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Simard P, Turcotte S, Vallée C, Lamontagne ME. Implementation of the strengths model of case management for people with a traumatic brain injury: a qualitative pre-implementation study. Brain Inj 2024; 38:734-741. [PMID: 38704843 DOI: 10.1080/02699052.2024.2347548] [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: 06/19/2023] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION People who sustain a traumatic brain injury (TBI) may have to live with permanent sequelae such as mental health problems, cognitive impairments, and poor social participation. The strengths-based approach (SBA) of case management has a number of positive impacts such as greater community integration but it has never been implemented for persons with TBI. To support its successful implementation with this population, it is essential to gain understanding of how the key components of the intervention are perceived within the organization applying the approach. OBJECTIVES Documenting the barriers and facilitators in the implementation of the SBA as perceived by potential adopters. METHODS A qualitative pre-implementation study was conducted using semi-structured interviews with community workers and managers of the community organization where the SBA is to be implemented. Data were analyzed using a deductive approach based on the Consolidated Framework for Implementation Research (CFIR). RESULTS The major barriers are associated with the intervention (e.g. adaptability of the intervention) and the external context (e.g. the impact of the pandemic). Perceived facilitators are mainly associated with the internal context (e.g. compatibility with current values). CONCLUSION The barriers and facilitators identified will inform the research team's actions to maximize the likelihood of successful implementation.
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Affiliation(s)
- Pascale Simard
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
| | - Samuel Turcotte
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
| | - Catherine Vallée
- School of Rehabilitation, Université Laval, Quebec, Canada
- VITAM Center for Sustainable Health Research, Quebec, Canada
| | - Marie-Eve Lamontagne
- School of Rehabilitation, Université Laval, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, Canada
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Taylor C, Maben J, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K. Care Under Pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics. BMJ Qual Saf 2024; 33:523-538. [PMID: 38575309 DOI: 10.1136/bmjqs-2023-016468] [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: 06/23/2023] [Accepted: 02/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Nurses, midwives and paramedics comprise over half of the clinical workforce in the UK National Health Service and have some of the highest prevalence of psychological ill health. This study explored why psychological ill health is a growing problem and how we might change this. METHODS A realist synthesis involved iterative searches within MEDLINE, CINAHL and HMIC, and supplementary handsearching and expert solicitation. We used reverse chronological quota screening and appraisal journalling to analyse each source and refine our initial programme theory. A stakeholder group comprising nurses, midwives, paramedics, patient and public representatives, educators, managers and policy makers contributed throughout. RESULTS Following initial theory development from 8 key reports, 159 sources were included. We identified 26 context-mechanism-outcome configurations, with 16 explaining the causes of psychological ill health and 10 explaining why interventions have not worked to mitigate psychological ill health. These were synthesised to five key findings: (1) it is difficult to promote staff psychological wellness where there is a blame culture; (2) the needs of the system often over-ride staff psychological well-being at work; (3) there are unintended personal costs of upholding and implementing values at work; (4) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; and (5) it is challenging to design, identify and implement interventions. CONCLUSIONS Our final programme theory argues the need for healthcare organisations to rebalance the working environment to enable healthcare professionals to recover and thrive. This requires high standards for patient care to be balanced with high standards for staff psychological well-being; professional accountability to be balanced with having a listening, learning culture; reactive responsive interventions to be balanced by having proactive preventative interventions; and the individual focus balanced by an organisational focus. PROSPERO REGISTRATION NUMBER CRD42020172420.
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Affiliation(s)
- Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Justin Jagosh
- School of Health Sciences, University of Surrey, Guildford, UK
| | | | - Simon Briscoe
- Exeter Medical School, University of Exeter, Exeter, UK
| | - Naomi Klepacz
- School of Health Sciences, University of Surrey, Guildford, UK
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Karen Mattick
- Exeter Medical School, University of Exeter, Exeter, UK
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Flores A, Wiener RS, Hon S, Wakeman C, Howard J, Virani N, Mattus B, Foreman AG, Singh J, Rosen L, Bulekova K, Kathuria H. Sustainability of an Opt-Out Electronic-Health Record-Based Tobacco Treatment Consult Service at a Large Safety-Net Hospital: A 6-Year Analysis. Nicotine Tob Res 2024; 26:1081-1088. [PMID: 38320328 DOI: 10.1093/ntr/ntae023] [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: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/31/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Our safety-net hospital implemented a hospital-based tobacco treatment intervention in 2016. We previously showed the intervention, an "opt-out" Electronic Health Record (EHR)-based Best Practice Alert (BPA)+ order-set that triggers consultation to an inpatient Tobacco Treatment Consult (TTC) service for all patients who smoke, improves smoking abstinence. We now report on sustainability, 6 years after inception. AIMS AND METHODS We analyzed data collected between July 2016-June 2022 of patients documented as "currently smoking" in the EHR. Across the 6 years, we used Pearson's correlation analysis to compare Adoption (clinician acceptance of the BPA+ order-set, thus generating consultation to the TTC service); Reach (number of consultations completed by the TTC service); and Effectiveness (receipt of pharmacotherapy orders between patients receiving and not receiving consultations). RESULTS Among 39 558 adult admissions (July 2016-June 2022) with "currently smoking" status in the EHR for whom the BPA triggered, clinicians accepted the TTC order set on 50.4% (19 932/39 558), though acceptance varied across services (eg, Cardiology [71%] and Obstetrics-Gynecology 12%]). The TTC service consulted on 17% (6779/39 558) of patients due to staffing constraints. Consultations ordered (r = -0.28, p = .59) and completed (r = 0.45, p = .37) remained stable over 6-years. Compared to patients not receiving consultations, patients receiving consultations were more likely to receive pharmacotherapy orders overall (inpatient: 50.8% vs. 35.1%, p < .0001; at discharge: 27.1% vs. 10%, p < .0001) and in each year. CONCLUSIONS The "opt-out" EHR-based TTC service is sustainable, though many did not receive consultations due to resource constraints. Health care systems should elevate the priority of hospital-based tobacco treatment programs to increase reach to underserved populations. IMPLICATIONS Our study shows that opt-out approaches that utilize the EHR are a sustainable approach to providing evidence-based tobacco treatment to all hospitalized individuals who smoke, regardless of readiness to stop smoking and clinical condition.
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Affiliation(s)
- Adriana Flores
- Division of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Stephanie Hon
- Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Cornelia Wakeman
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | - Jinesa Howard
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Nikita Virani
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bruce Mattus
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Alexis Gallardo Foreman
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Johar Singh
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Linda Rosen
- Clinical Data Warehouse, Boston Medical Center, Boston, MA, USA
| | - Katia Bulekova
- Research Computing Services (RCS) Group, Information Services & Technology, Boston University, Boston, MA, USA
| | - Hasmeena Kathuria
- Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Van Pelt AE, Paniagua-Avila A, Sanchez A, Sila S, Lowenthal ED, Powell BJ, Beidas RS. Spanish translation of the Expert Recommendations for Implementing Change (ERIC) compilation. Implement Sci Commun 2024; 5:77. [PMID: 39020427 PMCID: PMC11253493 DOI: 10.1186/s43058-024-00616-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Most implementation science resources (e.g., taxonomies) are published in English. Linguistic inaccessibility creates a barrier to the conduct of implementation research among non-English-speaking populations, so translation of resources is needed. Translation into Spanish can facilitate widespread reach, given the large proportion of Spanish speakers around the world. This research aimed to systematically translate the Expert Recommendations for Implementation Change (ERIC) compilation into Spanish as an exemplar for the linguistic translation process. METHODS Using the World Health Organization guidelines, this work translated the ERIC compilation strategy names, short definitions, and thematic clusters through a three-step process: 1) forward translation into Spanish by a native Spanish-speaking implementation scientist, 2) back-translation into English by a bilingual global health researcher, and 3) piloting via virtual focus group discussions with bilingual researchers not conducting implementation research. To achieve a generalizable translation, recruitment targeted a multicultural group of Spanish-speaking researchers. At the conclusion of each step, the transdisciplinary research team (N = 7) met to discuss discrepancies and refine translations. The Spanish version of the ERIC compilation was finalized through group consensus. Reflections from research team meetings and focus group discussions were synthesized qualitatively. RESULTS Given that dialectical nuances exist between Spanish-speaking regions, efforts prioritized universally accepted terminology. Team discussions focused on difficult translations, word choice, and clarity of concepts. Seven researchers participated in two focus groups, where discussion surrounded clarity of concepts, alternative word choice for Spanish translations, linguistic formality, grammar, and conciseness. Translation difficulties highlighted lack of precision in implementation science terminology, and the lack of conceptual clarity of words underscored limitations in the application of the compilation. CONCLUSIONS The work demonstrated the feasibility of translating implementation science resources. As one of the first systematic efforts to translate implementation resources, this study can serve as a model for additional efforts, including translation into other languages and the expansion to conceptual modifications. Further, this work yielded insights into the need to provide conceptual clarity in implementation science terminology. Importantly, the development of Spanish resources will increase access to conduct implementation research among Spanish-speaking populations.
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Affiliation(s)
- Amelia E Van Pelt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA.
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA.
- Global Health Center, Children's Hospital of Philadelphia, 734 Schuylkill Avenue, Philadelphia, PA, 19146, USA.
| | - Alejandra Paniagua-Avila
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, 10032, USA
| | - Amanda Sanchez
- Department of Psychology, George Mason University, 4400 University Dr, Fairfax, VA, 22030, USA
| | - Stephanie Sila
- School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce Street, Philadelphia, PA, 19104, USA
| | - Elizabeth D Lowenthal
- Global Health Center, Children's Hospital of Philadelphia, 734 Schuylkill Avenue, Philadelphia, PA, 19146, USA
- Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, 3600 Civic Center Blvd, Philadelphia, PA, 19146, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, 63130, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, 63110, USA
- Division of Infectious Diseases, John T. Milliken Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, 63110, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave Suite 2100, Chicago, IL, 60611, USA
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, 633 N St Clair St Suite 2000, Chicago, IL, 60611, USA
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Kwok G, Senger A, Sharma A, Mandato I, Devine KA. Understanding the multilevel factors influencing the implementation of digital health interventions for supportive care in Adolescents and Young Adult (AYA) cancer survivorship: determinants of adopting mindfulness-based mobile applications. Implement Sci Commun 2024; 5:76. [PMID: 39020422 PMCID: PMC11253365 DOI: 10.1186/s43058-024-00612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Adolescents and Young Adult (AYA) cancer survivors are at risk for psychological distress due to their unique developmental and medical needs. Healthcare providers can leverage the convenience and appeal of technology to provide supportive care for this vulnerable population. Using evidence-based mindfulness-based mobile interventions as a case example, the goal of this study was to identify key patient-, provider-, and organization-level barriers and facilitators to supportive care and implementing digital health interventions in AYA survivorship care. METHODS Twenty semi-structured interviews were conducted with stakeholders including AYA survivors (n = 10; between 18-29 years old) and clinical providers and administrators (n = 10). Interviews were transcribed and deductively mapped using the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF) complementary frameworks. RESULTS Results indicated that factors like cost and patients' needs and resources were prevalent among both survivors and providers. There were key differences between providers and AYA survivors. Providers' adoption and promotion of digital health interventions were influenced most strongly by contextual factors, including available resources (Inner Setting), culture (Outer Setting), and networks and communications (Outer Setting). On the other hand, survivors emphasized individual and intervention-related factors; they reported that social influence and knowledge influenced their adoption and use of digital health interventions, including meditation apps. CONCLUSIONS These results identified barriers and facilitators to the adoption of supportive care digital health interventions from multiple stakeholders. Results can be used to guide the development of implementation strategies to improve the uptake of digital health interventions in survivorship care, ultimately improving the psychosocial well-being of AYA cancer survivors.
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Affiliation(s)
- Gary Kwok
- Cancer Prevention Precision Control Institute, Center for Discovery & Innovation, at Hackensack Meridian Health, Nutley, NJ, 07110, USA.
