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Oche O, Murry LT, Keller MS, Pevnick JM, Schnipper JL, Nguyen AT, Ko EM, Kennelty KA. Pharmacist, nurse, and physician perspectives on the implementation of the pharmacist discharge care (pharm-dc) intervention: A qualitative study. Res Social Adm Pharm 2024; 20:740-746. [PMID: 38744561 PMCID: PMC11235093 DOI: 10.1016/j.sapharm.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits which has been implemented at two hospitals in the United States. The objectives of this study were to: 1) explore perspectives surrounding the PHARM-DC program from healthcare providers, leaders, and administrators at both institutions, and 2) identify factors which may contribute to intervention success and sustainability. METHODS Focus groups and interviews were conducted with pharmacists, physicians, nurses, hospital leaders, and pharmacy administrators at two institutions in the Northeastern and Western United States. Interviews were audio recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Thematic analysis was performed using an iterative process, with two study authors independently coding transcripts to identify themes. RESULTS Overall, 37 individuals participated in ten focus groups and seven interviews. The themes identified included: 1) Organizational, Pharmacist, and Patient Factors Contributing to Transitions of Care, 2) Medication Challenges in Transitions of Care at Admission and Discharge, 3) Transitions of Care Communication and Discharge Follow-up, and 4) Opportunities for Improvement and Sustainability. The four themes were mapped to the constructs of the CFIR and RE-AIM frameworks. Some factors facilitating intervention success and sustainability were accurate medication histories collected on admission, addressing medication barriers before discharge, coordinating discharge using electronic health record discharge features, and having a structured process for intervention training and delivery. Barriers to intervention implementation and sustainability included gaps in communication with other care team members, and variable pharmacist skills for delivering the intervention. This study identified that using educational resources to standardize the TOC process addressed the issue of variations in pharmacists' skills for delivering TOC interventions. CONCLUSIONS Nurses, physicians, pharmacists, pharmacist leaders, and hospital administrators were in agreement regarding the usefulness of the PHARM-DC intervention, while acknowledging challenges in its implementation and opportunities for improvement. Future research should focus on developing training materials to standardize and scale the intervention, eliminating barriers to medication access pre-discharge, coordinating discharge across care team members, and communicating medication changes to primary care providers post-discharge.
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Affiliation(s)
- Onyeche Oche
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States.
| | - Logan T Murry
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States.
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
| | - Joshua M Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - Jeffrey L Schnipper
- Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - An T Nguyen
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - EunJi Michelle Ko
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, United States.
| | - Korey A Kennelty
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States; The University of Iowa College of Medicine, Department of Family Medicine, United States.
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Stevens J, Scherrens AL, Pype P, Deliens L, De Vleminck A, Pardon K. Experiences with implementing advance care planning (ACP-GP) in Belgian general practice in the context of a cluster RCT: a process evaluation using the RE-AIM framework. BMC PRIMARY CARE 2024; 25:247. [PMID: 38971761 PMCID: PMC11227713 DOI: 10.1186/s12875-024-02510-5] [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: 11/07/2023] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND General practice is often recommended as an ideal setting to initiate advance care planning (ACP), but uptake of ACP in this setting is low. ACP-GP is a complex intervention to facilitate ACP for patients with chronic, life-limiting illness in Belgian general practice. It aims to increase patient ACP engagement and general practitioner (GP) ACP self-efficacy. In a cluster-randomized controlled trial, the intervention was not superior to control in increasing these outcomes. A parallel process evaluation aimed to enhance understanding of how the intervention was implemented, and which factors might have influenced trial results. METHODS We conducted a mixed-methods process evaluation following the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Data sources include recruitment and implementation monitoring, questionnaires for patients and GPs, and semi-structured (focus group) interviews with patients and GPs. Questionnaire data were analyzed descriptively. Qualitative data were first analyzed inductively; themes were then assigned deductively to RE-AIM dimensions. RESULTS Thirty-five GPs and 95 patients were recruited to the trial; GP reach was low. Sixteen GPs and 46 patients provided questionnaire data at 3 months post-baseline; qualitative data were transcribed for 14 GPs and 11 patients. Adoption of intervention components was moderate to good, with the exception of the documentation template for GPs. Interviews revealed varying patient attitudes towards ACP, but patients nonetheless emphasized that conversations made them feel reassured. GPs especially valued a positive framing of ACP. When adopted, the intervention was well-implemented and participant satisfaction was high. However, intention for maintenance was moderate, with GPs raising questions of how to sustainably implement ACP conversations in the future. CONCLUSIONS Implementing the complex ACP-GP intervention in general practice is feasible, and can be successful. However, the implementation process is challenging and the sustainability is suboptimal. Our findings will guide future research and recommendations for facilitating and implementing ACP in general practice. TRIAL REGISTRATION ISRCTN12995230; prospectively registered on 19/06/2020.
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Affiliation(s)
- Julie Stevens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium.
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium.
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium.
| | - Anne-Lore Scherrens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Gent, 9000, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
| | - Koen Pardon
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Laarbeeklaan 103, Brussels, 1090, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, 1090, Belgium
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Ferguson EF, Barnett ML, Goodwin JW, Vernon TW. "There is No Help:" Caregiver Perspectives on Service Needs for Adolescents and Adults with Profound Autism. J Autism Dev Disord 2024:10.1007/s10803-024-06451-x. [PMID: 38963473 DOI: 10.1007/s10803-024-06451-x] [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: 06/21/2024] [Indexed: 07/05/2024]
Abstract
The underrepresentation of individuals with profound autism (who require 24/7 access to care) in autism research has resulted in limited knowledge about their service needs and a lack of evidence-based practices tailored to those needs. This study explored caregiver perspectives on service needs, barriers to accessing care, and treatment priorities to guide treatment development and improvement of service delivery. A sequential mixed-methods design integrated quantitative survey data (n = 423; Mage = 18.89 years; 26.7% female) with qualitative interviews (n = 20) with caregivers of adolescents and adults with profound autism. Quantitative findings indicated regular socialization opportunities were the most frequently endorsed unmet service need (60.3% of caregivers), followed by primary health care with autism-trained staff (59.3%), social skills instruction (55.8%), life skills instruction (51.3%), and behavioral support (47.3%). Higher likelihood of needing social activity groups was associated with elevated emotional reactivity, higher language level, minoritized ethnicity, and lower household income. Greater need for specialized primary health care was associated with lower income, while the need for social and life skills instruction was associated with increased age and elevated dysphoria. Qualitative analysis identified 10 themes that converged and expanded quantitative findings by highlighting a pervasive shortage of individualized, goal-oriented services, common barriers to care, and the priority of developing centralized treatment settings that coordinate care throughout adulthood. This study identified pressing service needs for adolescents and adults with profound autism in the United States. These insights are crucial for improving the accessibility and quality of clinical care.
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Affiliation(s)
- Emily F Ferguson
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, 401 Quarry Rd, Stanford, CA, 94305-5719, USA.
| | | | | | - Ty W Vernon
- University of California, Santa Barbara, CA, USA
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Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024:ibae030. [PMID: 38907663 DOI: 10.1093/tbm/ibae030] [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: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
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Donald C, Rajani K, Singer M, Skye M, Craig Rushing S, Kelley A, Morgan B, Zaback T, Becker T, Lambert W. A Qualitative Review of Barriers and Facilitators Identified While Implementing the Native Students Together Against Negative Decisions Curriculum in a Multisite Dissemination and Implementation Study. HEALTH EDUCATION & BEHAVIOR 2024; 51:425-435. [PMID: 36124442 DOI: 10.1177/10901981221123228] [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] [Indexed: 11/16/2022]
Abstract
Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum. METHODS We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND. RESULTS We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest. DISCUSSION The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress. CONCLUSION EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings.
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Affiliation(s)
| | - Kavita Rajani
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Megan Skye
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Brittany Morgan
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Tosha Zaback
- Oregon Health & Science University, Portland, OR, USA
| | - Thomas Becker
- Northwest Portland Area Indian Health Board, Portland, OR, USA
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Ojute F, Gonzales PA, Berler M, Puente N, Johnston B, Singh D, Edwards A, Lin J, Lebares C. Identifying Novel Inhibitors of Workplace Support and the Importance of Value Congruence and Feeling Valued in General Surgery Residency Training. JOURNAL OF SURGICAL EDUCATION 2024; 81:804-815. [PMID: 38658309 DOI: 10.1016/j.jsurg.2024.02.008] [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: 08/23/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To explore residents' perceptions of workplace support inhibitors and their relationship to resident wellbeing. We aim to provide evidence-based targets to inform future work operationalizing support in surgical training. DESIGN This is a 2-part mixed-methods cross-sectional study. Part 1 analyzed qualitative data from focus groups (April 2021-May 2022). Part 2 comprised an online survey (informed by findings in Part 1, May 2022) to assess the association between perceived workplace support (e.g. feeling valued and value congruence) and poor individual global wellbeing (e.g. languishing). SETTING National multi-center study including 16 ACGME-accredited academic programs. PARTICIPANTS General surgery residents at all training levels, both clinical and research years. RESULTS 28 residents participated in the focus groups which revealed three major themes around perceived inhibitors of workplace support: lack of trust in residency program (e.g. ulterior motives), poor communication from leadership (e.g. lack of transparency, ineffective dialogue), and unfair systems in residency training (e.g. exploitation of residents, paternal leave policies). These themes emphasized the importance of feeling valued and value congruence, with the latter reflected in the form of trust and communication with leadership, a key element of worker-workplace alignment. 251 residents responded to the survey (response rate 31%, 50.6% women) which revealed that a lower sense of feeling valued and lower perceived value congruence were significantly associated with languishing. CONCLUSIONS Our findings suggest feeling valued and value congruence (specifically, having trust and communication with leadership) are important targets for increasing workplace support in surgical training, offering evidence-based targets for future work to operationalize support in surgical training.
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Affiliation(s)
- Feyisayo Ojute
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Paul Adam Gonzales
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Michael Berler
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Nicole Puente
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Brianna Johnston
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Damin Singh
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Anya Edwards
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Joseph Lin
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carter Lebares
- UCSF Center of Mindfulness in Surgery, Department of Surgery, University of California San Francisco, San Francisco, California.
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Phuong J, Moles R, Mason D, White C, Center J, Carter S. Osteoporosis screening in Australian community pharmacies: A mixed methods study. Health Promot J Austr 2024. [PMID: 38778716 DOI: 10.1002/hpja.876] [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: 11/03/2023] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
ISSUES ADDRESSED Osteoporosis and poor bone health impact a large proportion of the Australian population, but is drastically underdiagnosed and undertreated. Community pharmacies are a strategic location for osteoporosis screening services due to their accessibility and the demographic profile of customers. The aim of this study was to develop, implement and evaluate a community pharmacy health promotion service centred on encouraging consumers to complete an anonymous osteoporosis screening survey called Know Your Bones. METHODS The implementation process was documented using the REAIM (reach, effectiveness, adoption, implementation, maintenance) framework. Uptake of the Know Your Bones screening tool was monitored anonymously with website traffic. Surveys and interviews were designed to capture consumer outcomes after screening. Semi-structured interviews were conducted with Australian community pharmacy stakeholders during design and implementation phases to explore their perspectives of the barriers and facilitators. RESULTS The service was implemented in 27 community pharmacies. There were 448 visits to the screening website. Interviews were conducted with 41 stakeholders. There were a range of factors that appeared to influence implementation of the service. Perceived acceptability was critical, which depended on staff training, pharmacists' altruism, and remuneration. Staff relied heavily on their existing close relationships with consumers. No consumers completed non-anonymous surveys or agreed to participate in interviews post-screening. CONCLUSION Using an implementation science approach, a community pharmacy osteoporosis screening service for the Australian context was designed and found to be acceptable to pharmacy staff and effective in reaching the target population. SO WHAT?: This low-cost and non-invasive health promotion has potential to sustainably increase national screening rates for osteoporosis.
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Affiliation(s)
- Jonathan Phuong
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Rebekah Moles
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Mason
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Christopher White
- Department of Endocrinology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jacqueline Center
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Stephen Carter
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Salvador-Carulla L, Woods C, de Miquel C, Lukersmith S. Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist. Heliyon 2024; 10:e29930. [PMID: 38726201 PMCID: PMC11078766 DOI: 10.1016/j.heliyon.2024.e29930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Background Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.
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Affiliation(s)
| | | | - Carlota de Miquel
- University of Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Spain
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Raeside R, Todd A, Sim KA, Kang M, Mihrshahi S, Gardner LA, Champion KE, Skinner J, Laranjo L, Steinbeck K, Redfern J, Partridge SR. Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders. Front Public Health 2024; 12:1389739. [PMID: 38765492 PMCID: PMC11100413 DOI: 10.3389/fpubh.2024.1389739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Background Chronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders' support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation. Methods Qualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis. Findings Nineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed. Interpretation Stakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.
