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Steinman L, Chadwick K, Chavez Santos E, Sravanam S, Johnson SS, Rensema E, Mayotte C, Denison P, Lorig K. Remote Evidence-Based Programs for Health Promotion to Support Older Adults During the COVID-19 Pandemic and Beyond: Mixed Methods Outcome Evaluation. JMIR Aging 2024; 7:e52069. [PMID: 38869932 PMCID: PMC11211707 DOI: 10.2196/52069] [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: 08/22/2023] [Revised: 03/28/2024] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Evidence-based programs (EBPs) for health promotion were developed to reach older adults where they live, work, pray, and play. When the COVID-19 pandemic placed a disproportionate burden on older adults living with chronic conditions and the community-based organizations that support them, these in-person programs shifted to remote delivery. While EBPs have demonstrated effectiveness when delivered in person, less is known about outcomes when delivered remotely. OBJECTIVE This study evaluated changes in remote EBP participants' health and well-being in a national mixed methods outcome evaluation in January 1, 2021, to March 31, 2022. METHODS We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) for equity framework to guide the evaluation. We purposively sampled for diverse remote EBP delivery modes and delivery organizations, staff, and traditionally underserved older adults, including people of color and rural dwellers. We included 5 EBPs for self-management, falls prevention, and physical activity: videoconferencing (Chronic Disease Self-Management Program, Diabetes Self-Management Program, and EnhanceFitness), telephone plus mailed materials (Chronic Pain Self-Management Program), and enhanced self-directed mailed materials (Walk With Ease). Participant and provider data included validated surveys, in-depth interviews, and open-ended survey questions. We used descriptive statistics to characterize the sample and the magnitude of change and paired t tests (2-tailed) and the Fisher exact test to test for change in outcomes between enrollment and 6-month follow-up. Thematic analysis was used to identify similarities and differences in outcomes within and across programs. Joint display tables facilitated the integration of quantitative and qualitative findings. RESULTS A total of 586 older adults, 198 providers, and 37 organizations providing EBPs participated in the evaluation. Of the 586 older adults, 289 (49.3%) provided follow-up outcome data. The mean age of the EBP participants was 65.4 (SD 12.0) years. Of the 289 EBP participants, 241 (83.4%) were female, 108 (37.3%) were people of color, 113 (39.1%) lived alone, and 99 (34.3%) were experiencing financial hardship. In addition, the participants reported a mean of 2.5 (SD 1.7) chronic conditions. Overall, the remote EBP participants showed statistically significant improvements in health, energy, sleep quality, loneliness, depressive symptoms, and technology anxiety. Qualitatively, participants shared improvements in knowledge, attitudes, and skills for healthier living; reduced their social isolation and loneliness; and gained better access to programs. Three-fourths of the providers (149/198, 75.2%) felt that effectiveness was maintained when switching from in-person to remote delivery. CONCLUSIONS The findings suggest that participating in remote EBPs can improve health, social, and technological outcomes of interest for older adults and providers, with benefits extending to policy makers. Future policy and practice can better support remote EBP delivery as one model for health promotion, improving access for all older adults.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Kelly Chadwick
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Erica Chavez Santos
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Sruthi Sravanam
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Selisha Snowy Johnson
- Office of Community Outreach and Engagement, Fred Hutch Cancer Center, Seattle, WA, United States
| | - Elspeth Rensema
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Caitlin Mayotte
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | | | - Kate Lorig
- Self Management Resource Center, Aptos, CA, United States
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Li Z, Hutchings-Hay C, Byford S, Tchanturia K. A qualitative evaluation of the pathway for eating disorders and autism developed from clinical experience (PEACE): clinicians' perspective. Front Psychiatry 2024; 15:1332441. [PMID: 38638414 PMCID: PMC11024361 DOI: 10.3389/fpsyt.2024.1332441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction The Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE pathway) is a clinical pathway of adapted treatment for individuals with eating disorders and autism in the UK. This study aims to investigate multidisciplinary clinicians' views of the strengths and challenges of PEACE pathway adaptations, while identifying areas where further improvement is needed. Method Semi-structured interviews were conducted with 16 clinicians who worked on the PEACE pathway. Themes relevant to the benefits, challenges and areas of improvement were identified, and a thematic map was produced. Results PEACE Pathway brought clinical benefits such as improved understanding of patients' perspective, improved flexibility and individualisation in clinicians' approach, increased patient engagement, and provision of resources that are helpful to all patients with or without autism. Benefits to the service included increase in autism awareness, clinicians' confidence, and team collaboration. Challenges were also identified, including difficulties in incorporating autism adaptations into existing treatment protocol, implementing PEACE at different levels of care, staff schedule conflicts, and increased pressure to meet patients' needs. Overall, there is a need for systemic improvement in aftercare and community support for autism, more suitable autism screening tool, and more structured guidelines for making adaptations. Conclusions and implications PEACE Pathway has brought clinical and service benefits, while also bringing practical challenges rooted in the difficulty in distinguishing between autism and eating disorder in comorbid population. Future areas of improvement are highlighted for PEACE resources as well as in the national support system for autistic individuals.
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Affiliation(s)
- Zhuo Li
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Chloe Hutchings-Hay
- National Eating Disorders Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Sarah Byford
- King’s Health Economics, Department of Health Service and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- National Eating Disorders Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
- Tbilisi State Medical University, Psychological Set Research and Correction Center, Tbilisi, Georgia
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Kohn MJ, Chadwick KA, Steinman LE. Adapting Evidence-Based Falls Prevention Programs for Remote Delivery - Implementation Insights through the RE-AIM Evaluation Framework to Promote Health Equity. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:163-173. [PMID: 37036550 PMCID: PMC10088656 DOI: 10.1007/s11121-023-01519-z] [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] [Accepted: 02/26/2023] [Indexed: 04/11/2023]
Abstract
COVID-19 disproportionally impacted the health and well-being of older adults-many of whom live with chronic conditions-due to their higher risk of dying and being hospitalized. It also created several secondary pandemics, including increased falls risk, sedentary behavior, social isolation, and physical inactivity due to limitations in mobility from lock-down policies. With falls as the leading cause of preventable death and hospitalizations, it became vital for in-person evidence-based falls prevention programs (EBFPPs) to pivot to remote delivery. In Spring 2020, many EBFPP administrators began re-designing programs for remote delivery to accommodate physical distancing guidelines necessitated by the pandemic. Transition to remote delivery was essential for older adults and persons with disabilities to access EBFPPs for staying healthy, falls and injury free, out of hospitals, and also keeping them socially engaged. We collaborated with the Administration on Community Living (ACL), the National Council on Aging (NCOA), and the National Falls Prevention Resource Center (NFPRC), for an in-depth implementation evaluation of remotely delivered EBFPPs. We examined the process of adapting and implementing four EBFPPs for remote delivery, best practices for implementing the programs remotely within the RE-AIM evaluation framework. This enhances NFPRC's ongoing work supporting dissemination, implementation, and sustainability of EBFPPs. We purposively sampled organizations for maximum variation in organization and provider type, geographic location, and reach of underserved older populations (Black, Indigenous, or other People of Color (BIPOC), rural, disabilities). This qualitative evaluation includes provider-level data from semi-structured interviews (N = 22) with program administrators, staff, and leaders. The interview guide included what, why, and how adaptations were made to EBFPP interventions and implementation strategies using Wiltsey-Stirman (2019) adaptations framework (FRAME), reach, and implementation outcomes (acceptability, feasibility, fidelity, and costs; Proctor et al., 2011), focusing on equity to learn for whom these programs were working and opportunities to address inequities. Findings demonstrate remote EBFPPs made planned and fidelity-consistent adaptations to remote delivery in partnership with researchers and community organizations, focusing on participant safety both in program content and delivery. Supports using and accessing technology were needed for delivery sites and leaders to facilitate engagement, and improved over time. While remote EBFPP delivery has increased access to EBFPPs for some populations from the perspective of program administrator, leaders, and staff (e.g., caregivers, rural-dwellers, persons with physical disabilities), the digital divide remains a barrier in access to and comfort using technology. Remote-delivered EBFPPs were acceptable and feasible to delivery organizations and leaders, were able to be delivered with fidelity using adaptations from program developers, but were more resource intensive and costly to implement compared to in-person. This work has important implications beyond the pandemic. Remote delivery has expanded access to groups traditionally underserved by in-person programming, particularly disability communities. This work will help answer important questions about reach, accessibility, feasibility, and cost of program delivery for older adults and people with disabilities at risk for falls, those living with chronic conditions, and communities most vulnerable to disparities in access to health care, health promotion programming, and health outcomes. It will also provide critical information to funders about elements required to adapt EBFPPs proven effective in in-person settings for remote delivery with fidelity to achieve comparable outcomes.
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Affiliation(s)
- Marlana J Kohn
- Health Promotion Research Center, University of Washington, Seattle, USA.
| | - Kelly A Chadwick
- Health Promotion Research Center, University of Washington, Seattle, USA
| | - Lesley E Steinman
- Health Promotion Research Center, University of Washington, Seattle, USA
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Säfström M, Löfkvist U. Employees' experiences of a large-scale implementation in a public care setting: a novel mixed-method approach to content analysis. BMC Health Serv Res 2024; 24:107. [PMID: 38238737 PMCID: PMC10797789 DOI: 10.1186/s12913-024-10560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Research for evidence-based interventions and strategies for implementation continues. Yet there is a continued shortage of qualified health care staff while stress and burnout are common. Health care professionals' individual perceptions towards change needs to be considered to succeed in organisational change. It is therefore relevant to investigate how implementation processes affect employees within the health care sector. Challenges to implementation are especially large in the field of disability care. The present study aims to investigate employees' experiences of an ongoing large-scale implementation, and what they perceived as important to succeed in a complex clinical setting. METHODS Semi-structured focus group interviews were conducted with a self-selected sample of employees from a large and complex health care organisation responsible for public disability care in a centrally located Swedish region. A mixed-method approach adapted to content analysis was performed in a three-step process. In the first round, each unit of analysis was selected and then colour coded. In a second round, the coloured units were coded according to content analysis, and categories and concepts were compared and adjusted until the two researchers reached consensus. Finally, to further complement the content analysis, a quantitative analysis of the colour categories was made. RESULTS In general, employees experienced the implementation as being insufficient, yet opinions of the process of implementation were mixed. Most positive experiences were found in relation to the outcomes that the new method had on work effectiveness and patient care. Closely related topics like time constraints, uncertainties concerning the method and the need for supportive functions reoccurred in several concepts suggesting a relationship between differing contextual factors, implementation activities and fidelity. Also evident in the results were the strain on organisational and social work environment and the importance of managers' active leadership. CONCLUSIONS Implementation processes are experienced as challenging for employees. Key facilitators are available support functions, clear leadership and time that is sufficient and kept sacrosanct. Leaders need to communicate how and why employees may experience implementation processes differently. The impact that organisational change has on work environment should be considered.
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Affiliation(s)
- My Säfström
- Primary care and health, Uppsala County Council, Uppsala, Sweden
| | - Ulrika Löfkvist
- Primary care and health, Uppsala County Council, Uppsala, Sweden.