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA.
| | - Angela Senger
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Archana Sharma
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Ivelisse Mandato
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
| | - Katie A Devine
- Department of Pediatrics, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08901, USA
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Haun JN, Melillo C, Schneider T, McDaniel J, McMahon-Grenz J, Benzinger RC, Nakase-Richardson R, Pugh MJV, Skop KM, Friedman Y, Sandoval R, Sabangan J, Samson K, Picon LM, Kean J. A Partner-Engaged Approach to Developing an Implementation Research Logic Model for a Traumatic Brain Injury-Intensive Evaluation and Treatment Program. J Head Trauma Rehabil 2024:00001199-990000000-00182. [PMID: 39038102 DOI: 10.1097/htr.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND A partnered evaluation project with Veterans Health Administration Physical Medicine and Rehabilitation program office uses a partner-engaged approach to characterize and evaluate the national implementation of traumatic brain injury (TBI)Intensive Evaluation and Treatment Program (IETP). OBJECTIVE This paper illustrates a partner-engaged approach to contextualizing the IETP within an implementation research logic model (IRLM) to inform program sustainment and spread. SETTING The project was conducted at five IETP sites: Tampa, Richmond, San Antonio, Palo Alto, and Minneapolis. PARTICIPANTS Partners included national and site program leaders, clinicians, Department of Defense Referral Representatives, and researchers. Participants included program staff (n = 46) and Service Members/Veterans (n = 48). DESIGN This paper represents a component of a larger participatory-based concurrent mixed methods quality improvement project. MAIN MEASURES Participant scripts and demographic surveys. METHODS Datasets were analyzed using rapid iterative content analysis; IETP model was iteratively revised with partner feedback. Each site had an IETP clinical team member participate. The IRLM was contextualized within the Consolidated Framework for Implementation Research (CFIR); systematic consensus building expert reviewed implementation strategies; RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance); and Implementation Outcomes Framework (IOF). RESULTS Analyses and partner feedback identified key characteristics, determinants, implementation strategies, mechanisms, and outcomes. CONCLUSIONS This partner-engaged IRLM informs implementation and sustainment of a rehabilitation program for individuals with TBI. Findings will be leveraged to examine implementation, standardize core outcome measurements, and inform knowledge translation.
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Affiliation(s)
- Jolie N Haun
- Author Affiliations: Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Haun, Melillo, and Schneider, and Mss McMahon-Grenz and Benzinger); Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah (Dr Haun); College of Public Health, University of South Florida, Tampa, Florida (Dr Schneider); School of Human Sciences, Southern Illinois University, Carbondale, Illinois (Dr McDaniel); Pulmonary/Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, Florida (Dr Nakase-Richardson); James A. Haley Veterans' Hospital, Associate Chief of Staff Office, Tampa, Florida (Dr Nakase-Richardson); VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah (Dr Pugh); Post-deployment Rehabilitation and Evaluation Program, Physical Medicine and Rehabilitation Services, James A Haley Veterans' Hospital, Tampa, Florida (Dr Skop and Ms Friedman); School of Physical Therapy, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Skop); Post-deployment Acceleration Comprehensive Evaluation and Rehabilitation Program Polytrauma System of Care, South Texas Veterans Health Care System, Audie L. Murphy VAMC, San Antonio, Texas (Dr Sandoval); Intensive Evaluation & Treatment Program (IETP), Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, California (Drs Sabangan and Samson); Office of Rehabilitation and Prosthetic Services, Department of Veterans Affairs, Washington, District of Columbia (Ms Picon); and VA Salt Lake City Health Care System, VA Informatics and Computing Infrastructure, Salt Lake City, Utah (Dr Kean)
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Dorr DA, Montgomery E, Ghumman AJ, Michaels L, Rolbiecki A, Canfield S, Shaffer V, Johnson B, Lockwood M, Ghosh P, Martinez W, Koopman R. Study protocol: Collaboration Oriented Approach to Controlling High blood pressure (COACH) in adults - a randomised controlled trial. BMJ Open 2024; 14:e085898. [PMID: 38977368 PMCID: PMC11256044 DOI: 10.1136/bmjopen-2024-085898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
INTRODUCTION Hypertension, the clinical condition of persistent high blood pressure (BP), is preventable yet remains a significant contributor to poor cardiovascular outcomes. Digital self-management support tools can increase patient self-care behaviours to improve BP. We created a patient-facing and provider-facing clinical decision support (CDS) application, called the Collaboration Oriented Approach to Controlling High BP (COACH), to integrate home BP data, guideline recommendations and patient-centred goals with primary care workflows. We leverage social cognitive theory principles to support enhanced engagement, shared decision-making and self-management support. This study aims to measure the effectiveness of the COACH intervention and evaluate its adoption as part of BP management. METHODS AND ANALYSIS The study design is a multisite, two-arm hybrid type III implementation randomised controlled trial set within primary care practices across three health systems. Randomised participants are adults with high BP for whom home BP monitoring is indicated. The intervention arm will receive COACH, a digital web-based intervention with effectively enhanced alerts and displays intended to drive engagement with BP lowering; the control arm will receive COACH without the alerts and a simple display. Outcome measures include BP lowering (primary) and self-efficacy (secondary). Implementation preplanning and postevaluation use the Consolidated Framework for Implementation Research and Reach-Effectiveness-Adoption-Implementation-Maintenance metrics with iterative cycles for qualitative integration into the trial and its quantitative evaluation. The trial analysis includes logistic regression and constrained longitudinal data analysis. ETHICS AND DISSEMINATION The trial is approved under a single IRB through the University of Missouri-Columbia, #2091483. Dissemination of the intervention specifications and results will be through open-source mechanisms. TRIAL REGISTRATION NUMBER NCT06124716.
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Affiliation(s)
- David Andrew Dorr
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Aisha J Ghumman
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - LeAnn Michaels
- Oregon Health & Science University, Portland, Oregon, USA
| | - Abigail Rolbiecki
- University of Missouri System, Columbia, Missouri, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | | | - Blake Johnson
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - Parijat Ghosh
- University of Missouri System, Columbia, Missouri, USA
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Zhou J, Yuan Q, Huang Q, Wang Q, Huang H, Chen W, Wang G, Liu S, Zhang T, Zhao X, Li Y. Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework. Infect Dis Poverty 2024; 13:52. [PMID: 38978081 PMCID: PMC11229258 DOI: 10.1186/s40249-024-01222-3] [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: 03/12/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. METHODS We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. RESULTS This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs' heavy workload, and 12 enablers such as HCWs' passion towards TCP planning. CONCLUSIONS With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.
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Affiliation(s)
- Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Quan Yuan
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingning Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingya Wang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Hexiang Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Wei Chen
- Institute of Tuberculosis Prevention and Control, Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Ting Zhang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Xi Zhao
- Guiyang Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China.
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Drake C, Wang V, Stechuchak KM, Sperber N, Bruening R, Coffman CJ, Choate A, Van Houtven CH, Allen KD, Colon-Emeric C, Jackson GL, Tucker M, Meyer C, Kappler CB, Hastings SN. Enhancing team communication to improve implementation of a supervised walking program for hospitalized veterans: Evidence from a multi-site trial in the Veterans Health Administration. PM R 2024. [PMID: 38967454 DOI: 10.1002/pmrj.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION The timely translation of evidence-based programs into real-world clinical settings is a persistent challenge due to complexities related to organizational context and team function, particularly in inpatient settings. Strategies are needed to promote quality improvement efforts and implementation of new clinical programs. OBJECTIVE This study examines the role of CONNECT, a complexity science-based implementation intervention to promote team readiness, for enhancing implementation of the 'Assisted Early Mobility for Hospitalized Older Veterans' program (STRIDE), an inpatient, supervised walking program. DESIGN We conducted a stepped-wedge cluster randomized trial using a convergent mixed-methods design. Within each randomly assigned stepped-wedge sequence, Veterans Affairs Medical Centers (VAMCs) were randomized to receive standardized implementation support only or additional training via the CONNECT intervention. Data for the study were obtained from hospital administrative and electronic health records, surveys, and semi-structured interviews with clinicians before and after implementation of STRIDE. SETTING Eight U.S. VAMCs. PARTICIPANTS Three hundred fifty-three survey participants before STRIDE implementation and 294 surveys after STRIDE implementation. Ninety-two interview participants. INTERVENTION CONNECT, a complexity-science-based intervention to improve team function. MAIN OUTCOME MEASURES The implementation outcomes included STRIDE reach and fidelity. Secondary outcomes included validated measures of team function (i.e., team communication, coordination, role clarity). RESULTS At four VAMCs randomized to CONNECT, reach was higher (mean 12.4% vs. 3.8%), and fidelity was similar to four non-CONNECT VAMCs. VAMC STRIDE delivery teams receiving CONNECT reported improvements in team function domains, similar to non-CONNECT VAMCs. Qualitative findings highlight CONNECT's impact and the influence of team characteristics and contextual factors, including team cohesion, leadership support, and role clarity, on reach and fidelity. CONCLUSION CONNECT may promote greater reach of STRIDE, but improvement in team function among CONNECT VAMCs was similar to improvement among non-CONNECT VAMCs. Qualitative findings suggest that CONNECT may improve team function and implementation outcomes but may not be sufficient to overcome structural barriers related to implementation capacity.
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Affiliation(s)
- Connor Drake
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Virginia Wang
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Stechuchak
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Nina Sperber
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca Bruening
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cynthia J Coffman
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ashley Choate
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Courtney Harold Van Houtven
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kelli D Allen
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cathleen Colon-Emeric
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - George L Jackson
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Matthew Tucker
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Cassie Meyer
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Caitlin B Kappler
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Susan N Hastings
- ADAPT Center of Innovation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Geriatrics Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA
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Ferguson AL, Erwin E, Sleeth J, Symonds N, Chard S, Yuma S, Oneko O, Macheku G, Andrews L, West N, Chelva M, Ginsburg O, Yeates K. An Implementation Evaluation of the Smartphone-Enhanced Visual Inspection with Acetic Acid (SEVIA) Program for Cervical Cancer Prevention in Urban and Rural Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:878. [PMID: 39063455 PMCID: PMC11277481 DOI: 10.3390/ijerph21070878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/24/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION The World Health Organization (WHO) recommends visual inspection with acetic acid (VIA) for cervical cancer screening (CCS) in lower-resource settings; however, quality varies widely, and it is difficult to maintain a well-trained cadre of providers. The Smartphone-Enhanced Visual Inspection with Acetic acid (SEVIA) program was designed to offer secure sharing of cervical images and real-time supportive supervision to health care workers, in order to improve the quality and accuracy of visual assessment of the cervix for treatment. The purpose of this evaluation was to document early learnings from patients, providers, and higher-level program stakeholders, on barriers and enablers to program implementation. METHODS From 9 September to 8 December 2016, observational activities and open-ended interviews were conducted with image reviewers (n = 5), providers (n = 17), community mobilizers (n = 14), patients (n = 21), supervisors (n = 4) and implementation partners (n = 5) involved with SEVIA. Sixty-six interviews were conducted at 14 facilities, in all five of the program regions Results SEVIA was found to be a highly regarded tool for the enhancement of CCS services in Northern Tanzania. Acceptability, adoption, appropriateness, feasibility, and coverage of the intervention were highly recognized. It appeared to be an effective means of improving good clinical practice among providers and fit seamlessly into existing roles and processes. Barriers to implementation included network connectivity issues, and community misconceptions and the adoption of CCS more generally. CONCLUSIONS SEVIA is a practical and feasible mobile health intervention and tool that is easily integrated into the National CCS program to enhance the quality of care.
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Affiliation(s)
| | - Erica Erwin
- Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Jessica Sleeth
- Canadian Cancer Trials Group, Kingston, ON K7L 2V5, Canada
| | - Nicola Symonds
- School of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Sidonie Chard
- Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Safina Yuma
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma 40478, Tanzania
| | - Olola Oneko
- Kilimanjaro Christian Medical Center, Moshi P.O. Box 3010, Tanzania
| | - Godwin Macheku
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma 40478, Tanzania
| | - Linda Andrews
- Pamoja Tunaweza Women’s Centre, Moshi P.O. Box 8434, Tanzania
| | - Nicola West
- Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Melinda Chelva
- Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Bethesda, MD 20892-9760, USA
| | - Karen Yeates
- Department of Medicine, Queen’s University, Kingston, ON K7L 3N6, Canada
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11
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Chapuma CIJ, Sakala D, Nyang'wa MN, Hosseinipour MC, Mbeye N, Matoga M, Kumwenda MK, Chikweza A, Nyondo‐Mipando AL, Mwapasa V. Examining barriers to antiretroviral therapy initiation in infants living with HIV in sub-Saharan Africa despite the availability of point-of-care diagnostic testing: a narrative systematic review. J Int AIDS Soc 2024; 27 Suppl 1:e26284. [PMID: 38965987 PMCID: PMC11224580 DOI: 10.1002/jia2.26284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 05/13/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Antiretroviral therapy (ART) initiation in infants living with HIV before 12 weeks of age can reduce the risk of mortality by 75%. Point-of-care (POC) diagnostic testing is critical for prompt ART initiation; however, despite its availability, rates of ART initiation are still relatively low before 12 weeks of age. This systematic review describes the barriers to ART initiation in infants before 12 weeks of age, despite the availability of POC. METHODS This systematic review used a narrative synthesis methodology. We searched PubMed and Scopus using search strategies that combined terms of multiple variants of the keywords "early infant initiation on antiretroviral therapy," "barriers" and "sub-Saharan Africa" (initial search 18th January 2023; final search 1st August 2023). We included qualitative, observational and mixed methods studies that reported the influences of early infant initiation on ART. We excluded studies that reported influences on other components of the Prevention of Mother to Child Transmission cascade. Using a deductive approach guided by the updated Consolidated Framework of Implementation Research, we developed descriptive codes and themes around barriers to early infant initiation on ART. We then developed recommendations for interventions for the identified barriers using the action, actor, target and time framework from the codes. RESULTS Of the 266 abstracts reviewed, 52 full-text papers were examined, of which 12 papers were included. South Africa had most papers from a single country (n = 3) and the most reported study design was retrospective (n = 6). Delays in ART initiation beyond 12 weeks in infants 0-12 months were primarily associated with health facility and maternal factors. The most prominent barriers identified were inadequate resources for POC testing (including human resources, laboratory facilities and patient follow-up). Maternal-related factors, such as limited male involvement and maternal perceptions of treatment and care, were also influential. DISCUSSION We identified structural barriers to ART initiation at the health system, social and cultural levels. Improvements in the timely allocation of resources for POC testing operations, coupled with interventions addressing social and behavioural barriers among both mothers and healthcare providers, hold a promise for enhancing timely ART initiation in infants. CONCLUSIONS This paper identifies barriers and proposes strategies for timely ART initiation in infants.
