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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Exploring the complexity of the implementation determinants of human papillomavirus vaccination in Africa through a systems thinking lens: A rapid review. Hum Vaccin Immunother 2024; 20:2381922. [PMID: 39113230 PMCID: PMC11312990 DOI: 10.1080/21645515.2024.2381922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 08/11/2024] Open
Abstract
A rapid review was conducted to explore the implementation determinants of human papillomavirus (HPV) vaccination in the World Health Organization African Region and describe their dynamic relationship. PubMed and Google Scholar were searched in October 2023 to find relevant literature. A total of 64 published studies that reported factors affecting HPV vaccination were identified. Analysis of identified factors yielded 74 implementation determinants of HPV vaccination across the five domains of the Consolidated Framework for Implementation Research (CFIR): two (2.70%) were in the innovation domain, seven (9.46%) were in the outer setting domain, 14 (18.92%) were in the inner setting domain, 37 (50%) were in the individual domain and 14 (18.92%) were in the implementation process domain. A causal loop diagram of these implementation determinants revealed four balancing and seven reinforcing loops. Applying systems lens promoted a more holistic understanding of the implementation determinants of HPV vaccination, exposing leverage points for interventions.
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Affiliation(s)
- Abdu A. Adamu
- Polio Eradication Programme, World Health Organization Region Office for Africa, Djoue, Congo
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoue, Congo
| | - Rabiu I. Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoue, Congo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Lin FF, Chen Y, Rattray M, Murray L, Jacobs K, Brailsford J, Free P, Garrett P, Tabah A, Ramanan M. Interventions to improve patient admission and discharge practices in adult intensive care units: A systematic review. Intensive Crit Care Nurs 2024; 85:103688. [PMID: 38494383 DOI: 10.1016/j.iccn.2024.103688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES To identify and synthesise interventions and implementation strategies to optimise patient flow, addressing admission delays, discharge delays, and after-hours discharges in adult intensive care units. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Five electronic databases, including CINAHL, PubMed, Emcare, Scopus, and the Cochrane Library, were searched from 2007 to 2023 to identify articles describing interventions to enhance patient flow practices in adult intensive care units. The Critical Appraisal Skills Program (CASP) tool assessed the methodological quality of the included studies. All data was synthesised using a narrative approach. SETTING Adult intensive care units. RESULTS Eight studies met the inclusion criteria, mainly comprising quality improvement projects (n = 3) or before-and-after studies (n = 4). Intervention types included changing workflow processes, introducing decision support tools, publishing quality indicator data, utilising outreach nursing services, and promoting multidisciplinary communication. Various implementation strategies were used, including one-on-one training, in-person knowledge transfer, digital communication, and digital data synthesis and display. Most studies (n = 6) reported a significant improvement in at least one intensive care process-related outcome, although fewer studies specifically reported improvements in admission delays (0/0), discharge delays (1/2), and after-hours discharge (2/4). Two out of six studies reported significant improvements in patient-related outcomes after implementing the intervention. CONCLUSION Organisational-level strategies, such as protocols and alert systems, were frequently employed to improve patient flow within ICUs, while healthcare professional-level strategies to enhance communication were less commonly used. While most studies improved ICU processes, only half succeeded in significantly reducing discharge delays and/or after-hours discharges, and only a third reported improved patient outcomes, highlighting the need for more effective interventions. IMPLICATIONS FOR CLINICAL PRACTICE The findings of this review can guide the development of evidence-based, targeted, and tailored interventions aimed at improving patient and organisational outcomes.
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Affiliation(s)
- Frances Fengzhi Lin
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia; Caring Futures Institute, Flinders University, South Australia, Australia; School of Health, University of the Sunshine Coast, Queensland, Australia.
| | - Yingyan Chen
- School of Health, University of the Sunshine Coast, Queensland, Australia
| | - Megan Rattray
- College of Medicine & Public Health, Flinders University, South Australia, Australia
| | - Lauren Murray
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Kylie Jacobs
- Redcliffe Hospital, Redcliffe, Queensland, Australia
| | - Jane Brailsford
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Patricia Free
- Caboolture Hospital, Caboolture, Queensland, Australia
| | - Peter Garrett
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Alexis Tabah
- Redcliffe Hospital, Redcliffe, Queensland, Australia
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Scott S, Atkins B, D'Costa T, Rendle C, Murphy K, Taylor D, Smith C, Kellar I, Briggs A, Griffiths A, Hornak R, Spinewine A, Thompson W, Tsuyuki R, Bhattacharya D. Development of the Guide to Disseminating Research (GuiDiR): A consolidated framework. Res Social Adm Pharm 2024; 20:1047-1057. [PMID: 39183076 DOI: 10.1016/j.sapharm.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/29/2024] [Accepted: 08/07/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Less than one third of research evidence is translated into policy or practice. Knowledge translation requires effective dissemination, adoption and finally implementation. These three stages are equally important, however, existing knowledge translation models and frameworks provide little and disparate information about the steps and activities required for effective dissemination. OBJECTIVE This study aimed to empirically develop a consolidated framework of evidence-based steps and activities for disseminating research evidence. METHODS We identified models and frameworks from a scoping review and dissemination and implementation webtool. We synthesised them into a prototype dissemination framework. Models and frameworks were eligible to inform steps in our framework if they fulfilled at least one of three elements of dissemination: intending to generate awareness of a message, incorporates targeting an audience: tailoring communication. An initial coding framework was created to organise data into dissemination steps. Drawing on 'co-approach' principles, authors of the included models and frameworks (dissemination experts) and health service researchers (end users) were invited to test and refine the prototype framework at a workshop. RESULTS From 48 models and frameworks reviewed, only 32 fulfilled one or more of the three dissemination elements. The initial coding framework, upon refinement, yielded the Guide to Disseminating Research (GuiDiR) comprising five steps. 1) Identify target audiences and dissemination partners. 2) Engage with dissemination partners. 3) Identify barriers and enablers to dissemination. 4) Create dissemination messages. 5) Disseminate and evaluate. Multiple activities were identified for each step and no single model or framework represents all steps and activities in GuiDiR. CONCLUSIONS GuiDiR unifies dissemination components from knowledge translation models and frameworks and harmonises language into a format accessible to non-experts. It outlines for researchers, funders and practitioners the expected structure of dissemination and details the activities for executing an evidence-based dissemination strategy.
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Affiliation(s)
- Sion Scott
- School of Healthcare, University of Leicester, Leicester, UK
| | - Bethany Atkins
- School of Healthcare, University of Leicester, Leicester, UK
| | - Thomas D'Costa
- School of Pharmacy, University of East Anglia, Norwich, UK
| | - Claire Rendle
- School of Pharmacy, University of East Anglia, Norwich, UK
| | | | - David Taylor
- School of Healthcare, University of Leicester, Leicester, UK
| | - Caroline Smith
- School of Healthcare, University of Leicester, Leicester, UK
| | - Ian Kellar
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Alys Griffiths
- School of Medicine and Population Health, University of Sheffield, UK
| | - Rebekah Hornak
- National Implementation Research Network, Frank-Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, USA
| | - Anne Spinewine
- Université Catholique de Louvain, Louvain Drug Research Institute, Brussels, Belgium & CHU UCL Namur, Pharmacy Department, Yvoir, Belgium
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Canada
| | - Ross Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta. Edmonton, AB., Canada
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Mehmood K, Qiu X, Ghaffar A, Khan MA. Deciphering the future of electric vehicles amid emissions and adoption drivers. AMBIO 2024; 53:1686-1713. [PMID: 38822966 PMCID: PMC11436704 DOI: 10.1007/s13280-024-02026-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 02/27/2024] [Accepted: 04/09/2024] [Indexed: 06/03/2024]
Abstract
Climate change and CO2 emissions are critical challenges for the environment and humanity. There is extensive literature on greenhouse gas (GHG) emissions, in particular CO2 emissions. However, comprehensive analyses focusing on electric vehicles (EVs) and their impact are lacking. This study fills this gap by conducting a bibliometric analysis of 1143 peer-reviewed studies from 1989 to 2023. We aimed to identify influential contributions, understand the field's structure, and reveal research gaps. Analysis included citation networks, research impact, authorship patterns, content, and publication trends. We utilized bibliometric techniques to identify the most dominant countries, institutions, authors, journals, articles, and thematic areas related to EVs and emissions. Additionally, we overviewed publications associated with key search terms. Guided by five research dimensions (EVs, emissions, adoption, policies, and infrastructures), we framed specific research questions. This research provides valuable insights for environmentalists, policymakers, regulators, and academic researchers, facilitating access to crucial data on EVs and emissions.
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Affiliation(s)
- Khalid Mehmood
- Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, No. 301 Xuefu Road, Jingkou District, Zhenjiang, 212013, Jiangsu, China
| | - Xuchun Qiu
- Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, No. 301 Xuefu Road, Jingkou District, Zhenjiang, 212013, Jiangsu, China.
- Jiangsu Collaborative Innovation Center of Technology and Material of Water Treatment, Suzhou University of Science and Technology, Suzhou, 215009, China.
| | - Abdul Ghaffar
- Zhejiang University-University of Illinois at Urbana-Champaign Institute (ZJU-UIUC), No. 718, Haizhou East Road, Haining City, 314400, Zhejiang Province, China
| | - Muhammad Ajmal Khan
- Directorate of Library Affairs, Build A-3, Eastern Campus, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Huey SL, Islam S, Mehta NH, Konieczynski EM, Friesen VM, Krisher JT, Mbuya MNN, Monterrosa EC, Nyangaresi AM, Mehta S. Review of the facilitators and barriers to adoption of biofortified foods and food products. Nutr Res Rev 2024:1-22. [PMID: 39376108 DOI: 10.1017/s0954422424000258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024]
Abstract
Biofortification - the process of increasing the concentrations of essential nutrients in staple crops - is a means of addressing the burden of micronutrient deficiencies at a population level via existing food systems, such as smallholder farms. To realise its potential for global impact, we need to understand the factors that are associated with decisions to adopt biofortified crops and food products. We searched the literature to identify adoption determinants, i.e. barriers to (factors negatively associated) or facilitators of (factors positively associated) adoption, of biofortified crops and food products. We found 41 studies reporting facilitator(s) and/or barrier(s) of adoption. We categorised the factors using the Consolidated Framework of Implementation Research 2.0, resulting in a set of factors that enable or constrain adoption of biofortified foods across twenty-four constructs and five domains of this meta-theoretical determinant framework from implementation science. Facilitators of orange sweet potato adoption included knowledge about importance, relative advantage, efficient production and management practices; barriers included lacking timely access to quality vines and market remoteness (28 studies total). Facilitators of vitamin A cassava adoption included awareness of its benefits and access to information; barriers included poor road networks and scarcity of improved technology including inadequate processing/storage facilities (8). Facilitators of high-iron bean adoption included farmers' networking and high farming experience; barriers included low knowledge of bean biofortification (8). Barriers to vitamin A maize adoption included low awareness and concerns regarding yield, texture and aflatoxin contamination (1). These barriers and facilitators may be a starting point for researchers to move towards testing implementation strategies and/or for policymakers to consider before planning scale-up and continuous optimisation of ongoing projects promoting adoption of biofortified crops and food products.
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Affiliation(s)
- Samantha L Huey
- Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Saiful Islam
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Neel H Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | | | - Jesse T Krisher
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | | | | | | | - Saurabh Mehta
- Center for Precision Nutrition and Health, Cornell University, Ithaca, NY, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Weerakkody A, Godecke E, Singer B. Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service. Aust Occup Ther J 2024. [PMID: 39375077 DOI: 10.1111/1440-1630.12993] [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: 06/21/2024] [Accepted: 09/12/2024] [Indexed: 10/09/2024]
Abstract
BACKGROUND Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery. METHODS This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n = 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF). CONSUMER AND COMMUNITY INVOLVEMENT Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study. FINDINGS Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences). CONCLUSION mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers. PLAIN LANGUAGE SUMMARY Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.