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
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Bradley CD, Irie WC, Geng EH. Situating implementation science (IS) in res(IS)tance: a conceptual frame toward the integration of scholarship from the black radical tradition. Front Public Health 2024; 11:1286156. [PMID: 38274530 PMCID: PMC10808293 DOI: 10.3389/fpubh.2023.1286156] [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: 08/31/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
This manuscript undertakes a disciplinary self-critique of the field of implementation science, a field which attempts to bridge the gap between evidence-based interventions and their practical application. Despite the heightened emphasis on health equity and racial disparities, the field's current discourse is limited by key epistemic shortcomings. First, even though prevalence of implementation gaps between racialized groups in the United States necessitates a comprehensive understanding of the systems perpetuating these disparities, the field does not operate with a general explanation for disparities not as a failure of systems, but a system historically and structural designed to produce disparities. Second, the field has attempted to address disparities without adequate dialog with a broad tradition of anti-racist and anti-colonial sociology, history and epistemology, and therefore risks a decontextualized analysis of disparities and under-informed approaches to achieving equity. Fortunately, scholarship from the Black radical tradition (BRT), such as the Public Health Critical Race Praxis (PHCRP), Critical Race Theory (CRT), and more broadly conceptual frameworks from post-modern, anti-colonial, Black feminist studies and social epistemology can offer to implementation science frameworks that center power dynamics and racialized oppression. This epistemic re-alignment of implementation research to "center at the margins" can enable the field of implementation science to more critically examine and dismantle systems that perpetuate racial inequalities in access to and utilization of health interventions. For example, normalization and dynamic fit, which are thought to be key mechanisms of implementation, are revealed in the light of this tradition of scholarship to be potentially problematic acquiescence to oppressive systems. Drawing from the concept of resistance anchored in the scholarship of the Black radical tradition as well as contemporary social epistemology such as the work of José Medina and Maria Fricker about epistemic justice, the authors further advance that implementation science could make more substantial contributions to the dismantling of racialized systems and actively work toward health justice through the transdisciplinary lens of resistance. This is a call to action for integrating implementation science with critical philosophical and theoretical perspectives rooted in Black studies and related insights, which have been acquired through the struggle for social justice, to inform the design of implementation strategies and research projects that improve health services and health outcomes for health disparity populations.
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Affiliation(s)
- Cory D. Bradley
- Center for Dissemination and Implementation in the Institute for Public Health at Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Whitney C. Irie
- School of Social Work, Boston College, Chestnut Hill, MA, United States
| | - Elvin H. Geng
- Center for Dissemination and Implementation in the Institute for Public Health at Washington University School of Medicine in St. Louis, St. Louis, MO, United States
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Lagerlöf H, Eriksson L, Sager M. Organizing implementation in healthcare: Balancing orders of worth. Soc Sci Med 2024; 340:116476. [PMID: 38056305 DOI: 10.1016/j.socscimed.2023.116476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/06/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
In this paper we direct attention to unavoidable conflicts between disparate value systems co-existing within organizations. Drawing on John Law's concept of ordering and Boltanski and Thévenot's orders of worth, we understand incompatibilities inherent in implementation and governance as competing orders. In extracting and articulating competing orders from our abductive analysis of semi-structured interviews with primary care managers (n = 32) in a Swedish county council, we hope to enable actors to utilise and address them as they engage in implementation work. The potential of such an approach is exemplified by analysing a regional case of health promotion implementation pursued in 2019, in a Swedish county council. Early approaches to implementation and governance have entailed linear models emphasizing program fidelity. Critics have broadened this view by calling for optimization of multiple values and more room for professional judgment. We seek to add to this development by attending to how healthcare practices often entail different and at times conflicting configurations of patients, professionals and priorities. The county council in our case study attempted to steer primary care providers towards health promotion work. To capture the realities of the organization that primary care managers described, we propose that three competing orders can be discerned in primary care: the order of immediate care, focusing on professional judgments of the most pressing needs of patients; the order of accessible care, in which patients themselves define what needs should be cared for; and the order of future health emphasizing prevention of health in the future population. Each order enacts a specific prioritization between patients and a vision of what is or should be primary in primary care. Organizing implementation, we suggest, requires a balancing of orders of worth.
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Affiliation(s)
- Helena Lagerlöf
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Sweden; Region Västmanland, Sweden.
| | - Lena Eriksson
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Sweden.
| | - Morten Sager
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Sweden.
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Steinman L, Xing J, Court B, Coe NB, Yip A, Hill C, Rector B, Baquero B, Weiner BJ, Snowden M. Can a Home-Based Collaborative Care Model Reduce Health Services Utilization for Older Medicaid Beneficiaries Living with Depression and Co-occurring Chronic Conditions? A Quasi-experimental Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:712-724. [PMID: 37233831 DOI: 10.1007/s10488-023-01271-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/27/2023]
Abstract
Depression remains a major public health issue for older adults, increasing risk of costly health services utilization. While home-based collaborative care models (CCM) like PEARLS have been shown to effectively treat depression in low-income older adults living with multiple chronic conditions, their economic impact is unclear. We conducted a quasi-experimental study to estimate PEARLS effect on health service utilization among low-income older adults. Our secondary data analysis merged de-identified PEARLS program data (N = 1106), home and community-based services (HCBS) administrative data (N = 16,096), and Medicaid claims and encounters data (N = 164) from 2011 to 2016 in Washington State. We used nearest neighbor propensity matching to create a comparison group of social service recipients similar to PEARLS participants on key determinants of utilization guided by Andersen's Model. Primary outcomes were inpatient hospitalizations, emergency room (ER) visits, and nursing home days; secondary outcomes were long-term supports and services (LTSS), mortality, depression and health. We used an event study difference-in-difference (DID) approach to compare outcomes. Our final dataset included 164 older adults (74% female, 39% people of color, mean PHQ-9 12.2). One-year post-enrollment, PEARLS participants had statistically significant improvements in inpatient hospitalizations (69 fewer hospitalizations per 1000 member months, p = 0.02) and 37 fewer nursing home days (p < 0.01) than comparison group participants; there were no significant improvements in ER visits. PEARLS participants also experienced lower mortality. This study shows the potential value of home-based CCM for participants, organizations and policymakers. Future research is needed to examine potential cost savings.
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Affiliation(s)
- Lesley Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA.
- Hans Rosling Center, University of Washington, 3980 15th Avenue NE, UW Mailbox 351621, Seattle, WA, 98195, USA.
| | - Jingping Xing
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Beverly Court
- Research and Data Analysis Division, Washington State Department of Social and Health Services, Olympia, USA
| | - Norma B Coe
- Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Andrea Yip
- Seattle-King County Aging and Disability Services, Seattle, USA
| | - Clara Hill
- Department of Human Development, Washington State University, Pullman, USA
| | - Bea Rector
- Washington State Department of Social and Health Services, Aging and Long-Term Support Administration, Lacey, USA
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, USA
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
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Kaiser BN, Kaufman J, Wall JT, Healy EAF, Ayuku D, Aarons GA, Puffer ES. Assessing ad-hoc adaptations' alignment with therapeutic goals: a qualitative study of lay counselor-delivered family therapy in Eldoret, Kenya. Implement Sci Commun 2023; 4:105. [PMID: 37644561 PMCID: PMC10464241 DOI: 10.1186/s43058-023-00477-5] [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: 10/06/2022] [Accepted: 07/26/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals. METHODS Tuko Pamoja (Swahili: "We are Together") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention ("TP-promoting"), disrupted them ("TP-interrupting"), or neither ("TP-neutral"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral. RESULTS Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall. CONCLUSION Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes. TRIAL REGISTRATION Pilot trial registered at clinicaltrials.gov (C0058).
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Affiliation(s)
- Bonnie N Kaiser
- Department of Anthropology; Global Health Program, University of California San Diego, La Jolla, CA, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | | | | | - Elsa A Friis Healy
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - David Ayuku
- Department of Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, University of Cailfornia San Diego, La Jolla, CA, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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Buccini G, Kofke L, Case H, Katague M, Pacheco MF, Pérez-Escamilla R. Pathways to scale up early childhood programs: A scoping review of Reach Up and Care for Child Development. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001542. [PMID: 37556418 PMCID: PMC10411826 DOI: 10.1371/journal.pgph.0001542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 07/03/2023] [Indexed: 08/11/2023]
Abstract
Evidence-based early childhood development (ECD) programs that strengthen nurturing parenting skills and promote early stimulation, such as Reach Up (RU) and Care for Child Development (CCD), are critical investments for interrupting cycles of intergenerational poverty; however, the implementation impact of these programs varies greatly globally. Analyzing systematically the evidence on the implementation pathways based on contexts (i.e., external and internal influences on intervention implementation), implementation strategies (i.e., mechanisms used to promote program initiation, design, and delivery with existing systems), and implementation outcomes (i.e., related to the implementation goals) can increase the likelihood of implementation success. Our scoping review aimed to identify implementation pathways of RU and CCD programs in low- and middle-income countries. A search in English, Spanish, and Portuguese of grey literature and five databases of peer reviewed literature; from inception through July 16, 2022, yielded 2,267 publications. Using predetermined eligibility criteria, 75 records yielded implementation details for 33 programs across 23 low- and middle-income countries. Two reviewers independently extracted program data on context, implementation strategies, and implementation outcomes following a program theory. A thematic analysis identified 37 implementation strategies across six "building blocks of implementation": program emergence, intersectoriality, intervention characteristics, workforce, training, and monitoring systems. Implementation pathways across building blocks are highly influenced by contextual factors, such as infrastructure, social norms, and the target population's demand and interest, which may shape different implementation outcomes. Six 'building blocks' shaping implementation pathways of CCD and RU in LMICs were identified. The careful consideration of context and use of intentional evidence-based planning can enable the successful implementation of ECD nurturing care interventions. We recommend the use of the ECD Implementation Checklist for Enabling Program Scale Up to guide decision-making regarding context and implementation strategies to support implementation outcomes and subsequent ECD program success.
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Affiliation(s)
- Gabriela Buccini
- Department of Social and Behavioral Health, University of Nevada Las Vegas School of Public Health, Las Vegas, Nevada, United States of America
| | - Lily Kofke
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Haley Case
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Marina Katague
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
| | | | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, United States of America
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Greene MC, Bonz AG, Cristobal M, Angulo A, Armijos A, Guevara ME, Vega C, Benavides L, Corrales C, de la Cruz A, Lopez MJ, Moyano A, Murcia A, Noboa MJ, Rodriguez A, Solis J, Vergara D, Bollman EB, Andersen LS, Wainberg M, Tol WA. Mixed-methods evaluation of a group psychosocial intervention for refugee, migrant and host community women in Ecuador and Panamá: Results from the Entre Nosotras cluster randomized feasibility trial. Glob Ment Health (Camb) 2023; 10:e42. [PMID: 37854436 PMCID: PMC10579653 DOI: 10.1017/gmh.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/07/2023] [Accepted: 07/09/2023] [Indexed: 10/20/2023] Open
Abstract
Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.