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Affiliation(s)
| | | | | | | | | | - Mitch Matoga
- University of North Carolina ProjectLilongweMalawi
| | - Moses Kelly Kumwenda
- Malawi Liverpool Research ProgrammeBlantyreMalawi
- Kamuzu University of Health SciencesBlantyreMalawi
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12
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Kulkarni AJ, Thiagarajan AB, Skolarus TA, Krein SL, Ellimoottil C. Attitudes and barriers toward video visits in surgical care: Insights from a nationwide survey among surgeons. Surgery 2024; 176:115-123. [PMID: 38734503 DOI: 10.1016/j.surg.2024.03.033] [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: 12/12/2023] [Revised: 02/16/2024] [Accepted: 03/21/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Surgeons rapidly adopted video visits during the COVID-19 pandemic. However, video visit use among surgeons has significantly declined, pointing to the need to better understand current attitudes and barriers to their use in surgical care. METHODS From August 2022 to March 2023, a nationwide survey was conducted among practicing surgeons in 6 specialties. The survey included multiple-choice and free-response questions based on an implementation determinants framework, covering demographics, provider, patient, and organizational factors. RESULTS A total of 170 surgeons responded (24% response rate). Overall, 67% of surgeons said their practice lacked motivation for video visit implementation. Additionally, 69% disagreed with using video visits as the sole means for preoperative surgical consultation, even with relevant medical history, labs, and imaging. Nearly 43% cited the need for a physical examination, whereas 58% of surgeons said video visits carried a greater malpractice risk than in-person visits. Other barriers included technological limitations, billing, and care quality concerns. Nevertheless, 41% agreed that video visits could improve outcomes for some patients, and 60% expressed openness to using video visits exclusively for postoperative consultations in uncomplicated surgeries. CONCLUSION Surgeons recognize the potential benefits of video visits for certain patients. However, perceived barriers include the need for a physical examination, technological limitations, care quality concerns, and malpractice risks.
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Affiliation(s)
- Ashwin J Kulkarni
- Department of Urology, University of Michigan, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI.
| | - Anagha B Thiagarajan
- Helen Diller Family Comprehensive Cancer Center at UCSF, San Francisco, CA; Institute for Healthcare Policy and Innovation, Ann Arbor, MI
| | - Ted A Skolarus
- Department of Surgery, Section of Urology, University of Chicago, IL
| | - Sarah L Krein
- University of Michigan Medical School, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI; Department of Veterans Affairs, Ann Arbor Healthcare System, MI
| | - Chad Ellimoottil
- Department of Urology, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, Ann Arbor, MI. https://twitter.com/chadellimoottil
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13
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Holbert MD, Duff J, Wood F, Holland AJA, Teague W, Frear C, Crellin D, Phillips N, Storey K, Martin L, Singer Y, Dimanopoulos TA, Cuttle L, Vagenas D, McPhail S, Calleja P, De Young A, Kimble RM, Griffin BR. Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study. J Pediatr Nurs 2024; 77:e520-e530. [PMID: 38762422 DOI: 10.1016/j.pedn.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. METHODS A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. RESULTS Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. CONCLUSION Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
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Affiliation(s)
- Maleea D Holbert
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia.
| | - Jed Duff
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Australia
| | - Fiona Wood
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Andrew J A Holland
- The Burns Unit, The Children's Hospital at Westmead, NSW 2145, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW 2050, Australia
| | - Warwick Teague
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Cody Frear
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dianne Crellin
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Nursing, The University of Melbourne, Victoria 3010, Australia
| | - Natalie Phillips
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Kristen Storey
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Lisa Martin
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Yvonne Singer
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Dimitrios Vagenas
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Steven McPhail
- Australian Centre for Health Services Innovation, and Centre for Healthcare Transformation, School of Public health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Pauline Calleja
- College of Healthcare Sciences, James Cook University, Cairns 4870, Australia
| | - Alexandra De Young
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Roy M Kimble
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
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Mbalilaki JA, Lilleheie I, Rimehaug SA, Tveitan SN, Linnestad AM, Krøll P, Lundberg S, Molle M, Moore JL. Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A Mixed-Methods Study. J Clin Med 2024; 13:3708. [PMID: 38999274 PMCID: PMC11242475 DOI: 10.3390/jcm13133708] [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: 05/14/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians' experiences with HIT implementation.
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Affiliation(s)
- Julia Aneth Mbalilaki
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
| | - Ingvild Lilleheie
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
- Department of Nursing and Health Sciences, University of South-Eastern Norway, 3045 Drammen, Norway
| | - Stein A. Rimehaug
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
| | - Siri N. Tveitan
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
| | - Anne-Margrethe Linnestad
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
| | - Pia Krøll
- Skogli Health and Rehabilitation Center, 2614 Lillehammer, Norway;
| | - Simen Lundberg
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital, 3103 Tønsberg, Norway;
| | | | - Jennifer L. Moore
- Regional Rehabilitation Knowledge Center, Sunnaas Rehabilitation Hospital, 1453 Nesodden, Norway; (J.A.M.); (I.L.); (S.A.R.); (S.N.T.); (A.-M.L.)
- Institute for Knowledge Translation, Carmel, IN 46082, USA
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15
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Sutherland MA, Hutchinson MK, Si B, Ding Y, Liebermann E, Connolly SL, Saint-Eloi Cadely H, Hayes JF, Mueller SD. Health screenings in college health centers: Variations in practice. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-8. [PMID: 38905516 DOI: 10.1080/07448481.2024.2361307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/19/2024] [Indexed: 06/23/2024]
Abstract
Objective: The purpose of this study was to examine the routine screening of female students in college health centers for six priority health-related behaviors and experiences (tobacco use, alcohol use, eating disorders [EDs], obesity, anxiety and depression, intimate partner violence/sexual violence [IPV/SV]), and to identify variations in practice. Participants: A nationally representative sample of 1,221 healthcare providers (HCPs), including nurse practitioners, physicians, and physician assistants, from 471 U.S. college health centers. Methods: HCPs completed surveys (on-line or paper) and reported on routine screening of female college students. Results: HCPs reported consistently high rates (75-85%) of screening for tobacco use, alcohol use, and anxiety/depression. Rates of screening for IPV/SV, obesity and EDs were much lower. Nurse practitioners reported the highest IPV/SV screening rates. Conclusions: College health centers present unique opportunities for screening, case-finding and intervening to reduce long-term sequelae. Providers are well-positioned to lead initiatives to improve screening practices.
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Affiliation(s)
| | | | - Bing Si
- Systems Science and Industrial Engineering, Binghamton University, Binghamton, New York, USA
| | - Yu Ding
- Systems Science and Industrial Engineering, Binghamton University, Binghamton, New York, USA
| | - Erica Liebermann
- College of Nursing, University of Rhode Island, Kingston, Rhode Island, USA
| | - Somatra L Connolly
- University of Rhode Island College of Nursing, RINEC, Providence, Rhode Island, USA
| | - Hans Saint-Eloi Cadely
- Developmental Science Graduate Program Director, Department of Human Development and Family Science, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jacqueline F Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island, USA
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16
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Bosch NM, Kalkdijk-Dijkstra AJ, Broens PMA, van Westreenen HL, Pierie JPEN, Klarenbeek BR, van der Heijden JAG. Implementation of Pelvic Floor Rehabilitation after rectal cancer surgery: A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). PLoS One 2024; 19:e0301518. [PMID: 38900764 PMCID: PMC11189208 DOI: 10.1371/journal.pone.0301518] [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: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Pelvic Floor Rehabilitation (PFR) is effective in a selection of patients with low anterior resection syndrome (LARS) after rectal cancer surgery. This study aimed to identify barriers and enablers to prepare for successful implementation into clinical practice. METHODS A qualitative study was performed, guided by the Consolidated Framework for Implementation Research (CFIR). Individual interviews (n = 27) and two focus groups were conducted to synthesize the perspectives of rectal cancer patients, pelvic floor (PF) physiotherapists, and medical experts. RESULTS Barriers were found to be the absence of guidelines about LARS treatment, underdeveloped network care, suboptimal patient information, and expectation management upfront to PFR. Financial status is frequently a barrier because insurance companies do not always reimburse PFR. Enablers were the current level of evidence for PFR, the positive relationship between patients and PF physiotherapists, and the level of self-motivation by patients. CONCLUSION The factors identified in our study play a crucial role in ensuring a successful implementation of PFR after rectal cancer surgery.
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Affiliation(s)
- N. M. Bosch
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - P. M. A. Broens
- Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | | | - J. P. E. N. Pierie
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
- Department of PGSoM, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - B. R. Klarenbeek
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J. A. G. van der Heijden
- Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
- Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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17
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Johnson G, Singh H, Helewa RM, Sibley KM, Reynolds KA, El-Kefraoui C, Doupe MB. Gastroenterologist and surgeon perceptions of recommendations for optimal endoscopic localization of colorectal neoplasms. Sci Rep 2024; 14:13157. [PMID: 38849393 PMCID: PMC11161634 DOI: 10.1038/s41598-024-63753-x] [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: 03/14/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.
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Affiliation(s)
- Garrett Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
- Clinician Investigator Program, University of Manitoba, Winnipeg, Canada.
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, and CancerCare Manitoba Research Institute, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Kristin A Reynolds
- Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Charbel El-Kefraoui
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Kabukye JK, Namagembe R, Nakku J, Kiberu V, Sjölinder M, Nilsson S, Wamala-Larsson C. Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e53976. [PMID: 38843515 PMCID: PMC11190627 DOI: 10.2196/53976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Rosemary Namagembe
- Hutchinson Centre Research Institute of Uganda, Uganda Cancer Institute, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Vincent Kiberu
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Susanne Nilsson
- Unit for Integrated Product Development and Design, Department of Machine Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Caroline Wamala-Larsson
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Gudenkauf LM, Hathaway CA, Carroll JE, Small BJ, Li X, Hoogland AI, Castro E, Armaiz-Pena GN, Oswald LB, Jim HSL, Tworoger SS, Gonzalez BD. Inequities in the Impacts of Hurricanes and Other Extreme Weather Events for Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2024; 33:771-778. [PMID: 38385842 PMCID: PMC11147728 DOI: 10.1158/1055-9965.epi-23-1029] [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: 09/20/2023] [Revised: 01/12/2024] [Accepted: 02/19/2024] [Indexed: 02/23/2024] Open
Abstract
In this minireview, we examine the impacts of hurricanes and other extreme weather events on cancer survivors, focusing on structural and social determinants of health. We briefly explore influences on biological, psychosocial, and behavioral outcomes and discuss risk and resilience factors in cancer survivorship during and after hurricanes. Our goal is to inform future directions for research that can identify areas in which we can most efficiently improve cancer outcomes and inform changes in health systems, clinical practice, and public health policies. This timely minireview provides researchers and clinicians with an overview of challenges and opportunities for improving disaster preparedness and response for cancer survivors.