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Affiliation(s)
- Ashan Weerakkody
- Department of Health, Rehabilitation in the Home, South Metropolitan Health Service, Fremantle, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Health, Sir Charles Gairdner Hospital, North Metropolitan Health Service, Nedlands, Western Australia, Australia
| | - Barby Singer
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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McCleary NJ, Merle JL, Richardson JE, Bass M, Garcia SF, Cheville AL, Mitchell SA, Jensen R, Minteer S, Austin JD, Tesch N, DiMartino L, Hassett MJ, Osarogiagbon RU, Wong S, Schrag D, Cella D, Smith AW, Smith JD. Bridging clinical informatics and implementation science to improve cancer symptom management in ambulatory oncology practices: experiences from the IMPACT consortium. JAMIA Open 2024; 7:ooae081. [PMID: 39234146 PMCID: PMC11373565 DOI: 10.1093/jamiaopen/ooae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/04/2024] [Accepted: 08/22/2024] [Indexed: 09/06/2024] Open
Abstract
Objectives To report lessons from integrating the methods and perspectives of clinical informatics (CI) and implementation science (IS) in the context of Improving the Management of symPtoms during and following Cancer Treatment (IMPACT) Consortium pragmatic trials. Materials and Methods IMPACT informaticists, trialists, and implementation scientists met to identify challenges and solutions by examining robust case examples from 3 Research Centers that are deploying systematic symptom assessment and management interventions via electronic health records (EHRs). Investigators discussed data collection and CI challenges, implementation strategies, and lessons learned. Results CI implementation strategies and EHRs systems were utilized to collect and act upon symptoms and impairments in functioning via electronic patient-reported outcomes (ePRO) captured in ambulatory oncology settings. Limited EHR functionality and data collection capabilities constrained the ability to address IS questions. Collecting ePRO data required significant planning and organizational champions adept at navigating ambiguity. Discussion Bringing together CI and IS perspectives offers critical opportunities for monitoring and managing cancer symptoms via ePROs. Discussions between CI and IS researchers identified and addressed gaps between applied informatics implementation and theory-based IS trial and evaluation methods. The use of common terminology may foster shared mental models between CI and IS communities to enhance EHR design to more effectively facilitate ePRO implementation and clinical responses. Conclusion Implementation of ePROs in ambulatory oncology clinics benefits from common understanding of the concepts, lexicon, and incentives between CI implementers and IS researchers to facilitate and measure the results of implementation efforts.
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Affiliation(s)
- Nadine Jackson McCleary
- Department of Medical Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - James L Merle
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, United States
| | - Joshua E Richardson
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Michael Bass
- Department of Medical Social Science, Northwestern University, Chicago, IL 60611, United States
| | - Sofia F Garcia
- Department of Medical Social Science, Northwestern University, Chicago, IL 60611, United States
| | - Andrea L Cheville
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, MN 55905, United States
| | - Sandra A Mitchell
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Roxanne Jensen
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Sarah Minteer
- Department of Physical Medicine & Rehabilitation, Mayo Clinic, MN 55905, United States
| | - Jessica D Austin
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic Arizona, Mayo Clinic Cancer Center, Population Sciences Program, Scottsdale, AZ 85054, United States
| | - Nathan Tesch
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, MN 55905, United States
| | - Lisa DiMartino
- University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
- RTI International, Research Triangle Park, NC 27709, United States
| | - Michael J Hassett
- Department of Medical Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | | | - Sandra Wong
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03766, United States
| | - Deborah Schrag
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - David Cella
- Institute for Public Health and Medicine, Center for Patient-Centered Outcomes, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Ashley Wilder Smith
- Outcomes Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States
| | - Justin D Smith
- Division of Health System Innovation and Research, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT 84132, United States
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Dawson S, Oster C, Page M, George S. Exploring the Safewards Programme to Reduce Restrictive Practices in Residential Aged Care: Protocol for a Pilot and Feasibility Study. Health Expect 2024; 27:e70037. [PMID: 39345156 PMCID: PMC11440635 DOI: 10.1111/hex.70037] [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: 03/21/2024] [Revised: 07/23/2024] [Accepted: 09/06/2024] [Indexed: 10/01/2024] Open
Abstract
INTRODUCTION Restrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence-based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes. METHODS This pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi-structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation. CONCLUSION This study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care. PATIENT OR PUBLIC CONTRIBUTION A person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards. TRIAL REGISTRATION ACTRN12624000044527.
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Affiliation(s)
- Suzanne Dawson
- Caring Futures Institute, Flinders University, Adelaide, South Australia, USA
| | - Candice Oster
- Caring Futures Institute, Flinders University, Adelaide, South Australia, USA
| | - Michael Page
- Uniting Communities, Adelaide, South Australia, USA
| | - Stacey George
- Caring Futures Institute, Flinders University, Adelaide, South Australia, USA
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Fishman J, Alexander T, Kim Y, Kindt I, Mendez P. A clinical decision support tool for metabolic dysfunction-associated steatohepatitis in real-world clinical settings: a mixed-method implementation research study protocol. J Comp Eff Res 2024; 13:e240085. [PMID: 39301878 PMCID: PMC11426282 DOI: 10.57264/cer-2024-0085] [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: 05/17/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024] Open
Abstract
Aim: A clinical decision support (CDS) tool for metabolic dysfunction-associated steatohepatitis (MASH) was developed to align health systems with clinical guidelines detailed in the MASH Clinical Care Pathway and improve patients' proactive self-management of their disease. The tool includes a provider-facing web-based application and a mobile application (app) for patients. This protocol outlines a pilot study that will systematically evaluate the implementation of the tool in real-world clinical practice settings. Materials & methods: This implementation research study will use a simultaneous mixed-methods design and is guided by the Consolidated Framework for Implementation Research. The CDS tool for MASH will be piloted for ≥3 months at multiple US-based sites with eligible gastroenterologists and hepatologists (n = 5-10 per site) and their patients (n = 50-100 per site) with MASH or suspected MASH. Each pilot site may choose one or all focus areas within the tool (i.e., risk stratification, screening and referral, or patient care management), based on on-site capabilities. Prior to and at the end of the pilot period, providers and patients will complete quantitative surveys and partake in semi-structured interviews. Outcomes will include understanding the feasibility of implementing the tool in real-world clinical settings, its effectiveness in increasing patient screenings and risk stratification for MASH, its ability to improve provider and patient knowledge of MASH, barriers to adoption of the tool and the tool's capacity to enhance patient engagement and satisfaction with their care. Conclusion: Findings will inform the scalable implementation of the tool to ensure patients at risk for MASH are identified early, referred to specialty care when necessary and managed appropriately. Successful integration of the patient app can contribute to better health outcomes for patients by facilitating their active participation in the management of their condition.
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Affiliation(s)
- Jesse Fishman
- Madrigal Pharmaceuticals, Inc., West Conshohocken, PA 19428, USA
| | | | - Yestle Kim
- Madrigal Pharmaceuticals, Inc., West Conshohocken, PA 19428, USA
| | - Iris Kindt
- DEARhealth, Westlake Village, CA 91362, USA
| | - Patricia Mendez
- Madrigal Pharmaceuticals, Inc., West Conshohocken, PA 19428, USA
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Mensah GA. Is a Low-Dose Triple-Drug Combination Pill Protocol the Answer for Hypertension Control in Sub-Saharan Africa? JAMA 2024; 332:1057-1058. [PMID: 39215617 DOI: 10.1001/jama.2024.18166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Affiliation(s)
- George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Kakumanu S, Szefler S, Pappalardo AA, Sales AE, Baptist AP, Stern J, Nyenhuis SM. Applying the dissemination and implementation sciences to allergy and immunology: A Work Group Report from the AAAAI Quality, Adherence, and Outcomes Committee. J Allergy Clin Immunol 2024; 154:893-902. [PMID: 39162669 DOI: 10.1016/j.jaci.2024.07.016] [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: 12/22/2023] [Revised: 06/04/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024]
Abstract
Translating evidence-based practice (EBP) into real-world clinical settings often takes a considerable amount of time and resources. In allergy and immunology, the dissemination and implementation (D&I) sciences facilitate the study of how variations in knowledge, resources, patient populations, and staffing models lead to differences in the clinical care of asthma, allergic disease, and primary immunodeficiency. Despite the need for validated approaches to study how to best apply EBP in the real world, the D&I sciences are underutilized. To address this gap, an American Academy of Allergy, Asthma & Immunology (AAAAI) work group was convened to provide an overview for the role of the D&I sciences in clinical care and future research within the field. For the D&I sciences to be leveraged effectively, teams should be multidisciplinary and inclusive of community and clinical partners, and multimethods approaches to data collection and analyses should be used. Used appropriately, the D&I sciences provide important tools to promote EBP and health equity as well as optimization of clinical practice in allergy and immunology.
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Affiliation(s)
- Sujani Kakumanu
- University of Wisconsin School of Medicine and Public Health, Madison, Wis; William S. Middleton Veterans Memorial Hospital, Madison, Wis.
| | - Stanley Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Andrea A Pappalardo
- Departments of Medicine and Pediatrics, Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois, Chicago, Ill
| | - Anne E Sales
- Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, Mo; Veterans Affairs, Ann Arbor Healthcare System, Ann Arbor, Mich
| | - Alan P Baptist
- Division of Allergy and Clinical Immunology, Henry Ford Health, Detroit, Mich
| | - Jessica Stern
- Division of Allergy, Immunology, and Rheumatology, Division of Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy, Immunology, and Pulmonology, University of Chicago, Chicago, Ill
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Sacca L, Lobaina D, Burgoa S, Rao M, Jhumkhawala V, Zapata SM, Issac M, Medina S. Using Patient-Centered Dissemination and Implementation Frameworks and Strategies in Palliative Care Settings for Improved Quality of Life and Health Outcomes: A Scoping Review. Am J Hosp Palliat Care 2024; 41:1195-1237. [PMID: 37956239 DOI: 10.1177/10499091231214241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND There is a need for patient-provider dissemination and implementation frameworks, strategies, and protocols in palliative care settings for a holistic approach when it comes to addressing pain and other distressing symptoms affecting the quality of life, function, and independence of patients with chronic illnesses. The purpose of this scoping review is to explore patient-centered D&I frameworks and strategies that have been adopted in PC settings to improve behavioral and environmental determinants influencing health outcomes through evidence-based programs and protocols. METHODS The five step Arksey and O'Malley's (2005) York methodology was adopted as a guiding framework: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. RESULTS Only 6 out of the 38 (16%) included studies applied a D&I theory and/or framework. The RE-AIM framework was the most prominently cited (n = 3), followed by the Diffusion of Innovation Model (n = 2), the CONNECT framework (n = 1), and the Transtheoretical Stages of Change Model (n = 1). The most frequently reported ERIC strategy was strategy #6 "Develop and organize quality monitoring systems", as it identified in all 38 of the included studies. CONCLUSION This scoping review identifies D&I efforts to translate research into practice in U.S. palliative care settings. Results may contribute to enhancing future D&I initiatives for dissemination/adaptation, implementation, and sustainability efforts aiming to improve patient health outcomes and personal satisfaction with care received.
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Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheena M Zapata
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Michelle Issac
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Suleyki Medina
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
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13
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Benzies KM, Zanoni P, McNeil DA. Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description. Implement Sci Commun 2024; 5:106. [PMID: 39350292 PMCID: PMC11441001 DOI: 10.1186/s43058-024-00644-2] [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: 11/14/2023] [Accepted: 09/16/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care. METHODS This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study. RESULTS To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system. CONCLUSIONS We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems. TRIAL REGISTRATION ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .
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Affiliation(s)
- Karen M Benzies
- Faculty of Nursing, Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, Social Innovation Initiative, PF3280C Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Pilar Zanoni
- PF4240-A2, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary AB, T2N 1N4, Canada
| | - Deborah A McNeil
- Maternal Newborn Child and Youth Strategic Clinical NetworkTM, Provincial Clinical Excellence, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada
- Faculty of Nursing and Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
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Pieterse AH, van Bodegom-Vos L. Shared Decision Making Is in Need of Effectiveness-Implementation Hybrid Studies. Med Decis Making 2024:272989X241286516. [PMID: 39344033 DOI: 10.1177/0272989x241286516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Affiliation(s)
- Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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15
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Straiton N, Lauck SB, Lewis KB. The nurse, the framework, and the digital future. Eur J Cardiovasc Nurs 2024:zvae123. [PMID: 39316550 DOI: 10.1093/eurjcn/zvae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/26/2024]
Affiliation(s)
- Nicola Straiton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, New South Wales, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia
| | - Sandra B Lauck
- St. Paul's Hospital, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Krystina B Lewis
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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16
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Al-Omary H, Soltani A, Stewart D, Nazar Z. Implementing learning into practice from continuous professional development activities: a scoping review of health professionals' views and experiences. BMC MEDICAL EDUCATION 2024; 24:1031. [PMID: 39304841 DOI: 10.1186/s12909-024-06016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 09/11/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE Continuing professional development (CPD) is an approach for health professionals to preserve and expand their knowledge, skills, and performance, and can contribute to improving delivery of care. However, evidence indicates that simply delivering CPD activities to health professionals does not lead to a change in practice. This review aimed to collate, summarize, and categorize the literature that reported the views and experiences of health professionals on implementing into practice their learning from CPD activities. METHODS This review was guided by the Joanna Briggs Institute Reviewers' Manual methodology for scoping reviews. Three databases, PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL), were systematically searched in February 2023 for articles published since inception. Two independent reviewers screened the articles against the inclusion criteria, and completed the data extraction. Data were summarized quantitatively, and the findings relating to views and experiences were categorized into challenges and facilitators. RESULTS Thirteen articles were included. Implementation of learning was not the primary focus in the majority of studies. Studies were published between 2008-2022; the majority were conducted in North America and nurses were the most common stakeholder group among Healthcare Professionals (HCPs). Five studies adopted qualitative methods, four quantitative studies, and four mixed-methods studies. The reported barriers of implementation included lack of time and human resource; the facilitators included the nature of the training, course content and opportunity for communal learning. CONCLUSION This review highlights a gap in the literature. Available studies indicate some barriers for health professionals to implement their learning from CPD activities into their practice. Further studies, underpinned with appropriate theory and including all relevent stakeholders are required to investigate strategies that may facilitate the integration of learning from CPD into routine practice.