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Affiliation(s)
- M. Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | | | - Carolina Vega
- HIAS Ecuador, Quito, Ecuador
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | - E. Brennan Bollman
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lena S. Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Milton Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
- Department of Psychiatry, Columbia University New York State Psychiatric Institute, New York, NY, USA
| | - Wietse A. Tol
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Irimu G, Okwaro F, Coleman J, Waiyego M, Murila F, Chomba D, Parsimei M, Shitote C, Ochieng R, Shah J, Ogero M, Ginsburg AS, Ansermino JM, Macharia W. Developing and testing a clinical care bundle incorporating caffeine citrate to manage apnoea of prematurity in a resource-constrained setting: a mixed methods clinical feasibility study protocol. Implement Sci Commun 2023; 4:80. [PMID: 37461120 PMCID: PMC10351121 DOI: 10.1186/s43058-023-00455-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Apnoea of prematurity (AOP) is a common condition among preterm infants. Methylxanthines, such as caffeine and aminophylline/theophylline, can help prevent and treat AOP. Due to its physiological benefits and fewer side effects, caffeine citrate is recommended for the prevention and treatment of AOP. However, caffeine citrate is not available in most resource-constrained settings (RCS) due to its high cost. Challenges in RCS using caffeine citrate to prevent AOP include identifying eligible preterm infants where gestational age is not always known and the capability for continuous monitoring of vital signs to readily identify apnoea. We aim to develop an evidence-based care bundle that includes caffeine citrate to prevent and manage AOP in tertiary healthcare facilities in Kenya. METHODS This protocol details a prospective mixed-methods clinical feasibility study on using caffeine citrate to manage apnoea of prematurity in a single facility tertiary-care newborn unit (NBU) in Nairobi, Kenya. This study will include a 4-month formative research phase followed by the development of an AOP clinical-care-bundle prototype over 2 months. In the subsequent 4 months, implementation and improvement of the clinical-care-bundle prototype will be undertaken. The baseline data will provide contextualised insights on care practices within the NBU that will inform the development of a context-sensitive AOP clinical-care-bundle prototype. The clinical care bundle will be tested and refined further during an implementation phase of the quality improvement initiative using a PDSA framework underpinned by quantitative and qualitative clinical audits and stakeholders' engagement. The quantitative component will include all neonates born at gestation age < 34 weeks and any neonate prescribed aminophylline or caffeine citrate admitted to the NBU during the study period. DISCUSSION There is a need to develop evidence-based and context-sensitive clinical practice guidelines to standardise and improve the management of AOP in RCS. Concerns requiring resolution in implementing such guidelines include diagnosis of apnoea, optimal timing, dosing and administration of caffeine citrate, standardisation of monitoring devices and alarm limits, and discharge protocols. We aim to provide a feasible standardised clinical care bundle for managing AOP in low and middle-income settings.
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Affiliation(s)
- Grace Irimu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
| | | | - Jesse Coleman
- The University of British Columbia, Vancouver, Canada
| | - Mary Waiyego
- Division of Paediatrics, Kenyatta National Hospital, Nairobi, Kenya
| | - Florence Murila
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Dorothy Chomba
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | | | - Cynthia Shitote
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | | | - Jasmit Shah
- Department of Paediatrics, Aga Khan University, Nairobi, Kenya
| | - Morris Ogero
- London School of Hygiene and Tropical Medicine, London, UK
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Darling KE, Hayes JF, Evans EW, Sanchez I, Chachra J, Grenga A, Elwy AR, Jelalian E. Engaging Stakeholders to Adapt an Evidence-Based Family Healthy Weight Program. Transl Behav Med 2023; 13:423-431. [PMID: 36893021 PMCID: PMC10314725 DOI: 10.1093/tbm/ibac113] [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: 03/10/2023] Open
Abstract
Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention.
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Affiliation(s)
- Katherine E Darling
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jacqueline F Hayes
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - E Whitney Evans
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Irene Sanchez
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jessica Chachra
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Andrea Grenga
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - A Rani Elwy
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Elissa Jelalian
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
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Wyss-Hänecke R, Lauener SK, Sluka C, Deschodt M, Siqeca F, Schwendimann R. Implementation fidelity of a multifactorial in-hospital fall prevention program and its association with unit systems factors: a single center, cross-sectional study. BMC Health Serv Res 2023; 23:158. [PMID: 36793084 PMCID: PMC9930071 DOI: 10.1186/s12913-023-09157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/06/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Falls are a common, costly global public health burden. In hospitals, multifactorial fall prevention programs have proved effective in reducing falls' incidence; however, translating those programs accurately into daily clinical practice remains challenging. This study's aim was to identify ward-level system factors associated with implementation fidelity to a multifactorial fall prevention program (StuPA) targeting hospitalized adult patients in an acute care setting. METHODS This retrospective cross-sectional study used administrative data on 11,827 patients admitted between July and December 2019 to 19 acute care wards at the University Hospital Basel, Switzerland, as well as data on the StuPA implementation evaluation survey conducted in April 2019. Data were analysed using descriptive statistics, Pearson's coefficients and linear regression modelling for variables of interest. RESULTS The patient sample had an average age of 68 years and a median length of stay of 8.4 (IQR: 2.1) days. The mean care dependency score was 35.4 points (ePA-AC scale: from 10 points (totally dependent) to 40 points (totally independent)); the mean number of transfers per patient -(e.g., change of room, admission, discharge) was 2.6 (range: 2.4- 2.8). Overall, 336 patients (2.8%) experienced at least one fall, resulting in a rate of 5.1 falls per 1'000 patient days. The median inter-ward StuPA implementation fidelity was 80.6% (range: 63.9-91.7%). We found the mean number of inpatient transfers during hospitalisation and the mean ward-level patient care dependency to be statistically significant predictors of StuPA implementation fidelity. CONCLUSION Wards with higher care dependency and patient transfer levels showed higher implementation fidelity to the fall prevention program. Therefore, we assume that patients with the highest fall prevention needs received greater exposure to the program. For the StuPA fall prevention program, our results suggest a need for implementation strategies contextually adapted to the specific characteristics of the target wards and patients.
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Affiliation(s)
- Regula Wyss-Hänecke
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,MediZentrum Burgergut, Bernstrasse 107, 3613 Steffisburg, Switzerland
| | - Susanne Knüppel Lauener
- grid.410567.1Medizinische Direktion, University Hospital of Basel, Hebelstrasse 2, 4031 Basel, Switzerland
| | - Constantin Sluka
- grid.410567.1Department of Clinical Research, University of Basel and University Hospital of Basel, Spitalstrasse 8/12, 4031 Basel, Switzerland
| | - Mieke Deschodt
- grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, Gerontology and Geriatrics, KU Leuven, Herestraat 49, 3000 Leuven, Belgium ,grid.410569.f0000 0004 0626 3338Competence Center of Nursing, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Flaka Siqeca
- grid.6612.30000 0004 1937 0642Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - René Schwendimann
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Medizinische Direktion, University Hospital of Basel, Hebelstrasse 2, 4031, Basel, Switzerland.
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15
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Best S, Long JC, Braithwaite J, Taylor N. Standardizing variation: Scaling up clinical genomics in Australia. Genet Med 2023; 25:100109. [PMID: 35115231 DOI: 10.1016/j.gim.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Clinical genomics demands close interaction of physicians, laboratory scientists, and genetic professionals. Taking genomics to scale requires an understanding of the underlying processes from the perspective of nongenetic physicians who are new to the field. We identified components of the processes amenable to adaptation when scaling up clinical genomics. METHODS Semistructured interviews informed by the Theoretical Domains Framework with nongenetic physicians, who were using clinical genomics in practice, were guided by an annotated process map with 7 steps following the patient's journey. Findings from the individual maps were synthesized into an overview process map and a series of individual maps by common location and specialty. Interviews were analyzed using the Theoretical Domains Framework. RESULTS In total, 16 nongenetic physicians (eg, nephrologists, immunologists) participated, generating 1 overview and 10 individual process maps. Sixteen common steps were identified across clinical specialties and locations, with variations over 9 steps. We report the potential for standardization across these 9 steps. CONCLUSION When scaling up complex interventions, it is essential to identify steps where variation can be accommodated. With these results we show how process mapping can be used to identify steps where variation is acceptable during scale up to accommodate adaptation to local context, allowing for the inevitable evolution of factors influencing ongoing implementation and sustainability.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Australian Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Natalie Taylor
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
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16
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Steinman LE, Parrish AT, Kohn MJ, Wu S, Hara-Hubbard KK, Brown L, Imam S, Baquero B, Hannon PA, Snowden MB. Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research. Front Public Health 2023; 10:1079082. [PMID: 36793362 PMCID: PMC9922751 DOI: 10.3389/fpubh.2022.1079082] [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: 10/25/2022] [Accepted: 12/29/2022] [Indexed: 02/03/2023] Open
Abstract
Background Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. Methods We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. Results During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Discussion Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
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Affiliation(s)
- Lesley E. Steinman
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States,*Correspondence: Lesley E. Steinman ✉
| | - Amanda T. Parrish
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Marlana J. Kohn
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Sherry Wu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - KeliAnne K. Hara-Hubbard
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Lori Brown
- Southeast Washington Aging and Long-Term Care, Yakima, WA, United States
| | - Syed Imam
- Union for Pan Asian Communities (UPAC) Positive Solutions Program, San Diego, CA, United States
| | - Barbara Baquero
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Peggy A. Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Mark B. Snowden
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Paolino M, Sánchez Antelo V, Cuberli M, Curotto M, Le Pera A, Binder F, Mazzadi JD, Firmenich B, Arrossi S. Assessing the implementation fidelity of HPV self-collection offered by community health workers during home visits (the EMA strategy): a case study in a low-middle-resource setting in Argentina. Implement Sci Commun 2023; 4:4. [PMID: 36635749 PMCID: PMC9836335 DOI: 10.1186/s43058-022-00367-2] [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: 06/03/2022] [Accepted: 11/01/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND In Argentina, HPV self-collection offered by community health workers was demonstrated to be effective to improve cervical cancer screening uptake. Based on these findings, the EMA strategy was scaled up in nine Argentinian provinces. However, there is no evidence about the degree of fidelity-in relation to the core components proposed by the National Program on Cervical Cancer Prevention-with which this strategy was implemented in the new jurisdictions. We carried out a fidelity evaluation of the EMA strategy scaling-up aimed at evaluating the level of adherence to the core components of the EMA strategy, and how different moderating factors affected the implementation fidelity. METHODS This descriptive study used a multi-method approach involving quantitative and qualitative evaluations of the implementation fidelity using the Conceptual Framework for Implementation Fidelity. Evaluation of the degree of adherence to the core components of the EMA strategy was carried out through the analysis of a self-administered survey of health promoters, observations, and secondary data from the National Screening Information System. The analysis of moderating factors was carried out through analysis of field notes, and semi-structured interviews with key stakeholders. RESULTS Our results showed that the core components with highest fidelity were training, sample handling, and transportation. Regarding the offer of HPV self-collection, we found some adaptations such as locations in which health promoters offered HPV self-collection, and fewer pieces of information provided to women during the offer. In the follow-up and treatment core component, we found a reduced adherence to triage and colposcopy. Some contextual factors had a negative impact on implementation fidelity, such as urban insecurity and the reduction in the number of health promoters that offered HPV self-collection. Moderating factors that contributed to achieve high level of fidelity included a well-defined strategy with clear steps to follow, permanent feedback and high level of engagement among implementers. CONCLUSIONS Our study shows how the analysis of fidelity and adaptations of HPV self-collection in real-world contexts are key to measure and maximize its effectiveness in low-middle-income settings.