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Affiliation(s)
- Rebecca Raeside
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Allyson Todd
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A. Sim
- Metabolism & Obesity Service, Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Melissa Kang
- General Practice Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Lauren A. Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katrina E. Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Katharine Steinbeck
- Specialty of Child and Adolescent Health, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R. Partridge
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Bennett RJ, Bucks RS, Saulsman L, Pachana NA, Eikelboom RH, Meyer CJ. Evaluation of the Ask-Inform-Manage-Encourage-Refer Intervention and Its Implementation Targeting the Provision of Mental Wellbeing Support Within the Audiology Setting. Ear Hear 2024; 45:600-616. [PMID: 38148508 DOI: 10.1097/aud.0000000000001452] [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: 12/28/2023]
Abstract
OBJECTIVES The ask, inform, manage, encourage, refer (AIMER) program is a behavior change intervention designed to increase the frequency with which hearing healthcare clinicians (HHCs) ask about and provide information regarding mental wellbeing within adult audiology services. The objective of this study was to systematically evaluate the first iteration of the AIMER program to determine whether the intervention achieved the changes in HHC behaviors anticipated and to evaluate feasibility of implementing the AIMER program based on the implementation protocol. DESIGN The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide this evaluation. Data were collected from October 2020 to February 2022 and included both quantitative and qualitative measures (i.e., observation reports, staff surveys, clinical diaries, clinical file audits, and interviews). RESULTS Comparison between pre- and post-implementation data showed that the AIMER intervention successfully increased: (i) HHC's skills and confidence for discussing mental wellbeing; (ii) how often HHCs ask about mental wellbeing within audiology consultations; (iii) how often HHCs provide personalized information and support regarding mental wellbeing within audiology consultations; and (iv) how often HHCs use mental wellbeing terms within clinical case notes and general practitioner reports. The factors affecting feasibility of implementing the AIMER program within the clinical setting could be classified into three major categories: (i) the AIMER program itself and its way of delivery to clinical staff; (ii) people working with the AIMER program; and (iii) contextual factors. Key recommendations to improve future implementation of the AIMER program were provided by the participants. CONCLUSIONS The AIMER program was shown to be effective at increasing the frequency with which HHCs ask about and provide information regarding mental wellbeing within routine audiological service delivery. Implementation of the AIMER program was feasible but leaves room for improvement. Use of the reach, effectiveness, adoption, implementation, and maintenance framework facilitated systematic evaluation of multiple indicators providing a broad evaluation of the AIMER program. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve future scale-up of the AIMER program. The findings of this study will be used to further adapt and improve the AIMER program and to enhance program implementation strategies before its further dissemination.
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Affiliation(s)
- Rebecca J Bennett
- National Acoustic Laboratories, Sydney, Australia
- Ear Science Institute Australia, Subiaco, Australia
- Centre for Ear Sciences, The University of Western Australia, Perth, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Romola S Bucks
- The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Lisa Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, Australia
- Centre for Ear Sciences, The University of Western Australia, Perth, Australia
- Department of Speech Language Pathology and Audiology, University of Pretoria, South Africa
| | - Carly J Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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Richards JA, Kuo E, Stewart C, Shulman L, Parrish R, Whiteside U, Boggs JM, Simon GE, Rowhani-Rahbar A, Betz ME. Reducing Firearm Access for Suicide Prevention: Implementation Evaluation of the Web-Based "Lock to Live" Decision Aid in Routine Health Care Encounters. JMIR Med Inform 2024; 12:e48007. [PMID: 38647319 PMCID: PMC11063417 DOI: 10.2196/48007] [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: 04/07/2023] [Revised: 10/12/2023] [Accepted: 02/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background "Lock to Live" (L2L) is a novel web-based decision aid for helping people at risk of suicide reduce access to firearms. Researchers have demonstrated that L2L is feasible to use and acceptable to patients, but little is known about how to implement L2L during web-based mental health care and in-person contact with clinicians. Objective The goal of this project was to support the implementation and evaluation of L2L during routine primary care and mental health specialty web-based and in-person encounters. Methods The L2L implementation and evaluation took place at Kaiser Permanente Washington (KPWA)-a large, regional, nonprofit health care system. Three dimensions from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model-Reach, Adoption, and Implementation-were selected to inform and evaluate the implementation of L2L at KPWA (January 1, 2020, to December 31, 2021). Electronic health record (EHR) data were used to purposefully recruit adult patients, including firearm owners and patients reporting suicidality, to participate in semistructured interviews. Interview themes were used to facilitate L2L implementation and inform subsequent semistructured interviews with clinicians responsible for suicide risk mitigation. Audio-recorded interviews were conducted via the web, transcribed, and coded, using a rapid qualitative inquiry approach. A descriptive analysis of EHR data was performed to summarize L2L reach and adoption among patients identified at high risk of suicide. Results The initial implementation consisted of updates for clinicians to add a URL and QR code referencing L2L to the safety planning EHR templates. Recommendations about introducing L2L were subsequently derived from the thematic analysis of semistructured interviews with patients (n=36), which included (1) "have an open conversation," (2) "validate their situation," (3) "share what to expect," (4) "make it accessible and memorable," and (5) "walk through the tool." Clinicians' interviews (n=30) showed a strong preference to have L2L included by default in the EHR-based safety planning template (in contrast to adding it manually). During the 2-year observation period, 2739 patients reported prior-month suicide attempt planning or intent and had a documented safety plan during the study period, including 745 (27.2%) who also received L2L. Over four 6-month subperiods of the observation period, L2L adoption rates increased substantially from 2% to 29% among primary care clinicians and from <1% to 48% among mental health clinicians. Conclusions Understanding the value of L2L from users' perspectives was essential for facilitating implementation and increasing patient reach and clinician adoption. Incorporating L2L into the existing system-level, EHR-based safety plan template reduced the effort to use L2L and was likely the most impactful implementation strategy. As rising suicide rates galvanize the urgency of prevention, the findings from this project, including L2L implementation tools and strategies, will support efforts to promote safety for suicide prevention in health care nationwide.
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Affiliation(s)
- Julie Angerhofer Richards
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Elena Kuo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Christine Stewart
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Lisa Shulman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Rebecca Parrish
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
| | - Ursula Whiteside
- NowMattersNow.org, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Jennifer M Boggs
- Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, United States
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Mental Health & Wellness, Kaiser Permanente Washington, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA, United States
| | - Marian E Betz
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States
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12
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Chasco EE, Van Tiem J, Johnson N, Balkenende E, Steffen M, Jones D, Friberg JE, Steffensmeier K, Moeckli J, Arora K, Rabin BA, Reisinger HS. RE-AIM for rural health innovations: perceptions of (mis) alignment between the RE-AIM framework and evaluation reporting in the Department of Veterans Affairs Enterprise-Wide Initiatives program. FRONTIERS IN HEALTH SERVICES 2024; 4:1278209. [PMID: 38655394 PMCID: PMC11035780 DOI: 10.3389/frhs.2024.1278209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
Background The Department of Veterans Affairs (VA) Office of Rural Health (ORH) supports national VA program offices' efforts to expand health care to rural Veterans through its Enterprise-Wide Initiatives (EWIs) program. In 2017, ORH selected Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM), an implementation science framework, to structure the EWI evaluation and reporting process. As part of its mandate to improve EWI program evaluation, the Center for the Evaluation of Enterprise-Wide Initiatives conducted a qualitative evaluation to better understand EWI team' perceptions of, and barriers and facilitators to, the EWI evaluation process. Methods We conducted 43 semi-structured interviews with 48 team members (e.g., evaluators, program office leads, and field-based leads) representing 21 EWIs from April-December 2020. Questions focused on participants' experiences using strategies targeting each RE-AIM dimension. Interviews were inductively analyzed in MAXQDA. We also systematically reviewed 51 FY19-FY20 EWI annual reports to identify trends in misapplications of RE-AIM. Results Participants had differing levels of experience with RE-AIM. While participants understood ORH's rationale for selecting a common framework to structure evaluations, the perceived misalignment between RE-AIM and EWIs' work emerged as an important theme. Concerns centered around 3 sub-themes: (1) (Mis)Alignment with RE-AIM Dimensions, (2) (Mis)Alignment between RE-AIM and the EWI, and (3) (Mis)Alignment with RE-AIM vs. other Theories, Models, or Frameworks. Participants described challenges differentiating between and operationalizing dimensions in unique contexts. Participants also had misconceptions about RE-AIM and its relevance to their work, e.g., that it was meant for established programs and did not capture aspects of initiative planning, adaptations, or sustainability. Less commonly, participants shared alternative models or frameworks to RE-AIM. Despite criticisms, many participants found RE-AIM useful, cited training as important to understanding its application, and identified additional training as a future need. Discussion The selection of a shared implementation science framework can be beneficial, but also challenging when applied to diverse initiatives or contexts. Our findings suggest that establishing a common understanding, operationalizing framework dimensions for specific programs, and assessing training needs may better equip partners to integrate a shared framework into their evaluations.
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Affiliation(s)
- Emily E. Chasco
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Jennifer Van Tiem
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Veterans Rural Health Resource Center-Iowa City (VRHRC-Iowa City), VA Office of Rural Health, Iowa City, IA, United States
| | - Nicole Johnson
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Veterans Rural Health Resource Center-Iowa City (VRHRC-Iowa City), VA Office of Rural Health, Iowa City, IA, United States
| | - Erin Balkenende
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Melissa Steffen
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - DeShauna Jones
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Julia E. Friberg
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Veterans Rural Health Resource Center-Iowa City (VRHRC-Iowa City), VA Office of Rural Health, Iowa City, IA, United States
| | - Kenda Steffensmeier
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Veterans Rural Health Resource Center-Iowa City (VRHRC-Iowa City), VA Office of Rural Health, Iowa City, IA, United States
| | - Jane Moeckli
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
| | - Kanika Arora
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, United States
| | - Borsika Adrienn Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- UC San Diego ACTRI Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States
| | - Heather Schacht Reisinger
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States
- Center for Access and Delivery Research and Evaluation, Iowa City VA Healthcare System, Iowa City, IA, United States
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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13
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Daniels B, McGinnis C, Topaz LS, Greenwald P, Turchioe MR, Creber RMM, Sharma R. Bridging the digital health divide-patient experiences with mobile integrated health and facilitated telehealth by community-level indicators of health disparity. J Am Med Inform Assoc 2024; 31:875-883. [PMID: 38269583 PMCID: PMC10990509 DOI: 10.1093/jamia/ocae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Evaluate the impact of community tele-paramedicine (CTP) on patient experience and satisfaction relative to community-level indicators of health disparity. MATERIALS AND METHODS This mixed-methods study evaluates patient-reported satisfaction and experience with CTP, a facilitated telehealth program combining in-home paramedic visits with video visits by emergency physicians. Anonymous post-CTP visit survey responses and themes derived from directed content analysis of in-depth interviews from participants of a randomized clinical trial of mobile integrated health and telehealth were stratified into high, moderate, and low health disparity Community Health Districts (CHD) according to the 2018 New York City (NYC) Community Health Survey. RESULTS Among 232 CTP patients, 55% resided in high or moderate disparity CHDs but accounted for 66% of visits between April 2019 and October 2021. CHDs with the highest proportion of CTP visits were more adversely impacted by social determinants of health relative to the NYC average. Satisfaction surveys were completed in 37% of 2078 CTP visits between February 2021 and March 2023 demonstrating high patient satisfaction that did not vary by community-level health disparity. Qualitative interviews conducted with 19 patients identified differing perspectives on the value of CTP: patients in high-disparity CHDs expressed themes aligned with improved health literacy, self-efficacy, and a more engaged health system, whereas those from low-disparity CHDs focused on convenience and uniquely identified redundancies in at-home services. CONCLUSIONS This mixed-methods analysis suggests CTP bridges the digital health divide by facilitating telehealth in communities negatively impacted by health disparities.
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Affiliation(s)
- Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Christina McGinnis
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Peter Greenwald
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
| | | | | | - Rahul Sharma
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065, United States
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14
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Milan FJ, Knight CJ, de Oliveira LM, Ciampolini V, Milistetd M. An integrative review of parent education approaches in sport: Considerations for program planning and evaluation. Scand J Med Sci Sports 2024; 34:e14620. [PMID: 38581216 DOI: 10.1111/sms.14620] [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: 11/08/2023] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/08/2024]
Abstract
In recent years, there has been an increase in the delivery and evaluation of parent education programs within youth sport. Subsequently, some recent reviews of these programs have been conducted. However, one consistent issue across many of the programs and associated review papers is the lack of an appropriate evaluation framework to guide the planning or associated reporting of the outcomes of the interventions. This has limited understanding of the overall impact of sport parenting interventions. Thus, the purposes of the current study were as follows: (a) to identify commonalities in the reporting and evaluation of parent education programs; (b) to identify gaps in the reporting and evaluation of parent education programs; (c) to draw these insights together to provide suggestions regarding how the RE-AIM could be used to enhance planning and evaluation of evidence-based programs for parent education in sport. Specifically, utilizing the RE-AIM framework to provide insights into pertinent evaluation metrics, this integrative review aimed to identify commonalities and gaps in the reporting of parent education programs. The RE-AIM framework considers the essential elements to assess the external and internal validity of interventions through five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance (Am J Public Health. 1999;89(9):1322-1327). Subsequently, the review aimed to provide suggestions regarding strategies to enhance the planning and evaluation of evidence-based programs for parent education in sport. Overall, the analysis demonstrated that most studies presented some pertinent evaluation information related to the RE-AIM framework, such as the number of participants and contacts made, the measures used, and the program level. However, the studies also lacked information on participant exclusion criteria, the method used to select the delivery agent (e.g., parents engaged in the program), and cost measures. Overall, the current study identified various areas where programs could be enhanced, specifically related to reporting procedural elements (e.g., program design, target population, and costs) pertaining to the implementation of parent education programs.