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Affiliation(s)
- Heba Al-Omary
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Zachariah Nazar
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
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17
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Dulay E, Griffin B, Brannigan J, McBride C, Hudson A, Ullman A. Interventions to optimise preoperative fasting in paediatrics: a scoping review. Br J Anaesth 2024:S0007-0912(24)00479-3. [PMID: 39304471 DOI: 10.1016/j.bja.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/18/2024] [Accepted: 08/13/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Preoperative fasting is the standard of care for patients undergoing a procedure under general anaesthesia. Despite the increased leniency of fasting guideline recommendations, prolonged preoperative fasting periods continue to disproportionally affect paediatric patients. This review maps existing interventions optimising paediatric fasting practices, to explore strategies that can be best applied in clinical practice. METHODS A search strategy applied to PubMed, CINAHL, Embase, Scopus, and the Cochrane Database involved four key concepts: (1) fasting, (2) preoperative, (3) paediatric, and (4) quality improvement intervention. The Preferred Reporting Items of Systematic Reviews and Meta-analyses extension for Scoping Reviews was utilised in this review. RESULTS Thirteen heterogeneous studies, involving approximately 31 000 children across five continents, were included. Each intervention studied fell into at least one of the following six themes: (1) change in facility protocol, (2) technology-based intervention, (3) individualised fasting programs, (4) processes to improve communication between clinicians, (5) processes to improve communication to parents and families, and (6) staff education. CONCLUSIONS A variety of interventions have been studied to optimise paediatric preoperative fasting duration. These interventions show potential in reducing preoperative fasting duration.
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Affiliation(s)
- Erika Dulay
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia.
| | - Bronwyn Griffin
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia
| | - James Brannigan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Craig McBride
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adrienne Hudson
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia; Learning and Workforce, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia; School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Amanda Ullman
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia; School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia; Children's Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
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18
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Van Zyl-Cillié MM, van Dun DH, Meijer H. Toward a roadmap for sustainable lean adoption in hospitals: a Delphi study. BMC Health Serv Res 2024; 24:1088. [PMID: 39294661 PMCID: PMC11409581 DOI: 10.1186/s12913-024-11529-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 09/03/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND The benefits of lean adoption in healthcare include improved process efficiency and quality of patient care. However, research indicates that lean implementation in healthcare, and specifically hospitals, is often not sustained. Furthermore, there is a need for maturity models that guide lean implementation, specifically in hospitals. This study develops a prescriptive maturity model named the Sustaining of Lean Adoption in Hospitals Roadmap (SOLAR) that acts as a practical guideline for the sustainable adoption of lean in hospitals. METHODS The SOLAR has three theoretical foundations, namely lean implementation success factors in hospitals, implementation science, and change management theory. A systematic literature review was conducted to determine the lean implementation success factors in hospitals as the first building block. Secondly, practices from implementation science were used to create the action items in the SOLAR. Ten change steps were elicited from change management theory as the third theoretical building block of the roadmap. We refined the roadmap through three Delphi rounds that verified its useability in hospitals. RESULTS The final SOLAR consists of four maturity phases (prepare, plan, experiment and learn, and sustain) and includes action items for each phase related to the hospital's strategy, resources, engaging of people, and culture. The action items and change management steps shown in the SOLAR are not intended as an exhaustive list but provide guidelines on aspects hospitals must consider when they aim to adopt lean sustainably. CONCLUSIONS The strong theoretical base of the SOLAR enables hospitals to safely experiment and learn which implementation methods are best suited to their unique environment. The SOLAR is, therefore, an actionable guideline that informs both academics and practitioners involved in lean adoption in hospitals. This roadmap can guide future retrospective longitudinal or action research.
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Affiliation(s)
- Maria M Van Zyl-Cillié
- Faculty of Engineering, North-West University, 11 Hoffman Street, Potchefstroom, South Africa.
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands.
| | - Desirée H van Dun
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands
| | - Hanneke Meijer
- Faculty of Engineering, North-West University, 11 Hoffman Street, Potchefstroom, South Africa
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Lewis CC, Frank HE, Cruden G, Kim B, Stahmer AC, Lyon AR, Albers B, Aarons GA, Beidas RS, Mittman BS, Weiner BJ, Williams NJ, Powell BJ. A research agenda to advance the study of implementation mechanisms. Implement Sci Commun 2024; 5:98. [PMID: 39285504 PMCID: PMC11403843 DOI: 10.1186/s43058-024-00633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 08/30/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Implementation science scholars have made significant progress identifying factors that enable or obstruct the implementation of evidence-based interventions, and testing strategies that may modify those factors. However, little research sheds light on how or why strategies work, in what contexts, and for whom. Studying implementation mechanisms-the processes responsible for change-is crucial for advancing the field of implementation science and enhancing its value in facilitating equitable policy and practice change. The Agency for Healthcare Research and Quality funded a conference series to achieve two aims: (1) develop a research agenda on implementation mechanisms, and (2) actively disseminate the research agenda to research, policy, and practice audiences. This article presents the resulting research agenda, including priorities and actions to encourage its execution. METHOD Building on prior concept mapping work, in a semi-structured, 3-day, in-person working meeting, 23 US-based researchers used a modified nominal group process to generate priorities and actions for addressing challenges to studying implementation mechanisms. During each of the three 120-min sessions, small groups responded to the prompt: "What actions need to be taken to move this research forward?" The groups brainstormed actions, which were then shared with the full group and discussed with the support of facilitators trained in structured group processes. Facilitators grouped critical and novel ideas into themes. Attendees voted on six themes they prioritized to discuss in a fourth, 120-min session, during which small groups operationalized prioritized actions. Subsequently, all ideas were collated, combined, and revised for clarity by a subset of the authorship team. RESULTS From this multistep process, 150 actions emerged across 10 priority areas, which together constitute the research agenda. Actions included discrete activities, projects, or products, and ways to shift how research is conducted to strengthen the study of implementation mechanisms. CONCLUSIONS This research agenda elevates actions to guide the selection, design, and evaluation of implementation mechanisms. By delineating recommended actions to address the challenges of studying implementation mechanisms, this research agenda facilitates expanding the field of implementation science, beyond studying what works to how and why strategies work, in what contexts, for whom, and with which interventions.
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA, 98101, USA.
| | - Hannah E Frank
- The Warren Alpert Medical School, Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Gracelyn Cruden
- Chestnut Health System, Lighthouse Institute - OR Group, 1255 Pearl St, Ste 101, Eugene, OR 97401, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Aubyn C Stahmer
- UC Davis MIND Institute, 2825 50Th St, Sacramento, CA, 95819, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street Box 356560, Seattle, WA, 98195-6560, USA
| | - Bianca Albers
- Institute for Implementation Science in Health Care, University of Zurich, Zürich, Switzerland
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive La Jolla California, San Diego, 92093, CA, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N Michigan Avenue, Evanston, IL, 60661, USA
| | - Brian S Mittman
- Division of Health Services Research & Implementation Science, Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Bryan J Weiner
- Department of Global Health, School of Public Health, Box 357965, Seattle, WA, 98195, USA
| | - Nate J Williams
- School of Social Work, Boise State University, Boise, ID, 83725, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Dadich A, Vaughan P, Watfern C, Triandafilidis Z, Habak S, Boydell KM. Growing and fostering knowledge translation: Recommendations for health organisations from the SPHERE Envisionarium. Heliyon 2024; 10:e36817. [PMID: 39281604 PMCID: PMC11402184 DOI: 10.1016/j.heliyon.2024.e36817] [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: 03/14/2024] [Revised: 08/19/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Despite considerable investments in health research, there is a disconnect between what is known to enhance healthcare and how healthcare is delivered in situ. Knowledge translation (KT) plays a vital role in addressing this disconnect. Some governments promote KT via initiatives that encourage collaboration between researchers, clinicians, communities and others; this includes Maridulu Budyari Gumal SPHERE (Sydney Partnership for Health, Education, Research and Enterprise). To promote KT and address the knowledge-to-action gap, we held an envisionarium with SPHERE members, to generate recommendations to promote KT in, and beyond, SPHERE. METHODS To discern these recommendations, an envisionarium was facilitated with SPHERE members. Participants included researchers, healthcare providers and others (n = 16). Participants considered how KT can be fostered and promoted. Discussion notes and participant responses were thematically analysed. RESULTS Four recommendations were identified, accompanied by practical steps to action these to enable health and research institutions to foster KT. These include the need to: provide access to resources; reconceptualise impact and innovation; promote the legitimacy of different knowledges; and engage everyone in KT. CONCLUSIONS These recommendations are important for three reasons. First, they demonstrate that KT requires more than funding - it also requires networks that buoy the dynamic flow of knowledge in its varied manifestations. Second, the recommendations demonstrate the importance of supportive organisational mechanisms that inculcate positive, KT-friendly structures or cultures, while affording individuals the opportunity to organically foster innovation. Third, they demonstrate the methodological value of envisionariums to disrupt the status quo and envision different ways to promote KT.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Priya Vaughan
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Chloe Watfern
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Zoi Triandafilidis
- Central Coast Research Institute for Integrated Health Care, Central Coast Local Health District and University of Newcastle, Gosford, NSW, Australia
| | - Stephanie Habak
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
| | - Katherine M Boydell
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW, 2031, Australia
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Lapierre A, Bérubé M, Giroux M, Tardif PA, Turcotte V, Mercier É, Richard-Denis A, Williamson D, Moore L. Interprofessional interventions that impact collaboration and quality of care across inpatient trauma care continuum: A scoping review. Injury 2024; 55:111873. [PMID: 39303368 DOI: 10.1016/j.injury.2024.111873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Despite the recognized importance of interprofessional collaboration (IPC) in trauma care, healthcare professionals often work in silos. Interprofessional (IP) interventions are crucial for optimizing IPC and delivering high-quality care across clinical contexts, yet their effectiveness throughout the inpatient trauma care continuum is not well understood. Thus, this review aimed to examine the literature on the effectiveness of IP interventions on collaboration processes and related outcomes in inpatient trauma care. METHODS We conducted a scoping review following Joanna Briggs Institute's methodology. We searched six databases for studies from the last decade on IP interventions in inpatient trauma care. Two independent reviewers categorized IP interventions (education, practice, organization) and extracted their impact on IPC processes and related outcomes (team performance, patient, organization). RESULTS Of the 17,397 studies screened, 148 met the inclusion criteria. Most were cohort designs (72%), conducted in level I trauma centers (57%) and emergency departments (51%), and involved surgeons (56%) and nurses (53%). Studies focused on IP organization interventions (51%), such as clinical pathways; IP practice interventions (35%), such as trauma team activation protocols; and IP education interventions (14%) including multi-method education. IP practice interventions most effectively improved team performance results, while IP education interventions primarily improved IPC processes. Positive patient outcomes were limited, with few studies examining organizational effects. CONCLUSIONS Significant advancements are still required in IP interventions and trauma care research. Future studies should rigorously explore the effectiveness of interventions throughout the inpatient trauma care continuum and focus on developing robust measures for patient and organizational outcomes.