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Affiliation(s)
- Melisa Paolino
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Victoria Sánchez Antelo
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Milca Cuberli
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, 1067 Buenos Aires, Argentina
| | - Mariana Curotto
- Programa Nacional de Prevención de Cáncer Cervicouterino /Instituto Nacional del Cáncer (Argentina), Julio A. Roca 781, Piso 9, 1067 Buenos Aires, Argentina
| | - Anabella Le Pera
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Fernando Binder
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Juan David Mazzadi
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
| | - Beatriz Firmenich
- Dirección de Formación Capacitación y Planificación de Recursos Humanos en Salud. Secretaría de Salud Pública de La Matanza, Hipolito Yrigoyen 2562, 1754 Buenos Aires, San Justo Argentina
| | - Silvina Arrossi
- grid.423606.50000 0001 1945 2152Centro de Estudios de Estado y Sociedad/ Consejo Nacional de Investigaciones Científicas y Técnicas, Sánchez de Bustamante 27, 1193 Buenos Aires, Argentina
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Hasson H, Hedberg Rundgren E, Strehlenert H, Gärdegård A, Uvhagen H, Klinga C, Hedberg Rundgren Å, von Thiele Schwarz U. The adaptation and fidelity tool to support social service practitioners in balancing fidelity and adaptations: Longitudinal, mixed-method evaluation study. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231189198. [PMID: 37790175 PMCID: PMC10392202 DOI: 10.1177/26334895231189198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Evidence-based interventions (EBIs) seldom fit seamlessly into a setting and are often adapted. The literature identifies practitioners' management of fidelity and adaptations as problematic but offers little guidance. This study aimed to investigate practitioners' perceptions of the feasibility and usability of an intervention aimed to support them in fidelity and adaptation management when working with EBIs. Methods The intervention, the adaptation and fidelity tool (A-FiT), was developed based on the literature, along with input from social service practitioners and social services' Research and Development units' personnel. The intervention consisted of two workshops where the participants were guided through a five-step process to manage fidelity and adaptations. It was tested in a longitudinal mixed-method intervention study with 103 practitioners from 19 social service units in Stockholm, Sweden. A multimethod data collection was employed, which included interviews at follow-up, questionnaires at baseline and follow-up (readiness for change and self-rated knowledge), workshop evaluation questionnaires (usability and feasibility) after each workshop, and documentation (participants' notes on worksheets). To analyze the data, qualitative content analysis, Kruskal-Wallis tests, and Wilcoxon rank-sum tests were performed. Results Overall, the practitioners had a positive perception of the intervention and perceived it as relevant for fidelity and adaptation management (mean ratings over 7.0 on usability and feasibility). The workshops also provided new knowledge and skills to manage fidelity and adaptations. Furthermore, the intervention provided insights into the practitioners' understanding about adaptation and fidelity through a more reflective approach. Conclusion Practical tools are needed to guide professionals not only to adhere to intervention core elements but also to help them to manage fidelity and adaptation. The proposed A-FiT intervention for practitioners' management of both fidelity and adaptation is a novel contribution to the implementation literature. Potentially, the next step is an evaluation of the intervention's impact in an experimental design.
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Affiliation(s)
- Henna Hasson
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Emma Hedberg Rundgren
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Helena Strehlenert
- SOLIID Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Stockholm Gerontology Research Centre, Stockholm, Sweden
| | - Anna Gärdegård
- Stockholm Research and Development, Unit for Social Services (FOU Nordväst), Stockholm, Sweden
| | - Håkan Uvhagen
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
- Academic Primary Healthcare Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Charlotte Klinga
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU nu), Stockholm Health Care Services, Stockholm, Sweden
| | - Åsa Hedberg Rundgren
- Stockholm Gerontology Research Centre, Stockholm, Sweden
- Ageing Research Center, Karolinska Institutet, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17:75. [DOI: 10.1186/s13012-022-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework.
Methods
User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2.
Results
The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation.
Conclusion
The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances.
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Non-pharmacological Options in Postoperative Hospital-Based and Rehabilitation Pain Management (NOHARM): Protocol for a Stepped-Wedge Cluster-Randomized Pragmatic Clinical Trial. Pain Ther 2022; 11:1037-1053. [PMID: 35657564 PMCID: PMC9314477 DOI: 10.1007/s40122-022-00393-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/27/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Opioids may be necessary for guideline-concordant acute perioperative pain management, but their use carries risks for unintended prolonged use and addiction. Guidelines recommend use of validated non-pharmacological pain care (NPPC) approaches in conjunction with prescribed opioids and other analgesics. Our protocol outlines a population-level, pragmatic trial that will test a bundled intervention comprised of an electronic health record (EHR) portal-based conversation guide, EHR clinical decision support (CDS), and a suite of self-management educational and support materials to encourage and advance NPPC use. METHODS We are conducting a stepped-wedge, cluster-randomized pragmatic trial spanning seven surgical specialties across six geographically diverse locations within the Mayo Clinic Enterprise. Thirty two surgical practices across six locations (Rochester, Minnesota; Mankato, Minnesota; La Crosse, Wisconsin; Eau Claire, Wisconsin; Phoenix, Arizona; Jacksonville, Florida) comprise 22 distinct practice clusters that are randomly assigned to one of five steps using constrained randomization. Steps "go live" by initiating the intervention at 7-month intervals between March 2021 and July 2023. Patients over 18 years of age who are scheduled for qualifying procedures within "live" consenting practices are sent a Healing After Surgery guide via their patient portals pre-operatively, directing them to identify their preferred NPPC modalities among 13 approaches. These selections create CDS options for care teams to support patients with self-management materials that reinforce safe NPPC use. PLANNED OUTCOMES Patients' clinical, demographic, and outcome data will be abstracted from the Epic EHR. Primary outcomes will be the Patient Reported Outcomes Measurement Information System (PROMIS) pain interference and physical functioning computer adaptive tests (CAT) collected at 1, 2, and 3 months postoperatively via the patient portal. We will mail printed versions of the 6-item PROMIS short forms to portal non-responders to minimize bias. Secondary outcomes will include the PROMIS anxiety CAT, opioid consumption, and self-reported NPPC use. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04570371.
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Jarrett C, Baxter YC, Boch J, Carrasco C, Cobos Muñoz D, Mauro Dib K, Pessoa L, Saric J, Silveira M, Steinmann P. Deconstructing design thinking as a tool for the implementation of a population health initiative. Health Res Policy Syst 2022; 20:91. [PMID: 35986365 PMCID: PMC9389775 DOI: 10.1186/s12961-022-00892-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/25/2022] [Indexed: 12/05/2022] Open
Abstract
Background The translation of evidence-based practices and rapid uptake of innovations into global health practice is challenging. Design thinking is a consultative process involving multiple stakeholders and has been identified as a promising solution to create and apply implementation strategies in complex environments like health systems. Methods We conducted a process evaluation of a real-world example, namely an initiative to innovate hypertension screening, diagnosis and care in São Paulo, Brazil. The parameters of the evaluation were informed by a specification rubric and categorization system, recommended for the investigation of implementation strategies, and the double-diamond conceptual framework to describe and examine the strategic architecture and nature of the design thinking approach, with particular emphasis on identifying potential areas of “value-add” particular to the approach. The retrospective evaluation was performed by an independent partner who had not been involved in the setting up and implementation of the design thinking process. Results The evaluation unveiled a dense catalogue of strategically driven, mostly theoretically based, activities involving all identified health system stakeholders including patients. Narrative reconstruction illuminated the systematic and coherent nature of this approach, with different resulting actions progressively accounting for all relevant layers of the health system to engineer a broad selection of specific implementation solutions. The relevance of the identified features and the mechanics used to promote more successful implementation practices was manifested in several distinct ways: design thinking offered a clear direction on which innovations really mattered and when, as well as several new dimensions for consideration in the development of an innovation mindset amongst stakeholders. It thereby promoted relationship quality in terms of familiarity and trust, and commitment to evidence-based enquiry and action. Design thinking was also able to navigate the territory between the need for intervention “fidelity” versus “adaptation” and provide the operational know-how to face familiar implementation hurdles. Lastly, it brought a new kind of skill set to the public health stakeholders that incorporated diplomacy, multidisciplinary approaches and management sciences—skills that are considered necessary but not yet widely taught as part of public health training. Conclusions Design thinking is a sound and viable tool to use as part of an implementation strategy for engaging with health system stakeholders and successfully translating evidence-based practices and new innovations into routine practice, thereby addressing an important knowledge—practice gap and, more broadly, contributing to the strategic repertoire available to implementation science. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00892-5.
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Guerin R, Glasgow R, Tyler A, Rabin B, Huebschmann A. Methods to improve the translation of evidence-based interventions: A primer on dissemination and implementation science for occupational safety and health researchers and practitioners. SAFETY SCIENCE 2022; 152:105763. [PMID: 37854304 PMCID: PMC10583726 DOI: 10.1016/j.ssci.2022.105763] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
Objective A limited focus on dissemination and implementation (D&I) science has hindered the uptake of evidence-based interventions (EBIs) that reduce workplace morbidity and mortality. D&I science methods can be used in the occupational safety and health (OSH) field to advance the adoption, implementation, and sustainment of EBIs for complex workplaces. These approaches should be responsive to contextual factors, including the needs of partners and beneficiaries (such as employers, employees, and intermediaries). Methods By synthesizing seminal literature and texts and leveraging our collective knowledge as D&I science and/or OSH researchers, we developed a D&I science primer for OSH. First, we provide an overview of common D&I terminology and concepts. Second, we describe several key and evolving issues in D&I science: balancing adaptation with intervention fidelity and specifying implementation outcomes and strategies. Next, we review D&I theories, models, and frameworks and offer examples for applying these to OSH research. We also discuss widely used D&I research designs, methods, and measures. Finally, we discuss future directions for D&I science application to OSH and provide resources for further exploration. Results We compiled a D&I science primer for OSH appropriate for practitioners and evaluators, especially those newer to the field. Conclusion This article fills a gap in the OSH research by providing an overview of D&I science to enhance understanding of key concepts, issues, models, designs, methods and measures for the translation into practice of effective OSH interventions to advance the safety, health and well-being of workers.
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Affiliation(s)
- R.J. Guerin
- Division of Science Integration, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention, 1090
Tusculum Ave., MS C-10, Cincinnati, OH 45226, USA
| | - R.E. Glasgow
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Family Medicine,
Anschutz Medical Campus, Aurora, CO 80045, USA
| | - A. Tyler
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Department of Pediatrics, Section
of Hospital Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - B.A. Rabin
- Herbert Wertheim School of Public Health and Human
Longevity Science, University of California San Diego, La Jolla, CA 92037, USA
- UC San Diego Altman Clinical and Translational Research
Institute Dissemination and Implementation Science Center, University of California
San Diego, La Jolla, CA 92037, USA
| | - A.G. Huebschmann
- Dissemination and Implementation Science Program,
University of Colorado Adult and Child Center for Outcomes Research and Delivery
Science, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Division of General Internal
Medicine, Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Ludeman Family Center for
Women’s Health Research, Anschutz Medical Campus, Aurora, CO 80045, USA
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Lyon AR, Liu FF, Connors EH, King KM, Coifman JI, Cook H, McRee E, Ludwig K, Law A, Dorsey S, McCauley E. How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care. Implement Sci Commun 2022; 3:79. [PMID: 35869500 PMCID: PMC9306246 DOI: 10.1186/s43058-022-00325-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.
