reported vaccination due to workplace HPV exposure. Focus groups revealed themes consistent with the Health Belief Model. Most participants recognized their risk of aerosolized HPV exposure in the workplace but felt uneducated about occupational exposure risk and protective measures. Many participants recognized risk of exposure through surgical smoke but perceived that risk was stratified by medical specialty, proximity to surgical field, and personal protective equipment use. Many participants had some level of concern for head and neck lesions with exposure to aerosolized HPV. Most participants recognized the need to protect themselves against workplace HPV exposure. Those who were vaccinated felt that they were better protected against HPV exposure. Almost all participants said that they had not received formal education on workplace HPV exposure risk. Many participants voiced perceived barriers to HPV vaccination. CONCLUSION Health care workers encounter the HPV virus in a myriad of fields and procedures. Our mixed-methods study demonstrated that at-risk health care workers feel uninformed about their risk of HPV exposure in the workplace, availability of HPV vaccination, and appropriate protective equipment recommendations.
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Affiliation(s)
- Ann Marie Mercier
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Drs Mercier, Greulich, Alston, and Racher); and Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas (Dr Allison)
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Kalra N, Verma P, Verma S. Advancements in AI based healthcare techniques with FOCUS ON diagnostic techniques. Comput Biol Med 2024; 179:108917. [PMID: 39059212 DOI: 10.1016/j.compbiomed.2024.108917] [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: 04/16/2024] [Revised: 07/15/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024]
Abstract
Since the past decade, the interest towards more precise and efficient healthcare techniques with special emphasis on diagnostic techniques has increased. Artificial Intelligence has proved to be instrumental in development of various such techniques. The various types of AI like ML, NLP, RPA etc. are being used, which have streamlined and organised the Electronic Health Records (EHR) along with aiding the healthcare provider with decision making and sample and data analysis. This article also deals with the 3 major categories of diagnostic techniques - Imaging based, Pathology based and Preventive diagnostic techniques and what all changes and modifications were brought upon them, due to use of AI. Due to such a high demand, the investment in AI based healthcare techniques has increased substantially, with predicted market size of almost 188 billon USD by 2030. In India itself, AI in healthcare is expected to raise the GDP by 25 billion USD by 2028. But there are also several challenges associated with this like unavailability of quality data, black box issue etc. One of the major challenges is the ethical considerations and issues during use of medical records as it is a very sensitive document. Due to this, there is several trust issues associated with adoption of AI by many organizations. These challenges have also been discussed in this article. Need for further development in the AI based diagnostic techniques is also done in the article. Alongside, the production of such techniques and devices which are easy to use and simple to incorporate into the daily workflows have immense scope in the upcoming times. The increasing scope of Clinical Decision Support System, Telemedicine etc. make AI a promising field in the healthcare and diagnostics arena. Concluding the article, it can be said that despite the presence of various challenges to the implementation and usage, the future prospects for AI in healthcare is immense and work needs to be done in order to ensure the availability of resources for same so that high level of accuracy can be achieved and better health outcomes can be provided to patients. Ethical concerns need to be addressed for smooth implementation and to reduce the burden of the developers, which has been discussed in this narrative review article.
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Affiliation(s)
- Nishita Kalra
- Department of Pharmaceutical Chemistry/Analysis, Delhi Pharmaceutical Sciences & Research University, Pushp Vihar, Sector 3, New Delhi, 110017, India
| | - Prachi Verma
- Department of Pharmaceutical Chemistry/Analysis, Delhi Pharmaceutical Sciences & Research University, Pushp Vihar, Sector 3, New Delhi, 110017, India
| | - Surajpal Verma
- Department of Pharmaceutical Chemistry/Analysis, Delhi Pharmaceutical Sciences & Research University, Pushp Vihar, Sector 3, New Delhi, 110017, India.
