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Rasool S, Dobbie F, Khan Z, Holliday R, Khalid F, Khan T, Bauld L. Process evaluation of a pragmatic feasibility trial on smokeless tobacco cessation intervention delivered in dental hospitals. BMC Public Health 2024; 24:1327. [PMID: 38755594 PMCID: PMC11100072 DOI: 10.1186/s12889-024-18821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Article 14 of the WHO 'Framework Convention on Tobacco Control' recommends, that all oral healthcare providers provide support for tobacco cessation, to all patients. Despite evidence on the effectiveness of tobacco cessation interventions in dental settings, implementation remains low in most high-burden countries like Pakistan. A pragmatic pilot trial of a dentist-delivered behavioural support intervention for smokeless tobacco (ST) cessation, was conducted in dental hospitals in Pakistan. This paper presents the findings of the process evaluation of the trial. METHODS A mixed-method process evaluation of a multi-centre randomised control pilot trial of dentist-delivered behavioural support intervention ST cessation was conducted. The intervention included three sessions namely: pre-quit, quit and post-quit sessions. The process evaluation involved: semi-structured interviews with trial participants (n = 26, of which dental patients were n = 13 and participating dentists were n = 13 conducted from June-August 2022); and fidelity assessment of audio recordings of the intervention sessions (n = 29). The framework approach was used to thematically analyse the interview data. RESULTS Overall the trial procedures were well accepted, however, young patients expressed uneasiness over revealing their ST use status. The intervention was received positively by dentists and patients. Dentists identified some challenges in delivering behavioural support to their patients. Of these, some were related to the contents of the intervention whereas, others were related to the logistics of delivering the intervention in a clinical setting (such as workload and space). Acceptability of the intervention resources was overall low amongst young patients as they did not take the intervention resources home due to fear of their family members finding out about their ST use. The intervention was successful in achieving the intended impact (in those who engaged with the intervention), i.e., change in the patients' ST use behaviour. Giving up ST with the aid of behavioural support also had an unintended negative effect i.e., the use of harmful substances (cannabis, cigarettes) to give up ST use. Patients' satisfaction with their dental treatment seemed to influence the intervention outcome. CONCLUSION While there are many variables to consider, but for the participants of this study, behavioural support for abstinence delivered through dentists during routine dental care, appears to be an acceptable and practical approach in helping patients give up ST use, in a country like Pakistan, where negligible support is offered to ST users.
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Affiliation(s)
- Shaista Rasool
- Usher Institute, University of Edinburgh, Edinburgh, Scotland.
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
- The University of Edinburgh, ACCORD, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - Fiona Dobbie
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- The University of Edinburgh, ACCORD, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Zohaib Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Richard Holliday
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, England
| | - Fatima Khalid
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Tuba Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Linda Bauld
- Usher Institute, University of Edinburgh, Edinburgh, Scotland
- The University of Edinburgh, ACCORD, The Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Ghanmi N, Bondok M, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S. Optimizing Teamwork in the Operating Room: A Scoping Review of Actionable Teamwork Strategies. Cureus 2024; 16:e60522. [PMID: 38883070 PMCID: PMC11180536 DOI: 10.7759/cureus.60522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/18/2024] Open
Abstract
Suboptimal teamwork in the operating room (OR) is a contributing factor in a significant proportion of preventable complications for surgical patients. Specifying behaviour is fundamental to closing evidence-practice gaps in healthcare. Current teamwork interventions, however, have yet to be synthesized in this way. This scoping review aimed to identify actionable strategies for use during surgery by mapping the existing literature according to the Action, Actor, Context, Target, Time (AACTT) framework. The databases MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Cochrane, Scopus, and PsycINFO were searched from inception to April 5, 2022. Screening and data extraction were conducted in duplicate by pairs of independent reviewers. The search identified 9,289 references after the removal of duplicates. Across 249 studies deemed eligible for inclusion, eight types of teamwork interventions could be mapped according to the AACTT framework: bundle/checklists, protocols, audit and feedback, clinical practice guidelines, environmental change, cognitive aid, education, and other), yet many were ambiguous regarding the actors and actions involved. The 101 included protocol interventions appeared to be among the most actionable for the OR based on the clear specification of ACCTT elements, and their effectiveness should be evaluated and compared in future work.
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Affiliation(s)
- Nibras Ghanmi
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Mostafa Bondok
- Department of Anesthesiology, University of British Columbia, Faculty of Medicine, Vancouver, CAN
| | - Cole Etherington
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, CAN
| | | | | | | | | | | | - Jeanne Seguin
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | | | - Sindeed Islam
- Faculty of Medicine, University of Ottawa, Ottawa, CAN
| | - Sylvain Boet
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, CAN
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Ahmad SZ, Ivers N, Zenlea I, Parsons JA, Shah BR, Mukerji G, Punthakee Z, Shulman R. An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada. Implement Sci Commun 2024; 5:25. [PMID: 38500183 PMCID: PMC10946155 DOI: 10.1186/s43058-024-00563-2] [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: 12/18/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity. METHODS An audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt. RESULTS Fidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly. CONCLUSIONS We describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
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Affiliation(s)
- Syed Zain Ahmad
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- SickKids Research Institute, Toronto, Canada
| | - Noah Ivers
- Women's College Institute for Health System Solutions and Virtual Care, Toronto, Canada
- Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Janet A Parsons
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Endocrinology, Sunnybrook Health Sciences Centre, Toronto, Canada
- ICES, Toronto, Canada
| | - Geetha Mukerji
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Women's College Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Rayzel Shulman
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- SickKids Research Institute, Toronto, Canada.
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Canada.
- Department of Pediatrics, University of Toronto, Toronto, Canada.
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Schäfer WLA, Johnson JK, Ager MS, Iroz CB, Huang R, Balbale SN, Stulberg JJ. Learning from the implementation of a surgical opioid reduction initiative in an integrated health system: a qualitative study among providers and patients. Implement Sci Commun 2024; 5:22. [PMID: 38468284 PMCID: PMC10926556 DOI: 10.1186/s43058-024-00561-4] [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: 05/11/2023] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Surgical opioid overprescribing can result in long-term use or misuse. Between July 2018 and March 2019, the multicomponent intervention, Minimizing Opioid Prescribing in Surgery (MOPiS) was implemented in the general surgery clinics of five hospitals and successfully reduced opioid prescribing. To date, various studies have shown a positive outcome of similar reduction initiatives. However, in addition to evaluating the impact on clinical outcomes, it is important to understand the implementation process of an intervention to extend sustainability of interventions and allow for dissemination of the intervention into other contexts. This study aims to evaluate the contextual factors impacting intervention implementation. METHODS We conducted a qualitative study with semi-structured interviews held with providers and patients of the general surgery clinics of five hospitals of a single health system between March and November of 2019. Interview questions focused on how contextual factors affected implementation of the intervention. We coded interview transcripts deductively, using the Consolidated Framework for Implementation Research (CFIR) to identify the relevant contextual factors. Content analyses were conducted using a constant comparative approach to identify overarching themes. RESULTS We interviewed 15 clinicians (e.g., surgeons, nurses), 1 quality representative, 1 scheduler, and 28 adult patients and identified 3 key themes. First, we found high variability in the responses of clinicians and patients to the intervention. There was a strong need for intervention components to be locally adaptable, particularly for the format and content of the patient and clinician education materials. Second, surgical pain management should be recognized as a team effort. We identified specific gaps in the engagement of team members, including nurses. We also found that the hierarchical relationships between surgical residents and attendings impacted implementation. Finally, we found that established patient and clinician views on opioid prescribing were an important facilitator to effective implementation. CONCLUSION Successful implementation of a complex set of opioid reduction interventions in surgery requires locally adaptable elements of the intervention, a team-centric approach, and an understanding of patient and clinician views regarding changes being proposed.