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Affiliation(s)
- Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Freda F. Liu
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Kevin M. King
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Jessica I. Coifman
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Heather Cook
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Erin McRee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kristy Ludwig
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Amy Law
- grid.34477.330000000122986657Graduate Medical Education, University of Washington, Learning Gateway, Box 358220, Seattle, WA 98109 USA
| | - Shannon Dorsey
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Elizabeth McCauley
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Morena AL, Gaias LM, Larkin C. Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms. FRONTIERS IN HEALTH SERVICES 2022; 2:896885. [PMID: 36925794 PMCID: PMC10012807 DOI: 10.3389/frhs.2022.896885] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Background The clinical champion approach is a highly utilized implementation strategy used to mitigate barriers and improve outcomes of implementation efforts. Clinical champions are particularly effective at addressing provider-level barriers and promoting provider-behavior change. Yet, the specific causal pathways that explain how clinical champions impact provider behavior change have not been well-explicated. The current paper applies behavior change models to develop potential causal pathway mechanisms. Methods The proposed mechanisms are informed by previous literature involving clinical champions and empirically supported behavior change models. These models are applied to link specific attributes to different stages of behavior change and barriers for providers. Results Two unique pathway mechanisms were developed, one that explicates how providers develop intention to use EBPs, while the other explicates how providers transition to EBP use and sustainment. Clinical champions may promote intention development through behavioral modeling and peer buy-in. In contrast, champions promote behavioral enactment through skill building and peer mentorship. Conclusion Clinical champions likely play a critical role in reducing provider implementation barriers for providers across various phases of behavior change. The proposed pathways provide potential explanations for how clinical champions promote provider behavior change. Future research should prioritize empirically testing causal pathway mechanisms.
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Affiliation(s)
- Alexandra L. Morena
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Larissa M. Gaias
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Celine Larkin
- University of Massachusetts Chan Medical School, Worcester, MA, United States
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Loeb C, von Thiele Schwarz U, Hasson H, Tafvelin S. Congruence Rules! Increased Self-efficacy after Occupational Health Interventions—if Leaders and Teams Agree on the Participative Safety Climate. SCANDINAVIAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.16993/sjwop.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hills HA, Lengnick-Hall R, Johnson KA, Vermeer W, Hendricks Brown C, McGovern M. Rapid adaptation during the COVID crisis: Challenges experienced in delivering service to those with opioid Use disorders. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221096295. [PMID: 37091103 PMCID: PMC9924287 DOI: 10.1177/26334895221096295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Adaptation is an accepted part of implementing evidence-based practices. COVID-19 presented a unique opportunity to examine adaptation in evolving contexts. Delivering service to people with opioid use disorder during the pandemic required significant adaptation due to revised regulations and limited service access. This report evaluated changes to addiction medication services caused by the pandemic, challenges encountered in rapidly adapting service delivery, and initial impressions of which changes might be sustainable over time. Methods: Qualitatively-evaluated structured interviews (N = 20) were conducted in late 2020 with key informants in Pinellas County (FL) to assess the pandemic’s impact. Interviewees represented a cross-section of the professional groups including direct SUD/HIV service providers, and sheriff’s office, Department of Health, and regional clinical program administrative staff. The interview questions examined significant changes necessitated by the pandemic, challenges encountered in adapting to this evolving context, and considerations for sustained change. Results: The most significant changes to service delivery identified were rapid adaptation to a telehealth format, and modifying service consistent with SAMHSA guidance, to allow for ‘take-home’ doses of methadone. Limitations imposed by access to technology, and the retraining of staff and patients to give and receive service differently were the most common themes identified as challenging adaptation efforts. Respondents saw shifts towards telehealth as most likely to being sustained. Conclusions: COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations identified will only be sustained through multisystem collaboration and validation. Results suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery. Findings will also be integrated with quantitative data to help inform local policy decisions. Plain Language Summary: Adaptation is an accepted part of implementing evidencebased practices. COVID-19 presented a unique opportunity to examine rapid adaptation necessitated within evolving contexts. Delivering services to people with opioid use disorder required significant adaptation due to changing regulations and limited access to lifesaving services. This study examined changes in service delivery due to the pandemic, challenges encountered in rapid adaptation, and initial impressions of which changes might be sustainable over time. Qualitatively-evaluated structured interviews were conducted with a cross-section of professional groups (direct substance use disorder (SUD) and human immunodeficiency virus (HIV) service providers, and sheriff's office, Department of Health, and clinical program administrative staff) in Pinellas County (FL). The most significant changes to service delivery were rapid adaptation to a telehealth format and increased allowance for 'takehome' doses of methadone medication. Limitations imposed by access to technology, as well as the education of and staff and patients were the most common themes identified as challenges. Respondents saw shifts towards telehealth as most likely to be sustained. COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations will only be sustained through multisystem collaboration and validation. Findings suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery.
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Affiliation(s)
- Holly A. Hills
- Department of Mental Health Law and Policy (MHC 2636), College of
Behavioral and Community Sciences, University of South Florida, Tampa, FL
- Holly A. Hills, Department of Mental Health
Law and Policy (MHC 2636), College of Behavioral and Community Sciences,
University of South Florida, Tampa, FL, 33620.
| | | | - Kimberly A. Johnson
- Department of Mental Health Law and Policy (MHC 2636), College of
Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Wouter Vermeer
- Department of Psychiatry and Behavioral Sciences, Feinberg School of
Medicine, Northwestern University, Chicago, IL, USA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of
Medicine, Northwestern University, Chicago, IL, USA
| | - Mark McGovern
- Department of Psychiatry and Behavioral Sciences, Stanford University School of
Medicine, Palo Alto, CA, USA
- Division of Primary Care and Population Health, Department of
Medicine, Stanford University School of
Medicine, Palo Alto, CA, USA
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Petrescu-Prahova M, Harris JR, Leroux B, Kohn M, Kava CM, Zeliadt SB, Steinman L, Fishleder S, Basia Belza, Gakhar M, Hannon PA. Clinical-community linkages as a strategy for increasing evidence-based program reach: Results of the PT-REFER randomized controlled trial with older adults and YMCA associations. Contemp Clin Trials Commun 2022; 26:100888. [PMID: 35106400 PMCID: PMC8789527 DOI: 10.1016/j.conctc.2022.100888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 12/10/2021] [Accepted: 01/17/2022] [Indexed: 01/19/2023] Open
Abstract
Background Most older adults do not meet recommended guidelines for physical activity. Referrals from physical therapists (PTs) to community- and evidence-based physical-activity programs like Enhance®Fitness have potential to address this gap. We tested an intervention intended to increase referrals of older adults to Enhance®Fitness programs offered at YMCAs. Materials and methods We developed a capacity-building intervention that included a structured toolkit and technical-assistance calls. From April 2016 to September 2018, using stratified randomization, we conducted a trial with 20 YMCA Associations randomized into intervention and control arms. The primary outcome was the number of new Enhance®Fitness enrollees during the trial period. Using both quantitative and qualitative methods, we also conducted process and intermediate-outcome evaluations to assess intervention implementation and Association outreach activities, barriers, and facilitators. Results The intervention was implemented as intended, but PT outreach was similar for both intervention and control YMCA Associations. The intervention arm had similar enrollment (1695 new enrollees) to the control arm (1326 new enrollees; 95% confidence interval, −47%–199%, P = 0.61). Interviews revealed that barriers, including lack of staff and time for outreach, limited capacity for Enhance®Fitness program growth, and competing priorities, outweighed facilitators, including existing partnerships, presence of an outreach team, senior leadership support, and infrastructure for referrals. Conclusions YMCA Associations in the intervention arm were unable to increase their outreach to PTs and enrollment in Enhance®Fitness. Our evaluation findings indicate that community organizations that prioritize program growth, have support at all organizational levels, and allocate staff and time for outreach and partnership development may be more successful in creating sustainable linkages with clinical partners and increasing evidence-based-program reach. Physical therapists (PTs) may help older adults increase their physical activity by referring them to physical-activity programs. In a randomized trial, we helped YMCA Associations build capacity to increase referrals by PTs of older adults to YMCA Enhance®Fitness programs. The YMCA Associations encountered barriers and were unable to increase PT outreach and Enhance®Fitness enrollment. We did, however, identify facilitators that may help community organizations create linkages with clinical partners and increase program reach. Facilitators include prioritizing program growth, having senior-leadership support, and setting aside staff and time for outreach.
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Bejerholm U, Allaskog C, Andersson J, Nordström L, Roe D. Implementation of the Recovery Guide in inpatient mental health services in Sweden-A process evaluation study. Health Expect 2022; 25:1405-1417. [PMID: 35340092 PMCID: PMC9327815 DOI: 10.1111/hex.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. Methods A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. Results Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well‐being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. Conclusions The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. Patient and Public Contribution The current study involved stakeholders including a service user organization, the public, first‐line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.
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Affiliation(s)
- Ulrika Bejerholm
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Research, Development and Education, Division of Psychiatry and Habilitation, Lund, Sweden
| | - Conny Allaskog
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | | | - Linda Nordström
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | - David Roe
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Community Mental Health, University of Haifa, Haifa, Israel.,Department of Clinical Medicine, Psychiatry, Aalborg University, Aalborg, Denmark
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Richter A, Sjunnestrand M, Romare Strandh M, Hasson H. Implementing School-Based Mental Health Services: A Scoping Review of the Literature Summarizing the Factors That Affect Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063489. [PMID: 35329175 PMCID: PMC8948726 DOI: 10.3390/ijerph19063489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
Background: Mental illness in children and youths has become an increasing problem. School-based mental health services (SBMHS) are an attempt to increase accessibility to mental health services. The effects of these services seem positive, with some mixed results. To date, little is known about the implementation process of SBMHS. Therefore, this scoping review synthesizes the literature on factors that affect the implementation of SBMHS. Methods: A scoping review based on four stages: (a) identifying relevant studies; (b) study selection; (c) charting the data; and (d) collating, summarizing, and reporting the results was performed. From the searches (4414 citations), 360 were include in the full-text screen and 38 in the review. Results: Implementation-related factors were found in all five domains of the Consolidated Framework for Implementation Research. However, certain subfactors were mentioned more often (e.g., the adaptability of the programs, communication, or engagement of key stakeholders). Conclusions: Even though SBMHS differed in their goals and way they were conducted, certain common implementation factors were highlighted more frequently. To minimize the challenges associated with these types of interventions, learning about the implementation of SBMHS and using this knowledge in practice when introducing SBMHS is essential to achieving the best possible effects with SMBHSs.
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Affiliation(s)
- Anne Richter
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
- Correspondence: ; Tel.: +46-732-60-30-63
| | - My Sjunnestrand
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
| | - Maria Romare Strandh
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Reproductive Health Research Group, Department of Women’s and Children’s Health, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
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Kukhareva PV, Weir C, Fiol GD, Aarons GA, Taft TY, Schlechter CR, Reese TJ, Curran RL, Nanjo C, Borbolla D, Staes CJ, Morgan KL, Kramer HS, Stipelman CH, Shakib JH, Flynn MC, Kawamoto K. Evaluation in Life Cycle of Information Technology (ELICIT) framework: Supporting the innovation life cycle from business case assessment to summative evaluation. J Biomed Inform 2022; 127:104014. [PMID: 35167977 PMCID: PMC8959015 DOI: 10.1016/j.jbi.2022.104014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/16/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our objective was to develop an evaluation framework for electronic health record (EHR)-integrated innovations to support evaluation activities at each of four information technology (IT) life cycle phases: planning, development, implementation, and operation. METHODS The evaluation framework was developed based on a review of existing evaluation frameworks from health informatics and other domains (human factors engineering, software engineering, and social sciences); expert consensus; and real-world testing in multiple EHR-integrated innovation studies. RESULTS The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers four IT life cycle phases and three measure levels (society, user, and IT). The ELICIT framework recommends 12 evaluation steps: (1) business case assessment; (2) stakeholder requirements gathering; (3) technical requirements gathering; (4) technical acceptability assessment; (5) user acceptability assessment; (6) social acceptability assessment; (7) social implementation assessment; (8) initial user satisfaction assessment; (9) technical implementation assessment; (10) technical portability assessment; (11) long-term user satisfaction assessment; and (12) social outcomes assessment. DISCUSSION Effective evaluation requires a shared understanding and collaboration across disciplines throughout the entire IT life cycle. In contrast with previous evaluation frameworks, the ELICIT framework focuses on all phases of the IT life cycle across the society, user, and IT levels. Institutions seeking to establish evaluation programs for EHR-integrated innovations could use our framework to create such shared understanding and justify the need to invest in evaluation. CONCLUSION As health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated. The ELICIT framework can facilitate these evaluations.
