Changes in practitioners' attitudes, perceived training needs and self-efficacy over the implementation process of an evidence-based parenting program

Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study

Background

Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites.

Methods

We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME).

Results

In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described.

Conclusion

Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.

Evidence implementation in Australian manual therapy practice: A cross-sectional study

BACKGROUND

Few studies have explored the determinants of evidence implementation in complementary manual therapy professions. Exploring the factors that impede or enable evidence implementation in complementary manual therapy professions is critical to determining the most appropriate strategies to optimise this practice, and enhance the quality of care.

METHODS

The study used a cross-sectional study design to examine Australian complementary medicine manual therapists' attitudes, skills, training, use, barriers and enablers to evidence implementation. Eligible therapists were invited to self-administer the 84-item Evidence-Based practice Attitude and utilization Survey online.

RESULTS

The survey was completed by 294 manual therapists (77% female; 65% aged ≥50 years). Participants were mostly supportive of, and reported a moderate to moderate-high level of skill in evidence implementation. However, the level of engagement in evidence implementation was low. The leading barriers to evidence implementation were lack of time, and lack of clinical evidence. While few participants reported skill-level as a barrier, most indicated a desire to develop the skills necessary to improve their engagement in evidence implementation. Participants also supported a range of other enabling strategies to foster evidence implementation in their practice, with most of these strategies targeting access to evidence.

CONCLUSIONS

Although participants reported few barriers to evidence implementation, there was a low level of engagement in this activity. The barriers to evidence implementation therefore warrant further exploration. This ongoing work will help better understand how to optimise evidence implementation in complementary manual therapy practice, and help drive improvements in patient care.

The Change of Practitioner's Self-Efficacy in Triple P Professional Training: Moderating Role of Practitioner Characteristics, Country, and Delivery Mode

Two studies examined the change in self-efficacy of practitioners after attending Triple P training and the moderators that affect training outcomes. Study 1 used a large multidisciplinary sample of health, education, and welfare practitioners (N = 37,235) came from 30 countries around the world, which all participate in a Triple P professional training course during 2012-2019. This study assessed practitioners' overall self-efficacy and their consultation skills efficacy prior to training, immediately following training, and at six- to eight-weeks follow-up. Participants reported significant improvements of their overall self-efficacy and their consultation skills self-efficacy. There were significantly small differences based on practitioners' gender, disciplines, education levels, and country location. Study 2 examined the training outcomes of videoconference-based training (following the COVID-19 pandemic) compared to in-person training (N = 6867). No significant differences were found between videoconference and in-person training on any outcome measure. Implications for the global dissemination of evidence-based parenting programs as part of a comprehensive public health response to COVID-19 was discussed.

Predicting the Sustained Implementation of an Evidence-Based Parenting Program: A Structural Equation Modelling Approach

PURPOSE

Sustained implementation is required for evidence-based parenting programs to promote children and their families' wellbeing at the societal level. Previous literature has examined the role of a range of different factors in enhancing sustainability. However, the inter-relationship between, and the relative importance of different factors remain largely unknown. The overall aim of this study is to identify predictors of sustained program use, the relative importance of factors, and potential mediation pathways.

METHODS

We surveyed 1202 practitioners who were trained in at least one variant of the Triple P-Positive Parenting Program, at least one and half years before data collection. The present data were linked with data collected during professional training. We first examined the independent effect of each factor on sustained program use, then, developed and evaluated a structural equation model of sustained program use.

RESULTS

The structural equation model explained a considerable amount of variance in sustained program use, with seven positive predictors and one negative predictor identified. Organisational support was identified as a key facilitator, which was not only positively linked with other facilitators but also had an independent positive effect. Perceived usefulness of the program was the most important practitioner-level facilitator, which might be contributed by both research-based evidence and practice-based evidence. Practitioners' self-regulation in program delivery impacted sustained use by influencing other factors such as perceived usefulness of the program.

CONCLUSION

The findings provided insight into factors influencing the sustainability of evidence-based parenting programs which could be used to inform future implementation practice.