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Affiliation(s)
- Willemijn L A Schäfer
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA.
| | - Julie K Johnson
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | | | - Cassandra B Iroz
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
| | - Reiping Huang
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- American College of Surgeons, Chicago, IL, USA
| | - Salva N Balbale
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Department of Surgery, Northwestern University Feinberg School of Medicine, 633 North Saint Clair Street, 20th Floor, Chicago, IL, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonah J Stulberg
- Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX, USA
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Pinto R, Canário C, Leijten P, Rodrigo MJ, Cruz O. Implementation of Parenting Programs in Real-World Community Settings: A Scoping Review. Clin Child Fam Psychol Rev 2024; 27:74-90. [PMID: 38062309 PMCID: PMC10920434 DOI: 10.1007/s10567-023-00465-0] [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: 11/06/2023] [Indexed: 03/08/2024]
Abstract
Implementing parenting programs in real-world community settings is fundamental to making effective programs widely available and consequently improving the lives of children and their families. Despite the literature acknowledging that the high-quality implementation of parenting programs is particularly challenging in real-world community settings, little is known about how the programs are implemented in these settings. This scoping review followed the methodological framework described by the Joanna Briggs Institute to map evidence on how evidence-based parenting programs have been implemented under real-world conditions. A systematic search of 12 scientific databases, gray literature, and the reference lists of the included studies identified 1918 records, of which 145 were included in the review. Fifty-three parenting programs were identified in studies documenting implementation in real-world community settings worldwide. Most studies included families in psychosocial risk engaged with family-support agencies. The qualitative synthesis identified several implementation outcomes, adaptations, barriers, and facilitators. Most studies reported a maximum of two implementation outcomes, mainly fidelity and acceptability. Providers frequently made adaptations, mainly to bring down barriers and to tailor the program to improve its fit. Findings highlight the need for a more detailed description of the implementation of programs, with greater consistency in terminology, operationalization, and measurement of implementation outcomes across studies. This will promote a more transparent, consistent, and accurate evaluation and reporting of implementation and increase the public health impact of parenting programs. Future studies should also assess the impact of adaptations and the cost-effectiveness and sustainability of programs in real-world community settings.
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Affiliation(s)
- Rita Pinto
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
| | - Catarina Canário
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Patty Leijten
- Research Institute for Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria José Rodrigo
- Department of Developmental Psychology and Education, Faculty of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Orlanda Cruz
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Pettersson K, Liedgren P, Lyon AR, Hasson H, von Thiele Schwarz U. Fidelity-consistency and deliberateness of modifications in parenting programs. Implement Sci Commun 2024; 5:13. [PMID: 38351018 PMCID: PMC10865709 DOI: 10.1186/s43058-024-00545-4] [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: 07/22/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent-child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? METHODS In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. RESULTS A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. CONCLUSIONS These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.
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Affiliation(s)
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, SE, Sweden
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
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Mui HZ, Brown‐Johnson CG, Saliba‐Gustafsson EA, Lessios AS, Verano M, Siden R, Holdsworth LM. Analysis of FRAME data (A-FRAME): An analytic approach to assess the impact of adaptations on health services interventions and evaluations. Learn Health Syst 2024; 8:e10364. [PMID: 38249838 PMCID: PMC10797575 DOI: 10.1002/lrh2.10364] [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: 10/03/2022] [Revised: 02/06/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Tracking adaptations during implementation can help assess and interpret outcomes. The framework for reporting adaptations and modifications-expanded (FRAME) provides a structured approach to characterize adaptations. We applied the FRAME across multiple health services projects, and developed an analytic approach to assess the impact of adaptations. Methods Mixed methods analysis of research diaries from seven quality improvement (QI) and research projects during the early stages of the COVID-19 pandemic. Using the FRAME as a codebook, discrete adaptations were described and categorized. We then conducted a three-step analysis plan: (1) calculated the frequency of adaptations by FRAME categories across projects; (2) qualitatively assessed the impact of adaptations on project goals; and (3) qualitatively assessed relationships between adaptations within projects to thematically consolidate adaptations to generate more explanatory value on how adaptations influenced intervention progress and outcomes. Results Between March and July 2020, 42 adaptations were identified across seven health services projects. The majority of adaptations related to training or evaluation (52.4%) with the goal of maintaining the feasibility (66.7%) of executing projects during the pandemic. Five FRAME constructs offered the most explanatory benefit to assess the impact of adaptations on program and evaluation goals, providing the basis for creating an analytic approach dubbed the "A-FRAME," analysis of FRAME data. Using the A-FRAME, the 42 adaptations were consolidated into 17 succinct adaptations. Two QI projects discontinued altogether. Intervention adaptations related to staffing, training, or delivery, while evaluation adaptations included design, recruitment, and data collection adjustments. Conclusions By sifting qualitative data about adaptations into the A-FRAME, implementers and researchers can succinctly describe how adaptations affect interventions and their evaluations. The simple and concise presentation of information using the A-FRAME matrix can help implementers and evaluators account for the influence of adaptations on program outcomes.