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Affiliation(s)
- Polina V. Kukhareva
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Gregory A. Aarons
- Department of Psychiatry, UC San Diego ACTRI Dissemination and Implementation Science Center, UC San Diego, La Jolla, CA, USA
| | - Teresa Y. Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Chelsey R. Schlechter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Thomas J. Reese
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA
| | - Rebecca L. Curran
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Claude Nanjo
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | - Damian Borbolla
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
| | | | - Keaton L. Morgan
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Heidi S. Kramer
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | | | - Julie H. Shakib
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Michael C. Flynn
- Department of Family & Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA.
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Budhwani H, Kiszla BM, Hightow-Weidman LB. Adapting digital health interventions for the evolving HIV landscape: examples to support prevention and treatment research. Curr Opin HIV AIDS 2022; 17:112-118. [PMID: 35225251 PMCID: PMC9833493 DOI: 10.1097/coh.0000000000000721] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Although many HIV prevention and/or treatment digital health interventions (DHIs) have shown feasibility and acceptability, fewer have indicated efficacy, and only a subset have been adapted for new contexts. Adaptation is a key element of pragmatic implementation science research. Adaptation is cost effective and time efficient compared with new development. Leveraging adaptation can lead to accelerated scale-up and enhanced public health impact. Considering the value of adaptation, the purpose of this piece is to present examples of DHI to DHI adaptation sequences to inform future HIV prevention and/or treatment research. RECENT FINDINGS From an examination of recent academic articles (01 November 2016 to 31 October 2021), we identified adaptation sequences that included an original DHI with at least two adaptations. Four models are presented herein; examples consist of adapted DHIs for new population, health outcome, geography, or a combination thereof. SUMMARY Adaptation is a promising scientific approach to expeditiously respond to the evolving HIV landscape. We present examples of DHI adaptations alongside considerations for each type of adaptation; we also present adaptation challenges with responsive strategies. We suggest when conducted with attention to rigor (leveraging adaptation frameworks, community engagement, and tailoring content), adaptation is a powerful tool to pragmatically address the HIV epidemic.
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Affiliation(s)
- Henna Budhwani
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL 35294
| | - B. Matthew Kiszla
- University of Alabama at Birmingham, School of Medicine, Birmingham, AL 35294
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Maxwell AE, Vargas C, Santifer R, Chang LC, Crespi CM, Lucas-Wright A. Facilitators and Challenges to Health Promotion in Black and Latino Churches. J Racial Ethn Health Disparities 2022; 9:59-67. [PMID: 33230738 PMCID: PMC8141063 DOI: 10.1007/s40615-020-00929-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Churches are important assets for the African American and Latino communities. They can play a critical role in health promotion, especially in areas that are under-resourced and in which residents have limited access to health care. A better understanding of health promotion in churches is needed to support and maintain church collaborations and health initiatives that are integrated, data-driven, and culturally appropriate. The purpose of this study is to identify churches' facilitators and challenges to health promotion and to contrast and compare Black and Latino churches of different sizes (< 200 members versus > 200 members). METHODS We interviewed leaders of 100 Black and 42 Latino churches in South Los Angeles to assess their history of wellness activities, resources, facilitators, and challenges to conduct health promotion activities. RESULTS Eighty-three percent of African American and 86% of Latino church leaders reported at least one health activity in the last 12 months. Black and Latino churches of different sizes have similar interests in implementing specific health promotion strategies and face similar challenges. However, we found significant differences in the composition of their congregations, number of paid staff, and the proportions of churches that have a health or wellness ministry and that implement specific wellness strategies. Fifty-seven percent of African American and 43% of Latino church leaders stated that they needed both financial support and professional expertise for health promotion. DISCUSSION Our findings highlight the importance of conducting a readiness assessment for identifying intervention content and strategies that fit the intervention context of a church.
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Affiliation(s)
- Annette E Maxwell
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA.
| | - Claudia Vargas
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - Rhonda Santifer
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - L Cindy Chang
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Catherine M Crespi
- University of California Los Angeles Fielding School of Public Health & Jonsson Comprehensive Cancer Center, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
- UCLA Kaiser Permanente Center for Health Equity, 650 Charles Young Dr. South, A2-125 CHS, Box 956900, Los Angeles, CA, 90095-6900, USA
| | - Aziza Lucas-Wright
- Division of Cancer Research and Training, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Zetterlund J, von Thiele Schwarz U, Hasson H, Neher M. A Slippery Slope When Using an Evidence-Based Intervention Out of Context. How Professionals Perceive and Navigate the Fidelity-Adaptation Dilemma-A Qualitative Study. FRONTIERS IN HEALTH SERVICES 2022; 2:883072. [PMID: 36925897 PMCID: PMC10012672 DOI: 10.3389/frhs.2022.883072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022]
Abstract
Introduction Adaptations are often necessary to effectively translate evidence-based interventions (EBI) between contexts, but compliance with the EBIs' core components is still important, which is referred to as the fidelity-adaptation dilemma. In the sustainment phase of implementation, it is the professionals delivering the EBIs who are tasked with the decision-making regarding adaptations, but the currently used models and frameworks mostly focus on the initial phases of implementation. To better understand and guide professionals in using EBIs, there is a need to explore professionals' perceptions of the fidelity-adaptation dilemma. The aim of this study is consequently to explore how professionals perceive and navigate the fidelity-adaptation dilemma when using an EBI out of context. Materials and Methods Semi-structured interviews were held with 19 psychologists working in primary care. The interviews concerned EBIs in general and Cool Kids, an evidence-based parenting education program designed for children with anxiety that is now used for children with lower levels of anxiety in another setting. The data were analyzed using an inductive content analysis method. Results The analysis resulted in two themes: My standpoint regarding fidelity and adaptation is clear and Managing fidelity and adaptations is complicated. The first theme summarizes the professionals' perceptions of confidence for either favoring fidelity or adaptations, as well as reasons for why they made adaptations. For the second theme, the professionals expressed concern about sometimes meeting difficulties with the dilemma when following their original inclination and having second thoughts about the impact the adaptations have in practice. Conclusion The professionals generally had strong preferences regarding fidelity and adaptations, but neither preference prevented them from facing difficulties with the dilemma. The results point to a need for better information about possible adaptations from developers but also better support and guidance for professionals when implementing EBIs to ensure quality implementation and facilitate implementation. The results of this study can inform the design of support for professionals in managing the dilemma.
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Affiliation(s)
- Johanna Zetterlund
- Department of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Ulrica von Thiele Schwarz
- Department of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Margit Neher
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Pettersson K, Liedgren P, Giannotta F, von Thiele Schwarz U. Eleven Reasons for Adaptation of Swedish Parenting Programs. FRONTIERS IN HEALTH SERVICES 2022; 2:923504. [PMID: 36925861 PMCID: PMC10012651 DOI: 10.3389/frhs.2022.923504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022]
Abstract
While questions about adaptation and fidelity are of great concern in many implementation projects, less attention has been paid to reasons for adaptations that remain when evidence-based interventions (EBIs) are used in clinical and community settings. This study aims to explore reasons for adaptations that can arise when using parenting programs in a community setting. Seventeen individual interviews with providers were conducted and analyzed thematically, resulting in 11 reasons for adaptations organized into four separate areas: characteristics of group leaders (supplementary skills and knowledge, preferred ways of working), characteristics of families (problem complexity, diverse or limited educational experience, non-parenting needs for support, colliding value systems), group incidents (criticism and challenges, excessive questions or discussions), and didactic challenges (lack of focus or engagement, limitations of the material, language differences). The study shows that factors triggering adaptation and fidelity decisions continuously reappear in the provision of parenting programs in community settings. Knowledge about reasons for adaptation can be used to inform decision-making during implementation planning, as well as the sustainment of implemented interventions.
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Affiliation(s)
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Fabrizia Giannotta
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden
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35
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Yu SH, Brookman-Frazee L, Kim JJ, Barnett ML, Wright B, Lau AS. Therapist adaptations to evidence-based practices and associations with implementation outcomes in child therapy sessions. J Consult Clin Psychol 2022; 90:39-50. [PMID: 34410750 PMCID: PMC8857284 DOI: 10.1037/ccp0000667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Community therapists inevitably adapt evidence-based practices (EBPs) to meet the needs of their clients and practice settings. Yet, the implications of spontaneous, therapist-driven adaptations for EBP implementation outcomes are not well understood. We used a sequential QUAN → qual mixed-methods design to examine how different types of therapist-described adaptations were associated with observer-rated extensiveness of therapist delivery of EBP content and technique strategies at the session level. METHOD Data were drawn from an observational study of a system-driven implementation of multiple EBPs into public children's mental health services. Community therapists (n = 103) described adaptations they made in 680 sessions with 273 clients (50.92% female, 49.08% male, Mage = 9.72 years, 70.70% Hispanic/Latinx). Coders classified therapist-described adaptations into five types: (a) Modifying Presentation, (b) Integrating, (c) Extending, (d) Reducing, and (e) Generalizing. Independent observers rated the extensiveness of EBP strategy delivery from session recordings using the EBP Concordant Care Assessment (ECCA) Observational Coding System. RESULTS Quantitative analyses using multilevel regression revealed that Modifying Presentation adaptations were associated with higher extensiveness of EBP technique delivery, whereas Extending adaptations were associated with lower extensiveness of EBP content and technique delivery. Qualitative analysis of adaptation descriptions identified explanations for the quantitative findings. CONCLUSIONS Findings suggest that Modifying Presentation adaptations, associated with higher extensiveness, involved creative use of activities and materials, language modification, and personalization of EBP content to meet clients' diverse needs, whereas Extending adaptations, associated with lower extensiveness, involved slowing EBP pacing in response to client challenges. Implications for provider training are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Stephanie H. Yu
- Department of Psychology, University of California, Los Angeles, CA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, CA,Child and Adolescent Services Research Center (CASRC), San Diego, CA
| | - Joanna J. Kim
- Department of Psychology, Arizona State University, Phoenix, AZ
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA
| | - Blanche Wright
- Department of Psychology, University of California, Los Angeles, CA
| | - Anna S. Lau
- Department of Psychology, University of California, Los Angeles, CA
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Anderson DM, Birken SA, Bartram JK, Freeman MC. Adaptation of Water, Sanitation, and Hygiene Interventions: A Model and Scoping Review of Key Concepts and Tools. FRONTIERS IN HEALTH SERVICES 2022; 2:896234. [PMID: 36925880 PMCID: PMC10012759 DOI: 10.3389/frhs.2022.896234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022]
Abstract
Background Safe water, sanitation, and hygiene (WaSH) is important for health, livelihoods, and economic development, but WaSH programs have often underdelivered on expected health benefits. Underperformance has been attributed partly to poor ability to retain effectiveness following adaptation to facilitate WaSH programs' implementation in diverse contexts. Adaptation of WaSH interventions is common but often not done systematically, leading to poor outcomes. Models and frameworks from the adaptation literature have potential to improve WaSH adaptation to facilitate implementation and retain effectiveness. However, these models and frameworks were designed in a healthcare context, and WaSH interventions are typically implemented outside traditional health system channels. The purpose of our work was to develop an adaptation model tailored specifically to the context of WaSH interventions. Methods We conducted a scoping review to identify key adaptation steps and identify tools to support systematic adaptation. To identify relevant literature, we conducted a citation search based on three recently published reviews on adaptation. We also conducted a systematic database search for examples of WaSH adaptation. We developed a preliminary model based on steps commonly identified across models in adaptation literature, and then tailored the model to the WaSH context using studies yielded by our systematic search. We compiled a list of tools to support systematic data collection and decision-making throughout adaptation from all included studies. Results and Conclusions Our model presents adaptation steps in five phases: intervention selection, assessment, preparation, implementation, and sustainment. Phases for assessment through sustainment are depicted as iterative, reflecting that once an intervention is selected, adaptation is a continual process. Our model reflects the specific context of WaSH by including steps to engage non-health and lay implementers and to build consensus among diverse stakeholders with potentially competing priorities. We build on prior adaptation literature by compiling tools to support systematic data collection and decision-making, and we describe how they can be used throughout adaptation steps. Our model is intended to improve program outcomes by systematizing adaptation processes and provides an example of how systematic adaptation can occur for interventions with health goals but that are implemented outside conventional health system channels.