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Clark K, Messineo E, Bryant-Stephens T, Song A, Marx D, Lieberman A, Beidas RS, Wolk CB. Evaluating the implementation of a community health worker-delivered intervention integrating asthma care in West Philadelphia public schools. J Asthma 2024; 61:940-950. [PMID: 38299937 PMCID: PMC11291702 DOI: 10.1080/02770903.2024.2313146] [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: 11/02/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVE Schools are an important setting because students spend much of their time in school and engage in physical activity during the school day that could exacerbate asthma symptoms. Our objective is to understand the barriers and facilitators to implementing an experimental community health worker-delivered care coordination program for students with asthma within the context of the West Philadelphia Controls Asthma study. METHODS Surveys (n = 256) and semi-structured interviews (n = 41) were completed with principals, teachers, nurses, and community health workers from 21 public and charter schools in West Philadelphia between January 2019 and September 2021. Survey participants completed the Evidence Based Practice Attitudes Scale, the Implementation Leadership Scale, and Organizational Climate Index. Semi-structured qualitative interview guides were developed, informed by the Consolidated Framework for Implementation Research. RESULTS Participant responses indicate that they perceived benefits for schools and students related to the community health worker-based care coordination program. Several barriers and facilitators to implementing the program were noted, including challenges associated with incorporating the program into school nurse workflow, environmental triggers in the school environment, and challenges communicating with family members. An important facilitator that was identified was having supportive school administrators and staff who were engaged and saw the benefits of the program. CONCLUSIONS This work can inform implementation planning for other locales interested in implementing community-based pediatric asthma control programs delivered by community health workers in schools.
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Affiliation(s)
- Kayla Clark
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Elizabeth Messineo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | | | | | - Darby Marx
- Joan & Sanford I. Weill Medical College of Cornell University, New York, NY
| | - Adina Lieberman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Blackwell SE. Using the 'Leapfrog' Design as a Simple Form of Adaptive Platform Trial to Develop, Test, and Implement Treatment Personalization Methods in Routine Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:686-701. [PMID: 38316652 PMCID: PMC11379800 DOI: 10.1007/s10488-023-01340-4] [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] [Accepted: 12/21/2023] [Indexed: 02/07/2024]
Abstract
The route for the development, evaluation and dissemination of personalized psychological therapies is complex and challenging. In particular, the large sample sizes needed to provide adequately powered trials of newly-developed personalization approaches means that the traditional treatment development route is extremely inefficient. This paper outlines the promise of adaptive platform trials (APT) embedded within routine practice as a method to streamline development and testing of personalized psychological therapies, and close the gap to implementation in real-world settings. It focuses in particular on a recently-developed simplified APT design, the 'leapfrog' trial, illustrating via simulation how such a trial may proceed and the advantages it can bring, for example in terms of reduced sample sizes. Finally it discusses models of how such trials could be implemented in routine practice, including potential challenges and caveats, alongside a longer-term perspective on the development of personalized psychological treatments.
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Affiliation(s)
- Simon E Blackwell
- Department of Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Kurze-Geismar-Str.1, 37073, Göttingen, Germany.
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Danan ER, Amundson EC, Gowdy-Jaehnig A, Friedman JK, Pratt R, Krebs EE, Spoont M, Ackland PE. "It Feels Like Health Care with the Patient in Mind": VA Patient and Staff Perspectives on Self-Collected HPV Testing. Womens Health Issues 2024; 34:518-527. [PMID: 38890078 DOI: 10.1016/j.whi.2024.05.003] [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: 01/22/2024] [Revised: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE Self-collected testing for human papillomavirus (HPV) is poised to transform cervical cancer screening. Self-tests demonstrate similar accuracy to clinician-collected tests, but for the half a million women served by the Veterans Health Administration (VA) and their clinicians, self-collected cervical cancer screening would be a new practice. We examined VA patient and staff perspectives to inform future