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Affiliation(s)
- Heather Z. Mui
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Cati G. Brown‐Johnson
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Erika A. Saliba‐Gustafsson
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Anna Sophia Lessios
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Mae Verano
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Rachel Siden
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
| | - Laura M. Holdsworth
- Division of Primary Care and Population Health, Department of MedicineSchool of Medicine, Stanford UniversityPalo AltoCaliforniaUSA
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Camões-Costa V, Chakraborty S, Mozaffari F, Collie A, Kenardy J, Brijnath B, Mortimer D, Enticott J, Kidd M, Trevena L, Reid S, Mazza D. Assessing the fidelity of a behavioural intervention involving academic detailing in general practice: a sub-study of the 'Implementing work-related Mental health guidelines in general PRacticE' (IMPRovE) trial. Implement Sci Commun 2023; 4:154. [PMID: 38031194 PMCID: PMC10687810 DOI: 10.1186/s43058-023-00531-2] [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: 04/25/2023] [Accepted: 11/12/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Assessing the fidelity of intervention components enables researchers to make informed judgements about the influence of those components on the observed outcome. The 'Implementing work-related Mental health guidelines in general PRacticE' (IMPRovE) trial is a hybrid III trial aiming to increase adherence to the 'Clinical Guidelines for the diagnosis and management of work-related mental health conditions in general practice'. IMPRovE is a multifaceted intervention, with one of the central components being academic detailing (AD). This study describes the fidelity to the protocol for the AD component of the IMPRovE intervention. METHOD All AD sessions for the trial were audio-recorded and a sample of 22% were randomly selected for fidelity assessment. Fidelity was assessed using a tailored proforma based on the Modified Conceptual Framework for fidelity assessment, measuring duration, coverage, frequency and content. A descriptive analysis was used to quantify fidelity to the protocol and a content analysis was used to elucidate qualitative aspects of fidelity. RESULTS A total of eight AD sessions were included in the fidelity assessment. The average fidelity score was 89.2%, ranging from 80 to 100% across the eight sessions. The sessions were on average 47 min long and addressed all of the ten chapters in the guideline. Of the guideline chapters, 9 were frequently discussed. The least frequently discussed chapter related to management of comorbid conditions. Most general practitioner (GP) participants used the AD sessions to discuss challenges with managing secondary mental conditions. In line with the protocol, opinion leaders who delivered the AD sessions largely offered evidence-based strategies aligning with the clinical guideline recommendations. CONCLUSIONS/IMPLICATIONS The IMPRovE AD intervention component was delivered to high fidelity. The sessions adhered to the intended duration, coverage, frequency, and content allowing participating GPs to comprehend the implementation of the guideline in their own practice. This study also demonstrates that the Modified Conceptual Fidelity Framework with a mixed methods approach can support the assessment of implementation fidelity of a behavioural intervention in general practice. The findings enhance the trustworthiness of reported outcomes from IMPRovE and show that assessing fidelity is amenable for AD and should be incorporated in other studies using AD. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN 12620001163998, November 2020.
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Affiliation(s)
- Vera Camões-Costa
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Samantha Chakraborty
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Fatima Mozaffari
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alexander Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | | | - Duncan Mortimer
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Australia
| | - Michael Kidd
- College of Health and Medicine, Australian National University, Canberra, Australia
- Australian Government Department of Health and Aged Care, Canberra, Australia
| | - Lyndal Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Camperdown, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Danielle Mazza
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Steed L, Sheringham J, McClatchey K, Hammersley V, Marsh V, Morgan N, Jackson T, Holmes S, Taylor S, Pinnock H. IMP 2ART: development of a multi-level programme theory integrating the COM-B model and the iPARIHS framework, to enhance implementation of supported self-management of asthma in primary care. Implement Sci Commun 2023; 4:136. [PMID: 37957778 PMCID: PMC10644643 DOI: 10.1186/s43058-023-00515-2] [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: 07/13/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Supported asthma self-management, incorporating an asthma action plan and annual clinical review, has been recommended by UK/global guidelines for over three decades. However, implementation remains poor, as only around a third of individuals receive basic asthma care, according to the UKs leading respiratory charity Asthma and Lung UK. A systematic review of implementation studies recommended that a whole systems approach targeting patients, healthcare professional education, and organisations is needed to improve implementation of supported asthma self-management in primary care. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a national Hybrid-II implementation cluster randomised controlled trial that aims to evaluate such an approach. This paper describes the development of the implementation strategy for IMP2ART with particular focus on the integration of multiple level theories. METHODS The Medical Research Council design and evaluation of complex interventions framework and the Person-Based Approach to intervention development were used as guidance for stages of strategy development. Specifically, we (i) set up a multidisciplinary team (including practicing and academic clinicians, health psychologists, public health and patient colleagues), (ii) reviewed and integrated evidence and theory, (iii) developed guiding principles, (iv) developed prototype materials, and (v) conducted a pre-pilot study before final refinement. RESULTS The implementation strategy included resources for patients, team-based and individual healthcare professional education, practice audit and feedback, and an asthma review template, as well as a facilitator role accessible to primary care practices for 12 months. The synthesis of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) and Capability, Opportunity, Motivation and Behaviour (COM-B) frameworks led to an evolved framework bringing together important implementation and behaviour change elements which will be used as a basis for the study process evaluation. CONCLUSIONS A description of rigorous implementation strategy development for the IMP2ART study is provided along with newly theorised integration of implementation and behaviour change science which may be of benefit to others targeting implementation in primary care. TRIAL REGISTRATION ISRCTN15448074. Registered on 2nd December 2019.
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Affiliation(s)
- Liz Steed
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK.
| | - Kirstie McClatchey
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Vicky Hammersley
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Viv Marsh
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Noelle Morgan
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Tracy Jackson
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Steve Holmes
- The Park Medical Practice, Shepton Mallet, UK
- Severn School of Primary Care, Health Education England (South West), Bristol, UK
| | - Stephanie Taylor
- Wolfson Institute of Population Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham ID. Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research. FRONTIERS IN HEALTH SERVICES 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kate Seers
- Warwick Medical School, Faculty of Science, University of Warwick, Coventry, United Kingdom
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mark Embrett
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jiale Hu
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, United Kingdom
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junqiang Zhao
- Centre for Research on Health and Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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11
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Anderson E, Wiener RS, Molloy-Paolillo B, McCullough M, Kim B, Harris JI, Rinne ST, Elwy AR, Bokhour BG. Using a person-centered approach in clinical care for patients with complex chronic conditions: Perspectives from healthcare professionals caring for Veterans with COPD in the U.S. Veterans Health Administration's Whole Health System of Care. PLoS One 2023; 18:e0286326. [PMID: 37352241 PMCID: PMC10289382 DOI: 10.1371/journal.pone.0286326] [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: 02/10/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND The largest nationally integrated health system in the United States, the Veterans Health Administration (VHA), has been undergoing a transformation toward a Whole Health (WH) System of Care. WH Clinical Care, a component of this system, includes holistically assessing the Veteran's life context, identifying what really matters to the Veteran, collaboratively setting and monitoring personal health and well-being goals, and equipping the Veteran with access to conventional and complementary and integrative health resources. Implementation of WH Clinical Care has been challenging. Understanding healthcare professionals' perspectives on the value of and barriers and facilitators to practicing WH Clinical Care holds relevance for not only VHA's efforts but also other health systems, in the U.S. and internationally, that are engaged in person-centered care implementation. OBJECTIVES We sought to understand perspectives of healthcare professionals at VHA on providing WH Clinical Care to Veterans with COPD, as a lens to understand the broader issue of WH Clinical Care for Veterans living with complex chronic conditions. DESIGN We interviewed 25 healthcare professionals across disciplines and services at a VA Medical Center in 2020-2021, including primary care providers, pulmonologists, palliative care providers, and chaplains. Interview transcripts were analyzed using qualitative content analysis. KEY RESULTS Each element of WH Clinical Care raised complex questions and/or concerns, including: (1) the appropriate depth/breadth of inquiry in person-centered assessment; (2) the rationale for elicitation of what really matters; (3) the feasibility and appropriate division of labor in personal health goal setting and planning; and (4) challenges related to referring Veterans to a broad spectrum of supportive services. CONCLUSIONS Efforts to promote person-centered care must account for healthcare professionals' existing comfort with its elements, advocate for a team-based approach, and continue to grapple with the conflicting structural conditions and organizational imperatives.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- The Pulmonary Center and Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - Brianne Molloy-Paolillo