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Affiliation(s)
- Fabrício João Milan
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Camilla J Knight
- Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
- Department of Physical Education and Sport, University of Adger, Kristiansand, Norway
| | | | - Vitor Ciampolini
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Michel Milistetd
- Department of Physical Education, Federal University of Santa Catarina, Florianópolis, Brazil
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15
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Guzmán A, Orellana K, Ortega ML, Robledo LMG, Castro ST. Introducing a multicomponent staff training intervention to reduce antipsychotic medication: Care home management pre and post intervention views of systemic impact, and preliminary RE-AIM evaluation. EVALUATION AND PROGRAM PLANNING 2024; 103:102399. [PMID: 38194783 DOI: 10.1016/j.evalprogplan.2023.102399] [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: 02/23/2021] [Revised: 03/24/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES We explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes. METHOD We undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation. RESULTS Two pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members. CONCLUSION Funding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers' long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer's and other dementias plan.
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Affiliation(s)
- Azucena Guzmán
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Old Medical Quad, Teviot Place, Edinburgh EH8 9AG, United Kingdom.
| | - Katharine Orellana
- NIHR Policy Research Unit on Health & Social Care Workforce, The Policy Institute at King's, King's College London, Strand Campus, London WC2R 2LS, United Kingdom
| | - Mariana López Ortega
- National Institute of Geriatrics, Av. Contreras 428, San Jerónimo Lídice, Mexico City 10200, Mexico
| | | | - Sara Torres Castro
- National Institute of Geriatrics, Av. Contreras 428, San Jerónimo Lídice, Mexico City 10200, Mexico
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16
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Taylor JA, McDaniel CE, Stevens CA, Jacob-Files E, Acquilano SC, Freyleue SD, Bode R, Erdem G, Felman K, Lauden S, Bruce ML, Leyenaar JK. Direct Admission Program Implementation: A Qualitative Analysis of Variation Across Health Systems. Pediatrics 2024; 153:e2023063569. [PMID: 38533563 DOI: 10.1542/peds.2023-063569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Direct admission (DA) to the hospital has the potential to improve family satisfaction and timeliness of care by bypassing the emergency department. Using the RE-AIM implementation framework, we sought to characterize variation across health systems in the reach, effectiveness, adoption, and implementation of a DA program from the perspectives of parents and multidisciplinary clinicians. METHODS As part of a stepped-wedge cluster randomized trial to compare the effectiveness of DA to admission through the emergency department, we evaluated DA rates across 69 clinics and 3 health systems and conducted semi-structured interviews with parents and clinicians. We used thematic analysis to identify themes related to the reach, effectiveness, adoption, and implementation of the DA program and applied axial coding to characterize thematic differences across sites. RESULTS Of 2599 hospitalizations, 171 (6.6%) occurred via DA, with DA rates varying 10-fold across health systems from 0.9% to 9.3%. Through the analysis of 137 interviews, including 84 with clinicians and 53 with parents, we identified similarities across health systems in themes related to perceived program effectiveness and patient and family engagement. Thematic differences across sites in the domains of program implementation and clinician adoption included variation in transfer center efficiency, trust between referring and accepting clinicians, and the culture of change within the health system. CONCLUSIONS The DA program was adopted variably, highlighting unique challenges and opportunities for implementation in different hospital systems. These findings can inform future quality improvement efforts to improve transitions to the hospital.
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Affiliation(s)
- Jordan A Taylor
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Corrie E McDaniel
- Seattle Children's Hospital, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | | | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Seneca D Freyleue
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Ryan Bode
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
| | - Guliz Erdem
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
| | - Kristyn Felman
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Lauden
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
- University of Colorado, Department of Pediatrics, Denver, Colorado
| | - Martha L Bruce
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Health Children's, Lebanon, New Hampshire
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Health Children's, Lebanon, New Hampshire
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Vijayasingham L, Ansbro É, Zmeter C, Abbas LA, Schmid B, Sanga L, Larsen LB, Perone SA, Perel P. Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings. J Migr Health 2024; 9:100228. [PMID: 38577626 PMCID: PMC10992697 DOI: 10.1016/j.jmh.2024.100228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/08/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024] Open
Abstract
In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.
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Affiliation(s)
- Lavanya Vijayasingham
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Éimhín Ansbro
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carla Zmeter
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Linda Abou Abbas
- Beirut Delegation, International Committee for the Red Cross (ICRC) Beirut, Lebanon
| | - Benjamin Schmid
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Leah Sanga
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
| | | | - Sigiriya Aebischer Perone
- International Committee for the Red Cross (ICRC), Geneva, Switzerland
- Geneva University Hospitals, Geneva, Switzerland
| | - Pablo Perel
- NCD in Humanitarian Settings Group, Department of Epidemiology and Population Health & Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine, United Kingdom
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18
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Paniagua-Avila A, Shelton RC, Figueroa JC, Guzman AL, Gutierrez L, Hernandez-Galdamez DR, Ramirez JM, Rodriguez J, Irazola V, Ramirez-Zea M, Fort MP. Assessing the implementation of a multi-component hypertension program in a Guatemalan under-resourced dynamic context: an application of the RE-AIM/PRISM extension for sustainability and health equity. Implement Sci Commun 2024; 5:23. [PMID: 38491376 PMCID: PMC10941412 DOI: 10.1186/s43058-024-00560-5] [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: 01/10/2023] [Accepted: 02/20/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated rapid changes in healthcare delivery in Guatemala's public primary care settings. A new hypertension program, implemented as part of a type 2 hybrid trial since 2019, exemplifies an implementation effort amidst a changing context in an under-resourced setting. We assessed the implementation of an evidence-based intervention (EBI; protocol-based hypertension treatment) and one of its main implementation strategies (team-based collaborative care), raising implications for health equity and sustainability. We present innovative application of systems thinking visuals. METHODS Conducting a convergent mixed methods analysis, we assessed implementation in response to contextual changes across five Ministry of Health (MoH) districts at the pandemic's onset. Utilizing quantitative programmatic data and qualitative interviews with stakeholders (n=18; health providers, administrators, study staff), we evaluated dimensions of "Reach, Effectiveness, Adoption, Implementation and Maintenance," RE-AIM (Reach, Implementation delivery + adaptations), and "Practical Robust Implementation and Sustainability Model," PRISM (Organizational perspective on the EBI, Fit, Implementation and sustainability infrastructure) frameworks. We assessed representativeness by comparing participants to census data. To assess implementation delivery, we built behavior-over-time (BOT) graphs with quantitative programmatic data (July 2019-July 2021). To assess adaptations and contextual changes, we performed matrix-based thematic qualitative analysis. We converged quantitative implementation delivery data + qualitative adaptations data in joint displays. Finally, we analyzed qualitative and quantitative results across RE-AIM/PRISM and health districts to identify equity and sustainability considerations. RESULTS Contextual factors that facilitated program delivery included the perception that the EBI was beneficial, program champions, and staff communication. Key barriers to implementation delivery included competition with other primary care activities and limited implementation infrastructure (e.g., equipment, medications). Contextual changes related to COVID-19 hindered implementation delivery, threatened sustainability, and may have exacerbated inequities. However, adaptations that were planned enhanced implementation delivery and may have supported improved equity and sustainability. CONCLUSIONS Recognition of an EBI's benefits and program champions are important for supporting initial uptake. The ability to plan adaptations amid rapid contextual changes has potential advantages for sustainability and equitable delivery. Systems thinking tools and mixed methods approaches may shed light on the relations between context, adaptations, and equitable and sustainable implementation. TRIAL REGISTRATION NCT03504124.
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Affiliation(s)
- Alejandra Paniagua-Avila
- Epidemiology Department, Mailman School of Public Health, Columbia University, New York, NY, USA.
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Juan Carlos Figueroa
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
- Department of Epidemiology, Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, PA, USA
| | - Ana Lissette Guzman
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Laura Gutierrez
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Diego Rolando Hernandez-Galdamez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Juan Manuel Ramirez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Javier Rodriguez
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Meredith P Fort
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
- Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
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Loeb TB, Gholami M, Ramm K, Shedd K, Soetenga S, Jackson NJ, Chung UYR, Duru OK, Mangione CM, Hamilton AB, Moin T. Multilevel perceptions of the virtual delivery of the University of California Diabetes Prevention Program on RE-AIM domains due to COVID-19 mandates. Front Public Health 2024; 12:1327429. [PMID: 38525342 PMCID: PMC10959089 DOI: 10.3389/fpubh.2024.1327429] [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: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates. Methods We conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework. Results Among UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., "Zoom fatigue"); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP. Conclusion Perceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.
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Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Maryam Gholami
- Altman Clinical and Translational Research Institute (ACTRI), University of California, San Diego, San Diego, CA, United States
| | - Kate Ramm
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Kelly Shedd
- UCI Health, University of California, Irvine, Irvine, CA, United States
| | - Samantha Soetenga
- UCLA Campus Recreation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicholas J. Jackson
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Un Young Rebecca Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - O. Kenrik Duru
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Carol M. Mangione
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Alison B. Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Tannaz Moin
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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Beahm JD, McCall HC, Carleton RN, Jones N, Hadjistavropoulos HD. Examining how organizational leaders perceive internet-delivered cognitive behavioural therapy for public safety personnel using the RE-AIM implementation framework. Internet Interv 2024; 35:100718. [PMID: 38318086 PMCID: PMC10840103 DOI: 10.1016/j.invent.2024.100718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
Background Within Canada, internet-delivered cognitive behavioural therapy (ICBT) has recently been tailored by PSPNET to meet the needs of public safety personnel (PSP) to help address high rates of mental health problems within this population. Perceptions and outcomes of ICBT among PSP are promising, but it remains unknown how PSPNET is perceived by PSP organizational leaders. It is important to assess this gap because these leaders have significant potential to influence the uptake of ICBT. Methods In the current study, PSP leaders (n = 10) were interviewed to examine their perceptions of PSPNET and opportunities to improve ICBT implementation. The RE-AIM evaluation framework was used to assess PSP leaders' perceptions of PSPNET in terms of reach, effectiveness, adoption, implementation, and maintenance. Results The results evidenced that leaders perceived PSPNET as effective in reaching and serving PSP and PSP organizations. PSP leaders reported perceiving ICBT as effectively implemented, especially for being freely offered to individual PSP and for improving PSP's access to experienced therapists specifically trained to work with PSP. Participants indicated organizations have promoted and will continue promoting PSPNET longer-term, facilitating adoption and maintenance. Factors perceived as facilitating successful service delivery included building relationships and trust with PSP organizations and general support for PSP leadership mental health initiatives. PSP leaders identified perceived areas for improving ICBT implementation (e.g., ensuring leaders have access to data on PSPNET uptake and outcomes, creating promotional videos, expanding availability of PSPNET to other provinces, offering additional options for receiving therapist support). Implications Overall, the study provides insights into PSP leaders' perceptions of the implementation of ICBT among PSP and ideas for optimizing implementation efforts.
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Affiliation(s)
- Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Hugh C. McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nicholas Jones
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Department of Justice Studies, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
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Matthews E, Cowman M, Mulhare B, Banville E, Kissane S, Lederman O, Lowney P, Ronan F, Denieffe S. A qualitative evaluation of an exercise practitioner in an outpatient child and adolescent mental health service. Ir J Psychol Med 2024; 41:102-106. [PMID: 36239277 DOI: 10.1017/ipm.2022.45] [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: 11/05/2022]
Abstract
BACKGROUND Physical activity interventions can confer a range of physical and mental health benefits among young people with mental disorders. In some contexts, such as Ireland, integrated physical activity is not easily available within child and adolescent mental health services. Therefore, an interagency pilot intervention was established in a child and adolescent mental health service in Ireland with the integration of a novel exercise practitioner into the multidisciplinary mental health team. OBJECTIVE A qualitative evaluation was conducted to understand the impact of the pilot intervention and to understand issues of implementation that arose throughout. METHODS In-depth qualitative interviews with service users' parents/guardians (N = 3) and a single focus group with existing service providers (N = 3), framed by the RE-AIM framework were conducted to evaluate the pilot intervention. Data were analysed using thematic analysis to explore themes. RESULTS Three overarching themes were identified. These were as follows: (i) Making changes toward healthier physical activity behaviours; (ii) An intervention of therapeutic holism; and (iii) The integrated service delivery. CONCLUSIONS This research provides insight on the value of a novel integrated exercise practitioner in outpatient young persons' mental health services in Ireland, indicating an enhanced and complimentary therapeutic service. These findings will be helpful for integrating Exercise Practitioners in this setting going forward.