implementation. METHODS Semi-structured telephone interviews were conducted between 2021 and 2022 with female veterans receiving VA care (n = 22) and VA women's health nurses, clinicians, and administrators (n = 27). Interviews were audio-recorded and transcribed. Interview questions addressed knowledge and interest, potential advantages or disadvantages, and any questions participants had about self-collected screening. Responses were analyzed using rapid qualitative methods. MAIN FINDINGS Five overarching themes were identified. Both patients and staff indicated high interest and enthusiasm for self-collected HPV testing, tempered by questions about test accuracy and logistical considerations. Familiarity with self-testing for other conditions such as colon-cancer screening or COVID made self-collection seem like a simple, convenient option. However, self-testing was not viewed as a good fit for all patients, and concerns about lost opportunities or missed incidental lesions were raised. Patients and staff described challenges with pelvic examinations for patients with past sexual trauma, particularly in the male-dominated VA environment. Pelvic exams can leave patients feeling vulnerable and exposed; self-collected testing was seen as a mechanism for patient empowerment. PRINCIPAL CONCLUSIONS Veteran patients and VA staff shared common perspectives about potential advantages and disadvantages of self-collected HPV testing. Self-collected HPV testing has the potential to improve trauma-informed preventive health care for veterans.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Erin C Amundson
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Alexandra Gowdy-Jaehnig
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota
| | - Jessica K Friedman
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Greater Los Angeles VA Health Care System, Los Angeles, California
| | - Rebekah Pratt
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Erin E Krebs
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michele Spoont
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Princess E Ackland
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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Smale EM, Verkerk EW, Heerdink ER, Egberts TCG, van den Bemt BJF, Bekker CL. Barriers and facilitators to implement the redispensing of unused oral anticancer drugs in clinical care: A hybrid-effectiveness type I study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 15:100493. [PMID: 39263193 PMCID: PMC11388756 DOI: 10.1016/j.rcsop.2024.100493] [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: 03/26/2024] [Revised: 08/12/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024] Open
Abstract
Background Minimizing medication waste through the redispensing of oral anticancer drugs (OADs) that were unused by patients provides economic and environmental benefits, but this is not yet universally implemented in clinical care. ObjectiveS To identify barriers and facilitators to the implementation of redispensing unused OADs in clinical care. Methods A multicentre intervention study following a hybrid effectiveness-implementation type I design was conducted, consisting of semi-structured interviews with key stakeholders involved in the redispensing program: pharmacy employees, prescribing clinicians in oncology and haematology, patients who participated in redispensing and patients who declined trial participation. Questions encompassed experiences and suggestions for future implementation. The Consolidated Framework for Implementation Research (CFIR) guided data collection and categorisation of identified barriers and facilitators through thematic analysis. Results In total, 35 interviews were conducted, identifying 15 themes encompassing barriers and facilitators, reflecting all CFIR domains. Facilitators encompassed: 1) convenient process requiring an acceptable time-investment; 2) support from project leaders and implementation champions; 3) being well-motivated by personal values and societal impact; 4) feeling ensured of medication quality upon redispensing; 5) endorsement by healthcare providers for patient participation; 6) clear and personal patient communication; 7) good visibility of intervention successes; and 8) implementation well supported through a collaborative network. Barriers encompassed: 1) unclear target population; 2) redispensing legally prohibited; 3) absence of financial compensation for pharmacies; 4) complexity arising from two parallel work processes; 5) widespread communication on adjustments within local teams challenging; 6) patient's low receptiveness due to burden of oncology treatment; and 7) lack of familiarization among pharmacy technicians. Conclusions Facilitators for implementation of redispensing unused drugs mainly related to people's values, motivation, and societal demand, whereas barriers mainly encompassed practical issues, including knowledge, time, financial resources, and legal conditions. Strategies emphasizing the benefits of redispensing and further streamlining process compatibility could support implementation.