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, Massachusetts, United States of America
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - J. Irene Harris
- VA Maine Healthcare System, Lewiston, Maine, United States of America
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Seppo T. Rinne
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Division of Pulmonary and Critical Care Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts, United States of America
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Barbara G. Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts, United States of America
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, United States of America
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Gebeyehu EM, Debie A, Yazachew L, Fetene SM, Azanaw KA. Implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital, Northwest Ethiopia. BMC Infect Dis 2023; 23:343. [PMID: 37217843 DOI: 10.1186/s12879-023-08263-3] [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: 11/26/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Healthcare-Acquired Infections are a major problem in the world and within the healthcare delivery system. An estimated 5-10% and around 25% of hospitalized patients have healthcare-acquired infections in developed and developing countries, respectively. Infection prevention and control programs have proven to be successful in lowering the incidence and spread of infections. Thus, this evaluation aims to evaluate the implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital in Northwest Ethiopia. METHODS A facility-based cross-sectional design with a concurrent mixed method was used to evaluate the implementation fidelity of infection prevention practices. A total of 36 indicators were used to measure adherence, participant responsiveness, and facilitation strategy dimensions. A total of 423 clients were administered for an interview, an inventory checklist, a document review, 35 non-participatory observations, and 11 key informant interviews were conducted. A multivariable logistic regression analysis was used to identify factors significantly associated with the satisfaction of clients. The findings were presented using descriptions, tables, and graphs. RESULT The overall implementation fidelity of the infection prevention practices was 61.8%. The dimensions of adherence to infection prevention and control guidelines were 71.4%, participant responsiveness was 60.6%, and facilitation strategy was 48%. In multivariable analysis, ward admission and educational level had a p-value of below 0.05 and were significantly associated with the satisfaction of clients with infection prevention practices at the hospital. The major themes that emerged in qualitative data analysis were healthcare worker-related factors, management-related factors, and patient- and visitor-related factors. CONCLUSION The evaluation result of this study concluded that the overall implementation fidelity of infection prevention practice was judged to be medium and needed improvement. It included dimensions of adherence and participant responsiveness that were rated as medium, as well as a facilitation strategy that was rated as low. Enablers and barriers were thematized into factors related to healthcare providers, management, institutions, and patient and visitor relations.
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Affiliation(s)
| | - Ayal Debie
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
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Mavodza CV, Bernays S, Mackworth-Young CRS, Nyamwanza R, Nzombe P, Dauya E, Chikwari CD, Tembo M, Apollo T, Mugurungi O, Madzima B, Nguwo D, Ferrand RA, Busza J. Fidelity, Feasibility and Adaptation of a Family Planning Intervention for Young Women in Zimbabwe: Provider Perspectives and Experiences. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023. [PMCID: PMC10037356 DOI: 10.1007/s43477-023-00075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The CHIEDZA (Community-based Interventions to improve HIV outcomes in youth: a cluster randomised trial in Zimbabwe) trial evaluated an integrated package of HIV and sexual and reproductive health services for young people aged 16–24 years in Zimbabwe. The family planning component aimed to improve access to information, services, and contraceptives delivered by trained youth-friendly providers within a community-based setting for young women. Responsively adapting the intervention was a part of the intervention design’s rationale. We investigated the factors influencing implementation fidelity, quality, and feasibility using provider experiences and perspectives. We conducted provider interviews (N = 42), non-participant (N = 18), and participant observation (N = 30) of intervention activities. The data was analyzed thematically. CHIEDZA providers were receptive to providing the family planning intervention, but contexts outside of the intervention created challenges to the intervention’s fidelity. Strategic adaptations were required to ensure service quality within a youth-friendly context. These adaptations strengthened service delivery but also resulted in longer wait times, more frequent visits, and variability of Long-Acting Reversible contraceptives (LARCS) provision which depended on target-driven programming by partner organization. This study was a practical example of how tracking adaptations is vital within process evaluation methods in implementation science. Anticipating that changes will occur is a necessary pre-condition of strong evaluations and tracking adaptations ensures that lessons on feasibility of design, contextual factors, and health system factors are responded to during implementation and can improve quality. Some contextual factors are unpredictable, and implementation should be viewed as a dynamic process where responsive adaptations are necessary, and fidelity is not static. Trial registration ClinicalTrials.gov Identifier: NCT03719521.
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Affiliation(s)
- Constancia V. Mavodza
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Bernays
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- grid.1013.30000 0004 1936 834XSchool of Public Health, University of Sydney, Sydney, Australia
| | - Constance R. S. Mackworth-Young
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rangarirayi Nyamwanza
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Portia Nzombe
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Ethel Dauya
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
| | - Chido Dziva Chikwari
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Infectious Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Mandikudza Tembo
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tsitsi Apollo
- grid.415818.1HIV and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Owen Mugurungi
- grid.415818.1HIV and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | | | | | - Rashida Abbas Ferrand
- grid.418347.d0000 0004 8265 7435The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, 10 Seagrave Road, Avondale, Harare, Zimbabwe
- grid.8991.90000 0004 0425 469XDepartment of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Best S, Long JC, Braithwaite J, Taylor N. Standardizing variation: Scaling up clinical genomics in Australia. Genet Med 2023; 25:100109. [PMID: 35115231 DOI: 10.1016/j.gim.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Clinical genomics demands close interaction of physicians, laboratory scientists, and genetic professionals. Taking genomics to scale requires an understanding of the underlying processes from the perspective of nongenetic physicians who are new to the field. We identified components of the processes amenable to adaptation when scaling up clinical genomics. METHODS Semistructured interviews informed by the Theoretical Domains Framework with nongenetic physicians, who were using clinical genomics in practice, were guided by an annotated process map with 7 steps following the patient's journey. Findings from the individual maps were synthesized into an overview process map and a series of individual maps by common location and specialty. Interviews were analyzed using the Theoretical Domains Framework. RESULTS In total, 16 nongenetic physicians (eg, nephrologists, immunologists) participated, generating 1 overview and 10 individual process maps. Sixteen common steps were identified across clinical specialties and locations, with variations over 9 steps. We report the potential for standardization across these 9 steps. CONCLUSION When scaling up complex interventions, it is essential to identify steps where variation can be accommodated. With these results we show how process mapping can be used to identify steps where variation is acceptable during scale up to accommodate adaptation to local context, allowing for the inevitable evolution of factors influencing ongoing implementation and sustainability.