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Affiliation(s)
- Alexandra Lapierre
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
| | - Mélanie Bérubé
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Marianne Giroux
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Pier-Alexandre Tardif
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada
| | - Valérie Turcotte
- Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
| | - Éric Mercier
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada
| | - Andréane Richard-Denis
- Department of Physiatry and Research Center, CIUSSS du-Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - David Williamson
- Department of Pharmacy and Research Center, CIUSSS-Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Lynne Moore
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Costea VA, Bäck A, Bergström A, Lundin A, Hasson H, Eriksson L. A longitudinal mixed methods evaluation of a facilitation training intervention to build implementation capacity. FRONTIERS IN HEALTH SERVICES 2024; 4:1408801. [PMID: 39347375 PMCID: PMC11427355 DOI: 10.3389/frhs.2024.1408801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024]
Abstract
Background There is a demand for facilitators who can ease the collaboration within a team or an organization in the implementation of evidence-based interventions (EBIs) and who are positioned to build the implementation capacity in an organization. This study aimed to evaluate the results the Building implementation capacity for facilitation (BIC-F) intervention had on the participants' perceived knowledge, skills, and self-efficacy to facilitate implementation and the normalization of a systematic implementation model into their work routines, and its use into their respective organizations. Methods The BIC-F intervention was delivered to 37 facilitators in six workshops, which focused on teaching participants to apply a systematic implementation model and various facilitation tools and strategies. A longitudinal mixed methods design was used to evaluate the intervention. Data was collected pre- and post-intervention using questionnaires and semi-structured interviews grounded on the Normalization Process Theory (NPT). Quantitative data were analyzed using descriptive (mean, SD) and inferential (paired t-tests) methods. Qualitative data were analyzed using deductive content analysis according to NPT. Results An increase in the participants' perceived knowledge, skills, and self-efficacy was observed post-intervention. Normalization of the systematic implementation model in the participants' work routines was in an early phase, facilitated by high coherence, however, other NPT mechanisms were not sufficiently activated yet to contribute to full normalization. In the organizations where participants initiated the normalization process, they were still working towards achieving coherence and cognitive participation among relevant stakeholders. Conclusion The intervention had positive results on the participants' perceived knowledge, skills, and self-efficacy and these recognized the value of a systematic implementation model for their practice. However, further efforts are needed to apply it consistently as a part of their work routines and in the organization. Future interventions should provide long-term support for facilitators, and include methods to transfer training between organizational levels and to overcome contextual barriers.
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Affiliation(s)
- Veronica-Aurelia Costea
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Annika Bäck
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Anna Bergström
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Andreas Lundin
- Unit for Health Care Analysis, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Henna Hasson
- PROCOME Research Group, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
| | - Leif Eriksson
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm, Sweden
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Meddick-Dyson SA, Boland JW, Pearson M, Greenley S, Gambe R, Budding JR, Murtagh FEM. Implementing palliative care in the intensive care unit: a systematic review and mapping of knowledge to the implementation research logic model. Intensive Care Med 2024:10.1007/s00134-024-07623-0. [PMID: 39266771 DOI: 10.1007/s00134-024-07623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/20/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE The importance and effectiveness of palliative care (PC) in intensive care units (ICU) are known. Less is known about the implementation and integration of ICU-based PC interventions. This systematic review aims to use a modified implementation research logic model (IRLM) to identify, map, and synthesise evidence on implementation of ICU-PC (primary and/or specialist) interventions. METHODS This systematic review used an adapted Smith's IRLM to understand relationships between implementation factors-determinants (barriers and facilitators), strategies, and mechanisms-and report intervention characteristics and outcomes. Searches up to 2nd December 2023, of MEDLINE, Embase, Cochrane, CINAHL, and PsycINFO, combined PC, intensive care, and implementation terms. RESULTS 84 studies (8 process evaluations, 76 effectiveness studies) were included. Published evidence on ICU-PC interventions is substantial, but reporting on implementation factors is variable and often lacking, especially for patient and family-related determinants and for all aspects of mechanisms. Main facilitators for implementation are adequate resources and collaboration between PC and ICU teams. Main barriers to implementation are lack of resources, negative perceptions of PC, and high ICU acuity. Implementation strategies include auditing resources, building stakeholder collaboratives, creating adaptable interventions, utilising champions, and supporting education. Mechanisms most commonly worked by facilitating collaborative working. CONCLUSION This review provides recommendations for ICUs when designing (stakeholder involvement, ICU-PC collaboration, assessment of culture and resources); implementing (targeted and adapted strategies, champions, and education); and evaluating/reporting (collect effectiveness and implementation data, including mechanisms) ICU-PC interventions. Use of implementation structures and patient/family involvement are both needed and important to be included.
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Affiliation(s)
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sarah Greenley
- Cancer Awareness, Screening and Diagnostic Pathways Research Group (CASP), Hull York Medical School, University of Hull, Hull, UK
| | - Rutendo Gambe
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - John R Budding
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Martínez C, Camarelles Guillem F, González-Viana A, Sánchez Á, Tigova O, Fernández E. [From evidence to practice: The Disemination and Implementation Science in primary care]. Aten Primaria 2024; 57:103077. [PMID: 39265319 DOI: 10.1016/j.aprim.2024.103077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 09/14/2024] Open
Abstract
Dissemination and Implementation Science focuses on bridging the gap between scientific research and its practical application in the real world. By identifying and promoting effective strategies, the Science of Dissemination and Implementation disseminates and implements evidence-based interventions in healthcare settings, taking into account the needs, barriers, context, resources, and end users. This special article introduces and debates the most recent advances in this field, highlighting key approaches, theoretical frameworks, as well as specific challenges and opportunities applied to primary and community care. Additionally, concrete examples tailored to the Spanish context are presented. Given the nascent state of the use of the Dissemination and Implementation Science in Spain, the authors recommend strategically adopting this approach and its principles in primary and community care to expedite the adoption of effective interventions that promote health.
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Affiliation(s)
- Cristina Martínez
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Salut Pública, Materno Infantil y Salud Mental, Facultad de Enfermería, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, EE. UU..
| | - Francisco Camarelles Guillem
- Centro de Salud Infanta Mercedes, Programa Actividades Preventivas y Promoción de la Salud PAPPS de semFYC, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | - Angelina González-Viana
- Servicio Catalán de la Salud - CatSalut, España; Grup d'Atenció Primària Orientada a la Comunitat (APOC) de CAMFIC, Barcelona, España
| | - Álvaro Sánchez
- Unidad de Investigación Atención Primaria de Bizkaia, Subdirección para la Coordinación de la Atención Primaria, Dirección General OSAKIDETZA, España; Grupo de Investigación en Ciencias de la Diseminación e Implementación en Servicios Sanitarios, Instituto Investigación Biobizkaia, España; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), España
| | - Olena Tigova
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
| | - Esteve Fernández
- Unidad de Control del Tabaco, Programa de Prevención y Control del Cáncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Prevención y Control del Cáncer, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; CIBER en Enfermedades Respiratorias (CIBERES), Madrid, España; Departamento de Ciencias Clínicas, Facultad de Medicina, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, España
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Liwanag HJ, Famaloan FRA, Reyes KA, Tamayo RL, Villamater LD, Cabañero-Gasgonia RL, Frahsa A, Asuncion PJ. A conceptual framework from the Philippines to analyse organizational capacities for health policy and systems research. Health Policy Plan 2024; 39:878-889. [PMID: 38978194 PMCID: PMC11384115 DOI: 10.1093/heapol/czae062] [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: 04/02/2024] [Revised: 06/27/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024] Open
Abstract
Organizations that perform Health Policy and Systems Research (HPSR) need robust capacities, but it remains unclear what these organizations should look like in practice. We sought to define 'HPSRIs' (pronounced as 'hip-srees', i.e. 'Health Policy and Systems Research Institutions') as organizational models and developed a conceptual framework for assessing their capacities based on a set of attributes. We implemented a multi-method study in the Philippines that comprised: a qualitative analysis of perspectives from 33 stakeholders in the HPSR ecosystem on the functions, strengths and challenges of HPSRIs; a workshop with 17 multi-sectoral representatives who collectively developed a conceptual framework for assessing organizational capacities for HPSRIs based on organizational attributes; and a survey instrument development process that determined indicators for assessing these attributes. We defined HPSRIs to be formally constituted organizations (or institutions) with the minimum essential function of research. Beyond the research function, our framework outlined eight organizational attributes of well-performing HPSRIs that were grouped into four domains, namely: 'research expertise' (1) excellent research, (2) capacity-building driven; 'leadership and management' (3) efficient administration, (4) financially sustainable; 'policy translation' (5) policy orientation, (6) effective communication; and 'networking' (7) participatory approach, (8) convening influence. We developed a self-assessment instrument around these attributes that HPSRIs could use to inform their respective organizational development and collectively discuss their shared challenges. In addition to developing the framework, the workshop also analysed the positionality of HPSRIs and their interactions with other institutional actors in the HPSR ecosystem, and recommends the importance of enhancing these interactions and assigning responsibility to a national/regional authority that will foster the community of HPSRIs. When tailored to their context, HPSRIs that function at the nexus of research, management, policy and networks help achieve the main purpose of HPSR, which is to 'achieve collective health goals and contribute to policy outcomes'.
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Affiliation(s)
- Harvy Joy Liwanag
- Institute of Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
- Alliance for Improving Health Outcomes, Quezon City 1104, Philippines
| | - Ferlie Rose Ann Famaloan
- Alliance for Improving Health Outcomes, Quezon City 1104, Philippines
- Health Promotion Program, University of the Philippines Manila - National Institutes of Health, Manila 1000, Philippines
| | - Katherine Ann Reyes
- Alliance for Improving Health Outcomes, Quezon City 1104, Philippines
- Health Promotion Program, University of the Philippines Manila - National Institutes of Health, Manila 1000, Philippines
- LEAD Fellowship Program, Harvard Global Health Institute, Cambridge, MA 02138, United States
| | - Reiner Lorenzo Tamayo
- Alliance for Improving Health Outcomes, Quezon City 1104, Philippines
- Health Promotion Program, University of the Philippines Manila - National Institutes of Health, Manila 1000, Philippines
| | - Lynn Daryl Villamater
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia
- Health Research Division, Health Policy Development and Planning Bureau, Department of Health of the Philippines, Manila 1003, Philippines
| | - Renee Lynn Cabañero-Gasgonia
- Health Research Division, Health Policy Development and Planning Bureau, Department of Health of the Philippines, Manila 1003, Philippines
| | - Annika Frahsa
- Institute of Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
| | - Pio Justin Asuncion
- Health Research Division, Health Policy Development and Planning Bureau, Department of Health of the Philippines, Manila 1003, Philippines
- Institute of Health Sciences and Nursing, Far Eastern University, Manila 1008, Philippines
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Whidden C, Cissé AB, Cole F, Doumbia S, Guindo A, Karambé Y, Treleaven E, Liu J, Tolo O, Guindo L, Togola B, Chiu C, Tembely A, Keita Y, Greenwood B, Chandramohan D, Johnson A, Kayentao K, Webster J. Community case management to accelerate access to healthcare in Mali: a realist process evaluation nested within a cluster randomized trial. Health Policy Plan 2024; 39:864-877. [PMID: 39058651 PMCID: PMC11384120 DOI: 10.1093/heapol/czae066] [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: 05/07/2023] [Revised: 05/30/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024] Open
Abstract
The Proactive Community Case Management (ProCCM) trial in Mali reinforced the health system across both arms with user fee removal, professional community health workers (CHWs) and upgraded primary health centres (PHCs)-and randomized village-clusters to receive proactive home visits by CHWs (intervention) or fixed site-based services by passive CHWs (control). Across both arms, sick children's 24-hour treatment and pregnant women's four or more antenatal visits doubled, and under-5 mortality halved, over 3 years compared with baseline. In the intervention arm, proactive CHW home visits had modest effects on children's curative and women's antenatal care utilization, but no effect on under-5 mortality, compared with the control arm. We aimed to explain these results by examining implementation, mechanisms and context in both arms We conducted a process evaluation with a mixed method convergent design that included 79 in-depth interviews with providers and participants over two time-points, surveys with 195 providers and secondary analyses of clinical data. We embedded realist approaches in novel ways to test, refine and consolidate theories about how ProCCM worked, generating three context-intervention-actor-mechanism-outcome nodes that unfolded in a cascade. First, removing user fees and deploying professional CHWs in every cluster enabled participants to seek health sector care promptly and created a context of facilitated access. Second, health systems support to all CHWs and PHCs enabled equitable, respectful, quality healthcare, which motivated increased, rapid utilization. Third, proactive CHW home visits facilitated CHWs and participants to deliver and seek care, and build relationships, trust and expectations, but these mechanisms were also activated in both arms. Addressing multiple structural barriers to care, user fee removal, professional CHWs and upgraded clinics interacted with providers' and patients' agency to achieve rapid care and child survival in both arms. Proactive home visits expedited or compounded mechanisms that were activated and changed the context across arms.