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Affiliation(s)
- Evan Matthews
- School of Health Science, South East Technological University, Waterford, Ireland
| | - Mary Cowman
- School of Health Science, South East Technological University, Waterford, Ireland
| | - Brian Mulhare
- School of Health Science, South East Technological University, Waterford, Ireland
- School of Humanities, South East Technological University, Waterford, Ireland
| | - Elaine Banville
- School of Humanities, South East Technological University, Waterford, Ireland
| | - Sheila Kissane
- Wexford Mental Health Services, The Health Service Executive, Wexford, Ireland
| | - Oscar Lederman
- Eastern Suburbs Mental Health Service, Coogee, New South Wales, Australia
- School of Health Science, University of New South Wales, Sydney, Australia
| | - Paula Lowney
- Health and Wellbeing, South East Community Healthcare, The Health Service Executive, Wexford, Ireland
| | - Fran Ronan
- Sports Active Wexford, Wexford County Council, Wexford, Ireland
| | - Suzanne Denieffe
- School of Humanities, South East Technological University, Waterford, Ireland
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Lava JB, Claro VD, Quiñon MS, Labis R, Marcelo W, Lucero MA, Mendoza O, Stan L. Integrating COVID-19 Vaccination in Primary Care Service Delivery: Insights From Implementation Research in the Philippines. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300202. [PMID: 38378272 PMCID: PMC10948126 DOI: 10.9745/ghsp-d-23-00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND In 2019, the Philippines enacted a universal health coverage law that aimed to establish an integrated health system centered around robust primary care as a core strategy of its health system reform agenda. Although the COVID-19 pandemic disrupted initial progress in the reform process, it also presented an opportunity to pilot interventions to demonstrate integration in various ways. METHODS We conducted a participatory implementation research study to integrate selected public health interventions into the implementation of the primary care benefit package funded by public health insurance. The study was conducted from October 2022 to April 2023 in the Province of Iloilo, Philippines. Entry points within the primary care service delivery process were identified, and interventions related to COVID-19 vaccination and family planning were implemented and monitored. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to organize the results and present the analysis. RESULTS The intervention showed substantial improvement across the 5 dimensions of the RE-AIM framework, including enhanced access to health care services, as indicated by improvements in primary care patient registration, family planning services, and COVID-19 vaccination processes, as well as an increase in registrations and first patient encounters. These improvements corresponded to sustained primary care facility participation throughout the study period. Additionally, emergent factors that either impeded or facilitated the integration process were identified, providing insights for effectively integrating COVID-19 vaccination within the primary care health system. CONCLUSION Our study provides evidence of the feasibility of integrating public health interventions into primary care settings. It highlights the potential of using existing primary care service delivery and financing mechanisms as entry points for integration. However, further iteration of the model is required to identify specific conditions for success that can be applied in other contexts and settings.
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Affiliation(s)
| | | | | | - Rodney Labis
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
| | - Wendel Marcelo
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
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Weiss CR, Roberts M, Florell M, Wood R, Johnson-Koenke R, Amura CR, Kissler K, Barton AJ, Jones J. Best Practices for Telehealth in Nurse-Led Care Settings-A Qualitative Study. Policy Polit Nurs Pract 2024; 25:47-57. [PMID: 37750219 PMCID: PMC10841034 DOI: 10.1177/15271544231201417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.
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Affiliation(s)
- Charlotte R. Weiss
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Mia Roberts
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Melissa Florell
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Wood
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Rachel Johnson-Koenke
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Claudia R. Amura
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Katherine Kissler
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Amy J. Barton
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado, Denver - Anschutz Medical Campus, Denver, CO, USA
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Gbaja-Biamila TA, Obiezu-Umeh C, Nwaozuru U, Oladele D, Engelhart A, Shato T, Mason S, Carter V, Iwelunmor-Ezepue J. Interventions connecting young people living in Africa to healthcare; a systematic review using the RE-AIM framework. FRONTIERS IN HEALTH SERVICES 2024; 4:1140699. [PMID: 38356690 PMCID: PMC10864512 DOI: 10.3389/frhs.2024.1140699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024]
Abstract
Introduction Africa's young people are among the least focused groups in healthcare linkage. The disproportionally high burden of youth-related health problems is a burden, especially in developing regions like Africa, which have a high population of young people. More information is needed about factors that impact linkages in healthcare and the sustainability of health interventions among young people in Africa. Methods A systematic literature search was performed from October 2020 to May 2022 in PubMed, CINAHL, Scopus, Global Health, and the Web of Science. Studies included in the review were conducted among young people aged 10-24 living in Africa, written in English, and published between 2011 and 2021. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data was analyzed using narrative synthesis, synthesizing the details of the RE-AIM reporting component. Interventions were systematically compared using the Cochrane Collaboration risk-of-bias tool to evaluate the rigor of each intervention. Results A total of 2,383 potentially relevant citations were obtained after an initial database search. Retained in the final group were seventeen articles from electronic data searches; among these articles, 16 interventions were identified. Out of the seventeen studies, nine (53%) were randomized controlled trials, three (18%) were quasi-experimental designs, and five (29%) were observational studies. At the same time, the included interventions were reported on 20 (76.92%) of the 26 components of the RE-AIM dimensions. In eastern Africa, twelve (80%) interventions were conducted, and all the interventions addressed linkage to care for young people in preventing and treating HIV. The least reported RE-AIM dimensions were implementing and maintaining interventions connecting young people to care. Discussion Timely care remains critical to treating and preventing ailments. This review indicates that interventions created to link young people to care, especially HIV care, can help link them to health care and strengthen the programs. It is also clear that further research with more extended follow-up periods is needed to examine connections to care in all other aspects of health and to bridge the gap between research and practice in the care of young people in Africa. Systematic Review Registration PROSPERO [CRD42022288227].
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Affiliation(s)
- Titilola Abike Gbaja-Biamila
- Clinical Sciences Department, Nigerian Institute of Medical research, Lagos, Nigeria
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Chisom Obiezu-Umeh
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David Oladele
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Alexis Engelhart
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Thembekile Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Stacey Mason
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
| | - Victoria Carter
- School of Social Work, Saint Louis University, St. Louis, MO, United States
| | - Juliet Iwelunmor-Ezepue
- College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, United States
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Oelschlägel L, Moen A, Dihle A, Christensen VL, Heggdal K, Österlind J, Steindal SA. Implementation of remote home care: assessment guided by the RE-AIM framework. BMC Health Serv Res 2024; 24:145. [PMID: 38287394 PMCID: PMC10825998 DOI: 10.1186/s12913-024-10625-9] [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: 04/24/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Welfare technology interventions have become increasingly important in home-based palliative care for facilitating safe, time-efficient, and cost-effective methods to support patients living independently. However, studies evaluating the implementation of welfare technology innovations are scarce, and the empirical evidence for sustainable models using technology in home-based palliative care remains low. This study aimed to report on the use of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to assess the implementation of remote home care (RHC) a technology-mediated service for home-living patients in the palliative phase of cancer. Furthermore, it aimed to explore areas of particular importance determining the sustainability of technologies for remote palliative home-based care. METHODS A secondary analysis of data collected by semi-structured interviews with patients with cancer in the palliative phase, focus groups, and semi-structured interviews with healthcare professionals (HCPs) experienced with RHC was performed. A deductive reflexive thematic analysis using RE-AIM dimensions was conducted. RESULTS Five themes illustrating the five RE-AIM dimensions were identified: (1) Reach: protective actions in recruitment - gatekeeping, (2) Effectiveness: potential to offer person-centered care, (3) Adoption: balancing high touch with high tech, (4) Implementation: moving towards a common understanding, and (5) Maintenance: adjusting to what really matters. The RE-AIM framework highlighted that RHC implementation for patients in the palliative phase of cancer was influenced by HCP gatekeeping behavior, concerns regarding abandoning palliative care as a high-touch specialty, and a lack of competence in palliative care. Although RHC facilitated improved routines in patients' daily lives, it was perceived as a static service unable to keep pace with disease progression. CONCLUSIONS A person-centered approach that prioritizes individual needs and preferences is necessary for providing optimal care. Although technologies such as RHC are not a panacea, they can be integrated as support for increasingly strained health services.
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Affiliation(s)
- Lina Oelschlägel
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway.
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Anne Moen
- Department of Public Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alfhild Dihle
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Vivi L Christensen
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristin Heggdal
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
| | - Jane Österlind
- Department of Healthcare Sciences/Palliative Research Center, Marie Cederschiöld University, Stockholm, Sweden
| | - Simen A Steindal
- Lovisenberg Diaconal University College, Lovisenberggata 15B, Oslo, 0456, Norway
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
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Nangendo J, Wanyenze RK, Obeng-Amoako GO, Muwema M, Mukisa J, Okiring J, Kabami J, Karamagi CA, Semitala FC, Kalyango JN, Kamya MR, Katahoire AR. Health provider perspectives of Village Health Team-delivered oral HIV self-testing among men in Central Uganda: a qualitative evaluation using RE-AIM framework. RESEARCH SQUARE 2024:rs.3.rs-3816613. [PMID: 38343851 PMCID: PMC10854283 DOI: 10.21203/rs.3.rs-3816613/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Abstract
Background HIV self-testing (HIVST) is a practical and effective way to provide HIV testing services to at-risk and underserved populations, particularly men. Utilizing Village Health Teams (VHTs) could enhance community-based delivery of oral HIVST to reach the last un-tested individuals who may be at-risk of infection. However, little is known about what VHTs and facility-based healthcare workers think about facilitating oral HIVST and delivery of subsequent HIV services. We investigated the views of health providers on oral HIVST delivered by VHTs among men in rural communities in Central Uganda. Methods We conducted a qualitative study in Mpigi district, interviewing 27 health providers who facilitated oral HIV self-testing among men. The providers consisting of 15 VHTs and 12 facility-based health workers were purposively selected. All interviews were audio-recorded, transcribed verbatim, and translated to English for a hybrid inductive-deductive thematic analysis. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Implementation Science framework to generate and categorize open codes. Results In terms of reaching men with HIV testing services, the providers considered HIVST to be a fast and convenient method, which could boost HIV testing. However, they also had concerns about its accuracy. In terms of effectiveness, HIVST was perceived as a reliable, user-friendly, and efficient approach to HIV testing. However, it depended on the user's preference for testing algorithms. Regarding adoption, HIVST was considered to enhance autonomy, well-suited for use in the community, and offered opportunities for linkage and re-linkage into care. However, at times HIVST faced hesitance. As for Implementation, VHTs had various support roles in HIVST but had concerns about social insecurities and delays in seeking subsequent facility-based services after HIVST. Regarding Maintenance, providers recommended several ways to improve oral HIVST including; optimizing tracking of HIVST distribution and use, improving linkage and retention in care after HIVST, diversifying HIVST for combined HIV prevention packages and including more languages, broadening sensitization among potential HIVST users and health providers, differentiating distribution models, and prioritizing targeted HIVST efforts. Conclusion HIVST has the potential to increase testing rates and engagement of men in HIV services. However, for it to be implemented on a population-wide scale, continuous sensitization of potential users and health providers is necessary, along with streamlined structures for tracking kit distribution, use, and reporting of results. Further implementation research may be necessary to optimize the role of health providers in facilitating HIVST.
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Affiliation(s)
| | | | | | | | - John Mukisa
- Makerere University College of Health Sciences
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Armbruster SD, Brow K, Locklear T, Frazier M, Harden SM. Mixed-method approach to informing a lifestyle intervention to improve the survivorship of patients with endometrial cancer. Gynecol Oncol 2024; 180:160-167. [PMID: 38091776 PMCID: PMC10977604 DOI: 10.1016/j.ygyno.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To identify endometrial cancer survivors' (ECS) barriers and facilitators for participation in lifestyle interventions to improve their dietary and exercise behaviors. Our secondary objective is to determine baseline information: physical activity level, quality of life (QoL), and impact of COVID-19 on exercise, diet, and mental health. METHODS Obese, early-stage ECS participated in 2-part mixed-methods data collection; Part 1: survey gathering sample characteristics, QoL, exercise, and basic endometrial cancer- related knowledge. Part 2: virtual focus group or individual interviews using a brainwriting premortem protocol. Statistical analysis was performed using SAS (version 8.3). Qualitative data were analyzed using deductive thematic coding guided by the RE-AIM framework. RESULTS Twenty percent (70/358) of ECS from a survivorship database and clinic recruitment completed the survey; 16 ECS provided qualitative feedback. Common barriers to intervention participation included time and resource costs, meeting frequency, and pessimism about weight loss maintenance. Facilitators included an opportunity to connect with other survivors and a focus on health rather than weight loss. Most ECS could not identify exercise guidelines (60%) and 83% were not meeting these guidelines. Higher BMI was correlated with a lower confidence in completing in moderate physical activity (p-value = 0.0206). Post-COVID-19 pandemic, physical activity, nutritional decisions, and/or mental health worsened for 67% of ECS. CONCLUSION ECS are a disparate population, with worsening behaviors and mental health following the pandemic. The identified ECS-specific barriers and facilitators to behavioral intervention participation are being used to simultaneously improve the reach of and adherence to a lifestyle intervention aimed at improving their health and QoL.