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Affiliation(s)
- Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | | | - Judith E Carroll
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, California
| | - Brent J Small
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Eida Castro
- School of Behavior and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Guillermo N Armaiz-Pena
- Department of Basic Sciences, Division of Pharmacology, School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Shelley S Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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20
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Gayles JG, Chilenski SM, Barragán N, Rhoades Cooper B, Welsh JA, Galinsky M. Unpacking Technical Assistance (TA) Strategies Within a State-Level Prevention Support System: A Mixed-Method Study in Determining Types and Amount of TA. Eval Health Prof 2024; 47:204-218. [PMID: 38790112 PMCID: PMC11127505 DOI: 10.1177/01632787241248769] [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: 05/26/2024]
Abstract
The research-practice gap between evidence-based intervention efficacy and its uptake in real-world contexts remains a central challenge for prevention and implementation science. Providing technical assistance (TA) is considered a crucial support mechanism that can help narrow the gap. However, empirical measurement of TA strategies and their variation is often lacking. The current study unpacks the black box of TA, highlighting different TA strategies, amounts, and their relation to intervention characteristics. First, we qualitatively categorized interactions between TA providers and implementers. Second, we explored how characteristics of implementing organizations and the intervention related to variations in the amount of TA delivered. Using data spanning six years, we analyzed over 10,000 encounters between TA providers and implementers. Content analysis yielded four distinct strategies: Consultation (27.2%), Coordination Logistics (24.5%), Monitoring (16.5%), and Resource Delivery (28.2%). Organizations with prior experience required less monitoring and resource delivery. Additionally, characteristics of the intervention were significantly associated with the amount of consultation, monitoring, coordination logistics, and resource delivery provided. The specific features of the intervention showed significant variation in their relation to TA strategies. These findings provide initial insights into the implications of intervention characteristics in determining how much of which TA strategies are needed to support implementations in real-world settings.
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Affiliation(s)
- Jochebed G Gayles
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Sarah M Chilenski
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Nataly Barragán
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | | | - Janet Agnes Welsh
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
| | - Megan Galinsky
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, USA
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21
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Zheng X, Wang R, Thor A, Brantnell A. Oral and maxillofacial surgeons' views on the adoption of additive manufacturing: findings from a nationwide survey. Oral Maxillofac Surg 2024; 28:869-875. [PMID: 38316694 PMCID: PMC11144670 DOI: 10.1007/s10006-024-01219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Hospitals in many European countries have implemented Additive Manufacturing (AM) technology for multiple Oral and Maxillofacial Surgery (OMFS) applications. Although the technology is widely implemented, surgeons also play a crucial role in whether a hospital will adopt the technology for surgical procedures. The study has two objectives: (1) to investigate how hospital type (university or non-university hospital) influences surgeons' views on AM, and (2) to explore how previous experience with AM (AM experience or not) influences surgeons' views on AM. MATERIALS AND METHODS An online questionnaire to capture surgeons' views was designed, consisting of 11 Likert scale questions formulated according to the Consolidated Framework for Implementation Research (CFIR). The questionnaire was sent to OMF surgeons through the channel provided by the Association of Oral and Maxillofacial Surgery in Sweden. Data were analyzed using the Mann-Whitney U test to identify significant differences among OMF surgeons in terms of organizational form (i.e., university hospital or non-university hospital) and experience of AM (i.e., AM experience or no-experience). RESULTS In total, 31 OMF surgeons responded to the survey. Views of surgeons from universities and non-universities, as well as between surgeons with experience and no-experience, did not show significant differences in the 11 questions captured across five CFIR domains. However, the "individual characteristics" domain in CFIR, consisting of three questions, did show significant differences between surgeons' experience with AM and no-experience (P-values: P = 0.01, P = 0.01, and P = 0.04). CONCLUSIONS Surgeons, whether affiliated with university hospitals or non-university hospitals and regardless of their prior experience with AM, generally exhibit a favorable attitude towards AM. However, there were significant differences in terms of individual characteristics between those who had prior experience with AM and those who did not. CLINICAL RELEVANCE This investigation facilitates the implementation of AM in OMFS by reporting on the views of OMF surgeons on AM.
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Affiliation(s)
- Xuewei Zheng
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden
| | - Ruilin Wang
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden
| | - Andreas Thor
- Department of Surgical Sciences, Plastic & Oral and Maxillofacial Surgery, Uppsala University, 751 85, Uppsala, Sweden
| | - Anders Brantnell
- Department of Civil and Industrial Engineering, Industrial Engineering and Management, Uppsala University, Ångströmlaboratoriet, Lägerhyddsvägen 1, 752 37, Uppsala, Sweden.
- Department of Women's and Children's Health, Healthcare Sciences and e-Health, Uppsala University, MTC-Huset, Dag Hammarskjölds väg 14B, 1 tr, 752 37, Uppsala, Sweden.
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22
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Wai JM, Blevins D, Hunt T, Gilbert L, Campbell ANC, Levin FR, El-Bassel N, Nunes E. An Approach to Enhancing Medication Treatment for Opioid Use Disorder in the HEALing Communities Study. Psychiatr Serv 2024; 75:580-588. [PMID: 38347814 DOI: 10.1176/appi.ps.20230159] [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] [Indexed: 04/13/2024]
Abstract
The HEALing (Helping to End Addiction Long-term) Communities Study (HCS) aims to test the effectiveness of the Communities That HEAL intervention in decreasing opioid overdose deaths in 67 communities across four U.S. states. This intervention enlists a collaborative team of researchers, academic experts, and community coalitions to select and implement interventions from a menu of evidence-based practices, including medications for opioid use disorder (MOUD). The HCS's New York team developed an integrated network systems (INS) approach with a mapping tool to coach coalitions in the selection of strategies to enhance medication treatment. With the INS approach, community coalitions develop a map of service delivery venues in their local county to better engage people with medication treatment wherever this need arises. The map is structured around core services that can provide maintenance MOUD and satellite services, which include all settings where people with opioid use disorder are encountered and can be identified, possibly given medication, and referred to core programs for ongoing MOUD care. This article describes the rationale for the INS mapping tool, with a discussion framed by the consolidated framework for implementation research, and provides a case example of its application.
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Affiliation(s)
- Jonathan M Wai
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Derek Blevins
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Tim Hunt
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Louisa Gilbert
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Frances R Levin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Nabila El-Bassel
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
| | - Edward Nunes
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and Division on Substance Use Disorders, New York State Psychiatric Institute, New York City (Wai, Blevins, Campbell, Levin, Nunes); School of Social Work, Columbia University, New York City (Hunt, Gilbert, El-Bassel)
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23
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Stevens ER, Xu L, Kwon J, Tasneem S, Henning N, Feldthouse D, Kim EJ, Hess R, Dauber-Decker KL, Smith PD, Halm W, Gautam-Goyal P, Feldstein DA, Mann DM. Barriers to Implementing Registered Nurse-Driven Clinical Decision Support for Antibiotic Stewardship: Retrospective Case Study. JMIR Form Res 2024; 8:e54996. [PMID: 38781006 PMCID: PMC11157178 DOI: 10.2196/54996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Up to 50% of antibiotic prescriptions for upper respiratory infections (URIs) are inappropriate. Clinical decision support (CDS) systems to mitigate unnecessary antibiotic prescriptions have been implemented into electronic health records, but their use by providers has been limited. OBJECTIVE As a delegation protocol, we adapted a validated electronic health record-integrated clinical prediction rule (iCPR) CDS-based intervention for registered nurses (RNs), consisting of triage to identify patients with low-acuity URI followed by CDS-guided RN visits. It was implemented in February 2022 as a randomized controlled stepped-wedge trial in 43 primary and urgent care practices within 4 academic health systems in New York, Wisconsin, and Utah. While issues were pragmatically addressed as they arose, a systematic assessment of the barriers to implementation is needed to better understand and address these barriers. METHODS We performed a retrospective case study, collecting quantitative and qualitative data regarding clinical workflows and triage-template use from expert interviews, study surveys, routine check-ins with practice personnel, and chart reviews over the first year of implementation of the iCPR intervention. Guided by the updated CFIR (Consolidated Framework for Implementation Research), we characterized the initial barriers to implementing a URI iCPR intervention for RNs in ambulatory care. CFIR constructs were coded as missing, neutral, weak, or strong implementation factors. RESULTS Barriers were identified within all implementation domains. The strongest barriers were found in the outer setting, with those factors trickling down to impact the inner setting. Local conditions driven by COVID-19 served as one of the strongest barriers, impacting attitudes among practice staff and ultimately contributing to a work infrastructure characterized by staff changes, RN shortages and turnover, and competing responsibilities. Policies and laws regarding scope of practice of RNs varied by state and institutional application of those laws, with some allowing more clinical autonomy for RNs. This necessitated different study procedures at each study site to meet practice requirements, increasing innovation complexity. Similarly, institutional policies led to varying levels of compatibility with existing triage, rooming, and documentation workflows. These workflow conflicts were compounded by limited available resources, as well as an implementation climate of optional participation, few participation incentives, and thus low relative priority compared to other clinical duties. CONCLUSIONS Both between and within health care systems, significant variability existed in workflows for patient intake and triage. Even in a relatively straightforward clinical workflow, workflow and cultural differences appreciably impacted intervention adoption. Takeaways from this study can be applied to other RN delegation protocol implementations of new and innovative CDS tools within existing workflows to support integration and improve uptake. When implementing a system-wide clinical care intervention, considerations must be made for variability in culture and workflows at the state, health system, practice, and individual levels. TRIAL REGISTRATION ClinicalTrials.gov NCT04255303; https://clinicaltrials.gov/ct2/show/NCT04255303.
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Affiliation(s)
- Elizabeth R Stevens
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lynn Xu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - JaeEun Kwon
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sumaiya Tasneem
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Natalie Henning
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Dawn Feldthouse
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Eun Ji Kim
- Northwell, New Hyde Park, NY, United States
| | - Rachel Hess
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | | | - Paul D Smith
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Wendy Halm
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
- University of Wisconsin-Madison School of Nursing, Madison, WI, United States
| | | | - David A Feldstein
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Devin M Mann
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Department of Medicine, New York University Langone, New York, NY, United States
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24
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Zhang X, Warner ME, Tennyson S, Brunner W, Wethington E, Sipple JW. School-based health centers as an approach to address health disparities among rural youth: A study protocol for a multilevel research framework. PLoS One 2024; 19:e0303660. [PMID: 38748704 PMCID: PMC11095684 DOI: 10.1371/journal.pone.0303660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
School-Based Health Centers (SBHCs) are important healthcare providers for children in medically underserved communities. While most existing research on SBHCs has focused on urban environments, this study protocol proposes a mixed-methods, multi-level research framework to evaluate the role of SBHCs in addressing health disparities among underserved children and adolescents in rural communities. The study area includes four high-poverty rural counties in New York State served by Bassett Healthcare Network that permits a comparison of school districts with SBHCs to those without SBHCs, all served by providers within the Bassett Healthcare Network. We employ a human ecological framework that integrates the micro layer of individuals and families, the meso layer of school districts and community institutions, and the macro layer of local and state policies. Our research framework first identifies the socioecological health risk factors, and then proposes innovative strategies to investigate how SBHCs impact them. We propose evaluating the impact of SBHCs on the individual (micro) level of child healthcare utilization using patient records data. At the meso level, we propose to investigate how School-SBHCs partnership may facilitate greater cross-agency collaboration and broader structural and social determinist of health to address health disparities. At the macro level, we propose to assess the impact of SBHCs and cross-agency collaboration on outcomes associated with a culture of community health. This study protocol will enable researchers to assess how SBHCs reduce rural health disparities, and provide evidence for organizational and public policy change.
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Affiliation(s)
- Xue Zhang
- Department of City and Regional Planning, Cornell University, Ithaca, NY, United States of America
| | - Mildred E. Warner
- Department of City and Regional Planning, Cornell University, Ithaca, NY, United States of America
- Department of Global Development, Cornell University, Ithaca, NY, United States of America
| | - Sharon Tennyson
- Jeb E. Brooks School of Public Policy and Department of Economics, Cornell University, Ithaca, NY, United States of America
| | - Wendy Brunner
- Bassett Research Institute, Center for Rural Community Health, Bassett Medical Center, Cooperstown, NY, United States of America
| | - Elaine Wethington
- Department of Sociology and Department of Psychology, Cornell University, Ithaca, NY, United States of America
| | - John W. Sipple
- Department of Global Development, Cornell University, Ithaca, NY, United States of America
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25
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Ito N, Sato A, Takeuchi K, Shigeno T, Sasaki H, Aoyama M, Miyashita M. Development and validation of clinical implementation methods for patient-reported outcomes in Japanese multi-center palliative care units. J Patient Rep Outcomes 2024; 8:49. [PMID: 38743180 PMCID: PMC11093964 DOI: 10.1186/s41687-024-00730-y] [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: 08/22/2023] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Patient-Reported Outcomes (PROs) are recommended for use in clinical oncology. However, they are not routinely used in professional palliative care practices in Japan. The reasons include both patient and healthcare provider factors and the implementation of PROs. This study aimed to develop and validate clinical implementation methods for PROs in Japanese palliative care units. METHODS The Consolidated Framework for Implementation Research (CFIR) was conducted with four palliative care units in Japan. The study was conducted in six steps: unit assessment, development and implementation of a PRO implementation plan, PRO post-implementation survey and analysis of its utilization, a review of the PRO implementation process, creation of a PRO implementation method in a palliative care unit, and use and verification of the implementation method. Steps 1-5 were the development phase, and step 6 was the verification phase. RESULTS Interviews were conducted with healthcare providers prior to PRO implementation. Intervention characteristics, patient needs in the palliative care unit, and factors related to the organization were identified as barriers. The implementation plan was developed, and the core members were selected. The implementation procedures were created in the above mentioned steps. PROs were used in the palliative care units. The same was true in the validation phase. CONCLUSIONS This study guided PROs in specialized palliative care unit in a clinical setting. The method was developed and validated for the implementation of PROs in the palliative care unit. In the PRO implementation process, it was important to assess the unit, address the barriers to implementation, and reduce the burden on healthcare providers. Furthermore, healthcare providers had to be supported by the champion, a person responsible for the implementation of PROs in the palliative care unit.