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Affiliation(s)
- Stephanie Best
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia; Australian Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
| | - Janet C Long
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Natalie Taylor
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
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Hedible GB, Louart S, Neboua D, Catala L, Anago G, Sawadogo AG, Kargougou GD, Meda B, Kolié JS, Hema A, Keita S, Niome M, Savadogo AS, Peters-Bokol L, Agbeci H, Zair Z, Lenaud S, Vignon M, Ouedraogo Yugbare S, Abarry H, Diakite AA, Diallo IS, Lamontagne F, Briand V, Dahourou DL, Cousien A, Ridde V, Leroy V. Evaluation of the routine implementation of pulse oximeters into integrated management of childhood illness (IMCI) guidelines at primary health care level in West Africa: the AIRE mixed-methods research protocol. BMC Health Serv Res 2022; 22:1579. [PMID: 36566173 PMCID: PMC9789366 DOI: 10.1186/s12913-022-08982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The AIRE operational project will evaluate the implementation of the routine Pulse Oximeter (PO) use in the integrated management of childhood illness (IMCI) strategy for children under-5 in primary health care centers (PHC) in West Africa. The introduction of PO should promote the accurate identification of hypoxemia (pulse blood oxygen saturation Sp02 < 90%) among all severe IMCI cases (respiratory and non-respiratory) to prompt their effective case management (oxygen, antibiotics and other required treatments) at hospital. We seek to understand how the routine use of PO integrated in IMCI outpatients works (or not), for whom, in what contexts and with what outcomes. METHODS The AIRE project is being implemented from 03/2020 to 12/2022 in 202 PHCs in four West African countries (Burkina Faso, Guinea, Mali, Niger) including 16 research PHCs (four per country). The research protocol will assess three complementary components using mixed quantitative and qualitative methods: a) context based on repeated cross-sectional surveys: baseline and aggregated monthly data from all PHCs on infrastructure, staffing, accessibility, equipment, PO use, severe cases and care; b) the process across PHCs by assessing acceptability, fidelity, implementation challenges and realistic evaluation, and c) individual outcomes in the research PHCs: all children under-5 attending IMCI clinics, eligible for PO use will be included with parental consent in a cross-sectional study. Among them, severe IMCI cases will be followed in a prospective cohort to assess their health status at 14 days. We will analyze pathways, patterns of care, and costs of care. DISCUSSION This research will identify challenges to the systematic implementation of PO in IMCI consultations, such as health workers practices, frequent turnover, quality of care, etc. Further research will be needed to fully address key questions such as the best time to introduce PO into the IMCI process, the best SpO2 threshold for deciding on hospital referral, and assessing the cost-effectiveness of PO use. The AIRE research will provide health policy makers in West Africa with sufficient evidence on the context, process and outcomes of using PO integrated into IMCI to promote scale-up in all PHCs. TRIAL REGISTRATION Trial registration number: PACTR202206525204526 retrospectively registered on 06/15/2022.
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Affiliation(s)
- Gildas Boris Hedible
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Sarah Louart
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal ,grid.500774.1IRD, CEPED, Paris, France ,grid.503422.20000 0001 2242 6780University of Lille, CLERSE - Centre Lillois d’Études et de Recherches Sociologiques et Économiques, Lille, France
| | - Désiré Neboua
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | - Laura Catala
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Gildas Anago
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | | | | | | | | | - Adama Hema
- Terre des hommes-Lausanne (Tdh), Ouagadougou, Burkina Faso
| | | | | | | | - Lucie Peters-Bokol
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Honorat Agbeci
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | - Zineb Zair
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France
| | | | - Marine Vignon
- grid.512067.70000 0004 9338 1016ALIMA, Dakar, Senegal
| | | | - Hannatou Abarry
- Ministère de la santé, des populations et des affaires sociales, Niamey, Niger
| | | | | | | | - Valérie Briand
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Inserm UMR 1219, IRD EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Désiré Lucien Dahourou
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France ,grid.433132.40000 0001 2165 6445Institut de Recherche en Sciences de la Santé/CNRST, Département Biomédical, Santé Publique, Ouagadougou, Burkina Faso
| | - Anthony Cousien
- grid.508487.60000 0004 7885 7602Université Paris Cité and Université Sorbonne Paris Nord, Inserm, IAME, F-75018 Paris, France
| | | | - Valériane Leroy
- grid.15781.3a0000 0001 0723 035XInserm, University Paul Sabatier Toulouse 3, CERPOP, UMR 1295, Toulouse, France ,grid.15781.3a0000 0001 0723 035XCenter for Epidemiology and Research in Population Health (CERPOP), UMR 1295, Inserm, University Paul Sabatier Toulouse 3, Toulouse, France
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Ayton D, Pirotta S, Morello R, Rosenich E, Barton C, Lavale A, Pase MP, Maruff P, Yassi N, Brodtmann A, Lim YY, Barker A. Protocol for a Mixed-Methods Process Evaluation of BetterBrains: A Person-Centered Online Intervention to Delay Cognitive Decline in Adults at Risk of Dementia. J Alzheimers Dis 2022; 90:1689-1703. [PMID: 36314199 DOI: 10.3233/jad-220341] [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: 12/24/2022]
Abstract
BACKGROUND The BetterBrains Randomized Controlled Trial (RCT) will evaluate the effectiveness of an online, person-centered, risk factor management, coaching intervention in community-dwelling, healthy adults at risk of cognitive decline. Multi-component interventions are challenging to evaluate due to program complexity and personalization to individual needs and contexts. This paper describes a multi-level process evaluation conducted alongside the BetterBrains RCT. OBJECTIVE To understand how and why the BetterBrains intervention was effective or ineffective at reducing cognitive decline in healthy adults whilst considering the context in which it was implemented. METHODS 1,510 non cognitively-deteriorated community-dwelling adults aged 40-70 years old at risk of cognitive decline will be recruited and randomly assigned to the intervention or control group. All BetterBrains intervention participants, coaches, and the research team will be included in the evaluation. A mixed-methods design will be used, guided by The Framework for Implementation Fidelity and the program logic model. Data will be sourced from interviews, focus groups, surveys, BetterBrains coach notes, participant weekly check-in surveys, and audio recordings of intervention coaching sessions. Quantitative data will be analyzed via descriptive and inferential statistics and qualitative data will be analyzed using content and thematic analysis. RESULTS The process evaluation will provide information about contextual and influencing factors related to the implementation of BetterBrains and the RCT outcomes. CONCLUSION Understanding how BetterBrains was implemented and its associated impacts will inform the translation of the program into community and clinical settings, providing easy access to online, personalized dementia prevention services.