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Affiliation(s)
- Caroline Whidden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
- Department of Research, Monitoring & Evaluation, Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | | | - Faith Cole
- Department of Anthropology, University of California, 375 Portola Plaza, Los Angeles, CA 90095, United States
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48103, United States
| | - Saibou Doumbia
- Department of Research, Monitoring & Evaluation, Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | - Abdoulaye Guindo
- Faculté des Sciences de l'Éducation et des Sciences Humaines, Université des Lettres et des Sciences Humaines de Bamako, Rue 627 Porte 83, Bamako BP E 2528, Mali
| | - Youssouf Karambé
- Institut National de la Jeunesse et des Sports, Bamako J35J+CJF, Mali
| | - Emily Treleaven
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48103, United States
| | - Jenny Liu
- Institute for Health & Aging, University of California, 490 Illinois Street, San Francisco, CA 94158, United States
| | - Oumar Tolo
- Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | - Lamine Guindo
- Department of Research, Monitoring & Evaluation, Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | - Bréhima Togola
- Department of Research, Monitoring & Evaluation, Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | - Calvin Chiu
- School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA 94704, United States
| | - Aly Tembely
- Ministère de la Santé et du Développement Social, Cité Administrative, Bamako JXGR+R48, Mali
| | - Youssouf Keita
- Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Daniel Chandramohan
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Ari Johnson
- Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
- Institute for Global Health Sciences, University of California, 550 16th Street, San Francisco, CA 94110, United States
| | - Kassoum Kayentao
- Department of Research, Monitoring & Evaluation, Muso, SEMA Route de 501 Logements, Bamako H3M8+VJC, Mali
- Malaria Research & Training Centre, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako PO Box 1805, Mali
| | - Jayne Webster
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
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Zotareli V, Bento S, Souza R, Cecatti JG. Thinking on the purposes, roles and activities of networks for research on maternal and perinatal health: opinions of coordinators and members. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo75. [PMID: 39380587 PMCID: PMC11460412 DOI: 10.61622/rbgo/2024rbgo75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 06/07/2024] [Indexed: 10/10/2024] Open
Abstract
Objective To identify the opinion of coordinators and members about the essential characteristics and to understand the research networks characteristics, to facilitate their implementation, sustainability and effectiveness so it can be replicated in low and middle-income countries. Methods A qualitative study using a semi-structured interview technique was conducted. We selected potential members, managers and participants of networks from publications identified in PubMed. After checking the FIGO congress program, we identified authors who were assigned as speakers at the event. An invitation was sent and interviews were scheduled. Results In total, eleven interviews were performed. Coordinators and members of networks have the same goal when they decide to participate in a network. In general, they cited that these individuals had to be committed, responsible and enthusiastic people. The network should be composed also of postgraduate students. A network should allow multi-leadership, co-responsibility, autonomy and empowerment of its members. Effective communication was mentioned as an important pillar for network maintenance. Another motivation is being an author or coauthor in publications. One way to maintain a network running is social or governmental commitment, after resources expire, studies continue. Conclusion Networks are different due to the social context where they are inserted, however, some characteristics are common to all of them, such as having engaged leaders. For an effective and sustainable network, commitment and motivation in a leader and members are more in need than financial resources. Ideally, to ensure the operation of the network, the institution where the leader is linked should support this network.
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Affiliation(s)
- Vilma Zotareli
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - Silvana Bento
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - Renato Souza
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
| | - José Guilherme Cecatti
- Department of Obstetrics and GynecologyUniversidade Estadual de CampinasCampinasSPBrazilDepartment of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil.
- Center for Research in Reproductive HealthCampinasSPBrazilCenter for Research in Reproductive Health, Campinas, SP, Brazil.
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Michael N, Moore G, Appleton J, Kissane D. Implementation of the psycho-existential symptom assessment scale in palliative care: Qualitative analysis of stakeholders perspectives. PATIENT EDUCATION AND COUNSELING 2024; 130:108419. [PMID: 39260291 DOI: 10.1016/j.pec.2024.108419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/11/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES To explore 1) perspectives of feasibility, acceptability, integration and sustainability of the Psycho-existential Symptom Assessment Scale (PeSAS); 2) barriers and benefits of PeSAS in its real-world performance; and 3) clinician confidence and perceived competency in using PeSAS. METHODS Thirty-one key stakeholders from nine palliative care services who participated in the implementation of the PeSAS were purposefully sampled and participated in semi-structured interviews. Data was managed using the Determinants Framework. RESULTS Benefits of PeSAS were a common language enhancing communication, identifying symptoms of psycho-existential distress, initiating referral, providing acknowledgement for previously unrecognised distress and enhancing patient agency. Key barriers were the availability of skilled clinicians, patient characteristics such as delirium and phase of illness, avoidance of confronting end-of-life conversations, information technology resourcing, and reduced engagement due to language, culture and health literacy. CONCLUSION Screening using the PeSAS is feasible and acceptable once clinicians are adequately trained to administer it. Our study highlights the benefits of qualitative enquiry in developing and implementing new interventions. PRACTICE IMPLICATIONS The identification and management of psycho-existential symptoms should be part of routine practice in palliative care. However, adequate staff training, resourcing, referral pathways and implementation process and outcome assessments are important to ensure sustainability.
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Affiliation(s)
- Natasha Michael
- University of Notre Dame, Sydney, NSW, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Gaye Moore
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - David Kissane
- University of Notre Dame, Sydney, NSW, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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Harden SM, Brow K, Zoellner J, Armbruster SD. Identification of weight loss interventions for translation among endometrial cancer survivors: A RE-AIM analysis. Transl Behav Med 2024; 14:527-536. [PMID: 38907663 PMCID: PMC11370635 DOI: 10.1093/tbm/ibae030] [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: 06/24/2024] Open
Abstract
Interventions for obesity-related cancers that combine nutrition and physical activity for weight loss exist; however, their application to survivors of endometrial cancer is unknown. Furthermore, little is known about pre-implementation perceptions of existing programs from a variety of interested persons (physicians, researchers) who may be part of the implementation team. Adapting an existing intervention rather than developing a new intervention may speed the translational lag time as long as intervention characteristics and fit within the delivery system are considered during the planning phase. To describe the process of determining the core elements of obesity-related interventions for cancer survivors and determine which one might be best delivered by an urban healthcare system that predominantly serves individuals who live in rural areas of Virginia and West Virginia. A pragmatic review of the literature was conducted via PubMed and Google Scholar with broad search terms of cancer survivor AND weight loss AND health intervention. Identified interventions were scored related to the Practical, Robust Implementation and Sustainability Model-which is an extension of RE-AIM framework to guide the understanding of who, what, where, when, and how the intervention was conducted. Intervention characteristics are reported. In addition, ratings from three independent reviewers on the validated 5-point Likert scale of an intervention's acceptability, appropriateness, and feasibility in the intended delivery system were collected and summarized. Twelve interventions were identified with an average sample size of 241(±195) and a range of 48-683 participants. Target populations included survivors of colorectal, breast, and endometrial cancers as well as general cancer survivors and included both men and women or only women. Most participants (74%) identified as white/Caucasian and average age ranged from 47.1 to 65.9 years. Program duration ranged from 4 weeks to 18 months, with an average duration of 32 weeks. Intervention dosage ranged from three times a week to once a month. Intervention acceptability, appropriateness, and feasibility had average and standard deviation ratings of 3.52(±0.46), 3.41(±0.45), and 3.21(±0.46), respectively, out of 5. The four interventions with the highest combined acceptable, appropriate, and feasible scores are being considered for potential use as an obesity-related intervention for survivors of endometrial cancer. Future work is needed to determine relevant adaptations and efficacy among survivors of endometrial cancer with obesity. Our approach may be beneficial for other interventionists aiming to speed intervention development and implementation.
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Affiliation(s)
- Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Katie Brow
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Jamie Zoellner
- Public Health Sciences, University of Virginia, Christiansburg, VA, USA
| | - Shannon D Armbruster
- Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
- Obstetrics and Gynecology, Carilion Clinic, Roanoke, VA, USA
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Mogk J, Idu AE, Bobb JF, Key D, Wong ES, Palazzo L, Stefanik-Guizlo K, King D, Beatty T, Dorsey CN, Caldeiro RM, Garza McWethy A, Glass JE. Prescription Digital Therapeutics for Substance Use Disorder in Primary Care: Mixed Methods Evaluation of a Pilot Implementation Study. JMIR Form Res 2024; 8:e59088. [PMID: 39222348 PMCID: PMC11406110 DOI: 10.2196/59088] [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: 04/03/2024] [Revised: 05/21/2024] [Accepted: 06/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Delivering prescription digital therapeutics (ie, evidence-based interventions designed to treat, manage, or prevent disorders via websites or smartphone apps) in primary care could increase patient access to substance use disorder (SUD) treatments. However, the optimal approach to implementing prescription digital therapeutics in primary care remains unknown. OBJECTIVE This pilot study is a precursor to a larger trial designed to test whether implementation strategies (practice facilitation [PF] and health coaching [HC]) improve the delivery of prescription digital therapeutics for SUDs in primary care. This mixed methods study describes outcomes among patients in the 2 pilot clinics and presents qualitative findings on implementation. METHODS From February 10 to August 6, 2021, a total of 3 mental health specialists embedded in 2 primary care practices of the same integrated health system were tasked with offering app-based prescription digital therapeutics to patients with SUD. In the first half of the pilot, implementation activities included training and supportive tools. PF (at 1 clinic) and HC (at 2 clinics) were added in the second half. All study analyses relied on secondary data, including electronic health records and digital therapeutic vendor data. Primary outcomes were the proportion of patients reached by the prescription digital therapeutics and fidelity related to ideal use. We used qualitative methods to assess the adherence to planned activities and the barriers and facilitators to implementing prescription digital therapeutics. RESULTS Of all 18 patients prescribed the apps, 10 (56%) downloaded the app and activated their prescription, and 8 (44%) completed at least 1 module of content. Patients who activated the app completed 1 module per week on average. Ideal use (fidelity) was defined as completing 4 modules per week and having a monthly SUD-related visit; 1 (6%) patient met these criteria for 10 weeks (of the 12-week prescription period). A total of 5 (28%) patients had prescriptions while HC was available, 2 (11%) were successfully contacted, and both declined coaching. Clinicians reported competing clinical priorities, technical challenges, and logistically complex workflows in part because the apps required a prescription. Some pilot activities were impacted by staff turnover that coincided with the COVID-19 pandemic. The facilitators to implementation were high engagement and the perception that the apps could meet patient needs. CONCLUSIONS The pilot study encountered the barriers to implementing prescription digital therapeutics in a real-world primary care setting, especially staffing shortages, turnover, and competing priorities for clinic teams. The larger randomized trial will clarify the extent to which PF and HC improve the implementation of digital therapeutics. TRIAL REGISTRATION ClinicalTrials.gov NCT04907045; https://clinicaltrials.gov/study/NCT04907045.
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Affiliation(s)
- Jessica Mogk
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Abisola E Idu
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jennifer F Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Dustin Key
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Edwin S Wong
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | - Lorella Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Deborah King
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Tara Beatty
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Ryan M Caldeiro
- Mental Health and Wellness Services, Kaiser Permanente Washington, Renton, WA, United States
| | | | - Joseph E Glass
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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Lawrason SVC, DaSilva P, Michalovic E, Latimer-Cheung A, Tomasone JR, Sweet S, Forneris T, Leo J, Greenwood M, Giles J, Arkell J, Patatas J, Boyle N, Adams N, Martin Ginis KA. Using mixed methods and partnership to develop a program evaluation toolkit for organizations that provide physical activity programs for persons with disabilities. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:91. [PMID: 39223687 PMCID: PMC11367884 DOI: 10.1186/s40900-024-00618-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The purpose of this paper is to report on the process for developing an online RE-AIM evaluation toolkit in partnership with organizations that provide physical activity programming for persons with disabilities. METHODS A community-university partnership was established and guided by an integrated knowledge translation approach. The four-step development process included: (1) identify, review, and select knowledge (literature review and two rounds of Delphi consensus-building), (2) adapt knowledge to local context (rating feasibility of outcomes and integration into online platform), (3) assess barriers and facilitators (think-aloud interviews), and (4) select, tailor, implement (collaborative dissemination plan). RESULTS Step 1: Fifteen RE-AIM papers relevant to community programming were identified during the literature review. Two rounds of Delphi refined indicators for the toolkit related to reach, effectiveness, adoption, implementation, and maintenance. Step 2: At least one measure was linked with each indicator. Ten research and community partners participated in assessing the feasibility of measures, resulting in a total of 85 measures. Step 3: Interviews resulted in several recommendations for the online platform and toolkit. Step 4: Project partners developed a dissemination plan, including an information package, webinars, and publications. DISCUSSION This project demonstrates that community and university partners can collaborate to develop a useful, evidence-informed evaluation resource for both audiences. We identified several strategies for partnership when creating a toolkit, including using a set of expectations, engaging research users from the outset, using consensus methods, recruiting users through networks, and mentorship of trainees. The toolkit can be found at et.cdpp.ca. Next steps include disseminating (e.g., through webinars, conferences) and evaluating the toolkit to improve its use for diverse contexts (e.g., universal PA programming).