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Affiliation(s)
- Shannon D Armbruster
- Division of Gynecologic Oncology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA.
| | - Katie Brow
- Virginia Tech School of Medicine, Roanoke, VA, USA
| | - Tonja Locklear
- Carilion Clinic Health Analytics Research Team, Roanoke, VA, USA
| | - Mary Frazier
- Translational Biology, Medicine, and Health Program, Virginia Tech, Roanoke, VA, USA
| | - Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
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Brewer LC, Abraham H, Clark D, Echols M, Hall M, Hodgman K, Kaihoi B, Kopecky S, Krogman A, Leth S, Malik S, Marsteller J, Mathews L, Scales R, Schulte P, Shultz A, Taylor B, Thomas R, Wong N, Olson T. Efficacy and Adherence Rates of a Novel Community-Informed Virtual World-Based Cardiac Rehabilitation Program: Protocol for the Destination Cardiac Rehab Randomized Controlled Trial. J Am Heart Assoc 2023; 12:e030883. [PMID: 38014699 PMCID: PMC10727355 DOI: 10.1161/jaha.123.030883] [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: 05/06/2023] [Accepted: 09/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Innovative restructuring of cardiac rehabilitation (CR) delivery remains critical to reduce barriers and improve access to diverse populations. Destination Cardiac Rehab is a novel virtual world technology-based CR program delivered through the virtual world platform, Second Life, which previously demonstrated high acceptability as an extension of traditional center-based CR. This study aims to evaluate efficacy and adherence of the virtual world-based CR program compared with center-based CR within a community-informed, implementation science framework. METHODS Using a noninferiority, hybrid type 1 effectiveness-implementation, randomized controlled trial, 150 patients with an eligible cardiovascular event will be recruited from 6 geographically diverse CR centers across the United States. Participants will be randomized 1:1 to either the 12-week Destination Cardiac Rehab or the center-based CR control groups. The primary efficacy outcome is a composite cardiovascular health score based on the American Heart Association Life's Essential 8 at 3 and 6 months. Adherence outcomes include CR session attendance and participation in exercise sessions. A diverse patient/caregiver/stakeholder advisory board was assembled to guide recruitment, implementation, and dissemination plans and to contextualize study findings. The institutional review board-approved randomized controlled trial will enroll and randomize patients to the intervention (or control group) in 3 consecutive waves/year over 3 years. The results will be published at data collection and analyses completion. CONCLUSIONS The Destination Cardiac Rehab randomized controlled trial tests an innovative and potentially scalable model to enhance CR participation and advance health equity. Our findings will inform the use of effective virtual CR programs to expand equitable access to diverse patient populations. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05897710.
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Affiliation(s)
- LaPrincess C. Brewer
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
- Center for Health Equity and Community Engagement ResearchMayo ClinicRochesterMN
| | - Helayna Abraham
- Department of Internal MedicineMayo Clinic College of MedicineRochesterMN
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Melvin Echols
- Department of Cardiovascular MedicineMorehouse School of MedicineAtlantaGA
| | - Michael Hall
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Karen Hodgman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Brian Kaihoi
- Global Products and ServicesMayo Clinic Center for InnovationRochesterMN
| | - Stephen Kopecky
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Ashton Krogman
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shawn Leth
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Shaista Malik
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Jill Marsteller
- Center for Health Services and Outcomes ResearchJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Lena Mathews
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Robert Scales
- Department of Cardiovascular MedicineMayo Clinic College of MedicinePhoenixAZ
| | - Phillip Schulte
- Division of Clinical Trials and BiostatisticsMayo ClinicRochesterMN
| | - Adam Shultz
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Bryan Taylor
- Department of Cardiovascular MedicineMayo Clinic College of MedicineJacksonvilleFL
| | - Randal Thomas
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
| | - Nathan Wong
- Division of Cardiology, Department of MedicineUniversity of CaliforniaIrvineCA
| | - Thomas Olson
- Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterMN
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Nordlund H, Fäldt A. "They aren't waiting for an SLP, they think 'what can I as a parent do now?'" course leaders' perceptions of AAC interventions targeting parents. Augment Altern Commun 2023; 39:282-292. [PMID: 37470437 DOI: 10.1080/07434618.2023.2233033] [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: 04/20/2022] [Revised: 05/23/2023] [Accepted: 06/15/2023] [Indexed: 07/21/2023] Open
Abstract
Parental interventions can help parents use strategies to support their child's language and communication development. The ComAlong courses are parental interventions that focus on responsive communication, enhanced milieu teaching, and augmentative and alternative communication. This interview study aimed to investigate the course leaders' perceptions of the three ComAlong courses, ComAlong Habilitation, ComAlong Developmental Language Disorder, and ComAlong Toddler, and to evaluate their experiences of the implementation of the courses. Qualitative content analysis was used to analyze the interview data. Thereafter, three categories resulted from the findings: Impact on the Family, A Great Course Concept, and Accessibility of the Courses. The results indicate that participants perceived that the courses had positive effects on both parents and themself. Furthermore, it was described that parents gained knowledge about communication and strategies in how to develop their child's communication; however, the courses were not accessible to all parents. The collaboration between the parents and course leaders improved, and course leaders viewed the courses as an important part of their work. The following factors had an impact on the implementation: several course leaders in the same workplace, support from colleagues and management, and recruitment of parents to the courses.
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Affiliation(s)
- Hanna Nordlund
- Department of Public Health and Caring Sciences, Social medicine/CHAP, Uppsala University, Uppsala, Sweden
| | - Anna Fäldt
- Department of Public Health and Caring Sciences, Social medicine/CHAP, Uppsala University, Uppsala, Sweden
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Koon W, Peden AE, Brander RW. Impact of a surfer rescue training program in Australia and New Zealand: a mixed methods evaluation. BMC Public Health 2023; 23:2193. [PMID: 37940894 PMCID: PMC10631059 DOI: 10.1186/s12889-023-17057-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Surfers play a critical role in coastal drowning prevention, conservatively estimated to make as many rescues as beach lifeguards. The Surfer Rescue 24/7 (SR24/7) program is a coastal safety intervention in Australia and New Zealand that teaches surfers safe rescue skills and promotes prevention activities. This multi-part, mixed-methods study aimed to evaluate the impact of the SR24/7 program. METHODS The study consisted of three parts employing quantitative and qualitative methods: a retrospective survey of course participants, in-depth interviews with course participants who had conducted rescues, and an analysis of self-reported skills confidence ratings before and after the program. RESULTS Triangulated results from the three study components indicated that after the course, participants exhibited high levels of satisfaction with their experience in the program and would encourage others to attend, were more observant and aware of safety concerns while surfing, had a better understanding of ocean conditions and hazards, learned new rescue techniques and skills, grasped important course concepts related to their own personal safety, and improved their confidence in responding to an emergency situation. Several participants had conducted rescues in real life and indicated that the course was effective in providing them with the baseline knowledge and skills to keep safe while helping others in the ocean. This study also provides new insight on the role of surfers in coastal safety, specifically that surfers are engaged in a range of prevention activities before rescue is required. CONCLUSIONS Despite persistent challenges in combating coastal drowning rates, the SR24/7 program is an effective intervention that helps save lives. Importantly, this study provides evidence that the course successfully equips surfers with techniques to act responsibly and safely. Expanding coastal safety focus and resources towards surfers, an often-overlooked demographic in beach safety strategies, could substantially enhance community-level capacity to prevent and respond to ocean emergencies.
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Affiliation(s)
- William Koon
- School of Biological Earth and Environmental Sciences, University of New South Wales, Kensington NSW 2052, Sydney, NSW, Australia.
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia.
| | - Amy E Peden
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, University of New South Wales, Sydney, NSW, Australia
| | - Robert W Brander
- School of Biological Earth and Environmental Sciences, University of New South Wales, Kensington NSW 2052, Sydney, NSW, Australia
- Beach Safety Research Group, University of New South Wales, Sydney, NSW, Australia
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Zimmermann M, Peacock-Chambers E, Merton C, Pasciak K, Thompson A, Mackie T, Clare CA, Lemon SC, Byatt N. Equitable reach: Patient and professional recommendations for interventions to prevent perinatal depression and anxiety. Gen Hosp Psychiatry 2023; 85:95-103. [PMID: 37862962 PMCID: PMC11056209 DOI: 10.1016/j.genhosppsych.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/14/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Perinatal depression and anxiety are the most common complications in the perinatal period and disproportionately affect those experiencing economic marginalization. Fewer than 15% of individuals at risk for perinatal depression are referred for preventative counseling. The goal of this study was to elicit patient and perinatal care professionals' perspectives on how to increase the reach of interventions to prevent perinatal depression and anxiety among economically marginalized individuals. METHODS We conducted qualitative interviews with perinatal individuals with lived experience of perinatal depression and/or anxiety who were experiencing economic marginalization (n = 12) and perinatal care professionals and paraprofessionals (e.g., obstetrician/gynecologists, midwives, doulas; n = 12) serving this population. Three study team members engaged a "a coding consensus, co-occurrence, and comparison," approach to code interviews. RESULTS Perinatal individuals and professionals identified prevention intervention delivery approaches and content to facilitate equitable reach for individuals who are economically marginalized. Factors influential included availability of mental health counselors, facilitation of prevention interventions by a trusted professional, digital health options, and options for mental health intervention delivery approaches. Content that was perceived as increasing equitable intervention reach included emphasizing stigma reduction, using cultural humility and inclusive materials, and content personalization. CONCLUSIONS Leveraging varied options for mental health intervention delivery approaches and content could reach perinatal individuals experiencing economic marginalization and address resource considerations associated with preventative interventions.
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Affiliation(s)
- Martha Zimmermann
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America.
| | - Elizabeth Peacock-Chambers
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Catherine Merton
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Katarzyna Pasciak
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Azure Thompson
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Thomas Mackie
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Camille A Clare
- SUNY Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, United States of America
| | - Stephenie C Lemon
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
| | - Nancy Byatt
- UMass Chan Medical School, 222 Maple Avenue - Chang Building Shrewsbury, MA 01545, United States of America
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Koorts H, Timperio A, Lonsdale C, Ridgers ND, Lubans DR, Della Gatta J, Bauman A, Telford A, Barnett L, Lamb KE, Lander N, Lai SK, Sanders T, Arundell L, Brown H, Wilhite K, Salmon J. Scaling up a school-based intervention to increase physical activity and reduce sedentary behaviour in children: protocol for the TransformUs hybrid effectiveness-implementation trial. BMJ Open 2023; 13:e078410. [PMID: 37907301 PMCID: PMC10618986 DOI: 10.1136/bmjopen-2023-078410] [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: 08/01/2023] [Accepted: 10/06/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Efficacious programmes require implementation at scale to maximise their public health impact. TransformUs is an efficacious behavioural and environmental intervention for increasing primary (elementary) school children's (5-12 years) physical activity and reducing their sedentary behaviour within school and home settings. This paper describes the study protocol of a 5-year effectiveness-implementation trial to assess the scalability and effectiveness of the TransformUs programme. METHODS AND ANALYSIS A type II hybrid implementation-effectiveness trial, TransformUs is being disseminated to all primary schools in the state of Victoria, Australia (n=1786). Data are being collected using mixed methods at the system (state government, partner organisations), organisation (school) and individual (teacher, parent and child) levels. Evaluation is based on programme Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. RE-AIM domains are being measured using a quasi-experimental, pre/post, non-equivalent group design, at baseline, 12 and 24 months. Effectiveness will be determined in a subsample of 20 intervention schools (in Victoria) and 20 control schools (in New South Wales (NSW), Australia), at baseline, 12 and 24 months. Primary outcomes include TransformUs Reach, Adoption, Implementation and organisational Maintenance (implementation trial), and children's physical activity and sedentary time assessed using accelerometers (effectiveness trial). Secondary outcomes include average sedentary time and moderate to vigorous-intensity physical activity on weekdays and during school hours, body mass index z-scores and waist circumference (effectiveness trial). Linear mixed-effects models will be fitted to compare outcomes between intervention and control participants accounting for clustering of children within schools, confounding and random effects. ETHICS AND DISSEMINATION The trial was approved by the Deakin University Human Research Ethics Committee (HEAG-H 28_2017), Victorian Department of Education, the NSW Department of Education, Australian Catholic University (2017-145R), Melbourne Archdiocese Catholic Schools and Catholic Schools NSW. Partners, schools/teachers and parents will provide an informed signed consent form prior to participating. Parents will provide consent for their child to participate in the effectiveness trial. Findings will be disseminated via peer-reviewed publications, scientific conferences, summary reports to schools and our partner organisations, and will inform education policy and practice on effective and sustainable ways to promote physical activity and reduce sedentary behaviours population-wide. TRIAL REGISTRATION NUMBER Australian Clinical Trials Registration Registry (ACTRN12617000204347).
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Affiliation(s)
- Harriet Koorts
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Anna Timperio
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Chris Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Nicola D Ridgers
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, South Australia 5001, Australia
| | - David R Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jacqueline Della Gatta
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Adrian Bauman
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Amanda Telford
- Australian Catholic University, National School of Education, Melbourne, VIC 3065, Australia
| | - Lisa Barnett
- Deakin University, Institute for Physical Activity and Nutrition, School of Health and Social Development, Geelong, VIC 3125, Australia
| | - Karen E Lamb
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3053, Australia
| | - Natalie Lander
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Samuel K Lai
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Taren Sanders
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Lauren Arundell
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Helen Brown
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
| | - Katrina Wilhite
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, NSW 2060, Australia
| | - Jo Salmon
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, VIC 3216, Australia
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Fox S, Drennan J, Guerin S, Kernohan WG, Murphy A, O'Connor N, Rukundo A, Timmons S. A comparison of four dementia palliative care services using the RE-AIM framework. BMC Geriatr 2023; 23:677. [PMID: 37858076 PMCID: PMC10585827 DOI: 10.1186/s12877-023-04343-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Living with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned. METHODS A long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services. RESULTS The four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place. CONCLUSIONS An effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.