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Affiliation(s)
- Darcy M Anderson
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, United States.,Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Jamie K Bartram
- Public Health and Environment, The Water Institute, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,School of Civil Engineering, University of Leeds, Leeds, United Kingdom
| | - Matthew C Freeman
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Laur C, Bell J, Valaitis R, Ray S, Keller H. The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study. BMJ Nutr Prev Health 2021; 4:435-446. [PMID: 35028514 PMCID: PMC8718867 DOI: 10.1136/bmjnph-2021-000281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Many patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1. METHODS Semistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups. RESULTS Ten interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice. CONCLUSION Trained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements. TRIAL REGISTRATION NUMBER NCT02800304, NCT03391752.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
| | - Jack Bell
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
- The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Renata Valaitis
- Knowledge Development and Exchange Hub, Renison University College, Waterloo, Ontario, Canada
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Ulster, UK
- School of the Humanities and Social Sciences, University of Cambridge, Cambridge, UK
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Winterling J, Delilovic S, Dervish J, Gunarsson M, Åhström M, Hasson H. Exploring experiences of implementing standardized cancer patient pathways within investigatory units - a qualitative study. BMC Health Serv Res 2021; 21:933. [PMID: 34493265 PMCID: PMC8425083 DOI: 10.1186/s12913-021-06915-1] [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: 11/01/2020] [Accepted: 08/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background In the implementation of standardized cancer patient pathways (CPPs), the investigatory units, endoscopy, radiology and pathology, are crucial to ensure an eventual cancer diagnosis. However, when evaluating the implementation of CPPs, little attention has been paid to the healthcare professionals working in these units. The aim of this study was to explore experiences of the implementation of CPPs among health professionals in investigatory units. Methods This descriptive qualitative study included 55 health professionals working in investigatory units. Participants were interviewed in 2017–2018, and data were analysed using thematic analysis. Results The health professionals reported benefits, facilitators and challenges when describing their experiences of implementing CPPs. Benefits included that CPP improved collaboration and increased focus on the patients. Facilitators in the implementation process included pre-existing well-functioning work processes and having supportive functions (e.g. coordinators). Challenges included the lack of staff and clinical equipment, as well as unjustified time-slots and incorrect referrals. Conclusions The findings show that most health professionals working in investigatory units’ experience benefits with the implementation of CPP, but the lack of resources was especially hard to overcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06915-1.
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Affiliation(s)
- Jeanette Winterling
- Medical Unit Head, Neck, Lung and Skin, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden. .,Department of Neurobiology, Care Sciences and Society, Division of Nursing Karolinska Institutet, Stockholm, Sweden.
| | - Sara Delilovic
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Jessica Dervish
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Malin Gunarsson
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Mårten Åhström
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Henna Hasson
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden.,PROCOME research group, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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von Thiele Schwarz U, Lyon AR, Pettersson K, Giannotta F, Liedgren P, Hasson H. Understanding the value of adhering to or adapting evidence-based interventions: a study protocol of a discrete choice experiment. Implement Sci Commun 2021; 2:88. [PMID: 34380575 PMCID: PMC8356451 DOI: 10.1186/s43058-021-00187-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background Whereas the value of an evidence-based intervention (EBI) is often determined by its effect on clinical outcomes, the value of implementing and using EBIs in practice is broader, reflecting qualities such as appropriateness, equity, costs, and impact. Reconciling these value conflicts involves a complicated decision process that has received very limited scholarly attention. Inspired by studies on decision-making, the objective of this project is to explore how practitioners appraise the values of different outcomes and to test how this appraisal influences their decisions surrounding the so-called fidelity–adaptation dilemma. This dilemma is related to the balance between using an EBI as it was designed (to ensure its effectiveness) and making appropriate adaptations (to ensure alignment with constraints and possibilities in the local context). Methods This project consists of three sub-studies. The participants will be professionals leading evidence-based parental programs in Sweden and, in Sub-study 1, parents and decision-makers. Sub-study 1 will use sequential focus groups and individual interviews to explore parameters that influence fidelity and adaptation decisions—the dilemmas encountered, available options, how outcomes are valued by practitioners as well as other stakeholders, and value trade-offs. Sub-study 2 is a discrete choice experiment that will test how value appraisals influence decision-making using data from Sub-study 1 as input. Sub-study 3 uses a mixed-method design, with findings from the two preceding sub-studies as input in focus group interviews to investigate how practitioners make sense of findings from optimal decision situations (experiment) and constrained, real-world decision situations. Discussion The project will offer unique insights into decision-making processes that influence how EBIs are used in practice. Such knowledge is needed for a more granular understanding of how practitioners manage the fidelity–adaptation dilemma and thus, ultimately, how the value of EBI implementation can be optimized. This study contributes to our knowledge of what happens once EBIs are adopted—that is, the gap between the way in which EBIs are intended to be used and the way in which they are used in practice.
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Affiliation(s)
- Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden. .,Procome, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kristoffer Pettersson
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Fabrizia Giannotta
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Henna Hasson
- Procome, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Hagaman A, Rhodes EC, Nyhan K, Katague M, Schwartz A, Spiegelman D. How are qualitative methods used in implementation science research? A scoping review protocol. JBI Evid Synth 2021; 19:1344-1353. [PMID: 33323772 DOI: 10.11124/jbies-20-00120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This systematic scoping review will describe the use of qualitative methods in implementation research in health. INTRODUCTION Implementation science is an expanding field of study that investigates the integration of evidence-based practices into real world settings. Qualitative methods are useful for providing an in-depth understanding of implementation strategies and outcomes from the perspectives of stakeholders such as policy makers, health practitioners, and individuals targeted by health interventions. Qualitative research methods are increasingly used in implementation research. A synthesis of the applications of qualitative methods is lacking, although it is critical for understanding how qualitative methods have been used to date and identifying areas for improvement. INCLUSION CRITERIA The review will include implementation research studies that collect primary data using one or more qualitative methods, alone or with quantitative methods. Studies must assess implementation research issues in health but will not be restricted by the type of setting, health issue, or country of origin. METHODS The search for relevant studies will be restricted to articles published in English from 2006 to the present that are found in 46 prominent medical and public health journals that publish research in implementation science. Multiple reviewers will screen articles to identify those that meet the inclusion criteria. Data extraction will involve a structured and systematic method with categories for descriptive characteristics of studies, health topics, qualitative methods for data collection and analysis, implementation science outcomes and issues explored, and implementation science frameworks applied.
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Affiliation(s)
- Ashley Hagaman
- Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Elizabeth C Rhodes
- Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.,Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.,Yale Center for Implementation Science, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.,Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Marina Katague
- Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Anna Schwartz
- Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Donna Spiegelman
- Center for Methods in Implementation and Prevention Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA.,Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, USA
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Giannopoulos V, Morley KC, Uribe GM, Louie E, Wood K, Teesson M, Baillie A, Haber PS. The role of clinical supervision in implementing evidence-based practice for managing comorbidity. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1909517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C. Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabriela M. Uribe
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Gaias LM, Arnold KT, Liu FF, Pullmann MD, Duong MT, Lyon AR. Adapting strategies to promote implementation reach and equity (ASPIRE) in school mental health services. PSYCHOLOGY IN THE SCHOOLS 2021. [DOI: 10.1002/pits.22515] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Larissa M. Gaias
- Department of Psychology University of Massachusetts Lowell Lowell Massachusetts USA
| | - Kimberly T. Arnold
- Department of Psychiatry, Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Freda F. Liu
- Psychiatry and Behavioral Medicine Seattle Children's Hospital Seattle Washington USA
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
| | - Mylien T. Duong
- Education, Research & Impact Committee for Children Seattle WA USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences University of Washington School of Medicine Seattle Washington USA
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Handley MA, Landeros J, Wu C, Najmabadi A, Vargas D, Athavale P. What matters when exploring fidelity when using health IT to reduce disparities? BMC Med Inform Decis Mak 2021; 21:119. [PMID: 33827562 PMCID: PMC8028253 DOI: 10.1186/s12911-021-01476-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Implementation of evidence-based interventions often involves strategies to engage diverse populations while also attempting to maintain external validity. When using health IT tools to deliver patient-centered health messages, systems-level requirements are often at odds with 'on-the ground' tailoring approaches for patient-centered care or ensuring equity among linguistically diverse populations. METHODS We conducted a fidelity and acceptability-focused evaluation of the STAR MAMA Program, a 5-month bilingual (English and Spanish) intervention for reducing diabetes risk factors among 181 post-partum women with recent gestational diabetes. The study's purpose was to explore fidelity to pre-determined 'core' (e.g. systems integration) and 'modifiable' equity components (e.g. health coaching responsiveness, and variation by language) using an adapted implementation fidelity framework. Participant-level surveys, systems-level databases of message delivery, call completion, and coaching notes were included. RESULTS 96.6% of participants are Latina and 80.9% were born outside the US. Among those receiving the STAR MAMA intervention; 55 received the calls in Spanish (61%) and 35 English (39%). 90% (n = 81) completed ≥ one week. Initially, systems errors were common, and increased triggers for health coach call-backs. Although Spanish speakers had more triggers over the intervention period, the difference was not statistically significant. Of the calls triggering a health coach follow-up, attempts were made for 85.4% (n = 152) of the English call triggers and for 80.0% (n = 279) of the Spanish call triggers (NS). Of attempted calls, health coaching calls were complete for 55.6% (n = 85) of English-language call triggers and for 56.6% of Spanish-language call triggers (NS). Some differences in acceptability were noted by language, with Spanish-speakers reporting higher satisfaction with prevention content (p = < 0.01) and English-speakers reporting health coaches were less considerate of their time (p = 0.03). CONCLUSIONS By exploring fidelity by language-specific factors, we identified important differences in some but not all equity indicators, with early systems errors quicky remedied and high overall engagement and acceptability. Practice implications include: (1) establishing criteria for languge-equity in interventions, (2) planning for systems level errors so as to reduce their impact between language groups and over time; and (3) examining the impact of engagement with language-concordant interventions on outcomes, including acceptability. Trial Registration National Clinical Trials registration number: CT02240420 Registered September 15, 2014. ClinicalTrials.gov.