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Affiliation(s)
- Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stephanie Pirotta
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Renata Morello
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emily Rosenich
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Chris Barton
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alexandra Lavale
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Paul Maruff
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia.,Cogstate Ltd., Melbourne, VIC, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Amy Brodtmann
- Department of Neuroscience, Central Clinical School, Monash University, The Alfred Centre, Melbourne, VIC, Australia
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
| | - Anna Barker
- Silver Chain Group, Melbourne, VIC, Australia
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17
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McEachan RRC, Rashid R, Santorelli G, Tate J, Thorpe J, McQuaid JB, Wright J, Pickett KE, Pringle K, Bojke L, Jones S, Islam S, Walker S, Yang TC, Bryant M. Study Protocol. Evaluating the life-course health impact of a city-wide system approach to improve air quality in Bradford, UK: A quasi-experimental study with implementation and process evaluation. Environ Health 2022; 21:122. [PMID: 36464683 PMCID: PMC9720926 DOI: 10.1186/s12940-022-00942-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Air quality is a major public health threat linked to poor birth outcomes, respiratory and cardiovascular disease, and premature mortality. Deprived groups and children are disproportionately affected. Bradford will implement a Clean Air Zone (CAZ) as part of the Bradford Clean Air Plan (B-CAP) in 2022 to reduce pollution, providing a natural experiment. The aim of the current study is to evaluate the impact of the B-CAP on health outcomes and air quality, inequalities and explore value for money. An embedded process and implementation evaluation will also explore barriers and facilitators to implementation, impact on attitudes and behaviours, and any adverse consequences. METHODS The study is split into 4 work packages (WP). WP1A: 20 interviews with decision makers, 20 interviews with key stakeholders; 10 public focus groups and documentary analysis of key reports will assess implementation barriers, acceptability and adverse or unanticipated consequences at 1 year post-implementation (defined as point at which charging CAZ goes 'live'). WP1B: A population survey (n = 2000) will assess travel behaviour and attitudes at baseline and change at 1 year post-implementation). WP2: Routine air quality measurements will be supplemented with data from mobile pollution sensors in 12 schools collected by N = 240 pupil citizen scientists (4 within, 4 bordering and 4 distal to CAZ boundary). Pupils will carry sensors over four monitoring periods over a 12 month period (two pre, and two post-implementation). We will explore whether reductions in pollution vary by CAZ proximity. WP3A: We will conduct a quasi-experimental interrupted time series analysis using a longitudinal routine health dataset of > 530,000 Bradford residents comparing trends (3 years prior vs 3 years post) in respiratory health (assessed via emergency/GP attendances. WP3B: We will use the richly-characterised Born in Bradford cohort (13,500 children) to explore health inequalities in respiratory health using detailed socio-economic data. WP4: will entail a multi-sectoral health economic evaluation to determine value for money of the B-CAP. DISCUSSION This will be first comprehensive quasi-experimental evaluation of a city-wide policy intervention to improve air quality. The findings will be of value for other areas implementing this type of approach. TRIAL REGISTRATION ISRCTN67530835 https://doi.org/10.1186/ISRCTN67530835.
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Affiliation(s)
- Rosemary R C McEachan
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England.
| | - Rukhsana Rashid
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England
| | - Gillian Santorelli
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England
| | - James Tate
- Institute for Transport Studies, University of Leeds, Leeds, LS2 9JT, England
| | - Jamie Thorpe
- St Stephen's Church of England Primary School, Bradford, BD5 7HU, England
| | - James B McQuaid
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, England
| | - John Wright
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England
| | - Kate E Pickett
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Kirsty Pringle
- School of Earth and Environment, University of Leeds, Leeds, LS2 9JT, England
| | - Laura Bojke
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Sally Jones
- Bradford District Metropolitan Council, Bradford, BD1 1HX, England
| | - Shahid Islam
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England
| | - Simon Walker
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - Tiffany C Yang
- Bradford Institute of Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, England
| | - Maria Bryant
- Department of Health Sciences, University of York, York, YO10 5DD, UK
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Siraneh Y, Woldie M, Birhanu Z. Assessment of Implementation Outcome Measures for Positive Deviance Approach as a New Strategy to Promote Exclusive Breastfeeding: A Psychometric Follow-Up Study. Int J Womens Health 2022; 14:1579-1601. [DOI: 10.2147/ijwh.s385662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
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19
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Ramsden V, Middleton S, McInnes E, Babl FE, Tavender E. Review article: A primer for clinical researchers in the emergency department: Part XII. Sustainability of improvements in care: An introduction. Emerg Med Australas 2022; 34:670-674. [PMID: 35918063 DOI: 10.1111/1742-6723.14052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 01/07/2023]
Abstract
Despite an increased focus on ways to improve implementation of evidence and de-implementation of practices with no known benefit, there is limited guidance on how to sustain these improvements. This review provides an introduction to sustainability of improvements in care and sustainability research, discussing how to support sustainability in practice and detailing a sustainability research agenda for the emergency medicine setting.
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Affiliation(s)
- Victoria Ramsden
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia.,Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Midwifery and Health Sciences, The University of Notre Dame Australia, Sydney, New South Wales, Australia
| | - Sandy Middleton
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
| | - Elizabeth McInnes
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, New South Wales, Australia.,Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne and Australian Catholic University, Sydney, New South Wales, Australia
| | - Franz E Babl
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Tavender
- Emergency Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
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20
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Koorts H, Timperio A, Abbott G, Arundell L, Ridgers ND, Cerin E, Brown H, Daly RM, Dunstan DW, Hume C, Chinapaw MJM, Moodie M, Hesketh KD, Salmon J. Is level of implementation linked with intervention outcomes? Process evaluation of the TransformUs intervention to increase children’s physical activity and reduce sedentary behaviour. Int J Behav Nutr Phys Act 2022; 19:122. [PMID: 36115963 PMCID: PMC9482275 DOI: 10.1186/s12966-022-01354-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/23/2022] [Indexed: 01/16/2023] Open
Abstract
Background TransformUs was a four-arm school-based intervention to increase physical activity and reduce sedentary behaviour among primary school children. Pedagogical and environmental strategies targeted the classroom, school grounds and family setting. The aims of this study were to evaluate program fidelity, dose, appropriateness, satisfaction and sustainability, and associations between implementation level and outcomes among the three intervention arms. Methods At baseline, 18-months (mid-intervention) and 30-months (post-intervention), teachers, parents and children completed surveys, and children wore GT3X ActiGraph accelerometers for 8 days at each time point to determine physical activity and sedentary time. Implementation data were pooled across the three intervention groups and teachers were categorised by level of implementation: (i) ‘Low’ (< 33% delivered); (ii) ‘Moderate’ (33–67% delivered); and (iii) ‘High’ (> 67% delivered). Linear and logistic mixed models examined between group differences in implementation, and the association with children’s physical activity and sedentary time outcomes. Qualitative survey data were analysed thematically. Results Among intervention recipients, 52% (n = 85) of teachers, 29% (n = 331) of parents and 92% (n = 407) of children completed baseline evaluation surveys. At 18-months, teachers delivered on average 70% of the key messages, 65% set active/standing homework, 30% reported delivering > 1 standing lesson/day, and 56% delivered active breaks per day. The majority of teachers (96%) made activity/sports equipment available during recess and lunch, and also used this equipment in class (81%). Fidelity and dose of key messages and active homework reduced over time, whilst fidelity of standing lessons, active breaks and equipment use increased. TransformUs was deemed appropriate for the school setting and positively received. Implementation level and child behavioural outcomes were not associated. Integration of TransformUs into existing practices, children’s enjoyment, and teachers’ awareness of program benefits all facilitated delivery and sustainability. Conclusions This study demonstrated that intervention dose and fidelity increased over time, and that children’s enjoyment, senior school leadership and effective integration of interventions into school practices facilitated improved intervention delivery and sustainability. Teacher implementation level and child behavioural outcomes were unrelated, suggesting intervention efficacy was achieved irrespective of implementation variability. The potential translatability of TransformUs into practice contexts may therefore be increased. Findings have informed scale-up of TransformUs across Victoria, Australia. Trial registration International Standard Randomized Controlled Trial Number ISRCTN83725066; Australian New Zealand Clinical Trials Registry Number ACTRN12609000715279. Registered 19 August 2009. Available at: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=308387&isReview=true Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01354-5.