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Affiliation(s)
- Siobhan Fox
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, County Antrim, Ulster University, Shore Road, Newtownabbey, Northern Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Cork, Ireland
| | - Niamh O'Connor
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Aphie Rukundo
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Utz RL, Caserta M, Iacob E, Sparks C, Stark L, Terrill A, Thompson A, Wong B. Maximizing the Benefit of Respite for Dementia Caregivers: A Study Protocol Describing the Development & Evaluation of the Time for Living & Caring (TLC) Intervention. OBM INTEGRATIVE AND COMPLIMENTARY MEDICINE 2023; 8:040. [PMID: 38313766 PMCID: PMC10838170 DOI: 10.21926/obm.icm.2304040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Dementia caregivers are susceptible to adverse physical and mental health outcomes, given the often prolonged and challenging care and support they provide to family members with Alzheimer's Disease and Related Dementias (ADRD). This report describes a community-engaged implementation of a novel behavioral intervention - an "app" (interactive website) called TLC (Time for Living and Caring) that coaches caregivers on how to maximize the benefits associated with respite time. The rationale and features of the TLC intervention and the full research protocol used to develop and then evaluate its feasibility, acceptability, and initial efficacy are described here.
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Affiliation(s)
- Rebecca L. Utz
- University of Utah, College of Social and Behavioral Sciences, 260 South Central Campus Drive, Salt Lake City, UT, USA
| | - Michael Caserta
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
| | - Eli Iacob
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
| | - Catharine Sparks
- University of Utah, College of Social and Behavioral Sciences, 260 South Central Campus Drive, Salt Lake City, UT, USA
| | - Louisa Stark
- University of Utah, School of Medicine, 27 S. Mario Capecchi Dr, Salt Lake City, UT, USA
| | - Alexandra Terrill
- University of Utah, College of Health, 15 N 2030 East, Salt Lake City, UT, USA
| | - Amber Thompson
- University of Utah, College of Social and Behavioral Sciences, 260 South Central Campus Drive, Salt Lake City, UT, USA
| | - Bob Wong
- University of Utah, College of Nursing, 10 S. 2000 E., Salt Lake City, UT, USA
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Drury A, Goss J, Afolabi J, McHugh G, O’Leary N, Brady AM. A Mixed Methods Evaluation of a Pilot Multidisciplinary Breathlessness Support Service. EVALUATION REVIEW 2023; 47:820-870. [PMID: 37014066 PMCID: PMC10492442 DOI: 10.1177/0193841x231162402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires (n = 10), medical record audit (n = 14) and a post-discharge interview (n = 8). Caregivers (n = 1) and healthcare professionals involved in referral to (n = 2) and delivery of (n = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.
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Affiliation(s)
- Amanda Drury
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Julie Goss
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Jide Afolabi
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | | | - Norma O’Leary
- Our Lady’s Hospice and Care Services, Dublin, Ireland
| | - Anne-Marie Brady
- Trinity Centre Practice & Healthcare Innovation, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Ritchie ND, Gurfinkel D, Sajatovic M, Carter M, Glasgow RE, Holtrop JS, Waxmonsky JA, Kwan BM. A Multi-Method Study of Patient Reach and Attendance in a Pragmatic Trial of Diabetes Shared Medical Appointments. Clin Diabetes 2023; 41:526-538. [PMID: 37849523 PMCID: PMC10577507 DOI: 10.2337/cd23-0015] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Shared medical appointments (SMAs) are an evidence-based approach to diabetes care in primary care settings, yet practices can struggle to ensure participation, especially among racial and ethnic minority and low-income patients. We conducted a multimethod evaluation of reach and attendance in the Invested in Diabetes study of the comparative effectiveness of two SMA delivery models (standardized and patient-driven) in two practice settings (federally qualified health centers [FQHCs] and clinics serving more commercially insured patients). Through this study, 22 practices reached 6.2% of patients with diabetes through SMAs over 3 years, with good attendance for both practice types and both SMA delivery models. FQHCs were especially successful at enrolling underserved populations and improved attendance with virtual SMAs.
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Affiliation(s)
- Natalie D. Ritchie
- Center for Health Systems Research, Denver Health & Hospital Authority, Denver, CO
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Dennis Gurfinkel
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Martha Sajatovic
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Madelaine Carter
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Russell E. Glasgow
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jodi Summers Holtrop
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jeanette A. Waxmonsky
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Bethany M. Kwan
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Beisheim-Ryan EH, Butera KA, Hinrichs LA, Derlein DL, Malone DJ, Holtrop JS, Forster JE, Diedrich D, Gustavson AM, Stevens-Lapsley JE. Advancing Rehabilitation Paradigms for Older Adults in Skilled Nursing Facilities: An Effectiveness-Implementation Hybrid Type 1 Clinical Trial Protocol. Phys Ther 2023; 103:pzad053. [PMID: 37255325 PMCID: PMC10506848 DOI: 10.1093/ptj/pzad053] [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: 12/07/2022] [Revised: 02/16/2023] [Accepted: 05/08/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Skilled nursing facility rehabilitation is commonly required to address hospital-associated deconditioning among older adults with medical complexity. In skilled nursing facilities, standard-of-care rehabilitation focuses on low-intensity interventions, which are not designed to sufficiently challenge skeletal muscle and impart functional improvements. In contrast, a high-intensity resistance training approach (IntenSive Therapeutic Rehabilitation for Older NursinG homE Residents; i-STRONGER) in a single-site pilot study resulted in better physical function among patients in skilled nursing facilities. To extend this work, an effectiveness-implementation hybrid type 1 design, cluster-randomized trial will be conducted to compare patient outcomes between 16 skilled nursing facilities utilizing i-STRONGER principles and 16 Usual Care sites. METHODS Clinicians at i-STRONGER sites will be trained to deliver i-STRONGER as a standard of care using an implementation package that includes a clinician training program. Clinicians at Usual Care sites will continue to provide usual care. Posttraining, changes in physical performance (eg, gait speed, Short Physical Performance Battery scores) from patients' admission to discharge will be collected over a period of 12 months. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework will be used to evaluate i-STRONGER effectiveness and factors underlying successful i-STRONGER implementation. Effectiveness will be evaluated by comparing changes in physical function between study arms. Reach (proportion of patients treated with i-STRONGER), adoption (proportion of clinicians utilizing i-STRONGER), implementation (i-STRONGER fidelity), and maintenance (i-STRONGER sustainment) will be concurrently quantified and informed by clinician surveys and focus groups. IMPACT This effectiveness-implementation hybrid type 1 cluster-randomized trial has the potential to shift rehabilitation care paradigms in a nationwide network of skilled nursing facilities, resulting in improved patient outcomes and functional independence. Furthermore, evaluation of the facilitators of, and barriers to, implementation of i-STRONGER in real-world clinical settings will critically inform future work evaluating and implementing best rehabilitation practices in skilled nursing facilities.
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Affiliation(s)
- Emma H Beisheim-Ryan
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Katie A Butera
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Lauren A Hinrichs
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Danielle L Derlein
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Daniel J Malone
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
| | - Jodi S Holtrop
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
- Adult and Child Center for Outcomes Research and Delivery (ACCORDS), University of Colorado, Aurora, Colorado, USA
| | - Jeri E Forster
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | | | - Allison M Gustavson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, Colorado, USA
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Mazza D, Assifi AR, Hussainy SY, Bateson D, Johnston S, Tomnay J, Kasza J, Church J, Grzeskowiak LE, Nissen L, Cameron ST. Expanding community pharmacists' scope of practice in relation to contraceptive counselling and referral: a protocol for a pragmatic, stepped-wedge, cluster randomised trial (ALLIANCE). BMJ Open 2023; 13:e073154. [PMID: 37652588 PMCID: PMC10476139 DOI: 10.1136/bmjopen-2023-073154] [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: 02/24/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
INTRODUCTION Improving access to effective contraception has the potential to reduce unintended pregnancy and abortion rates. Community pharmacists could play an expanded role in contraceptive counselling and referral to contraceptive prescribers particularly when women are already attending community pharmacy to obtain emergency contraceptive pills (ECPs) or to have medical abortion (MA) medicines dispensed. The ALLIANCE trial aims to compare the subsequent uptake of effective contraception (hormonal or intrauterine) in women seeking ECP or MA medicines, who receive the ALLIANCE community pharmacy-based intervention with those who do not receive the intervention. METHODS AND ANALYSIS ALLIANCE is a stepped-wedge pragmatic cluster randomised trial in Australian community pharmacies. The ALLIANCE intervention involves community pharmacists delivering structured, patient-centred, effectiveness-based contraceptive counselling (and a referral to a contraceptive prescriber where appropriate) to women seeking either ECPs or to have MA medicines dispensed. Women participants will be recruited by participating pharmacists. A total of 37 pharmacies and 1554 participants will be recruited. Pharmacies commence in the control phase and are randomised to transition to the intervention phase at different time points (steps). The primary outcome is the self-reported use of effective contraception at 4 months; secondary outcomes include use of effective contraception and the rate of pregnancies or induced abortions at 12 months. A process and economic evaluation of the trial will also be undertaken. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Monash University Human Research Ethics Committee (#34563). An explanatory statement will be provided and written consent will be obtained from all participants (pharmacy owner, pharmacist and women) before their commencement in the trial. Dissemination will occur through a knowledge exchange workshop, peer-reviewed journal publications, presentations, social media and conferences. TRIAL REGISTRATION NUMBER ACTRN12622001024730.
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Affiliation(s)
- Danielle Mazza
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anisa Rojanapenkul Assifi
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Safeera Yasmeen Hussainy
- SPHERE NHMRC Centre of Research Excellence, Department General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Pharmacy Department, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Deborah Bateson
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Jane Tomnay
- Centre for Excellence in Rural Sexual Health, University of Melbourne, Shepparton, Victoria, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Luke E Grzeskowiak
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Lisa Nissen
- Centre for the Business & Economics of Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Sharon Tracey Cameron
- Obstetrics and Gynaecology, University of Edinburgh, Edinburgh, UK
- Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
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Faro EZ, Sauder KA, Norman GS, Anderson A, Vélez-Vega C, Napp D, Huddleston KC. A mixed-methods analysis to understand the implementation of a multistakeholder research consortium: Environmental influences on child health outcomes (ECHO). J Clin Transl Sci 2023; 7:e198. [PMID: 37830008 PMCID: PMC10565193 DOI: 10.1017/cts.2023.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/14/2023] Open
Abstract
Introduction Large, transdisciplinary research consortia have increasingly been called upon to address complex and challenging health problems. The National Institutes of Health's (NIH) Environmental influences on Child Health Outcomes (ECHO) Program developed multisite collaboration strategies to promote impactful collaborative observational research on child health. Team science and implementation science offer theoretical and methodological structure to answer questions about the strategies that facilitate successful consortia. We sought to characterize the elements and conditions that influence the implementation of a complex, interdisciplinary longitudinal research program, ECHO. Methods Informed by the Practical, Robust, Implementation and Sustainability Model, our ethnographic research included semi-structured interviews with internal stakeholders and program evaluation metrics. We conducted template and matrix analysis and triangulated the qualitative and quantitative data to understand the implementation of ECHO. Results Between February and May 2022, we conducted 24 virtual interviews with representatives from ECHO components. The main cross-cutting topics that emerged from thematic analysis were collaboration and team science; communication and decision-making; data processes and harmonization; and diversity, equity, and inclusion. Both the qualitative and secondary quantitative evaluation data provided insights into the reach, adoption, implementation, and effectiveness of the program. Conclusion A large, multidisciplinary research consortium such as ECHO has produced conceptual, instrumental, capacity building, and connectivity impact for internal and external stakeholders. Facilitators included infrastructure that supported collaboration and learning, alignment of data processes, and harmonization. Opportunities for enhanced impact include multidisciplinary, multimethod communication strategies, and alignment of research priorities.
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Affiliation(s)
- Elissa Z. Faro
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Katherine A. Sauder
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gwendolyn S. Norman
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Amber Anderson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Carmen Vélez-Vega
- Social Sciences Department, Graduate School of Public Health, University of Puerto Rico, San Juan, Puerto Rico
| | - David Napp
- Practical Applications of Public Health, Durham, NC, USA
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Tézier B, Lucas Q, Johnson S, Vuillemin A, Lemonnier F, Rostan F, Guillemin F, Van Hoye A. A RE-AIM framework analysis of a sports club health promotion MOOC: the PROSCeSS MOOC. Health Promot Int 2023; 38:daad069. [PMID: 37432775 DOI: 10.1093/heapro/daad069] [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: 07/13/2023] Open
Abstract
Acquisition of health promotion (HP) skills and knowledge is essential for interventions development in this field. In sports clubs (SC), little HP training exists even though it was requested by SC actors. In response, the PROSCeSS (PROmotion de la Santé au sein du Clubs SportifS) MOOC (Massive Open Online Course) was developed to support actors of HP in the SC in the development of HP interventions. The present study evaluates the MOOC's effectiveness and learning process. The RE-AIM framework, measuring reach, effectiveness, adoption, implementation and maintenance was used to structure this study. Surveys were sent before and after the MOOC to the 2814 learners. Among the 502 (18%) respondents to the pre-survey, 80% reported belonging to a SC as a coach (35%) or manager (25%). The 14% of pre-survey respondents who completed the post-survey increased their HP knowledge score by 42% and their confidence to implement HP actions by 6%. Results present the strategies considered most important and feasible by the learners and the main barriers to the implementation of HP actions in the SC. This study shows that MOOC appears to be an appealing (93% of learners were satisfied) and effective solution (as long as it is followed) to develop HP knowledge and skills of SC actors in HP, meeting their needs and constraints. Although improvements should be made (especially in terms of promoting adoption), this type of educational format should be encouraged to support the HP potential of SC.