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Affiliation(s)
- Sarah V C Lawrason
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada.
| | | | | | - Amy Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
- Revved Up, Kingston, ON, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
- Revved Up, Kingston, ON, Canada
| | - Shane Sweet
- Department of Kinesiology and Physical Education, McGill University, Montreal, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Tanya Forneris
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Jennifer Leo
- The Steadward Centre for Personal and Physical Achievement, University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | - Nick Boyle
- Rocky Mountain Adaptive, Canmore, AB, Canada
| | - Nathan Adams
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Scheffler A, Klocker L, Puls A, Hummers E, Demmer I. [Facilitators and barriers to the implementation of health promotion in daycare centers and elementary schools based on four selected projects]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:1021-1030. [PMID: 39164394 DOI: 10.1007/s00103-024-03935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/11/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Health promotion (HP) is a complex, politically required task. The quality of implementation correlates with the effectiveness of health promotion initiatives. Successful implementation requires consideration of contextual conditions, which tend to be neglected in effectiveness studies. The aim is to identify success factors and obstacles to the implementation of HP in daycare centers and elementary schools based on 4 projects (Fit fürs Leben, fit für pisa +, Buchprojekt Sonnige Traurigtage, and The Daily Mile) in the Göttingen/South Lower Saxony region. The effects of the COVID-19 pandemic are assumed to be relevant for the implementation of these projects. METHODS In 24 semi-structured interviews and 2 focus group discussions between August 2021 and March 2022, practitioners were asked about the implementation of the four projects in their areas of activity. After transcription, the interviews were analyzed using qualitative content analysis. The Consolidated Framework for Implementation Research supported the analysis. RESULTS A total of 22 groups of factors were identified, on the basis of which 22 recommendations for action for GF implementation were formulated. Success factors at the individual and intervention level were at the forefront. The COVID-19 pandemic had a positive impact on the importance of HP, even though its feasibility was hampered. DISCUSSION Numerous findings on the implementation of HP in children's living environments were confirmed by the study. The high significance of the individual factors is striking, which could be due to the survey of interviewees being familiar with the projects. The study results contribute to the further development of implementation strategies in HP.
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Affiliation(s)
- Anna Scheffler
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Laura Klocker
- Gesundheitsregion Göttingen/Südniedersachsen, Göttingen, Deutschland
| | - Angelika Puls
- Gesundheitsamt für Stadt und Landkreis Göttingen, Göttingen, Deutschland
| | - Eva Hummers
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Iris Demmer
- Institut für Allgemeinmedizin, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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Coe JL, Morgan MH, Rehberg K, Kranzler EC, Ingersoll R, Namrow N, Huber-Krum S. Evaluating the implementation of family-centered substance use treatment for pregnant and postpartum people: A mixed-methods study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209409. [PMID: 38768816 PMCID: PMC11300141 DOI: 10.1016/j.josat.2024.209409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Family-centered substance use treatment (FCSUT) approaches for pregnant and postpartum people have the potential to prevent intergenerational transmission of adverse childhood experiences (ACEs). Guided by two theoretical frameworks drawn from implementation science (the Consolidated Framework for Implementation Research [CFIR] and the Reach, Effectiveness, Adoption, Implementation and Maintenance [RE-AIM] framework), this study used a mixed methods approach to answer: (1) What is the extent to which FCSUT approaches are offered for pregnant and postpartum people seeking substance use disorder (SUD) treatment? and (2) How are FCSUT approaches for pregnant and postpartum people implemented? METHODS This study utilized a sequential mixed methods design that began with quantitative data collection followed by qualitative data collection. The quantitative component consisted of service provision surveys of facilities that provided FCSUT to pregnant and postpartum people (n = 118). The qualitative component consisted of semi-structured in-depth interviews with administrators and providers working at FCSUT facilities (n = 26) and pregnant and postpartum people who were currently receiving or had previously received services in the last two years from FCSUT facilities (n = 27). The qualitative findings were used to deepen understanding of the quantitative findings. RESULTS Findings from the quantitative survey of treatment facilities' FCSUT provision revealed that while most facilities offered services related to substance use treatment, behavioral health, and parenting skills development or parent training, a smaller proportion offered services related to prenatal and postpartum health, sexual and reproductive health, and family-related services. Qualitative in-depth interviews with program administrators and providers and pregnant and postpartum people who had participated in FCSUT programs revealed major themes around expanding reach of facilities by maintaining participants' familial connections, resources for implementation and maintenance of FCSUT, the importance of program adaptation, and gaps in service delivery. CONCLUSIONS Results indicated there is a wide range of FCSUT services offered at treatment facilities across the United States. Furthermore, while many pregnant and postpartum people expressed positive experiences with FCSUT, there are some areas that should be considered for future progress to be made.
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Affiliation(s)
- Jesse L Coe
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary Harbert Morgan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | - Sarah Huber-Krum
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Stout NL, Alfano CM, Liu R, Dixit N, Jefford M. Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. JCO Oncol Pract 2024; 20:1173-1181. [PMID: 38709984 DOI: 10.1200/op.23.00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 05/08/2024] Open
Abstract
Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.
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Affiliation(s)
- Nicole L Stout
- Department of Hematology Oncology, School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- Department of Health Policy, Management, and Leadership, School of Public Health, West Virginia University, Morgantown, WV
| | - Catherine M Alfano
- Northwell Health Cancer Institute, New Hyde Park, NY
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Raymond Liu
- Department of Hematology Oncology, The Permanente Medical Group, San Francisco, CA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Niharika Dixit
- Division of Hematology/Oncology, University of California, San Francisco, San Francisco, CA
- Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Michael Jefford
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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McBain K, Dinh C, Haffar M, Steinberg E, Cachecho S, Bussières A, Dahan-Oliel N. Perspectives from clinicians and managers: facilitators and barriers to the uptake of rehabilitation guidance for children with arthrogryposis. Disabil Rehabil 2024; 46:4140-4156. [PMID: 37782214 DOI: 10.1080/09638288.2023.2263361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To identify the perceived facilitators and barriers among clinicians and managers about the uptake of expert guidance for rehabilitation of children with arthrogryposis multiplex congenita (AMC) in practice. METHODS Qualitative study using individual interviews, guided by the Theoretical Domains Framework (TDF), to explore beliefs and to identify facilitators and barriers to guidance uptake. Interviews were conducted with a convenience sample of 15 clinicians working with children with AMC and four pediatric clinical managers using Microsoft Teams©. Interviews were then transcribed verbatim and analyzed by four independent reviewers using deductive and inductive coding. RESULTS The TDF domains of Environmental Context and Resources, Behavioural Regulation, Reinforcement, Beliefs about Consequences, and Social Influences were shared amongst clinicians and clinical managers across North America and Europe as being relevant and influential on the target behaviour of using rehabilitation expert guidance to manage pediatric patients. Among clinicians only, the domain Memory, Attention, and Decision-Making Processes was also found relevant. Among managers only, the domain Social/Professional Role and Identity was found relevant. CONCLUSIONS Coupling shared relevant domains amongst clinicians and managers with individual supports and barriers helps to map out what is needed to promote the uptake of rehabilitation guidance at multiple levels.
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Affiliation(s)
- Kimberly McBain
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cameron Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Melanie Haffar
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Emily Steinberg
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sarah Cachecho
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Noémi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
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Choi S, Shanahan E, Casey-Wilke B, An J, Johnson L. Implementation Drivers of Data-Based Instruction for Students With Intensive Learning Needs: A Systematic Review. JOURNAL OF LEARNING DISABILITIES 2024; 57:291-302. [PMID: 38158822 DOI: 10.1177/00222194231220070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Despite decades of research efforts, data-based instruction (DBI) for students with intensive intervention needs are not being widely used in practice as anticipated, and many educators have difficulties in implementing it. This systematic review aimed to examine what kinds of implementation drivers and strategies have been used to support educators implementing DBI and what kinds of implementation outcomes researchers have measured. Eighteen studies were synthesized using the Implementation Drivers framework and Implementation Outcomes taxonomy and were quality appraised. We found that the majority of studies primarily used competency drivers to increase teachers' DBI expertise, while a limited number of studies focused on organizational and leadership drivers. Acceptability and fidelity were frequently assessed as implementation outcomes. We discussed the implications of the findings, including the need for researchers to incorporate implementation drivers and outcomes at diverse levels to best support educators' implementation of DBI, as well as the limitations of this review, such as the limited generalizability of the findings.
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Affiliation(s)
- Seohyeon Choi
- University of Minnesota Twin Cities, Minneapolis, USA
| | | | | | - Jechun An
- University of Minnesota Twin Cities, Minneapolis, USA
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Peters-Corbett A, Parke S, Bear H, Clarke T. Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review. Child Adolesc Ment Health 2024; 29:242-265. [PMID: 37608642 DOI: 10.1111/camh.12672] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers. METHODS Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis. RESULTS We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP. CONCLUSIONS Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users. REGISTRATION This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).
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Affiliation(s)
| | - Sheryl Parke
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Holly Bear
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Timothy Clarke
- University of Cardiff, Cardiff, UK
- East of England NIHR Applied Research Collaborative, Norwich, UK
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Engdawork K, Tadele G, Anagnostopoulou V, Nahar P, Davey G, Zaman S. Improving health behaviours and attitudes around podoconiosis in Northern Western Ethiopia: Implementation and intervention effectiveness. PLoS Negl Trop Dis 2024; 18:e0012507. [PMID: 39283920 PMCID: PMC11426432 DOI: 10.1371/journal.pntd.0012507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 09/26/2024] [Accepted: 09/02/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Assessing how interventions are implemented is essential to understanding why interventions may or may not achieve their intended outcomes. There is little evidence about how interventions against Neglected Tropical Diseases (NTDs) are being implemented. Guided by the Context and Implementation of Complex Intervention (CICI) framework, we evaluated an ongoing intervention against the NTD podoconiosis to examine the implementation process and its effectiveness in terms of improving shoe wearing practices, increasing knowledge and reducing stigmatizing attitudes towards podoconiosis in rural Ethiopia. METHODS We employed an exploratory mixed methods approach, qualitative followed by quantitative, between April and July 2022 to assess implementation agents, theory, strategy, process and outcomes of the intervention. We conducted document analysis, observations, focus group discussions, in-depth interviews and key informant interviews for the qualitative phase. We administered a survey to 369 rural residents, of whom 42 were affected by podoconiosis. RESULTS The implementers utilized government healthcare centers in a bid to mainstream podoconiosis services within local healthcare structures. The implementers provided training for health professionals and the public and distributed supplies to patients over a three-month period. The intervention reached 62% of patients, but female patients were less likely to participate than male patients. Only 18% of community members had participated in health education campaigns linked to the intervention. Involvement in the intervention resulted in improved shoe wearing practice and holding fewer stigmatizing attitudes. However, internalized stigma among patients was still rife; and the plan to utilize community assets to extend the intervention activities was not effective. CONCLUSIONS Implementers must monitor the fidelity and progression of programs on a constant basis to make corrections. They also need to expand health education, provide psychosocial support and design economic empowerment programs for patients to reduce stigma. They must also collaborate with policy makers and international partners to sustain program activities at intervention delivery points.
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Affiliation(s)
- Kibur Engdawork
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Tadele
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Vasso Anagnostopoulou
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Papreen Nahar
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Gail Davey
- College of Social Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shahaduz Zaman
- Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, United Kingdom
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Harden SM, Chang K, Chen S. Integrating a Dissemination and Implementation Science Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework as a Cornerstone of a Masters in Dietetics Training Program. J Acad Nutr Diet 2024; 124:1099-1108. [PMID: 38750789 DOI: 10.1016/j.jand.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia.
| | - Kristen Chang
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia
| | - Susan Chen
- Department of Nutrition, Food Science, and Packaging, San José State University, San José, California
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Genné-Bacon E, Fux M, Bove SA, Payne F, Xenakis G, Coley JD, Bascom-Slack C. Dipping Your Toe in The CURE Pool: Longitudinal Tracking of Instructors Suggests Use of a Short-Duration CURE Can Catalyze Expansion to Longer CURE Experiences. CBE LIFE SCIENCES EDUCATION 2024; 23:ar31. [PMID: 38981006 PMCID: PMC11440735 DOI: 10.1187/cbe.23-05-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Course-based undergraduate research experiences (CUREs) are an effective method of engaging large numbers of students in authentic research but are associated with barriers to adoption. Short CURE modules may serve as a low-barrier entryway, but their effectiveness in promoting expansion has not been studied. The Prevalence of Antibiotic Resistance in the Environment (PARE) project is a modular CURE designed to be a low-barrier gateway into CURE use. In a series of interviews, we track and characterize use of PARE in 19 PARE-interested instructors throughout the Innovation-Decision Process described by Rogers' Diffusion of Innovations theory. The majority (16/19) implement PARE at least once, and a majority of these implementers (11/16) expanded use by the final interview. Three of four cases of discontinuance were due to a disruption such as moving institutions or a change in course assignment and occurred for community college faculty. Expanders expressed fewer personal challenges than nonexpanders. Overall analysis shows that perception of barriers is nuanced and impacted by the innovation itself, the institutional context, and one's own experiences. These results suggest that a short duration, low barrier CURE can serve as a catalyst for implementation of a longer duration CURE.