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21
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Farah Saliba L, Allen P, Mazzucca SL, Rodriguez Weno E, Moreland-Russell S, Padek M, Brownson RC. Program adaptation by health departments. Front Public Health 2022; 10:892258. [PMID: 36172214 PMCID: PMC9512313 DOI: 10.3389/fpubh.2022.892258] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/22/2022] [Indexed: 01/21/2023] Open
Abstract
Introduction The dissemination of evidence-based interventions (i.e., programs, practices, and policies) is a core function of US state health departments (SHDs). However, interventions are originally designed and tested with a specific population and context. Hence, adapting the intervention to meet the real-world circumstances and population's needs can increase the likelihood of achieving the expected health outcomes for the target population from the implemented intervention. This study identified how SHD employees decide to adapt public health programs and what influences decisions on how to adapt them. Materials and methods SHD employees (n = 45) were interviewed using a qualitative semi-structured interview guide. Telephone interviews were audio-recorded and transcribed verbatim. The transcripts were consensus-coded and themes were identified using thematic analysis. Several themes aligned with the Model for Adaptation Design and Impact. Results Data, outcomes, and health department evaluations influenced decisions to adapt a program (pre-adaptation), and reasons to adapt a program included organizational and sociopolitical contextual factors. SHD middle-level managers, program managers and staff, and local agencies were involved in the decisions to adapt the programs. Finally, the goals for adapting a program included enhancing effectiveness/outcomes, reach and satisfaction with the program; funding; and partner engagement. After SHD employees decided to adapt a program, data and evidence guided the changes. Program staff and evaluators were engaged in the adaptation process. Program managers consulted partners to gather ideas on how best to adapt a program based on partners' experiences implementing the program and obtaining community input. Lastly, program managers also received input on adapting content and context from coalition meetings and periodic technical assistance calls. Discussion The findings related to decisions to adapt public health programs provide practitioners with considerations for adapting them. Findings reaffirm the importance of promoting public health competencies in program evaluation and adaptation, as well as systematically documenting and evaluating the adaptation processes. In addition, the themes could be studied in future research as mechanisms, mediators, and moderators to implementation outcomes.
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Affiliation(s)
- Louise Farah Saliba
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Peg Allen
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Stephanie L. Mazzucca
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Emily Rodriguez Weno
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Sarah Moreland-Russell
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Margaret Padek
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School at Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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22
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Londoño Agudelo EA, Battaglioli T, Soto A, Vásquez Gómez J, Aguilar Ramírez H, Pérez Ospina V, Rodríguez Salvá A, Ortiz Solórzano P, Pérez D, Gómez-Arias R, Van Der Stuyft P. Protocol for a controlled before-after quasi-experimental study to evaluate the effectiveness of a multi-component intervention to reduce gaps in hypertension care and control in low-income communes of Medellin, Colombia. BMJ Open 2022; 12:e056262. [PMID: 36002215 PMCID: PMC9413173 DOI: 10.1136/bmjopen-2021-056262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Research on public health interventions to improve hypertension care and control in low-income and middle-income countries remains scarce. This study aims to evaluate the effectiveness and assess the process and fidelity of implementation of a multi-component intervention to reduce the gaps in hypertension care and control at a population level in low-income communes of Medellin, Colombia. METHODS AND ANALYSIS A multi-component intervention was designed based on international guidelines, cross-sectional population survey results and consultation with the community and institutional stakeholders. Three main intervention components integrate activities related to (1) health services redesign, (2) clinical staff training and (3) patient and community engagement. The effectiveness of the intervention will be evaluated in a controlled before-after quasi-experimental study, with two deprived communes of the city selected as intervention and control arms. We will conduct a baseline and an endline survey 2 years after the start of the intervention. The primary outcomes will be the gaps in hypertension diagnosis, treatment, follow-up and control. Effectiveness will be evaluated with the difference-in-difference measures. Generalised estimation equation models will be fitted considering the clustered nature of data and adjusting for potential confounding variables. The implementation process will be studied with mixed methods. Implementation fidelity will be documented to assess to which degree the intervention components were implemented as intended. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Research Committee of Metrosalud in Colombia (reference 1400/5.2), the Medical Ethics Committee of the Antwerp University Hospital (reference 18/40/424) and the Institutional Review Board of the Antwerp Institute of Tropical Medicine (reference 1294/19). We will share and discuss the study results with the community, institutional stakeholders and national health policymakers. We will publish them in national and international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05011838.
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Affiliation(s)
- Esteban Augusto Londoño Agudelo
- Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | | | - Alonso Soto
- Departamento de Medicina, Hospital Nacional Hipólito Unanue, Lima, Peru
| | | | | | | | - Armando Rodríguez Salvá
- Centro de Epidemiología y Salud Ambiental, Instituto Nacional de Higiene, Epidemiología y Microbiología (INHEM), La Habana, Cuba
| | | | - Dennis Pérez
- Departamento de Vigilancia e Investigaciones Epidemiológicas, Instituto de Medicina Tropical Pedro Kourí, La Habana, Cuba
| | - Rubén Gómez-Arias
- Facultad Nacional de Salud Pública, Grupo de Epidemiología, Universidad de Antioquia, Medellín, Colombia
- Facultad de Medicina, Universidad CES, Medellin, Colombia
| | - Patrick Van Der Stuyft
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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Ridde V, Carillon S, Desgrées du Loû A, Sombié I. Analyzing implementation of public health interventions : a need for rigor, and the challenges of stakeholder involvement. Rev Epidemiol Sante Publique 2022; 71:101376. [PMID: 35835715 DOI: 10.1016/j.respe.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES This article shows how conceptual models can help to develop and evaluate public health interventions. It also reports on the challenges of getting stakeholders involved. METHOD The analysis is based on the reflexive approach applied by the authors during their participation in two public health intervention research (PHIR) projects, in France and in Burkina Faso. RESULTS In Paris, PHIR aimed to enable sub-Saharan immigrants to appropriate the existing means of prevention and sexual health care and to strengthen their empowerment in view of preserving their health. Evaluation was carried out using mixed methods. The intervention process theory is based on Ninacs' conceptual model of individual empowerment. The Consolidated Framework For Implementation Research (CFIR) was mobilized a posteriori to analyze the process. PHIR stemmed from collaboration between a research team and two associations. The different stakeholders were involved in the evaluation process, as were, at certain times, persons in highly precarious situations. In Ouagadougou, a community-based dengue vector control intervention was deployed to address an essential but neglected need. As regards evaluation, we opted for a holistic, mixed method approach (effectiveness and process). The contents of the intervention were determined based on tacit knowledge, a community preference survey and solid evidence. The theoretical framework of the intervention consisted in an eco-biological model of vector control. The implementation analysis combined an internal assessment of implementation fidelity with an external CFIR process analysis. All stakeholders were involved in the evaluation process. DISCUSSION Analysis confirmed not only the value of process evaluations in PHIR, but also the primordial importance of a rigorous approach. Stakeholder involvement is a major challenge to be addressed early in the planning of RISPs; with this in mind, effective and ethically sound assessment mechanisms need to be drawn up. Interdisciplinary evaluative approaches should be preferred, and the use of justified, relevant, and flexible frameworks is highly recommended. CONCLUSION Lessons learned for those wishing to engage in the process evaluation of a public health intervention are hereby presented.