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Affiliation(s)
| | | | - Stacey Johnson
- Institut de Cancérologie de l'Ouest, Nantes 44000, France
- UPR6312 LAHMESS, Université Côte d'Azur Nice 06000,, France
| | - Anne Vuillemin
- UPR6312 LAHMESS, Université Côte d'Azur Nice 06000,, France
| | | | | | | | - Aurélie Van Hoye
- UR4360 APEMAC, Université de Lorraine, Nancy 54000, France
- Physical Education and Sport Sciences Department, University of Limerick, Limerick V94T9PX, Ireland
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Kenney RR, Klocko RP, Manheim CE, Mog AC, Young JP. Applying RE-AIM to evaluations of Veterans Health Administration Enterprise-Wide Initiatives: lessons learned. FRONTIERS IN HEALTH SERVICES 2023; 3:1209600. [PMID: 37575975 PMCID: PMC10421720 DOI: 10.3389/frhs.2023.1209600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023]
Abstract
Introduction The United States Veterans Health Administration (VHA) Office of Rural Health funds Enterprise-Wide Initiatives (system-wide initiatives) to spread promising practices to rural Veterans. The Office requires that evaluations of Enterprise-Wide Initiatives use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. This presents a unique opportunity to understand the experience of using RE-AIM across a series of evaluations. The authors conducted a study to document the benefits and pitfalls of using RE-AIM, capture the variety of ways that the team captured the elements of RE-AIM, and develop recommendations for the future use of RE-AIM in evaluation. Materials and methods The authors first conducted a document review to capture pre-existing information about how RE-AIM was used. They subsequently facilitated two focus groups to gather more detailed information from team members who had used RE-AIM. Finally, they used member-checking throughout the writing process to ensure accurate data representation and interpretation and to gather additional feedback. Results Four themes emerged from the document review, focus groups, and member checking. RE-AIM: provides parameters and controls the evaluation scope, "buckets" are logical, plays well with other frameworks, and can foster collaboration or silo within a team. Challenges and attributes for each RE-AIM dimension were also described. Discussion Overall, participants reported both strengths and challenges to using RE-AIM as an evaluation framework. The overarching theme around the challenges with RE-AIM dimensions was the importance of context. Many of these benefits and challenges of using RE-AIM may not be unique to RE-AIM and would likely occur when using any prescribed framework. The participants reported on the RE-AIM domains in a variety of ways in their evaluation reports and were not always able capture data as originally planned. Recommendations included: start with an evaluation framework (or frameworks) and revisit it throughout the evaluation, consider applying RE-AIM PRISM (Practical Robust Implementation Framework) to gain a broader perspective, and intentionally integrate quantitative and qualitative team members, regardless of the framework used.
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Affiliation(s)
- Rachael R. Kenney
- Seattle-Denver COIN, Veterans Health Administration, Denver, CO, United States
- VA Collaborative Evaluation Center, Veterans Health Administration, Denver, CO, United States
| | - Robert P. Klocko
- Seattle-Denver COIN, Veterans Health Administration, Denver, CO, United States
- VA Collaborative Evaluation Center, Veterans Health Administration, Denver, CO, United States
| | - Chelsea E. Manheim
- Seattle-Denver COIN, Veterans Health Administration, Denver, CO, United States
- VA Collaborative Evaluation Center, Veterans Health Administration, Denver, CO, United States
| | - Ashley C. Mog
- Seattle-Denver COIN, Veterans Health Administration, Seattle, WA, United States
- VA Collaborative Evaluation Center, Veterans Health Administration, Seattle, WA, United States
| | - Jessica P. Young
- Seattle-Denver COIN, Veterans Health Administration, Seattle, WA, United States
- VA Collaborative Evaluation Center, Veterans Health Administration, Seattle, WA, United States
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Rubenstein LV, Curtis I, Wheat CL, Grembowski DE, Stockdale SE, Kaboli PJ, Yoon J, Felker BL, Reddy AS, Nelson KM. Learning from national implementation of the Veterans Affairs Clinical Resource Hub (CRH) program for improving access to care: protocol for a six year evaluation. BMC Health Serv Res 2023; 23:790. [PMID: 37488518 PMCID: PMC10367243 DOI: 10.1186/s12913-023-09799-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The Veterans Affairs (VA) Clinical Resource Hub (CRH) program aims to improve patient access to care by implementing time-limited, regionally based primary or mental health staffing support to cover local staffing vacancies. VA's Office of Primary Care (OPC) designed CRH to support more than 1000 geographically disparate VA outpatient sites, many of which are in rural areas, by providing virtual contingency clinical staffing for sites experiencing primary care and mental health staffing deficits. The subsequently funded CRH evaluation, carried out by the VA Primary Care Analytics Team (PCAT), partnered with CRH program leaders and evaluation stakeholders to develop a protocol for a six-year CRH evaluation. The objectives for developing the CRH evaluation protocol were to prospectively: 1) identify the outcomes CRH aimed to achieve, and the key program elements designed to achieve them; 2) specify evaluation designs and data collection approaches for assessing CRH progress and success; and 3) guide the activities of five geographically dispersed evaluation teams. METHODS The protocol documents a multi-method CRH program evaluation design with qualitative and quantitative elements. The evaluation's overall goal is to assess CRH's return on investment to the VA and Veterans at six years through synthesis of findings on program effectiveness. The evaluation includes both observational and quasi-experimental elements reflecting impacts at the national, regional, outpatient site, and patient levels. The protocol is based on program evaluation theory, implementation science frameworks, literature on contingency staffing, and iterative review and revision by both research and clinical operations partners. DISCUSSION Health systems increasingly seek to use data to guide management and decision-making for newly implemented clinical programs and policies. Approaches for planning evaluations to accomplish this goal, however, are not well-established. By publishing the protocol, we aim to increase the validity and usefulness of subsequent evaluation findings. We also aim to provide an example of a program evaluation protocol developed within a learning health systems partnership.
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Affiliation(s)
- Lisa V Rubenstein
- Evidence-Based Practice Center, RAND Corporation, Santa Monica, CA, USA.
- Geffen School of Medicine and Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
| | - Idamay Curtis
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - Chelle L Wheat
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
| | - David E Grembowski
- The Department of Health Systems and Population Health in the School of Public Health, University of Washington, Seattle, USA
| | - Susan E Stockdale
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Peter J Kaboli
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Jean Yoon
- Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Department of General Internal Medicine, UCSF School of Medicine, San Francisco, CA, USA
| | - Bradford L Felker
- Mental Health Service Line, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ashok S Reddy
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Karin M Nelson
- Primary Care Analytics Team, VA Puget Sound Healthcare System, Seattle, WA, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Abraham O, Slonac E, Paulsen Z. Pharmacists' perspectives on MedSMA℞T: A serious game to educate youth about opioid safety. J Am Pharm Assoc (2003) 2023; 63:1087-1094.e1. [PMID: 37116795 PMCID: PMC10942740 DOI: 10.1016/j.japh.2023.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adolescent opioid misuse has been recognized as a dire public health issue. Despite efforts to address the opioid epidemic in the United States, opioid-related morbidity and mortality have continued to rise. Few interventions have been tailored to prevent adolescent opioid misuse. MedSMA℞T: Adventures in PharmaCity (MedSMA℞T), is a serious game that educates the end-user by challenging them to make applicable decisions in a low-stakes environment. OBJECTIVE The study aimed to characterize pharmacists' perspectives on using MedSMA℞T to educate adolescents and families about opioid medication safety. METHODS Pharmacists were recruited from the Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin. Consented pharmacists played the MedSMA℞T game for 30 minutes while a research team member observed via Zoom. Virtual semi-structured interviews (45 minutes) were recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analyses. Bi-weekly meetings were held to discuss and refine codes as well as the master codebook, and identify prevalent themes (intercoder reliability, kappa = 0.91). RESULTS Twenty-two pharmacists were interviewed between August and November 2021. Four themes were identified: game content and design, patient education, implementation barriers, and implementation facilitators. Most pharmacists perceived MedSMA℞T to be an effective resource for opioid safety education. Pharmacists reported that age-appropriate language was used in combination with realistic scenarios and relatable characters. Pharmacists also highlighted the value of interactive gameplay to engage the player to actively learn and recall educational content. CONCLUSIONS Pharmacists play an integral role as medication experts and contributed valuable insights into using and incorporating the MedSMA℞T game into various pharmacy practice settings. Future work is necessary to understand parents' and adolescents' perceptions of using MedSMA℞T as an opioid safety education tool in pharmacies.
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Affiliation(s)
- Olufunmilola Abraham
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Evan Slonac
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Zachary Paulsen
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
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Barrett T, Ho KY, Rasavage J, Wilson M, Goo-Tam M, Trumbull T. Implementation of 2D Running Gait Analysis in Orthopedic Physical Therapy Clinics. Int J Sports Phys Ther 2023; V18:606-618. [PMID: 37425116 PMCID: PMC10324309 DOI: 10.26603/001c.74726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/26/2023] [Indexed: 07/11/2023] Open
Abstract
Background Despite 2D motion analysis deemed valid and reliable in assessing gait deviations in runners, current use of video-based motion analysis among orthopedic physical therapists is not prevalent. Purpose/Hypothesis To investigate clinician-perceived effectiveness, adherence, and barriers to using a 2D running gait analysis protocol for patients with running-related injuries. Study Design Survey. Methods Thirty outpatient physical therapy clinics were contacted to assess interest in participation. Participating therapists were trained on 2D running gait analysis protocol and given a running gait checklist. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to assess the implementation process by collecting a baseline survey at the beginning of the study, effectiveness and implementation surveys at two months, and a maintenance survey at six months. Results Twelve of the 15 responding clinics met eligibility criteria, giving a Reach rate of 80%. Twelve clinicians from 10 different clinics participated, giving an Adoption rate of 83%. For Effectiveness, the majority of clinicians valued having a checklist, and reported the protocol was easy to conduct, the methodology was reasonable and appropriate, and patients saw the benefits of using the protocol. Assessing Implementation, 92% performed all steps of the protocol on all appropriate runners. Average time spent conducting the protocol was 32 minutes. With respect to Maintenance, 50% reported continuing to use the protocol, while 50% answered they were not to continue use. Conclusion Clinicians expressed a perceived benefit of implementing a running gait analysis protocol with common themes of ease of use, being a useful adjunct to evaluating a patient, and increased satisfaction with treating injured runners. Potential barriers for not using the protocol included not having an appropriate clinic setup, time constraints, and not having adequate caseload. Level of Evidence 3b.
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Affiliation(s)
- Tiffany Barrett
- Department of Physical Therapy University of Nevada, Las Vegas
| | - Kai-Yu Ho
- Department of Physical Therapy University of Nevada, Las Vegas
| | - Justin Rasavage
- Department of Physical Therapy University of Nevada, Las Vegas
| | - Micah Wilson
- Department of Physical Therapy University of Nevada, Las Vegas
| | - Melissa Goo-Tam
- Department of Physical Therapy University of Nevada, Las Vegas
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Polo J, Basile MJ, Zhang M, Ordonez K, Rodriguez D, Boye-Codjoe E, Williams M, Tsang D, Medina R, Jacome S, Mir P, Khanijo S, Pekmezaris R, Hajizadeh N. Application of the RE-AIM framework to evaluate the implementation of telehealth pulmonary rehabilitation in a randomized controlled trial among African-American and Hispanic patients with advanced stage Chronic Obstructive Pulmonary Disease. BMC Health Serv Res 2023; 23:515. [PMID: 37218000 DOI: 10.1186/s12913-023-09492-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/03/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) decreases rehospitalization for people with COPD. However, less than 2% receive PR, partly due to lack of referral and sparsity of PR facilities. This disparity is particularly pronounced in African American and Hispanic persons with COPD. Telehealth-provided PR could increase access and improve health outcomes. METHODS We applied the RE-AIM framework in a post-hoc analysis of our mixed methods RCT comparing referral to Telehealth-delivered PR (TelePR) versus standard PR (SPR) for African American and Hispanic COPD patients hospitalized for COPD exacerbation. Both arms received a referral to PR for 8 weeks, social worker follow-up, and surveys administered at baseline, 8 weeks, 6, and 12 months. PR sessions were conducted twice a week for 90 min each (16 sessions total). Quantitative data were analyzed using 2-sample t tests or nonparametric Wilcoxon tests for continuous data and χ2/Fisher exact tests for categorical data. Logistic regression-estimated odds ratios (ORs) were used for the intention-to-treat primary outcome. Qualitative interviews were conducted at the end of the study to assess adherence and satisfaction and were analyzed using inductive and deductive methods. The goal was to understand Reach (whether the target population was able to be enrolled), Effectiveness (primary outcome was a composite of 6-month COPD rehospitalization and death), Adoption (proportion of people willing to initiate the program), Implementation (whether the program was able to be executed as intended, and Maintenance (whether the program was continued). RESULTS Two hundred nine people enrolled out of a 276-recruitment goal. Only 85 completed at least one PR session 57/111 (51%) TelePR; 28/98 (28%) SPR. Referral to TelePR compared to SPR did not decrease the composite outcome of 6-month COPD-readmission rate/death (OR1.35;95%CI 0.69,2.66). There was significant reduction in fatigue (PROMIS® scale) from baseline to 8-weeks in TelePR compared to SPR (MD-1.34; ± SD4.22; p = 0.02). Participants who received TelePR experienced improvements from baseline in several outcomes (ie, before and after 8 weeks of PR) in the following: COPD symptoms, knowledge about COPD management, fatigue, and functional capacity. Among the patients who had 1 initial visit, adherence rates were similar (TelePR arm, 59% of sessions; SPR arm, 63%). No intervention-related adverse events occurred. Barriers to PR adoption included difficulty or reluctance to complete medical clearances and beliefs about PR efficacy. Notably, only 9 participants sustained exercise after program completion. Maintenance of the program was not possible due to low insurance reimbursement and sparsity of Respiratory Therapists. CONCLUSIONS TelePR can reach COPD patients with health disparities and can be successfully implemented. The small sample size and large confidence intervals prevent conclusion about the relative effectiveness of participating in TelePR compared to SPR. However, improved outcomes were seen for those in TelePR as well as in SPR. Increasing adoption of PR and TelePR requires consideration of comorbidity burden, and perception of PR utility, and must facilitate medical clearances. Given the sparsity of SPR locations, TelePR can overcome at least the barrier of access. However, given the challenges to the uptake and completion of PR - many of the additional barriers in PR (both in TelePR and SPR) need to be addressed. Awareness of these real-world challenges will not only inform implementation of TelePR for clinicians seeking to adopt this platform but will also inform study designers and reviewers regarding the feasibility of approaches to patient recruitment and retention.