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Affiliation(s)
- Nao Ito
- Health Sciences, Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan.
- Iwate Medical University School of Nursing, Iwate, Japan.
| | - Azusa Sato
- Department of Nursing, Hikarigaoka Spellman Hospital, Miyagi, Japan
| | - Kana Takeuchi
- Department of Nursing, Iwate Medelical University Hospital, Iwate, Japan
| | - Tomoko Shigeno
- Health Sciences, Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
- Department of Nursing, Sanyudo Hospital, Yamagata, Japan
| | - Hiroko Sasaki
- Depart of Nursing, Omagari Kousei Medical Center, Akita, Japan
| | - Maho Aoyama
- Health Sciences, Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsunori Miyashita
- Health Sciences, Department of Palliative Nursing, Tohoku University Graduate School of Medicine, Miyagi, Japan
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26
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Colton ZA, Liles SM, Griffith MM, Stanek CJ, Walden J, King A, Barnard-Kirk T, Creary S, Nahata L. Using the consolidated framework for implementation research to identify challenges and opportunities for implementing a reproductive health education program into sickle cell disease care. J Pediatr Psychol 2024:jsae031. [PMID: 38699955 DOI: 10.1093/jpepsy/jsae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND As survival rates for individuals with sickle cell disease (SCD) increase, calls have been made to improve their reproductive healthcare and outcomes. The research team created a web-based program entitled Fertility edUcaTion to Understand ReproductivE health in Sickle cell disease (FUTURES). The study aim was to use the Consolidated Framework for Implementation Research (CFIR) during pre-implementation to identify challenges and opportunities from the individual to systems level of implementation to ultimately optimize the integration of FUTURES into clinical practice. METHODS Semi-structured interviews were conducted with clinicians, research team members, and adolescent and young adult (AYA) males with SCD and their caregivers who participated in pilot testing. Interviews (N = 31) were coded inductively and then mapped onto CFIR domains (i.e., outer setting, inner setting, characteristics of individuals, and intervention characteristics). RESULTS Research team interviews indicated the lack of universal guidelines for reproductive care in this population and gaps in reproductive health knowledge as key reasons for developing FUTURES, also highlighting the importance of collaboration with community members during development. Clinicians reported intraorganizational communication as essential to implementing FUTURES and discussed challenges in addressing reproductive health due to competing priorities. Clinicians, AYAs, and caregivers reported positive views of FUTURES regarding length, engagement, accessibility, and content. Suggestions for the best setting and timing for implementation varied. CONCLUSIONS Using CFIR during the pre-implementation phase highlighted challenges and opportunities regarding integrating this program into SCD care. These findings will inform adaptation and further testing of FUTURES to ensure effective implementation of this novel education program.
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Affiliation(s)
- Zachary A Colton
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Sophia M Liles
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Megan M Griffith
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Charis J Stanek
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Joseph Walden
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Allison King
- Department of Pediatrics, Washington University in St Louis, St Louis, MO, United States
| | - Toyetta Barnard-Kirk
- Department of Social Work at Nationwide Children's Hospital, Columbus, OH, United States
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Leena Nahata
- Center for Biobehavioral Health, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
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Gago C, De Leon E, Mandal S, de la Calle F, Garcia M, Colella D, Dapkins I, Schoenthaler A. "Hypertension is such a difficult disease to manage": federally qualified health center staff- and leadership-perceived readiness to implement a technology-facilitated team-based hypertension model. Implement Sci Commun 2024; 5:49. [PMID: 38698497 PMCID: PMC11067286 DOI: 10.1186/s43058-024-00587-8] [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: 07/27/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Despite decades of evidence demonstrating the efficacy of hypertension care delivery in reducing morbidity and mortality, a majority of hypertension cases remain uncontrolled. There is an urgent need to elucidate and address multilevel facilitators and barriers clinical staff face in delivering evidence-based hypertension care, patients face in accessing it, and clinical systems face in sustaining it. Through a rigorous pre-implementation evaluation, we aimed to identify facilitators and barriers bearing the potential to affect the planned implementation of a multilevel technology-facilitated hypertension management trial across six primary care sites in a large federally qualified health center (FQHC) in New York City. METHODS During a dedicated pre-implementation period (3-9 months/site, 2021-2022), a capacity assessment was conducted by trained practice facilitators, including (1) online anonymous surveys (n = 124; 70.5% of eligible), (2) hypertension training analytics (n = 69; 94.5% of assigned), and (3) audio-recorded semi-structured interviews (n = 67; 48.6% of eligible) with FQHC leadership and staff. Surveys measured staff sociodemographic characteristics, adaptive reserve, evidence-based practice attitudes, and implementation leadership scores via validated scales. Training analytics, derived from end-of-course quizzes, included mean score and number attempts needed to pass. Interviews assessed staff-reported facilitators and barriers to current hypertension care delivery and uptake; following audio transcription, trained qualitative researchers employed a deductive coding approach, informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS Most survey respondents reported moderate adaptive reserve (mean = 0.7, range = 0-1), evidence-based practice attitudes (mean = 2.7, range = 0-4), and implementation leadership (mean = 2.5, range = 0-4). Most staff passed training courses on first attempt and demonstrated high scores (means > 80%). Findings from interviews identified potential facilitators and barriers to implementation; specifically, staff reported that complex barriers to hypertension care, control, and clinical communication exist; there is a recognized need to improve hypertension care; in-clinic challenges with digital tool access imposes workflow delays; and despite high patient loads, staff are motivated to provide high-quality cares. CONCLUSIONS This study serves as one of the first to apply the CFIR to a rigorous pre-implementation evaluation within the understudied context of a FQHC and can serve as a model for similar trials seeking to identify and address contextual factors known to impact implementation success. TRIAL REGISTRATION ClinicalTrials.gov NCT03713515 , date of registration: October 19, 2018.
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Affiliation(s)
- Cristina Gago
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Elaine De Leon
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Soumik Mandal
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Franze de la Calle
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Masiel Garcia
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | | | - Isaac Dapkins
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
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Bahraini S, Maisonneuve AR, Wu D, Huang M, Xu M, Yang L, Li F, Samson A, Li F, Robaey P. Barriers and facilitators to implementing a Canadian shared-care ADHD program in pediatric settings in Shanghai: a consolidated framework for implementation research approach. BMC Health Serv Res 2024; 24:564. [PMID: 38698381 PMCID: PMC11064246 DOI: 10.1186/s12913-024-10910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES The vast majority of children with Attention-Deficit Hyperactivity Disorder (ADHD) do not have access to proper diagnosis and treatment in China. The goal of this project is to identify the challenges and facilitators in implementing a Canadian ADHD Shared Care Pathways program in pediatric settings in Shanghai region. METHODS Purposive semi-structured focus groups were conducted on a total of 13 healthcare practitioners from the Shanghai Xinuha, Ninghai and Chongming hospitals. Two independent researchers conducted a thematic analysis of the data with themes emerging based on the Consolidated Framework for Implementation Research (CFIR). RESULTS Notable barriers identified by participants included: (1) lack of knowledge in the management of ADHD, primarily among general practitioners; (2) lack of resources such as lack of staff, time, and medication for ADHD; (3) challenges in implementing an international multicentre intervention (such as communication difficulties between teams and integration of resources available in different hospitals); and (4) mental health stigma, difficulties in identifying ADHD patients, and logistical problems related to medication procurement rules put in place by provincial governments. Notable facilitators included: (1) the strong motivation of stakeholders and their confidence in their ability to learn and subsequently execute action plans to achieve the implementation goal; (2) the compatibility between the values and goals of the stakeholders and those of the program despite some cultural tension, a positive learning climate, strong tensions for change, and the high interest of organization leaders in engaging in the program (3) the perceived benefits of the program, such as standardization of the diagnostic and treatment process, and engaging primary care providers in ADHD management; and (4) the strong relationship between participating institutions and schools as well as provincial health initiatives available to support collaborative models of care. Mixed factors to implementation were also explored. CONCLUSIONS Appropriate training of health care providers, cultural adaptation of the program, increase public awareness about ADHD to decrease stigma, as well as strong project management and guidelines that clearly describe the role and expectations of each team member appeared essential to successful implementation.
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Affiliation(s)
- Sayna Bahraini
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Alexander R Maisonneuve
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minhui Huang
- Ninghai Maternity and Child Health Care Hospital, Ning Bo, China
| | - Mingyu Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Yang
- Peking University Sixth Hospital (Institute of Mental Health), National Clinical Research Center for Mental Disorders, Beijing, China
- Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Feng Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research, Shanghai, China.
- Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Philippe Robaey
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- University of Ottawa, Ottawa, Canada.
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Kimpel CC, Myer EA, Cupples A, Roman Jones J, Seidler KJ, Rick CK, Brown R, Rawlins C, Hadler R, Tsivitse E, Lawlor MAC, Ratcliff A, Holt NR, Callaway-Lane C, Godwin K, Ecker AH. Identifying Barriers and Facilitators to Veterans Affairs Whole Health Integration Using the Updated Consolidated Framework for Implementation Research. J Healthc Qual 2024; 46:137-149. [PMID: 38147581 PMCID: PMC11065588 DOI: 10.1097/jhq.0000000000000419] [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: 12/28/2023]
Abstract
BACKGROUND Veterans Affairs (VA) implemented the Veteran-centered Whole Health System initiative across VA sites with approaches to implementation varying by site. PURPOSE Using the Consolidated Framework for Implementation Research (CFIR), we aimed to synthesize systemic barriers and facilitators to Veteran use with the initiative. Relevance to healthcare quality, systematic comparison of implementation procedures across a national healthcare system provides a comprehensive portrait of strengths and opportunities for improvement. METHODS Advanced fellows from 11 VA Quality Scholars sites performed the initial data collection, and the final report includes CFIR-organized results from six sites. RESULTS Key innovation findings included cost, complexity, offerings, and accessibility. Inner setting barriers and facilitators included relational connections and communication, compatibility, structure and resources, learning centeredness, and information and knowledge access. Finally, results regarding individuals included innovation deliverers, implementation leaders and team, and individual capability, opportunity, and motivation to implement and deliver whole health care. DISCUSSION AND IMPLICATIONS Examination of barriers and facilitators suggest that Whole Health coaches are key components of implementation and help to facilitate communication, relationship building, and knowledge access for Veterans and VA employees. Continuous evaluation and improvement of implementation procedures at each site is also recommended.
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Fehlberg Z, Stark Z, Best S. Reanalysis of genomic data, how do we do it now and what if we automate it? A qualitative study. Eur J Hum Genet 2024; 32:521-528. [PMID: 38212661 PMCID: PMC11061153 DOI: 10.1038/s41431-023-01532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024] Open
Abstract
Automating reanalysis of genomic data for undiagnosed rare disease patients presents a paradigm shift in how clinical genomics is delivered. We aimed to map the current manual and proposed automated approach to reanalysis and identify possible implementation strategies to address clinical and laboratory staff's perceived challenges to automation. Fourteen semi-structured interviews guided by a simplified process map were conducted with clinical and laboratory staff across Australia. Individual process maps were integrated into an overview of the current process, noting variation in service delivery. Participants then mapped an automated approach and were invited to discuss perceived challenges and possible supports to automation. Responses were analysed using the Consolidated Framework for Implementation Research, linking to the Expert Recommendations for Implementing Change framework to identify theory-informed implementation strategies. Process mapping demonstrates how automation streamlines processes with eleven steps reduced to seven. Although participants welcomed automation, challenges were raised at six of the steps. Strategies to overcome challenges include embedding project champions, developing education materials, facilitating clinical innovation and quality monitoring tools, and altering reimbursement structures. Future work can build on these findings to develop context specific implementation strategies to guide translation of an automated approach to reanalysis to improve clinical care and patient outcomes.