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Affiliation(s)
- Elisabeth M Smale
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
| | - Eva W Verkerk
- Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands
| | - Eibert R Heerdink
- University Medical Centre Utrecht, Division of Laboratory, Genetics and Pharmacy, Department of Clinical Pharmacy, Utrecht, the Netherlands
- Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, the Netherlands
- Utrecht University of Applied Medical Centre Utrecht, Research Group Innovations of Pharmaceutical Care, Utrecht, the Netherlands
| | - Toine C G Egberts
- University Medical Centre Utrecht, Division of Laboratory, Genetics and Pharmacy, Department of Clinical Pharmacy, Utrecht, the Netherlands
- Utrecht University, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, the Netherlands
| | - Bart J F van den Bemt
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
- Sint Maartenskliniek, Department of Pharmacy, Ubbergen, the Netherlands
| | - Charlotte L Bekker
- Radboud University Medical Center, Department of Pharmacy, Nijmegen, the Netherlands
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Scheffler A, Klocker L, Puls A, Hummers E, Demmer I. [Facilitators and barriers to the implementation of health promotion in daycare centers and elementary schools based on four selected projects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:1021-1030. [PMID: 39164394 DOI: 10.1007/s00103-024-03935-0] [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: 01/16/2024] [Accepted: 07/11/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Health promotion (HP) is a complex, politically required task. The quality of implementation correlates with the effectiveness of health promotion initiatives. Successful implementation requires consideration of contextual conditions, which tend to be neglected in effectiveness studies. The aim is to identify success factors and obstacles to the implementation of HP in daycare centers and elementary schools based on 4 projects (Fit fürs Leben, fit für pisa +, Buchprojekt Sonnige Traurigtage, and The Daily Mile) in the Göttingen/South Lower Saxony region. The effects of the COVID-19 pandemic are assumed to be relevant for the implementation of these projects. METHODS In 24 semi-structured interviews and 2 focus group discussions between August 2021 and March 2022, practitioners were asked about the implementation of the four projects in their areas of activity. After transcription, the interviews were analyzed using qualitative content analysis. The Consolidated Framework for Implementation Research supported the analysis. RESULTS A total of 22 groups of factors were identified, on the basis of which 22 recommendations for action for GF implementation were formulated. Success factors at the individual and intervention level were at the forefront. The COVID-19 pandemic had a positive impact on the importance of HP, even though its feasibility was hampered. DISCUSSION Numerous findings on the implementation of HP in children's living environments were confirmed by the study. The high significance of the individual factors is striking, which could be due to the survey of interviewees being familiar with the projects. The study results contribute to the further development of implementation strategies in HP.
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Affiliation(s)
- Anna Scheffler
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Laura Klocker
- Gesundheitsregion Göttingen/Südniedersachsen, Göttingen, Deutschland
| | - Angelika Puls
- Gesundheitsamt für Stadt und Landkreis Göttingen, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Iris Demmer
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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Coe JL, Morgan MH, Rehberg K, Kranzler EC, Ingersoll R, Namrow N, Huber-Krum S. Evaluating the implementation of family-centered substance use treatment for pregnant and postpartum people: A mixed-methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209409. [PMID: 38768816 PMCID: PMC11300141 DOI: 10.1016/j.josat.2024.209409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Family-centered substance use treatment (FCSUT) approaches for pregnant and postpartum people have the potential to prevent intergenerational transmission of adverse childhood experiences (ACEs). Guided by two theoretical frameworks drawn from implementation science (the Consolidated Framework for Implementation Research [CFIR] and the Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] framework), this study used a mixed methods approach to answer: (1) What is the extent to which FCSUT approaches are offered for pregnant and postpartum people seeking substance use disorder (SUD) treatment? and (2) How are FCSUT approaches for pregnant and postpartum people implemented? METHODS This study utilized a sequential mixed methods design that began with quantitative data collection followed by qualitative data collection. The quantitative component consisted of service provision surveys of facilities that provided FCSUT to pregnant and postpartum people (n = 118). The qualitative component consisted of semi-structured in-depth interviews with administrators and providers working at FCSUT facilities (n = 26) and pregnant and postpartum people who were currently receiving or had previously received services in the last two years from FCSUT facilities (n = 27). The qualitative findings were used to deepen understanding of the quantitative findings. RESULTS Findings from the quantitative survey of treatment facilities' FCSUT provision revealed that while most facilities offered services related to substance use treatment, behavioral health, and parenting skills development or parent training, a smaller proportion offered services related to prenatal and postpartum health, sexual and reproductive health, and family-related services. Qualitative in-depth interviews with program administrators and providers and pregnant and postpartum people who had participated in FCSUT programs revealed major themes around expanding reach of facilities by maintaining participants' familial connections, resources for implementation and maintenance of FCSUT, the importance of program adaptation, and gaps in service delivery. CONCLUSIONS Results indicated there is a wide range of FCSUT services offered at treatment facilities across the United States. Furthermore, while many pregnant and postpartum people expressed positive experiences with FCSUT, there are some areas that should be considered for future progress to be made.
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Affiliation(s)
- Jesse L Coe
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Harbert Morgan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | - Sarah Huber-Krum
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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