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Affiliation(s)
- Jennifer Polo
- Northwell Health, Great Neck, NY, USA.
- Institute of Health System Science, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY, 11030, USA.
| | - Melissa J Basile
- Northwell Health, Great Neck, NY, USA
- Institute of Health System Science, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY, 11030, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Meng Zhang
- Northwell Health, Great Neck, NY, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | | | | | | | - Myia Williams
- Northwell Health, Great Neck, NY, USA
- Institute of Health System Science, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY, 11030, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | | | | | | | - Parvez Mir
- Wyckoff Heights Medical Center, Brooklyn, NY, USA
| | - Sameer Khanijo
- Northwell Health, Great Neck, NY, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Renee Pekmezaris
- Northwell Health, Great Neck, NY, USA
- Institute of Health System Science, Northwell Health, 600 Community Drive, Suite 403, Manhasset, NY, 11030, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
- Department of Occupational Medicine, Epidemiology, and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - Negin Hajizadeh
- Northwell Health, Great Neck, NY, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Walklin CG, Young HML, Asghari E, Bhandari S, Billany RE, Bishop N, Bramham K, Briggs J, Burton JO, Campbell J, Castle EM, Chilcot J, Cooper N, Deelchand V, Graham-Brown MPM, Hamilton A, Jesky M, Kalra PA, Koufaki P, McCafferty K, Nixon AC, Noble H, Saynor ZL, Sothinathan C, Taal MW, Tollitt J, Wheeler DC, Wilkinson TJ, Macdonald JH, Greenwood SA. The effect of a novel, digital physical activity and emotional well-being intervention on health-related quality of life in people with chronic kidney disease: trial design and baseline data from a multicentre prospective, wait-list randomised controlled trial (kidney BEAM). BMC Nephrol 2023; 24:122. [PMID: 37131125 PMCID: PMC10152439 DOI: 10.1186/s12882-023-03173-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Physical activity and emotional self-management has the potential to enhance health-related quality of life (HRQoL), but few people with chronic kidney disease (CKD) have access to resources and support. The Kidney BEAM trial aims to evaluate whether an evidence-based physical activity and emotional wellbeing self-management programme (Kidney BEAM) leads to improvements in HRQoL in people with CKD. METHODS This was a prospective, multicentre, randomised waitlist-controlled trial, with health economic analysis and nested qualitative studies. In total, three hundred and four adults with established CKD were recruited from 11 UK kidney units. Participants were randomly assigned to the intervention (Kidney BEAM) or a wait list control group (1:1). The primary outcome was the between-group difference in Kidney Disease Quality of Life (KDQoL) mental component summary score (MCS) at 12 weeks. Secondary outcomes included the KDQoL physical component summary score, kidney-specific scores, fatigue, life participation, depression and anxiety, physical function, clinical chemistry, healthcare utilisation and harms. All outcomes were measured at baseline and 12 weeks, with long-term HRQoL and adherence also collected at six months follow-up. A nested qualitative study explored experience and impact of using Kidney BEAM. RESULTS 340 participants were randomised to Kidney BEAM (n = 173) and waiting list (n = 167) groups. There were 96 (55%) and 89 (53%) males in the intervention and waiting list groups respectively, and the mean (SD) age was 53 (14) years in both groups. Ethnicity, body mass, CKD stage, and history of diabetes and hypertension were comparable across groups. The mean (SD) of the MCS was similar in both groups, 44.7 (10.8) and 45.9 (10.6) in the intervention and waiting list groups respectively. CONCLUSION Results from this trial will establish whether the Kidney BEAM self management programme is a cost-effective method of enhancing mental and physical wellbeing of people with CKD. TRIAL REGISTRATION NCT04872933. Registered 5th May 2021.
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Affiliation(s)
- C G Walklin
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - Hannah M L Young
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
| | - E Asghari
- Department of Nephrology, Guy's and St Thomas' NHS Trust, London, UK
| | - S Bhandari
- Department of Nephrology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - R E Billany
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - N Bishop
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | - K Bramham
- Department of Women's Health, King's College London, London, UK
| | - J Briggs
- Renal Therapies, King's College Hospital NHS Trust, London, UK
| | - J O Burton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - J Campbell
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | - E M Castle
- School of Physiotherapy, Department of Health Sciences, Brunel University, London, UK
| | - J Chilcot
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Cooper
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - V Deelchand
- Department of Nephrology, Royal Free Hospital, London, UK
| | | | - A Hamilton
- Department of Nephrology, Royal Exeter Hospital, Devon, UK
| | - M Jesky
- Department of Nephrology, Nottingham NHS Trust, Nottingham, UK
| | - P A Kalra
- Department of Nephrology, Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - P Koufaki
- Dietetics, Nutrition and Biological Sciences, Queen Margaret University, Edinburgh, UK
| | - K McCafferty
- Department of Nephrology, Barts Health NHS Trust, London, UK
| | - A C Nixon
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - H Noble
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Z L Saynor
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, UK
| | - C Sothinathan
- Department of Physiotherapy, Chelsea and Westminster NHS Trust, London, UK
| | - M W Taal
- Centre for Kidney Research and Innovation, University of Nottingham, Nottingham, UK
| | - J Tollitt
- Department of Renal Medicine, University College London, London, UK
| | - D C Wheeler
- National Institute of Health Research Leicester Biomedical Research Centre , Leicester, UK
| | - T J Wilkinson
- Institute for Applied Human Physiology, Bangor University, Bangor, Gwynedd, UK
| | - J H Macdonald
- Faculty of life sciences and medicine, King's College London, London, UK
| | - S A Greenwood
- Renal Therapies, King's College Hospital NHS Trust, London, UK
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Purdy GM, Sobierajski FM, Al Onazi MM, Effa CJ, Venner CP, Tandon P, McNeely ML. Exploring participant perceptions of a virtually supported home exercise program for people with multiple myeloma using a novel eHealth application: a qualitative study. Support Care Cancer 2023; 31:298. [PMID: 37097319 PMCID: PMC10126542 DOI: 10.1007/s00520-023-07762-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/16/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Supervision, tailoring, and flexibility have been proposed as key program elements for delivering successful exercise programs for people with multiple myeloma (MM). However, no studies to date have evaluated the acceptability of an intervention employing these components. The aim of this study was to determine the acceptability of a virtually supported exercise program and eHealth application for people with MM. METHODS A qualitative description approach was used. One-on-one interviews were conducted with participants who completed the exercise program. Content analysis was used to analyze verbatim transcripts from interviews. RESULTS Twenty participants were interviewed (64.9 ± 6.7 years of age, n = 12 females). Participants had positive perceptions of the exercise program. Two themes emerged related to strengths/limitations: One Size Does Not Fit All (sub-themes: Supportive & Responsive Programming and Diverse Exercise Opportunities), and App Usability. Supportive and Responsive Programming was a main strength of the program, characterized as programming that was tailored, involved active support, and delivered by appropriate personnel. The inclusion of Diverse Exercise Opportunities was also regarded as a strength, as it accommodated the preferences of all participants. Related to App Usability, participants felt the app was simple and user friendly but had a few less intuitive components. CONCLUSION The virtually supported exercise program and eHealth application were acceptable for people with MM. Programs should employ tailoring, active support, and appropriate personnel to bolster acceptability and include both supervised and flexible exercise formats. eHealth apps should be simple to use so technology proficiency is not a barrier to participation.
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Affiliation(s)
- Graeme M Purdy
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Frances M Sobierajski
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mona M Al Onazi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Corrie J Effa
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Puneeta Tandon
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Margaret L McNeely
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Cancer Care Alberta, Alberta Health Services, Calgary, AB, Canada.
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Roddy MK, Chen P, Jeffery AD, Gutierrez J, Rubenstein M, Campbell C, Blake E, Ward MJ. Telemental health in emergency care settings: A qualitative analysis of considerations for sustainability and spread. Acad Emerg Med 2023; 30:368-378. [PMID: 36786633 PMCID: PMC10983773 DOI: 10.1111/acem.14682] [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: 12/20/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVES Following rapid uptake of telehealth during the COVID-19 pandemic, we examined barriers and facilitators for sustainability and spread of telemental health video (TMH-V) as policies regarding precautions from the pandemic waned. METHODS We conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. We asked four groups, local clinicians, facility leadership, Veterans, and external partners, about barriers and facilitators impacting patient willingness to engage in TMH-V (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). Interviews were recorded, transcribed, and analyzed using framework analysis. We also observed TMH-V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology. RESULTS We conducted 35 interviews with ED/UC clinicians and staff (n = 10), clinical and facility leadership (n = 7), Veterans (n = 5), and external partners (n = 13), January-May 2022. We completed 10 observations. All interviewees were satisfied with the TMH-V program, and interviewees highlighted increased comfort discussing difficult topics for Veterans (reach). Clinicians identified that TMH-V allowed for cross-coverage across sites as well as increased safety and flexibility for clinicians (adoption). Opportunities for improvement include alleviating technological burdens for on-site staff, electronic health record (EHR) modifications to accurately capture workload and modality (telehealth vs. in-person), and standardizing protocols to streamline communication between on-site and remote clinical staff (implementation). Finally, interviewees encouraged its spread (maintenance) and thought there was great potential for service expansion. CONCLUSIONS Interviewees expressed support for continuing TMH-V locally and spread to other sites. Ensuring adequate infrastructure (e.g., EHR integration and technology support) and workforce capacity are key for successful spread. Given the shortage of mental health (MH) clinicians in rural settings, TMH-V represents a promising intervention to increase the access to high-quality emergency MH care.
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Affiliation(s)
- McKenzie K. Roddy
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alvin D. Jeffery
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | | | - Melissa Rubenstein
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Corey Campbell
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eric Blake
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Michael J. Ward
- Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Byrd TF, Speigel PS, Cameron KA, O'Leary KJ. Barriers to Adoption of a Secure Text Messaging System: a Qualitative Study of Practicing Clinicians. J Gen Intern Med 2023; 38:1224-1231. [PMID: 36376637 PMCID: PMC10110803 DOI: 10.1007/s11606-022-07912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Secure text messaging systems (STMS) offer HIPAA-compliant text messaging and mobile phone call functionalities that are more efficient than traditional paging. Although some studies associate improved provider satisfaction and healthcare delivery with STMS use, healthcare organizations continue to struggle with achieving widespread and sustained STMS adoption. OBJECTIVE To understand the barriers to adoption of an STMS among physicians and advanced practice providers (APPs). DESIGN We qualitatively analyzed free-text comments that clinicians (physicians and APPs) across a large healthcare organization offered on a survey about STMS perceptions. PARTICIPANTS A total of 1110 clinicians who provided a free-text comment in response to one of four open-ended survey questions. APPROACH Data were analyzed using a grounded theory approach and constant comparative method to characterize responses and identify themes. KEY RESULTS The overall survey response rate was 20.5% (n = 1254). Clinicians familiar with the STMS frequently believed the STMS was unnecessary (existing tools worked well enough) and would overburden them with more communications. They were frustrated that the STMS app had to be downloaded onto their personal mobile device and that it drained their battery. Ambiguity regarding who was reachable in the app led to missed messages and drove distrust of the STMS. Clinicians saw the exclusion of other care team members (e.g., nurses) from the STMS as problematic; however, some clinicians at hospitals with expanded STMS access complained of excessive messages. Secondhand reports of several of these barriers prevented new users from downloading the app and contributed to ongoing low use. CONCLUSIONS Clinicians are reluctant to adopt an STMS that does not offer a clear and trustworthy communication benefit to offset its potential burden and intrusiveness. Our findings can be incorporated into STMS implementation strategies that maximize active users by targeting and mitigating barriers to adoption.
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Affiliation(s)
- Thomas F Byrd
- Division of Hospital Medicine, University of Minnesota, MMC 741, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
| | - Philip S Speigel
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kenzie A Cameron
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kevin J O'Leary
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR. Prim Health Care Res Dev 2023; 24:e17. [PMID: 36883652 PMCID: PMC10050826 DOI: 10.1017/s1463423623000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
AIM Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers. BACKGROUND Cardiovascular disease and its risk factors are the world's leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project 'SPICES', which aims to implement validated preventive interventions in vulnerable populations. METHODS We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR). FINDINGS Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse's roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community - health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.
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