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Affiliation(s)
- Zoe Fehlberg
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
| | - Zornitza Stark
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- University of Melbourne, Melbourne, VIC, Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
- University of Melbourne, Melbourne, VIC, Australia.
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia.
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia.
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Evans SK, Ober AJ, Korn AR, Peltz A, Friedmann PD, Page K, Murray-Krezan C, Huerta S, Ryzewicz SJ, Tarhuni L, Nuckols TK, E Watkins K, Danovitch I. Contextual barriers and enablers to establishing an addiction-focused consultation team for hospitalized adults with opioid use disorder. Addict Sci Clin Pract 2024; 19:31. [PMID: 38671482 PMCID: PMC11046820 DOI: 10.1186/s13722-024-00461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Hospitalization presents an opportunity to begin people with opioid use disorder (OUD) on medications for opioid use disorder (MOUD) and link them to care after discharge; regrettably, people admitted to the hospital with an underlying OUD typically do not receive MOUD and are not connected with subsequent treatment for their condition. To address this gap, we launched a multi-site randomized controlled trial to test the effectiveness of a hospital-based addiction consultation team (the Substance Use Treatment and Recovery Team (START)) consisting of an addiction medicine specialist and care manager team that provide collaborative care and a specified intervention to people with OUD during the inpatient stay. Successful implementation of new practices can be impacted by organizational context, though no previous studies have examined context prior to implementation of addiction consultation services (ACS). This study assessed pre-implementation context for implementing a specialized ACS and tailoring it accordingly. METHODS We conducted semi-structured interviews with hospital administrators, physicians, physician assistants, nurses, and social workers at the three study sites between April and August 2021 before the launch of the pragmatic trial. Using an analytical framework based on the Consolidated Framework for Implementation Research, we completed a thematic analysis of interview data to understand potential barriers or enablers and perceptions about acceptability and feasibility. RESULTS We interviewed 28 participants across three sites. The following themes emerged across sites: (1) START is an urgently needed model for people with OUD; (2) Intervention adaptations are recommended to meet local and cultural needs; (3) Linking people with OUD to community clinicians is a highly needed component of START; (4) It is important to engage stakeholders across departments and roles throughout implementation. Across sites, participants generally saw a need for change from usual care to support people with OUD, and thought the START was acceptable and feasible to implement. Differences among sites included tailoring the START to support the needs of varying patient populations and different perceptions of the prevalence of OUD. CONCLUSIONS Hospitals planning to implement an ACS in the inpatient setting may wish to engage in a systematic pre-implementation contextual assessment using a similar framework to understand and address potential barriers and contextual factors that may impact implementation. Pre-implementation work can help ensure the ACS and other new practices fit within each unique hospital context.
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Affiliation(s)
- Sandra K Evans
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA.
| | - Allison J Ober
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Ariella R Korn
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Alex Peltz
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Peter D Friedmann
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Kimberly Page
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Cristina Murray-Krezan
- Departement of Medicine, University of Pittsburgh School of Medicine, 200 Meyran Ave, Suite 300, 15213, Pittsburgh, PA, USA
| | - Sergio Huerta
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Stephen J Ryzewicz
- Department of Medicine, University of Massachusetts Chan Medical School-Baystate and Baystate Health, 3601 Main Street, 3rd Floor, 01107, Springfield, MA, USA
| | - Lina Tarhuni
- University of New Mexico Health Sciences Center, 1 University, MSC10 5550, 87133, Albuquerque, NM, USA
| | - Teryl K Nuckols
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
| | - Katherine E Watkins
- RAND Corporation, 1776 Main Street, 90407‑2138, Santa Monica, CA, P.O. Box 2138, USA
| | - Itai Danovitch
- Cedars-Sinai Medical Center, 8700 Beverly Boulevard, 90048, West Hollywood, CA, USA
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Otani VHO, Novaes RACB, Pedron J, Nabhan PC, Rodrigues TM, Chiba R, Guedes JVC, Marques LM, Vissoci JRN. Framework proposal for Role-Playing Games as mental health intervention: the Critical Skills methodology. Front Psychiatry 2024; 15:1297332. [PMID: 38726380 PMCID: PMC11079307 DOI: 10.3389/fpsyt.2024.1297332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/19/2024] [Indexed: 05/12/2024] Open
Abstract
Gamified interventions are an emerging approach in mental health treatment and prevention. Their positive effects on managing various clinical conditions stem from enhancing social skills. However, cost-effective options like Table-top Role-Playing Games (TTRPGs), which offer similar benefits to other game-based interventions, lack standardized methods for ensuring replicability. In this regard, the method outlined in this study endeavors, in a structured and guided manner drawing from the Consolidated Framework for Implementation Research (CFIR), to establish a six-step protocol for developing an intervention method utilizing TTRPGs. In all Steps, we aim to anchor ourselves in robust literature concerning social skills training (SST), cognitive behavioral therapy (CBT), and gamification comprehensively. Thus, the method presented encompasses the objectives of SST, the strategies of CBT, and the dynamics of gamification via TTRPGs. Furthermore, we demonstrate a possible application of the method to illustrate its feasibility. Ultimately, the final method is structured, evidence-based, easily applicable, cost-effective, and thus viable. Mental health professionals seeking a structured and instructional tool for protocol development will find support in the method proposed here.
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Affiliation(s)
| | | | - Julia Pedron
- Mental Health Department, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Pedro Chen Nabhan
- Mental Health Department, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Thaísa Malbar Rodrigues
- Mental Health Department, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - Ryo Chiba
- Mental Health Department, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Lucas Murrins Marques
- Mental Health Department, Santa Casa de Sao Paulo School of Medical Sciences, São Paulo, Brazil
| | - João Ricardo Nickenig Vissoci
- Division of Translational Health Sciences, Department of Emergency Medicine, Duke Global Health Institute, Duke University, Durham, NC, United States
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Tucker R, Vickers R, Adams EJ, Burgon C, Lock J, Goldberg SE, Gladman J, Masud T, Orton E, Timmons S, Harwood RH. Factors influencing the commissioning and implementation of health and social care interventions for people with dementia: commissioner and stakeholder perspectives. Arch Public Health 2024; 82:54. [PMID: 38654372 PMCID: PMC11036601 DOI: 10.1186/s13690-024-01283-8] [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: 12/12/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Despite several interventions demonstrating benefit to people living with dementia and their caregivers, few have been translated and implemented in routine clinical practice. There is limited evidence of the barriers and facilitators for commissioning and implementing health and social care interventions for people living with dementia. The aim of the current study was to explore the barriers and facilitators to commissioning and implementing health and social care interventions for people with dementia, using a dementia friendly exercise and physical activity-based intervention (PrAISED [Promoting Activity, Stability and Independence in Early Dementia and Mild Cognitive Impairment]) as a case study. METHODS Qualitative semi-structured interviews were conducted with stakeholders from a range of backgrounds including individuals from health and social care, local government, the voluntary and community sector, universities, and research centres in England. The Consolidated Framework for Intervention Research (CFIR) was used to guide the design and analysis. RESULTS Fourteen participants took part, including commissioning managers, service managers, partnership managers, charity representatives, commercial research specialists, academics/researchers, and healthcare professionals. Data were represented in 33 constructs across the five CFIR domains. Participants identified a need for greater support for people diagnosed with dementia and their caregivers immediately post dementia diagnosis. Key barriers included cost/financing, the culture of commissioning, and available resources. Key facilitators included the adaptability of the intervention, cosmopolitanism/partnerships and connections, external policy and incentives, and the use of already existing (and untapped) workforces. CONCLUSION Several barriers and facilitators for commissioning and implementing health and social care interventions for people with dementia were identified which need to be addressed. Recommended actions to facilitate the commissioning and implementation of dementia friendly services are: 1) map out local needs, 2) evidence the intervention including effectiveness and cost-effectiveness, 3) create/utilise networks with stakeholders, and 4) plan required resources.
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Affiliation(s)
- Rachael Tucker
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Robert Vickers
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- National Institute for Health and Social Care Research (NIHR) Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
| | - Emma J Adams
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Clare Burgon
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Juliette Lock
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - John Gladman
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- National Institute for Health and Social Care Research (NIHR) Nottingham Biomedical Research Centre (BRC), Nottingham, UK
- National Institute for Health and Social Care Research (NIHR) Applied Research Collaboration (ARC) East Midlands, Nottingham, UK
| | - Tahir Masud
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Elizabeth Orton
- School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | | | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Scantlebury A, Sivey P, Anteneh Z, Ayres B, Bloor K, Castelli A, Castro-Avila AC, Davies F, Davies S, Glerum-Brooks K, Gutacker N, Lampard P, Rangan A, Saad A, Street A, Wen J, Adamson J. Mixed Methods EvAluation of the high-volume low-complexity Surgical hUb pRogrammE (MEASURE): a mixed methods study protocol. BMJ Open 2024; 14:e086338. [PMID: 38643003 PMCID: PMC11033628 DOI: 10.1136/bmjopen-2024-086338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The waiting list for elective surgery in England recently reached over 7.8 million people and waiting time targets have been missed since 2010. The high-volume low complexity (HVLC) surgical hubs programme aims to tackle the backlog of patients awaiting elective surgery treatment in England. This study will evaluate the impact of HVLC surgical hubs on productivity, patient care and the workforce. METHODS AND ANALYSIS This 4-year project consists of six interlinked work packages (WPs) and is informed by the Consolidated Framework for Implementation Research. WP1: Mapping current and future HVLC provision in England through document analysis, quantitative data sets (eg, Hospital Episodes Statistics) and interviews with national service leaders. WP2: Exploring the effects of HVLC hubs on key performance outcomes, primarily the volume of low-complexity patients treated, using quasi-experimental methods. WP3: Exploring the impact and implementation of HVLC hubs on patients, health professionals and the local NHS through approximately nine longitudinal, multimethod qualitative case studies. WP4: Assessing the productivity of HVLC surgical hubs using the Centre for Health Economics NHS productivity measure and Lord Carter's operational productivity measure. WP5: Conducting a mixed-methods appraisal will assess the influence of HVLC surgical hubs on the workforce using: qualitative data (WP3) and quantitative data (eg, National Health Service (NHS) England's workforce statistics and intelligence from WP2). WP6: Analysing the costs and consequences of HVLC surgical hubs will assess their achievements in relation to their resource use to establish value for money. A patient and public involvement group will contribute to the study design and materials. ETHICS AND DISSEMINATION The study has been approved by the East Midlands-Nottingham Research Ethics Committee 23/EM/0231. Participants will provide informed consent for qualitative study components. Dissemination plans include multiple academic and non-academic outputs (eg, Peer-reviewed journals, conferences, social media) and a continuous, feedback-loop of findings to key stakeholders (eg, NHS England) to influence policy development. TRIAL REGISTRATION Research registry: Researchregistry9364 (https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/64cb6c795cbef8002a46f115/).
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Affiliation(s)
| | - Peter Sivey
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Zecharias Anteneh
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Ben Ayres
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Adriana Castelli
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | | | - Firoza Davies
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Simon Davies
- Centre for Health and Population Sciences, Hull York Medical School, Hull, UK
| | - Karen Glerum-Brooks
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Pete Lampard
- Department of Health Sciences, University of York, York, Yorkshire, UK
| | - Amar Rangan
- Department of Health Sciences, University of York, York, Yorkshire, UK
- Trauma and Orthopaedics, James Cook University Hospital, Middlesbrough, UK
| | - Ahmed Saad
- Opthamology, James Cook University Hospital, Middlesbrough, UK
- Hull York Medical School, Hull, UK
| | | | - Jinglin Wen
- Centre for Health Economics, University of York, York, Yorkshire, UK
| | - Joy Adamson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
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Sorensen J, Kadowaki L, Kervin L, Hamilton C, Berndt A, Dhadda S, Irfan A, Leong E, Mithani A. Quality improvement collaborative approach to COVID-19 pandemic preparedness in long-term care homes: a mixed-methods implementation study. BMJ Open Qual 2024; 13:e002589. [PMID: 38589056 PMCID: PMC11015329 DOI: 10.1136/bmjoq-2023-002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The devastating impact of the COVID-19 pandemic on long-term care (LTC) homes underscores the importance of effective pandemic preparedness and response. This mixed-methods, implementation science study investigated how a virtual-based quality improvement (QI) collaborative approach can improve uptake of pandemic-related promising practices and shared learning across six LTC homes in British Columbia, Canada in 2021 during the COVID-19 pandemic health emergency. METHODS QI teams consisting of residents, family/informal caregivers, care providers and leadership in LTC homes are supported by QI facilitation and shared learning through virtual communication platforms. QI projects address gaps in outbreak preparation, prevention and response; planning for care; staffing; and family presence. Thematically analysed semi-structured qualitative interviews and a validated questionnaire on organisational readiness investigated participants' perceptions of challenges, success factors and benefits of participating in the virtual QI collaborative approach. RESULTS Nine themes were identified through interview analysis, including two related to challenges (ie, making time for QI and hands tied by external forces), four regarding factors for successes (ie, team buy-in, working together as a team, bringing together diverse perspectives and facilitators keep us on track) and three on the benefits of the QI collaborative approach (ie, seeing improvements, staff empowerment and appetite for change). Continuous QI facilitation and coaching for QI teams was feasible and sustainable virtually via video conferencing (Zoom). The QI team members showed limited engagement on the virtual communication platform (Slack), which was predominantly used by the implementation science team and QI facilitators to coordinate the study and QI projects, respectively. CONCLUSIONS The virtual-based QI collaborative approach to pandemic preparedness supported LTC homes to rapidly and successfully form multidisciplinary QI teams, learn about QI methods and conduct timely QI projects to implement promising practice for improved COVID-19 pandemic response.