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Affiliation(s)
- Elizabeth Genné-Bacon
- Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111
| | - Michal Fux
- Department of Psychology, Northeastern University, Boston MA 02115
| | - Sara A Bove
- Department of Psychology, Northeastern University, Boston MA 02115
| | - Finn Payne
- Department of Psychology, Northeastern University, Boston MA 02115
| | - Georgia Xenakis
- Department of Psychology, Northeastern University, Boston MA 02115
| | - John D Coley
- Department of Psychology, Northeastern University, Boston MA 02115
- Department of Marine and Environmental Sciences, Northeastern University Marine Science Center, Nahant MA 01908
| | - Carol Bascom-Slack
- Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111
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Kennedy B, Curtis K, Kourouche S, Casey L, Hughes D, Chapman V, Fry M. Establishing enablers and barriers to implementing the HIRAID® emergency nursing framework in rural emergency departments. Australas Emerg Care 2024:S2588-994X(24)00052-6. [PMID: 39217022 DOI: 10.1016/j.auec.2024.08.002] [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: 02/05/2024] [Revised: 07/17/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Rural Australia has large geographic distances between emergency departments with variability of services and medical support. Emergency nurses must be appropriately skilled to assess and manage unpredictable and diverse presentations. HIRAID® is an evidence-based framework to support emergency nurses in assessment and care delivery. To inform implementation, the study aimed to identify the enablers and barriers to introducing HIRAID® in practice. METHODS This embedded mixed methods study was conducted in 11 rural, regional emergency departments in Southern New South Wales, Australia. Respondents completed a 22-item survey, indicating their level of agreement on statements related to practice change, free text responses were optional. Quantitative data were analysed using descriptive statistics and qualitative data using content analysis. Results were identified as barriers or enablers, then integrated and mapped to the Theoretical Domains Framework. RESULTS The survey was completed by 102 (54 %) nurses. Two enablers and four barriers to implementation were identified and mapped to 10 Theoretical Domains Framework domains. Key barriers were workplace limitations, such as time and resources, and knowledge of the HIRAID® intervention. CONCLUSION Barriers varied between facilities related to adequate support to implement and the impact on patient care. The results will inform a strategy to implement HIRAID®.
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Affiliation(s)
- Belinda Kennedy
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia.
| | - Kate Curtis
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia; Illawarra Shoalhaven Local Health District, New South Wales, Wollongong Hospital, Crown St, Wollongong, NSW, Australia
| | - Sarah Kourouche
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia
| | - Louise Casey
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Dorothy Hughes
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Vivienne Chapman
- Southern New South Wales Local Health District, Collett St, Queanbeyan, NSW, Australia
| | - Margaret Fry
- The University of Sydney, Camperdown, NSW Australia. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Australia; University of Technology Sydney, 15 Broadway, Ultimo, NSW, Australia; Northern Sydney Local Health District, Reserve Rd, St Leonards, NSW, Australia
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Schutte M, van Mansfeld R, de Vries R, Dekker M. Determinants of compliance with infection prevention measures by physicians: a scoping review. J Hosp Infect 2024; 153:30-38. [PMID: 39214255 DOI: 10.1016/j.jhin.2024.08.011] [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: 05/31/2024] [Revised: 08/05/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking. The aim of this review was to identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models, and frameworks from implementation science have been used in these studies. A literature search was performed in PubMed, Embase, APA PsycInfo and Web of Science up to June 2nd, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF). Fifty-six articles were included. The TDF domains 'environmental context and resources', 'social influences', 'beliefs about consequences', 'memory, attention and decision-making', 'knowledge', and 'skills' were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education, and a champion. Theories, models, and frameworks have rarely been used to guide implementation strategy development. In conclusion, it was found that intervention studies rarely specify the determinants that they aim to address and they lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.
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Affiliation(s)
- M Schutte
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - R van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - M Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Schwarz A, Verkooijen K, de Vet E, Simons M. Perceived Barriers and Facilitators Regarding the Implementation of Gamification to Promote Physical Activity in the Neighborhood: Interview Study Among Intermediaries. JMIR Serious Games 2024; 12:e52991. [PMID: 39196618 PMCID: PMC11391157 DOI: 10.2196/52991] [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: 09/21/2023] [Revised: 05/29/2024] [Accepted: 07/03/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND In the Netherlands, neighborhood sport coaches (NSCs) play an important role as intermediaries in promoting physical activity (PA) in the neighborhood. Gamification is the use of game elements in nongame contexts; it can be implemented with or without technology and holds promise for promoting PA. NSCs infrequently make use of this option. OBJECTIVE This study aims to understand barriers to, and facilitators of, using gamification to promote PA, as perceived by NSCs. METHODS A total of 25 semistructured interviews were conducted with NSCs in the Netherlands. The interviews were audiotaped, transcribed, and analyzed by means of thematic analysis using ATLAS.ti (version 22; ATLAS.ti Scientific Software Development GmbH) software. The deductive coding was informed by the capability, opportunity, motivation, behavior model and the theoretical domains framework, complemented by inductive coding. RESULTS Barriers and facilitators identified as factors influencing the implementation of gamification were related to 7 themes. NSCs required technical, creative, and promotion skills; knowledge about existing gamification tools; and social support from their employer and professional network. Financial costs were identified as a barrier to the successful implementation of gamification. Lack of clarity regarding stakeholders' responsibility to implement gamification could further hamper implementation. In general, NSCs were positive about investing time in implementing gamification and expected positive effects from implementing it. CONCLUSIONS To overcome identified barriers, a clear overview of tools, best practices, and available subsidies must be created, a gamification network must be established, the responsibility of NSCs must be clarified, and guidance must be offered on the promotion of gamification.
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Affiliation(s)
- Ayla Schwarz
- Wageningen University & Research, Wageningen, Netherlands
| | | | - Emely de Vet
- Wageningen University & Research, Wageningen, Netherlands
- Tilburg School of Humanities and Digital Sciences, University College Tilburg, Tilburg, Netherlands
| | - Monique Simons
- Wageningen University & Research, Wageningen, Netherlands
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Amuasi J, Agbogbatey MK, Sarfo F, Beyuo A, Agasiya P, Adobasom-Anane A, Newton S, Ovbiagele B. Protocol for a mixed-methods study to explore implementation outcomes of the Phone-based Interventions under Nurse Guidance after Stroke (PINGS-II) across 10 hospitals in Ghana. BMJ Open 2024; 14:e084584. [PMID: 39209507 PMCID: PMC11367291 DOI: 10.1136/bmjopen-2024-084584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Stroke survivors are at a substantially higher risk for adverse vascular events driven partly by poorly controlled vascular risk factors. Mobile health interventions supported by task shifting strategies have been feasible to test in small pilot trials in low-income settings to promote vascular risk reduction after stroke. However, real-world success and timely implementation of such interventions remain challenging, necessitating research to bridge the know-do gap and expedite improvements in stroke management. The Phone-based Interventions under Nurse Guidance after Stroke (PINGS-II) is a nurse-led mHealth intervention for blood pressure control among stroke survivors, currently being assessed for efficacy in a hybrid clinical trial across 10 hospitals in Ghana compared with usual care. This protocol aims to assess implementation outcomes such as feasibility, appropriateness, acceptability, fidelity, cost and implementation facilitators and barriers of the PINGS-II intervention. METHODS AND ANALYSIS This study uses descriptive mixed methods. Qualitative data to be collected include in-depth interviews and FGDs with patients who had a stroke on the PINGS-II intervention, as well as key informant interviews with medical doctors and health policy actors (implementation context, barriers and facilitators). Data will be analysed by thematic analysis. Quantitative data sources include structured questionnaires for clinicians (feasibility, acceptability and appropriateness), and patients who had a stroke (fidelity and costs). Analysis will include summary statistics like means, medians, proportions and exploratory tests of association including χ2 analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the Committee for Human Research Publication and Ethics at the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. Voluntary written informed consent will be obtained from all participants. All the rights of the participants and ethical principles guiding scientific research shall be adhered to. Findings from the study will be presented in scientific conferences and published in a peer-reviewed scientific journal. A dissemination meeting will be held with relevant agencies of the Ghana Ministry of Health, clinicians, patient group representatives, and non-governmental organisations.
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Affiliation(s)
- John Amuasi
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Department of Implementation Research, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | | | - Fred Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alexis Beyuo
- Department of Development Studies, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Patrick Agasiya
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - Sylvester Newton
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA
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Dark FL, Amado I, Erlich MD, Ikezawa S. International Experience of Implementing Cognitive Remediation for People With Psychotic Disorders. Schizophr Bull 2024; 50:1017-1027. [PMID: 38758086 PMCID: PMC11349011 DOI: 10.1093/schbul/sbae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
BACKGROUND Cognitive remediation (CR) is an effective therapy for the cognitive impact of mental illness, especially schizophrenia. Global efforts are being made to implement CR into routine mental health services with the aim of improving functional outcomes for the population of people recovering from mental illness. Implementation and dissemination of CR in heterogeneous settings require knowledge gleaned from formal implementation research and pragmatic experiential learning. This article describes cross-cultural approaches to CR implementation, focusing on initiatives in France, the United States, Australia, and Japan. METHOD Key leaders in the implementation of CR in France, the United States, Australia, and Japan were asked to describe the implementation and dissemination process in their settings with respect to the categories of context, implementation, outcomes, facilitators, and barriers. RESULTS All 4 sites noted the role of collaboration to leverage the implementation of CR into mental health rehabilitation services. In France, high-level, government organizational backing enhanced the dissemination of CR. Academic and clinical service partnerships in the United States facilitated the dissemination of programs. The advocacy from service users, families, and carers can aid implementation. The support from international experts in the field can assist in initiating programs but maintenance and dissemination require ongoing training and supervision of staff. CONCLUSIONS CR is an effective intervention for the cognitive impact of schizophrenia. Programs can be implemented in diverse settings globally. Adaptations of CR centering upon the core components of effective CR therapy enhance outcomes and enable programs to integrate into diverse settings.
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Affiliation(s)
- Frances L Dark
- The University of Queensland Medical School, Brisbane, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Isabelle Amado
- Ressource Centre in Ile de France for Cognitive Remediation and Psychosocial Rehabilitation (C3RP), GHU Paris Psychiatry Neurosciences, Paris, France
- Department for Cognitive Remediation and Rehabilitation, Paris Cité University
| | - Matthew D Erlich
- New York State Office of Mental Health, New York, NY, USA
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Satoru Ikezawa
- Department of Psychiatry, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
- Department of Psychiatry, National Centre of Neurology and Psychiatry, Tokyo, Japan
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Verdonschot A, Beauchamp MR, Brusseau TA, Chinapaw MJM, Christiansen LB, Daly-Smith A, Eather N, Fairclough SJ, Faulkner G, Foweather L, García-Hermoso A, Ha AS, Harris N, Jaakkola T, Jago R, Kennedy SG, Lander NJ, Lonsdale C, Manios Y, Mazzoli E, Murtagh E, Nathan N, Naylor PJ, Noetel M, O'Keeffe B, Resaland GK, Ridgers ND, Ridley K, Riley N, Rosenkranz RR, Rosenkranz SK, Sääkslahti A, Sczygiol SM, Skovgaard T, van Sluijs EMF, Smith JJ, Smith M, Stratton G, Vidal-Conti J, Webster CA, Young ES, Lubans DR. Development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS). Int J Behav Nutr Phys Act 2024; 21:93. [PMID: 39187858 PMCID: PMC11346190 DOI: 10.1186/s12966-024-01640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Teachers are recognized as 'key agents' for the delivery of physical activity programs and policies in schools. The aim of our study was to develop and evaluate a tool to assess teachers' capability, opportunity, and motivation to deliver school-based physical activity interventions. METHODS The development and evaluation of the Capability, Opportunity, and Motivation to deliver Physical Activity in School Scale (COM-PASS) involved three phases. In Phase 1, we invited academic experts to participate in a Delphi study to rate, provide recommendations, and achieve consensus on questionnaire items that were based on the Capability, Opportunity, and Motivation Behavior (COM-B) model. Each item was ranked on the degree to which it matched the content of the COM-B model, using a 5-point scale ranging from '1 = Poor match' to '5 = Excellent match'. In Phase 2, we interviewed primary and secondary school teachers using a 'think-aloud' approach to assess their understanding of the items. In Phase 3, teachers (n = 196) completed the COM-PASS to assess structural validity using confirmatory factor analysis (CFA). RESULTS Thirty-eight academic experts from 14 countries completed three rounds of the Delphi study. In the first round, items had an average rating score of 4.04, in the second round 4.51, and in the third (final) round 4.78. The final tool included 14 items, which related to the six constructs of the COM-B model: physical capability, psychological capability, physical opportunity, social opportunity, reflective motivation, and automatic motivation. In Phase 2, ten teachers shared their interpretation of COM-PASS via a 20-min interview, which resulted in minor changes. In Phase 3, CFA of the 3-factor model (i.e., capability, opportunity, and motivation) revealed an adequate fit to the data (χ2 = 122.6, p < .001, CFI = .945, TLI = .924, RMSEA = .066). The internal consistencies of the three subscale scores were acceptable (i.e., capability: α = .75, opportunity: α = .75, motivation: α = .81). CONCLUSION COM-PASS is a valid and reliable tool for assessing teachers' capability, opportunity, and motivation to deliver physical activity interventions in schools. Further studies examining additional psychometric properties of the COM-PASS are warranted.