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Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA.
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA.
| | - Jerad Landeros
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Cindie Wu
- University of California, Berkeley School of Public Health, Berkeley, USA
| | - Adriana Najmabadi
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Daniela Vargas
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
| | - Priyanka Athavale
- Division of General Internal Medicine, Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, San Francisco, USA
- University of California, Berkeley School of Public Health, Berkeley, USA
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Nylén K, Karlberg M, Klang N, Ogden T. Knowledge and Will: An Explorative Study on the Implementation of School-Wide Positive Behavior Support in Sweden. Front Psychol 2021; 12:618099. [PMID: 33716884 PMCID: PMC7951089 DOI: 10.3389/fpsyg.2021.618099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
School-wide positive behavior support (SWPBIS) is a well-evaluated school approach to promoting a positive school climate and decreasing problem behaviors. Initial implementation is one of the most critical stages of program implementation. In this qualitative study, the initial implementation of SWPBIS in Swedish schools was studied using an implementation model of behavior change as guidance for interviews and analyses. The study makes significant contributions to previous research as little is known of the implementation of SWPBIS in Swedish context. Focus-group interviews were conducted with 59 professionals on implementation teams from nine schools. Themes were extracted according to implementation team members' perceptions and descriptions of how the initial implementation was carried out. The results of this study revealed relevant themes within the three domains of Capability, Opportunity, and Motivation. Core features were found under the themes of knowledge and experience of similar evidence-based programs, process or result orientation, time, manual content, organizational prerequisites, team functioning, implementation leadership, program as a unifying factor, program aligning with staff beliefs, plausible expectations, and emotional reinforcement. Results are discussed in terms of how they can be used in continuing to develop the Swedish model of SWPBIS. Implications regarding implementation in Swedish schools are discussed, as is the applicability of the model of behavior change for studying implementation in schools.
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Affiliation(s)
- Kata Nylén
- Magelungen Utveckling, Stockholm, Sweden
| | - Martin Karlberg
- Department of Education, Uppsala University, Uppsala, Sweden
| | - Nina Klang
- Department of Education, Uppsala University, Uppsala, Sweden
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Oslo, Norway
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von Thiele Schwarz U, Giannotta F, Neher M, Zetterlund J, Hasson H. Professionals' management of the fidelity-adaptation dilemma in the use of evidence-based interventions-an intervention study. Implement Sci Commun 2021; 2:31. [PMID: 33726864 PMCID: PMC7962232 DOI: 10.1186/s43058-021-00131-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity–adaptation dilemma affects professionals’ psychosocial working conditions, and (3) how a structured decision support influences professionals’ management of the dilemma and their psychosocial working conditions. Methods The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents. Discussion This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity–adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity–adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00131-y.
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Affiliation(s)
- Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden. .,Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
| | - Fabrizia Giannotta
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Margit Neher
- Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Johanna Zetterlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Henna Hasson
- Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
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Hatch MR, Carandang K, Moullin JC, Ehrhart MG, Aarons GA. Barriers to Implementing Motivational Interviewing in Addiction Treatment: A Nominal Group Technique Process Evaluation. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 35211677 DOI: 10.1177/26334895211018400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The successful implementation of evidence-based practices (EBPs) in real-world settings requires an adaptive approach and ongoing process evaluation and tailoring. Although conducting a needs assessment during the preparation phase of implementation is beneficial, it is challenging to predict all barriers to EBP implementation that may arise over the course of implementation and sustainment. This article describes a process evaluation that identified emergent and persistent barriers that impacted the implementation of an EBP across multiple behavioral health organizations and clinics. Methods This study was conducted during the first cohort of a cluster randomized controlled trial testing the effectiveness of the Leadership and Organizational Change for Implementation (LOCI) strategy to implement motivational interviewing (MI) in substance use disorder treatment agencies and clinics. We used a modified nominal group technique (NGT) in which clinic leaders identified barriers faced during the implementation process. Barriers were categorized, then ranked and rated according to leaders' perceptions of each barrier's influence on implementation. The barriers were then contextualized through individual qualitative interviews. Results Fifteen barriers were identified, grouped into staff-level barriers, management-level barriers, and implementation program barriers. Time and resistance to MI were rated as the most influential staff-level barriers. Among management-level barriers, time was also rated highest, followed by turnover and external contractual constraints. The most influential implementation barrier was client apprehension of recording for fidelity assessment and feedback. Individual interviews supported these findings and provided suggested adaptations for future implementation efforts. Conclusion EBP implementation is an ongoing process whereby implementation strategies must be proactively and strategically tailored to address emergent barriers. This research described a process evaluation that was used to identify 15 emergent and/or persistent barriers related to staff, management, and the implementation program. Using implementation strategies that can be tailored and/or adapted to such emergent barriers is critical to implementation effectiveness.
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Affiliation(s)
- Mellissa R Hatch
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | | | - Joanna C Moullin
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA
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Berry N, Machin M, Ainsworth J, Berry K, Edge D, Haddock G, Lewis S, Morris R, Bucci S. Developing a Theory-Informed Smartphone App for Early Psychosis: Learning Points From a Multidisciplinary Collaboration. Front Psychiatry 2020; 11:602861. [PMID: 33362612 PMCID: PMC7758439 DOI: 10.3389/fpsyt.2020.602861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background: Actissist is a smartphone app designed to deliver an intervention grounded in cognitive behavior therapy for early psychosis. Actissist was developed by a multidisciplinary team of academics, clinicians, experts by experience and software engineers. Actissist has been tested in two trials, the first a proof-of-concept trial where Actissist was safe, acceptable and feasible, the second, a powered randomized controlled trial. Objective: This article describes how our multidisciplinary team designed and developed Actissist. This article describes: (i) how Actissist was informed by initial qualitative interviews and focus groups and an expert reference group; (ii) refinements made to the app based on ongoing user feedback; (iii) successes and challenges encountered; and (iv) learning points and recommendations for involving stakeholders in digital health interventions. Methods: Expert reference group meetings informed the development of Actissist and design of subsequent trials, which included individuals with lived experience of psychosis, clinicians, academics, computer scientists and software engineers. Person-centered stakeholder involvement was promoted using focus groups and qualitative interviews prior to the development of the app, which informed version one of Actissist. Interviews were carried out with participants who had used Actissist. Two further versions of Actissist were developed following additional rounds of testing. Results: Multidisciplinary working throughout the Actissist project led to the development, inclusion and improvement of the app design and content. These changes and features included non-directive and compassionate content, co-designed recovery videos, relaxation exercises, psychoeducation material, ability to "favorite" areas of the app that users found helpful, and goal-setting. Challenges to collaborative working included discrepancies between what stakeholders want and what is technically possible to deliver, resource pressures, trying to deliver desired features within the boundaries of fundamental trial design considerations, and power imbalances associated with multidisciplinary working. Conclusions: The involvement of stakeholders in the design and development and delivery of Actissist has been fundamental to our development approach. Through this collaborative process, we have identified different perspectives and ideas that would have not been generated by the research team alone. Clinical Trial Registrations: Proof-of-concept trial: http://www.isrctn.com/ISRCTN34966555 Fully-powered randomized controlled trial: https://www.isrctn.com/ISRCTN76986679.
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Affiliation(s)
- Natalie Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics Imaging and Data Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Ainsworth
- Division of Informatics Imaging and Data Sciences, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Gillian Haddock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Shon Lewis
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rohan Morris
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Lyon AR, Brewer SK, Areán PA. Leveraging human-centered design to implement modern psychological science: Return on an early investment. AMERICAN PSYCHOLOGIST 2020; 75:1067-1079. [PMID: 33252945 PMCID: PMC7709137 DOI: 10.1037/amp0000652] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although classic models of implementation emphasized the importance of innovation characteristics in their adoption and sustained use, contemporary implementation research and practice have deprioritized these variables. Human-centered design (HCD) is an approach that grounds product development in information collected about the people and settings that will ultimately use those products. HCD has strong roots in psychological theory, but its application is typically limited to the development of digital technologies. HCD is rarely applied to the design of psychosocial innovations-including both service-recipient-facing interventions and implementation strategies-within the applied psychological disciplines. The current article reviews the psychological origins of HCD and details pathways through which HCD theories and methods can be leveraged to advance the "core tasks" of contemporary implementation research and practice in psychology. These include (a) identification of multilevel implementation determinants through specification of user needs and contexts; (b) tailoring of implementation strategies, such as contextually driven intervention redesign; and (c) evaluating implementation mechanisms and outcomes, including disentangling how the core HCD focus on usability relates to closely associated implementation variables such as acceptability, feasibility, and appropriateness. Collectively, these applications provide directions through which to leverage the mature field of HCD, maximize psychology's return on its early theoretical investment, and promote the large-scale impact of findings from across the applied fields of psychology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Stephanie K Brewer
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington
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Gumport NB, Yu SH, Harvey AG. Implementing a transdiagnostic sleep and circadian intervention in a community mental health setting: A qualitative process evaluation with community stakeholders. Psychiatry Res 2020; 293:113443. [PMID: 32890862 DOI: 10.1016/j.psychres.2020.113443] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
The implementation of evidence-based psychological treatments (EBPTs) may be particularly challenging to accomplish in community mental health settings for individuals with severe mental illness (SMI). Transdiagnostic treatments, or treatments that target a mechanism that underpins multiple mental health problems, may be particularly well-suited to community mental health settings. This study examines community stakeholder perspectives (N = 22) of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) implemented in a community mental health setting in the context of a randomized controlled trial of TranS-C for SMI. The present study aimed to identify barriers and facilitators to the implementation of TranS-C for SMI in a community mental health setting using (1) a deductive theory-based process based on the Framework for Dissemination in Health Services Intervention Research and (2) an inductive thematic analysis process. All deductive themes were identified as both barriers and facilitators to the implementation of EBPTs and TranS-C in this community mental health setting. Seven additional themes were identified through the inductive thematic analysis. A discussion of how the findings are related to prior research, other EBPT implementation, and future TranS-C implementation are included.
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Affiliation(s)
- Nicole B Gumport
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States
| | - Stephanie H Yu
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States; Department of Psychology, University of California, Los Angeles, CA, United States
| | - Allison G Harvey
- Department of Psychology, University of California, 2121 Berkeley Way #1650, Berkeley, CA, United States.
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Ingvarsson S, Augustsson H, Hasson H, Nilsen P, von Thiele Schwarz U, von Knorring M. Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians. Implement Sci 2020; 15:93. [PMID: 33087154 PMCID: PMC7579796 DOI: 10.1186/s13012-020-01052-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and the quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n = 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified. Uncertainty and disagreement about what not to do was related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines. Perceived pressure from others concerned patient pressure, pressure from other physicians, or pressure from the health care system. A desire to do something for the patients was associated with the fact that the visit in itself prompts action, symptoms to relieve, or that patients' emotions need to be reassured. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians’ use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.
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Affiliation(s)
- Sara Ingvarsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), SE-171 29, Stockholm, Stockholm Region, Sweden
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), SE-171 29, Stockholm, Stockholm Region, Sweden
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Mia von Knorring
- Leadership in Healthcare and Academia Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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