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Affiliation(s)
- Janice Sorensen
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Laura Kadowaki
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Lucy Kervin
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University Gerontology Research Centre, Vancouver, British Columbia, Canada
| | - Clayon Hamilton
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Annette Berndt
- Long-Term Care and Assisted Living Research Partners Group, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Simran Dhadda
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Abeera Irfan
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Emma Leong
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Akber Mithani
- Long-Term Care and Assisted Living, Fraser Health Authority, Surrey, British Columbia, Canada
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
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Zettergren L, Larsson EC, Hellsten L, Kosidou K, Nielsen AM. Implementing digital sexual and reproductive health care services in youth clinics: a qualitative study on perceived barriers and facilitators among midwives in Stockholm, Sweden. BMC Health Serv Res 2024; 24:411. [PMID: 38566080 PMCID: PMC10988956 DOI: 10.1186/s12913-024-10932-1] [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: 01/03/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics. METHODS We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR). RESULTS Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents. CONCLUSION Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health.
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Affiliation(s)
- Linn Zettergren
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Elin C Larsson
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Department of Womens and Childrens Health, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden
| | - Lovisa Hellsten
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden
| | - Anna Maria Nielsen
- Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset 171 77, Stockholm, Sweden.
- Center for Epidemiology and Community Medicine, Region Stockholm, SE-104 31, Stockholm, Box 45436, Sweden.
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Wilson HK, Wieler C, Bell DL, Bhattarai AP, Castillo-Hernandez IM, Williams ER, Evans EM, Berg AC. Implementation of the Diabetes Prevention Program in Georgia Cooperative Extension According to RE-AIM and the Consolidated Framework for Implementation Research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:34-45. [PMID: 36930404 PMCID: PMC10021035 DOI: 10.1007/s11121-023-01518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/18/2023]
Abstract
Increased dissemination of the CDC's Diabetes Prevention Program (DPP) is imperative to reduce type 2 diabetes. Due to its nationwide reach and mission to improve health, Cooperative Extension (Extension) is poised to be a sustainable DPP delivery system. However, research evaluating DPP implementation in Extension remains scant. Extension professionals delivered the DPP in a single-arm hybrid type II effectiveness-implementation study. Semi-structured interviews with Extension professionals were conducted at three time points. The Consolidated Framework for Implementation Research (CFIR) guided interview coding and analysis. Constructs were rated for magnitude and valence and evaluated as facilitators or barriers of RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) outcomes. The program reached 119 participants, was adopted by 92% (n = 12/13) of trained Extension professionals and was implemented according to CDC standards: all programs exceeded the minimum 22-session requirement (26 ± 2 sessions). The program was effective in achieving weight loss (5.0 ± 5.2%) and physical activity (179 ± 122 min/week) goals. At post-intervention, eight professionals (67%) had begun or planned to maintain the intervention within the next 6 months. Several facilitators were identified, including Extension leadership structure, organizational compatibility, and technical assistance calls. Limited time to recruit participants was the primary barrier. Positive RE-AIM outcomes, facilitated by contextual factors, indicate Extension is an effective and sustainable DPP delivery system. Extension and other DPP implementers should plan strategies that promote communication, the program's evidence-base, recruitment time, and resource access. Researchers should explore DPP implementation in real-world settings to determine overall and setting-specific best practices, promote intervention uptake, and reduce diabetes.
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Affiliation(s)
- Hannah K Wilson
- Department of Nutrition, Dietetics and Exercise Science, Concordia College, Moorhead, MN, 56562, USA
| | - Caroline Wieler
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA
| | - Darci L Bell
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA
| | - Ajit P Bhattarai
- Department of Organizational Learning and Performance, Idaho State University, Pocatello, ID, 83209, USA
| | - Isaura M Castillo-Hernandez
- Human Movement Sciences Research Center, School of Physical Education and Sports, University of Costa Rica, San José, 11502, Costa Rica
| | - Ewan R Williams
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ellen M Evans
- Department of Kinesiology, University of Georgia, Athens, GA, 30602, USA
| | - Alison C Berg
- Department of Nutritional Sciences, University of Georgia, Athens, GA, 30602, USA.
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Lowenthal ED, Chapman J, Ohrenschall R, Calabrese K, Baltrusaitis K, Heckman B, Yin DE, Agwu AL, Harrington C, Van Solingen-Ristea RM, McCoig CC, Adeyeye A, Kneebone J, Chounta V, Smith-Anderson C, Camacho-Gonzalez A, D'Angelo J, Bearden A, Crauwels H, Huang J, Buisson S, Milligan R, Ward S, Bolton-Moore C, Gaur AH. Acceptability and tolerability of long-acting injectable cabotegravir or rilpivirine in the first cohort of virologically suppressed adolescents living with HIV (IMPAACT 2017/MOCHA): a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study. Lancet HIV 2024; 11:e222-e232. [PMID: 38538161 PMCID: PMC11061207 DOI: 10.1016/s2352-3018(23)00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND Long-acting injectable cabotegravir and rilpivirine have demonstrated safety, acceptability, and efficacy in adults living with HIV-1. The IMPAACT 2017 study (MOCHA study) was the first to use these injectable formulations in adolescents (aged 12-17 years) living with HIV-1. Herein, we report acceptability and tolerability outcomes in cohort 1 of the study. METHODS In this a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study, with continuation of pre-study oral combination antiretroviral treatment (ART), 55 adolescents living with HIV-1 were enrolled to receive sequential doses of either long-acting cabotegravir or rilpivirine and 52 received at least two injections. Participants had a body weight greater than 35 kg and BMI less than 31·5 kg/m2 and had been on stable ART for at least 90 consecutive days with an HIV-1 viral load of less than 50 copies per mL at a participating IMPAACT study site. Participants had to be willing to continue their pre-study ART during cohort 1. The primary objectives of the study were to confirm doses for oral and injectable cabotegravir and for injectable rilpivirine in adolescents living with HIV. This analysis of participant-reported outcomes included a face scale assessment of pain at each injection and a Pediatric Quality of Life Inventory (PedsQL) at baseline and week 16 for participants in the USA, South Africa, Botswana, and Thailand. A subset of 11 adolescents and 11 parents or caregivers in the USA underwent in-depth interviews after receipt of one or two injections. This trial is registered at ClinicalTrials.gov, NCT03497676. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled into cohort 1. Using the six-point face scale, 43 (83%) of participants at week 4 and 38 (73%) at week 8 reported that the injection caused "no hurt" or "hurts little bit", while only a single (2%) participant for each week rated the pain as one of the two highest pain levels. Quality of life was not diminished by the addition of one injectable antiretroviral. In-depth interviews revealed that parents and caregivers in the USA frequently had more hesitancy than adolescents about use of long-acting formulations, but parental acceptance was higher after their children received injections. INTERPRETATION High acceptability and tolerability of long-acting cabotegravir or rilpivirine injections suggests that these are likely to be favoured treatment options for some adolescents living with HIV. FUNDING National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Philadelphia, PA, USA.
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Dwight E Yin
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | | | | | | | | | - Jessica D'Angelo
- Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bearden
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jenny Huang
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Shawn Ward
- Frontier Science Foundation, Amherst, NY, USA
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia/University of Alabama Birmingham, Lusaka, Zambia
| | - Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA
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Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-171. [PMID: 38662367 DOI: 10.3310/twdu4109] [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: 04/26/2024]
Abstract
Background Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. Aim To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. Methods Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards' reporting guidelines. Data sources First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied. Results We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work ('serve and sacrifice'); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors. Conclusions Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being. Future work Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs. Limitations The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample. Study registration This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jill Maben
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Cath Taylor
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Justin Jagosh
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Simon Briscoe
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Naomi Klepacz
- School of Health Sciences, University of Surrey, Guildford, UK
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex, Southampton, UK
| | - Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Harris JI, Dunlap S, Xanthos D, Pyne JM, Hermes E, Griffin BJ, Kondrath SR, Kim SY, Golden KB, Cooney NJ, Usset TJ. Implementing a Multi-Disciplinary, Evidence-Based Resilience Intervention for Moral Injury Syndrome: Systemic Barriers and Facilitators. Behav Sci (Basel) 2024; 14:281. [PMID: 38667079 PMCID: PMC11047717 DOI: 10.3390/bs14040281] [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: 02/09/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/29/2024] Open
Abstract
Moral injury syndrome (MIS) is a mental health (MH) problem that substantially affects resilience; the presence of MIS reduces responsiveness to psychotherapy and increases suicide risk. Evidence-based treatment for MIS is available; however, it often goes untreated. This project uses principles of the Consolidated Framework for Implementation Research (CFIR) to assess barriers and facilitators to the implementation of Building Spiritual Strength (BSS), a multi-disciplinary treatment for MIS. Interviews were conducted with chaplains and mental health providers who had completed BSS facilitator training at six sites in the VA. Data were analyzed using the Hamilton Rapid Turnaround method. Findings included multiple facilitators to the implementation of BSS, including its accessibility and appeal to VA chaplains; leadership by VA chaplains trained in the intervention; and effective collaboration between the chaplains and mental health providers. Barriers to the implementation of BSS included challenges in engaging mental health providers and incorporating them as group leaders, veterans' lack of familiarity with the group format of BSS, and the impact of the COVID-19 pandemic. Results highlight the need for increased trust and collaboration between VA chaplains and mental health providers in the implementation of BSS and treatment of MIS.
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Affiliation(s)
- J. Irene Harris
- VA Maine Healthcare System, Augusta, ME 04330, USA; (S.R.K.); (N.J.C.); (T.J.U.)
- Department of Psychology, University of Maine, Orono, ME 04469, USA
| | - Shawn Dunlap
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA; (S.D.); (K.B.G.)
| | | | - Jeffrey M. Pyne
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA; (J.M.P.)
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Eric Hermes
- Veterans Affairs Northeast Program Evaluation Center, Orange, CT 06516, USA
| | - Brandon J. Griffin
- Center for Mental Health Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114, USA; (J.M.P.)
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Susannah Robb Kondrath
- VA Maine Healthcare System, Augusta, ME 04330, USA; (S.R.K.); (N.J.C.); (T.J.U.)
- Department of Psychology, University of Maine, Orono, ME 04469, USA
| | - Se Yun Kim
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA; (S.D.); (K.B.G.)
| | - Kristin B. Golden
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA 01730, USA; (S.D.); (K.B.G.)
| | - Nathaniel J. Cooney
- VA Maine Healthcare System, Augusta, ME 04330, USA; (S.R.K.); (N.J.C.); (T.J.U.)
| | - Timothy J. Usset
- VA Maine Healthcare System, Augusta, ME 04330, USA; (S.R.K.); (N.J.C.); (T.J.U.)
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN 55455, USA
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Dickson KS, Holt T, Arredondo EM. Enhancing Behavioral Health Implementation in a Care Coordination Program at a Federally Qualified Health Center: A Case Study Applying Implementation Frameworks. Health Promot Pract 2024:15248399241237958. [PMID: 38504420 DOI: 10.1177/15248399241237958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.