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Affiliation(s)
- A Verdonschot
- Centre for Active Living and Learning, School of Education, University of Newcastle, Newcastle, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - M R Beauchamp
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - T A Brusseau
- Department of Health and Kinesiology, University of Utah, Salt Lake City, USA
| | - M J M Chinapaw
- Department of Public and Occupational Health, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - L B Christiansen
- Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - A Daly-Smith
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - N Eather
- Centre for Active Living and Learning, School of Education, University of Newcastle, Newcastle, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - S J Fairclough
- Sport, Physical Activity, Health, & Wellbeing Research Group, and Department of Sport & Physical Activity, Edge Hill University, Ormskirk, UK
| | - G Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - L Foweather
- Physical Activity Exchange, Research Institute of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - A García-Hermoso
- Navarrabiomed, Hospital Universitario de Navarra, Universidad Pública de Navarra, IdiSNA, Pamplona, Navarra, Spain
| | - A S Ha
- Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - N Harris
- Human Potential Centre, Auckland University of Technology, Auckland, New Zealand
| | - T Jaakkola
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - S G Kennedy
- School of Health Sciences, Western Sydney University, Kingswood, New South Wales, Australia
| | - N J Lander
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - C Lonsdale
- Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Y Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
- Institute of Agri-Food and Life Sciences, University Research & Innovation Center, H.M.U.R.I.C., Hellenic Mediterranean University, Crete, Greece
| | - E Mazzoli
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Geelong, Victoria, Australia
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - E Murtagh
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - N Nathan
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- College of Health, Medicine and Wellbeing, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - P J Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - M Noetel
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - B O'Keeffe
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - G K Resaland
- Centre for Physically Active Learning, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
| | - N D Ridgers
- Alliance for Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - K Ridley
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - N Riley
- Centre for Active Living and Learning, School of Education, University of Newcastle, Newcastle, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - R R Rosenkranz
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - S K Rosenkranz
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - A Sääkslahti
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - S M Sczygiol
- Department of Neuromotor Behaviour and Exercise, University of Münster, Münster, Germany
| | - T Skovgaard
- Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | | | - J J Smith
- Centre for Active Living and Learning, School of Education, University of Newcastle, Newcastle, Australia
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - M Smith
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - G Stratton
- Applied Sport Technology Exercise and Medicine Research Centre, Faculty Science and Engineering, Swansea University, Wales, UK
- Sport and Exercise Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - J Vidal-Conti
- Physical Activity and Sport Sciences Research Group (GICAFE), University of the Balearic Islands, Palma, Spain
| | - C A Webster
- Department of Kinesiology, Texas A and M University - Corpus Christi, Corpus Christi, Texas, USA
| | - E S Young
- Faculty of Health Studies, University of Bradford, Bradford, UK
- Centre for Applied Education Research, Wolfson Centre for Applied Health Research, Bradford, UK
| | - D R Lubans
- Centre for Active Living and Learning, School of Education, University of Newcastle, Newcastle, Australia.
- Active Living Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Ducharme LJ, Wiley TRA, Zur JB, Vizcaino-Riveros JA, Martin L. A review of implementation research funded by the National Institute on Drug Abuse, 2007-2023: Progress and opportunities. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 167:209489. [PMID: 39182619 DOI: 10.1016/j.josat.2024.209489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/16/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND The ongoing and evolving overdose epidemic highlights the need to translate research results into routine clinical practice to address urgent service delivery needs. Implementation science is a relatively new discipline intended to develop systematic, replicable, scalable strategies to accelerate this translation. This article presents a comprehensive review of implementation research funded by the National Institute on Drug Abuse (NIDA). METHODS The study identified all NIDA-funded research grants awarded in fiscal years 2007 through 2023 in treatment services or prevention research (n = 1111) and screened them to find those with a pre-specified implementation science component (n = 248). Using the text of the grant application, two reviewers independently coded the key characteristics of each study. RESULTS The characteristics of these grants, and trends over time, are described, and priority gap areas are identified. NIDA's implementation research grants have demonstrated increasing rigor in design and measurement. CONCLUSIONS Growth in the portfolio has been driven in part by NIDA's investments in research-practice partnerships in the criminal-legal system, and by recent efforts to address the overdose epidemic.
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Affiliation(s)
- Lori J Ducharme
- National Institute on Drug Abuse, 11601 Landsdown Street, Rockville, MD 20852, USA.
| | - Tisha R A Wiley
- National Institute on Drug Abuse, 11601 Landsdown Street, Rockville, MD 20852, USA
| | - Julia B Zur
- National Institute on Drug Abuse, 11601 Landsdown Street, Rockville, MD 20852, USA
| | | | - Lindsey Martin
- National Institute on Drug Abuse, 11601 Landsdown Street, Rockville, MD 20852, USA
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Slep AMS, Rhoades KA, Heyman RE. Unlocking What Makes Military Behavioral Health Interventions Work, Stumble, or Fade Away. Mil Med 2024; 189:47-54. [PMID: 39160806 DOI: 10.1093/milmed/usae038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/05/2024] [Accepted: 02/20/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION The Office of the Secretary of Defense and each of the services have made an unprecedented commitment to the prevention of sexual assault and related behavioral health phenomena. Indeed, the Department of Air Force has selected, in some cases tailored, and disseminated a wide array of evidence-based preventative programs, policies, and practices (EBPs) over the last few decades. However, many of these efforts seem to follow a predictable life course. EBPs are initially implemented with great enthusiasm, supported for a few years, then fall out of favor, and are replaced by a different effort. This research effort aims to build on the existing civilian implementation science research to (1) offer a military-specific model of sustained, high-quality implementation and (2) test this model in a series of interconnected studies. MATERIALS AND METHODS New York University's Institutional Review Board approved the study protocols, and the Army's Human Research Protection Office provided permission to collect data. We conducted interviews first with prevention leaders in the services and at the Office of the Secretary of Defense level regarding factors that they thought helped or hurt the sustainment of EBPs. We used these interviews to identify EBPs currently implemented in Department of Air Force and selected four EBPs out of the 25 identified for intensive study. We then interviewed implementers of those four EBPs regarding what they thought helped or hurt the sustainment of that EBP. We also gathered information about the 25 currently implemented EBPs themselves and gathered policy and guidance, as well as leadership communication about those EBPs and the target problems they focus on. We coded this information to allow us to test EBP parameters and policy and leader communication that predict sustained high-quality implementation. We conducted over 100 observations of the 4 EBPs we are studying intensively and have collected quantitative data from implementers and participants to help us test factors related to sustained high-quality implementation within each of those 4 EBPs and across the EBPs. RESULTS Several military-specific factors were nominated for inclusion in the military-specific model of implementation sustainment. The implementation of even highly standardized EBPs varies greatly. Implementers and participants are generally highly engaged, but implementers vary in the extent to which they understand the mechanisms of action for the EBP they are implementing. CONCLUSIONS We recommend training implementers in the mechanisms of action in the EBPs they are expected to implement and including quality assurance as a component of prevention efforts in a manner more similar to how the military addresses aspects of the operational mission. By moving beyond counting classes and attendance, and specifying how to engage participants in the EBPs in the manner that produces the key outcomes, it is likely that EBPs will have more robust implementations that can be better sustained over time.
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Affiliation(s)
- Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Kimberly A Rhoades
- Family Translational Research Group, New York University, New York, NY 10010, USA
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, NY 10010, USA
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Tian C, Liu Y, Hou L, Jiang J, Li Y, Liu J, Ye Z, Cheng Q, Ma Y, Ning J, Huang J, Wang Y, Wang Y, Tong B, Lu J, Ge L. Knowledge mapping of barriers and strategies for clinical practice guideline implementation: a bibliometric analysis. JBI Evid Implement 2024:02205615-990000000-00122. [PMID: 39149772 DOI: 10.1097/xeb.0000000000000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
OBJECTIVE This study provides a comprehensive overview of the knowledge structure and research hotspots regarding barriers and strategies for the implementation of clinical practice guidelines. METHODS Publications on barriers and strategies for guideline implementation were searched for on Web of Science Core Collection from database inception to October 24, 2022. R package bibliometrix, VOSviewer, and CiteSpace were used to conduct the analysis. RESULTS The search yielded 21,768 records from 3,975 journals by 99,998 authors from 3,964 institutions in 186 countries between 1983 and 2022. The number of published papers had a roughly increasing trend annually. The United States, the United Kingdom, and Canada contributed the majority of records. The University of Toronto, the University of Washington, and the University of Sydney were the biggest node in their cluster on the collaboration network map. The three journals that published the greatest number of relevant studies were Implementation Science, BMJ Open, and BMC Health Services Research. Grimshaw JM was the author with the most published articles, and was the second most co-cited author. Research hotspots in this field focused on public health and education, evidence-based medicine and quality promotion, diagnosis and treatment, and knowledge translation and barriers. Challenges and barriers, as well as societal impacts and inequalities, are likely to be key directions for future research. CONCLUSIONS This is the first bibliometric study to comprehensively summarize the research trends of research on barriers and strategies for clinical practice guideline implementation. A better understanding of collaboration patterns and research hotspots may be useful for researchers. SPANISH ABSTRACT http://links.lww.com/IJEBH/A247.
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Affiliation(s)
- Chen Tian
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou, China
| | - Yajie Liu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liangying Hou
- Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou, China
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jingwen Jiang
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Ying Li
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jianing Liu
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Ziying Ye
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qianji Cheng
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yan Ma
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jinling Ning
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiajie Huang
- School of Nursing, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yong Wang
- First Clinical School of Medicine, Lanzhou University, Lanzhou, China
| | - Yiyun Wang
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Bo Tong
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - JiaLe Lu
- First Clinical School of Medicine, Lanzhou University, Lanzhou, China
| | - Long Ge
- Department of Health Policy and Management, School of Public Health, Lanzhou University, Lanzhou, China
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
- WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
- Key Laboratory of Evidence-Based Medicine of Gansu Province, Lanzhou, China
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Kraak JT, Verhoef K, Kramer SE, Merkus P. Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice-a qualitative post-implementation study. J Patient Rep Outcomes 2024; 8:96. [PMID: 39141062 PMCID: PMC11324631 DOI: 10.1186/s41687-024-00741-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/03/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The Otology Questionnaire Amsterdam (OQUA) is developed to evaluate multiple ear complaints and their impact on patients' daily lives. The current clinical use of this questionnaire is below the potential utilization. AIM To identify the barriers and enablers of using the OQUA as perceived by ENT surgeons and patients and provide recommendations for an implementation strategy. METHODS Prospective and qualitative analysis was performed using focus groups and interviews with ENT professionals (n = 15) and patients (n = 25) with ear complaints of one tertiary referral hospital and two regional hospitals. Barriers and enablers were identified and classified by using the Capability-Opportunity-Motivation-Behavior model and the Theoretical Domains Framework. Suggestions for an implementation strategy will be made accordingly. RESULTS ENT professionals' barriers included lack of knowledge and skills to use the OQUA, inadequate technological support and perceived time constraints during consultation, uncertainty about the clinical relevance and lack of feedback on the outcomes of the OQUA. Enablers included beneficial consequences of the OQUA for the professional, organization and science. Patients' barriers included lack of knowledge about the objective and usefulness of the OQUA, perceived burden, difficulties in completing the questionnaire and insufficient feedback during consultation. Patient enablers included beliefs about beneficial consequences of the OQUA for the patient, health care and society. Suggested interventions involved education, training, environmental restructuring and incentivisation. CONCLUSION Based on the findings, we propose an implementation strategy should focus on education and training about the objective, outcomes and relevance of the OQUA, environmental restructuring regarding the optimal use of the OQUA, and incentivisation with feedback on the valuable outcomes of the OQUA for the patient, professional and healthcare. Future research is needed to determine the feasibility of the implementation strategy.
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Affiliation(s)
- J T Kraak
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands.
| | - K Verhoef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
| | - S E Kramer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
| | - P Merkus
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology-Head and Neck Surgery, Ear and Hearing and Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, The Netherlands
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