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Affiliation(s)
- Kelsey S Dickson
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Tana Holt
- San Diego State University, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
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Oetzel J, Ngawati R, Penetito-Hemara D, Puke TT, Henry A, Povaru-Bourne S, Sika-Paotonu D. Facilitators and barriers for implementation of health programmes with Māori communities. Implement Sci Commun 2024; 5:26. [PMID: 38500225 PMCID: PMC10946171 DOI: 10.1186/s43058-024-00567-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/09/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Addressing health inequities that Māori (Indigenous peoples) communities face in New Zealand is a key aim of researchers and practitioners. However, there is limited understanding of the implementation processes and outcomes of health programmes for addressing these inequities. The aim of this study was twofold: (a) to identify correlates of implementation outcomes and (b) to identify facilitators and barriers to implementation effectiveness. METHODS The study involved a concurrent mixed method approach. Through an online survey, 79 participants with experience in implementing a health programme with a Māori community identified outcomes and processes of the programme. Additionally, nine Māori community providers shared their perceptions and experience of facilitators and barriers to implementation effectiveness through an in-depth interview. The quantitative and qualitative findings were integrated to address the aims of the study. RESULTS For the first aim, we identified two key outcomes: overall health impacts and sustainability. Three of the variables had significant and positive bivariate correlations with health impacts: cultural alignment, community engagement, and individual skills. The only significant correlate of sustainability was evidence-based. For the second aim, participants described four facilitators (leadership, whanaungatanga [relationships], sharing information, digestible information) and four barriers (system constraints, lack of funding, cultural constraints, lack of engagement) to effective implementation. CONCLUSION Overall, leadership, aligning culture, and building on whanaungatanga, while getting financial resources and systems support, are the core elements to supporting implementation efforts in Māori communities.
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Affiliation(s)
- John Oetzel
- University of Waikato, Private Bag 3105, Hamilton, 3240, New Zealand.
| | - Renei Ngawati
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
| | - Darrio Penetito-Hemara
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
| | - Tori Te Puke
- Te Hotu Manawa Māori trading as Toi Tangata, 9 Kalmia Street, Auckland, 1051, New Zealand
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Akarere Henry
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Sulita Povaru-Bourne
- South Waikato Pacific Islands Community Services Trust, 1 Maraetai Lane, Tokoroa, 3420, New Zealand
| | - Dianne Sika-Paotonu
- University of Otago, Wellington, 23A Mein Street, Wellington, 6242, New Zealand
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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 2024:103688. [PMID: 38494383 DOI: 10.1016/j.iccn.2024.103688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study. JMIR Hum Factors 2024; 11:e53391. [PMID: 38457798 PMCID: PMC10960209 DOI: 10.2196/53391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. OBJECTIVE This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). METHODS We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. RESULTS HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. CONCLUSIONS eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies-Digital Health and Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Dürsch H, Boltenhagen U, Mahler C, Joos S, Szecsenyi J, Klafke N. A Qualitative Analysis of Cancer Patients' Perceptions of an Interprofessional Counseling Service on Complementary and Integrative Healthcare. QUALITATIVE HEALTH RESEARCH 2024:10497323241231530. [PMID: 38441438 DOI: 10.1177/10497323241231530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive-inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services.
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Affiliation(s)
- Helena Dürsch
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ursula Boltenhagen
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Cornelia Mahler
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Hu Y, Yan R, Yin X, Gong E, Xin X, Gao A, Shi X, Wang J, Xue H, Feng L, Zhang J. Effectiveness of Multifaceted Strategies to Increase Influenza Vaccination Uptake: A Cluster Randomized Trial. JAMA Netw Open 2024; 7:e243098. [PMID: 38526493 PMCID: PMC10964116 DOI: 10.1001/jamanetworkopen.2024.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/26/2024] [Indexed: 03/26/2024] Open
Abstract
Importance Influenza vaccination rates remain low among primary school students and vary by school in Beijing, China. Theory-informed, multifaceted strategies are needed to improve influenza vaccination uptake. Objective To evaluate the effectiveness of multifaceted strategies in improving influenza vaccination uptake among primary school students. Design, Setting, and Participants This cluster randomized trial was conducted from September 2022 to May 2023 across primary schools in Beijing, China. Schools were allocated randomly in a 1:1 ratio to multifaceted strategies or usual practice. Schools were deemed eligible if the vaccination rates in the 2019 to 2020 season fell at or below the district-wide average for primary schools. Eligible participants included students in grades 2 and 3 with no medical contraindications for influenza vaccination. Intervention The multifaceted strategies intervention involved system-level planning and coordination (eg, developing an implementation blueprint, building social norms, and enhancing supervision), school-level training and educating school implementers (eg, conducting a 1-hour training and developing educational materials), and individual-level educating and reminding students and parents (eg, conducting educational activities and sending 4 reminders about vaccination). Main Outcomes and Measures The primary outcomes were influenza vaccination uptake at school reported by school clinicians as well as overall vaccine uptake either at school or outside of school as reported by parents at 3 months. Generalized linear mixed models were used for analysis. Results A total of 20 schools were randomized. One intervention school and 2 control schools did not administer vaccination on school grounds due to COVID-19, resulting in a total of 17 schools (9 intervention and 8 control). There was a total of 1691 students aged 7 to 8 years (890 male [52.6%]; 801 female [47.4%]) including 915 in the intervention group and 776 in the control group. Of all participants, 848 (50.1%) were in grade 2, and 1209 (71.5%) were vaccinated in the 2021 to 2022 season. Participants in the intervention and control groups shared similar characteristics. At follow-up, of the 915 students in the intervention group, 679 (74.5%) received a vaccination at school, and of the 776 students in the control group, 556 (71.7%) received a vaccination at school. The overall vaccination rates were 76.0% (695 of 915 students) for the intervention group and 71.3% (553 of 776 students) for the control group. Compared with the control group, there was significant improvement of vaccination uptake at school (odds ratio, 1.40; 95% CI, 1.06-1.85; P = .02) and overall uptake (odds ratio, 1.49; 95% CI, 1.12-1.99; P = .01) for the intervention group. Conclusions and Relevance In this study, multifaceted strategies showed modest effectiveness in improving influenza vaccination uptake among primary school students, which provides a basis for the implementation of school-located vaccination programs of other vaccines in China, and in other countries with comparable programs. Trial registration Chinese Clinical Trial Registry: ChiCTR2200062449.
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Affiliation(s)
- Yiluan Hu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruijie Yan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuejun Yin
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- The George Institute for Global Health, University of New South Wales, Newtown, New South Wales, Australia
| | - Enying Gong
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xin Xin
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Aiyu Gao
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Xiaoyan Shi
- Dongcheng Primary and Secondary School Health Care Center, Beijing, China
| | - Jing Wang
- Department of Infectious Disease, Dongcheng Center for Disease Control and Prevention, Beijing, China
| | - Hao Xue
- Stanford Center on China’s Economy and Institutions, Stanford University, Stanford, California
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Juan Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
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Gil N, Cox A, Whitaker KL, Kerrison RS. Cancer risk-factor and symptom awareness among adults with intellectual disabilities, paid and unpaid carers, and healthcare practitioners: a scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:193-211. [PMID: 38057951 DOI: 10.1111/jir.13110] [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: 08/08/2023] [Revised: 10/18/2023] [Accepted: 11/07/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The physical health of people with intellectual disabilities (ID) has been identified as an area of ongoing concern and priority. Research has increasingly focused on cancer, with studies indicating that people with ID are at an increased risk of cancer and of mortality, compared with the general population. This review aims to systematically identify and synthesise the published academic literature exploring cancer risk-factor and symptom awareness among people with IDs, carers and healthcare professionals. METHODS In line with Arksey and O'Malley's (2005) framework for scoping reviews, five incremental stages were followed: (1) identifying research question, (2) identifying relevant studies, (3) study selection, (4) extracting and charting of data, and (5) collating, summarising and reporting results. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews (PRISMA-Scr). RESULTS The search strategy identified 352 records, 16 records met all eligibility criteria and were included for review. The studies address a range of areas including knowledge and awareness of cancer risk-factors and symptoms and interventions to promote awareness of cancer. CONCLUSIONS Cancer risk-factor and symptom awareness is low among adults with ID, paid and unpaid carers and healthcare practitioners (HCPs). Theoretically underpinned, co-designed tools and interventions to improve awareness are lacking. There is uncertainty surrounding how to best support people with ID in raising cancer awareness, even within the professional healthcare environment. There is a predominance of research on breast cancer awareness. Future studies focusing on other cancers are needed to build a complete picture of awareness among adults with IDs, paid and unpaid carers, and HCPs.
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Affiliation(s)
- N Gil
- School of Health Sciences, University of Surrey, Guildford, UK
| | - A Cox
- School of Health Sciences, University of Surrey, Guildford, UK
| | - K L Whitaker
- School of Health Sciences, University of Surrey, Guildford, UK
| | - R S Kerrison
- School of Health Sciences, University of Surrey, Guildford, UK
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Lo B, Shin HD, Kemp J, Munnery M, Chen S, Ma C, Jankowicz D, Mehta R, Harris A, Sakal M, Pundit R, Chung K, Kuziemsky C, Rossetti S, Strudwick G. Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:217-227. [PMID: 37644885 PMCID: PMC10874602 DOI: 10.1177/07067437231197060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aims to understand whether higher use of a patient portal can have an impact on mental health functioning and recovery. METHOD A mixed methods approach was used for this study. In 2019-2021, patients with mental health diagnoses at outpatient clinics in an academic centre were invited to complete World Health Organization Disability Assessment Scale 12 (WHODAS-12) and Mental Health Recovery Measure surveys at baseline, 3 months, and 6 months after signing up for the portal. At the 3-month time point, patients were invited to a semistructured interview with a member of the team to contextualize the findings obtained from the surveys. Analytics data was also collected from the platform to understand usage patterns on the portal. RESULTS Overall, 113 participants were included in the analysis. There was no significant change in mental health functioning and recovery scores over the 6-month period. However, suboptimal usage was observed as 46% of participants did not complete any tasks within the portal. Thirty-five participants had low use of the portal (1-9 interactions) and 18 participants had high usage (10+ interactions). There were also no differences in mental health functioning and recovery scores between low and high users of the portal. Qualitative interviews highlighted many opportunities where the portal can support overall functioning and mental health recovery. CONCLUSIONS Collectively, this study suggests that higher use of a portal had no impact, either positive or negative, on mental health outcomes. While it may offer convenience and improved patient satisfaction, adequate support is needed to fully enable these opportunities for patient care. As the type of interaction with the portal was not specifically addressed, future work should focus on looking at ways to support patient engagement and portal usage throughout their care journey.
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Affiliation(s)
- Brian Lo
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Information Management & Technology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jessica Kemp
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mikayla Munnery
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sheng Chen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Clement Ma
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Damian Jankowicz
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rohan Mehta
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Harris
- Interprofessional Practice, Unity Health Toronto, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Moshe Sakal
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ryan Pundit
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Craig Kuziemsky
- Office of Research, MacEwan University, Edmonton, AB, Canada
| | - Sarah Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Moore SA, Cooper JM, Malloy J, Lyon AR. Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:172-195. [PMID: 38117431 PMCID: PMC10850020 DOI: 10.1007/s10488-023-01320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.
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Affiliation(s)
- Stephanie A Moore
- School of Education, University of California Riverside, Riverside, CA, 92521, USA.
| | | | - JoAnne Malloy
- Institute on Disability, College of Health and Human Services, University of New Hampshire, Durham, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Hettinger KN, Adeoye-Olatunde OA, Russ-Jara AL, Riley EG, Kepley KL, Snyder ME. Preparing community pharmacy teams for health information exchange (HIE). J Am Pharm Assoc (2003) 2024; 64:429-436.e2. [PMID: 38081515 DOI: 10.1016/j.japh.2023.12.003] [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: 06/27/2023] [Revised: 11/29/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Health information exchanges (HIEs) facilitate health care professionals' electronic sharing of patient information across different organizations. When community pharmacists have access to HIE, they can further contribute to improved patient outcomes. However, several implementation challenges are noted, which impede sustained pharmacist access to HIE. To our knowledge, no bidirectional HIE interface design and pharmacy team-informed implementation process has been documented. In response, our research team designed and developed an HIE interface prototype for use specifically by community pharmacy teams to access local HIE data through their pharmacy dispensing software. OBJECTIVES To 1) identify barriers, facilitators, and recommendations for using HIE data in community pharmacies and 2) create a curated list of resources addressing identified implementation needs to aid future implementation of a fully functional, bidirectional HIE interface by community pharmacy teams. METHODS Pharmacists, pharmacy technicians, and patients from three pharmacy sites within the Community Pharmacy Enhanced Services Network of Indiana participated in individual semi-structured interviews. Interview questions were mapped to select constructs across all domains of the Consolidated Framework for Implementation Research. Interview transcripts were deductively coded. A subset of participants participated in Evidence-Based Quality Improvement sessions to iteratively update planned resource items needed to support future HIE implementation. RESULTS We interviewed 23 total participants: 8 pharmacists, 8 pharmacy technicians, and 7 patients. Five facilitators, four barriers, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE; guidance on workflow and team roles; resources that are patient-facing; and resources that are provider-facing, resulting in 16 planned implementation resources. CONCLUSION Our study provides the first-of-its-kind list of pharmacy team-informed resources to facilitate sustainability and scalability of HIE implementation in community pharmacies.
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