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Affiliation(s)
- V Ridde
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France.
| | - S Carillon
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - A Desgrées du Loû
- Centre population et développement (Ceped), Institut de recherche pour le développement (IRD) et Université Paris Cité, Inserm ERL 1244, 45 rue des Saints-Pères, 75006 Paris, France
| | - I Sombié
- Institut des Sciences des Sociétés (INSS), Centre National de la Recherche Scientifique et Technologique (CNRST), 03 BP 7047, Avenue du Capitaine Thomas Sankara, Ouagadougou, Burkina Faso
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24
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Bernhardsson S, Boman C, Lundqvist S, Arvidsson D, Börjesson M, Larsson MEH, Lundh H, Melin K, Nilsen P, Lauruschkus K. Implementation of physical activity on prescription for children with obesity in paediatric health care (IMPA): protocol for a feasibility and evaluation study using quantitative and qualitative methods. Pilot Feasibility Stud 2022; 8:117. [PMID: 35650617 PMCID: PMC9158137 DOI: 10.1186/s40814-022-01075-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children's, parents', and healthcare providers' experiences of PAP. METHODS In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months' follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. DISCUSSION This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04847271 , registered 14 April 2021.
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Affiliation(s)
- Susanne Bernhardsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden. .,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Charlotte Boman
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Stefan Lundqvist
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden
| | - Daniel Arvidsson
- Department of Food and Nutrition and Sport Science, Faculty of Education, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine & Center for Health and Performance, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria E H Larsson
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden.,Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hannah Lundh
- Region Västra Götaland, Centre for Physical Activity, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Per Nilsen
- Division of Health and Society, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katarina Lauruschkus
- Faculty of Medicine, Institution of Health Sciences, Lund University, Lund, Sweden
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25
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Kalolo A, Lalashowi J, Pamba D, Shayo PJ, Gitige C, Mvungi H, Ntagazwa W, Lekule I, Kisonga R, Mleoh L, John J, Kapologwe NA, Mutayoba B, Matechi E, Mpagama SG, Ntinginya NE. Implementation of the 'Removed Injectable modified Short-course regimens for EXpert Multidrug Resistant Tuberculosis' (RISE study) in Tanzania: a protocol for a mixed-methods process evaluation. BMJ Open 2022; 12:e054434. [PMID: 35613774 PMCID: PMC9131053 DOI: 10.1136/bmjopen-2021-054434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tanzania is adapting a shortened injectable-free multidrug resistant tuberculosis (MDR-TB) regimen, comprising new drugs such as bedaquiline and delamanid and repurposed drugs such as clofazimine and linezolid. The regimen is implemented using a pragmatic prospective cohort study within the National TB and Leprosy Programme and is accompanied by a process evaluation. The process evaluation aims to unpack the implementation processes, their outcomes and the moderating factors in order to understand the clinical effectiveness of the regimen. This protocol describes the methods employed in understanding the implementation processes of the new MDR-TB regimen in 15 regions of Tanzania. METHODS This study adopts a concurrent mixed-methods design. Using multiple data collection tools, we capture information on: implementation outcomes, stakeholder response to the intervention and the influence of contextual factors. Data will be collected from the 22 health facilities categorised as dispensaries, health centres, district hospitals and referral hospitals. Health workers (n=132) and patients (n=220) will fill a structured questionnaire. For each category of health facility, we will conduct five focus group discussions and in-depth interviews (n=45) for health workers. Participant observations (n=9) and review documents (n=22) will be conducted using structured checklists. Data will be collected at two points over a period of 1 year. We will analyse quantitative data using descriptive and inferential statistical methods. Thematic analysis will be used for qualitative data. ETHICS AND DISSEMINATION This study received ethical approval from National Institute of Medical research (NIMR), Ref. NIMR/HQ/R.8a/Vol.IX/3269 and from the Mbeya Medical Research and Ethics Review Committee, Ref. SZEC-2439/R.A/V.I/38. Our findings are expected to inform the wider implementation of the new MDR-TB regimen as it is rolled out countrywide. Dissemination of findings will be through publications, conferences, workshops and implementation manuals for scaling up MDR-TB treatments.
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Affiliation(s)
- Albino Kalolo
- Department of Public Health, Saint Francis University College of Health and Allied Sciences, Ifakara, United Republic of Tanzania
- Implementation Research Division, Center for Reforms, Innovation, Health Policies and Implementation Research (CERIHI), Dodoma, United Republic of Tanzania
| | - Julieth Lalashowi
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Doreen Pamba
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | | | - Catherine Gitige
- Medical, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania
| | - Happiness Mvungi
- Medical, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania
| | - Webhale Ntagazwa
- National Tuberculosis and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - Isaac Lekule
- National Tuberculosis and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - Riziki Kisonga
- Medical, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania
| | - Liberate Mleoh
- National Tuberculosis and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - Johnson John
- National Tuberculosis and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - Ntuli A Kapologwe
- Implementation Research Division, Center for Reforms, Innovation, Health Policies and Implementation Research (CERIHI), Dodoma, United Republic of Tanzania
- Department of Health, Social welfare and Nutrition Services, President's Office Regional Administration and Local Government (PORALG), Dodoma, United Republic of Tanzania
| | - Beatrice Mutayoba
- National AIDS Control Programme, Dodoma, United Republic of Tanzania
| | - Emmanuel Matechi
- National Tuberculosis and Leprosy Programme, Dodoma, United Republic of Tanzania
| | - Stellah G Mpagama
- Medical, Kibong'oto Infectious Diseases Hospital, Kilimanjaro, United Republic of Tanzania
| | - Nyanda Elias Ntinginya
- National Institute of Medical Research-Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
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26
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McMullen H, Boydell V, Cordero JP, Steyn PS, Kiarie J, Kinemo P, Monyo A, Addah MA, Ahuno JT, Gyamfi OB. Accounting for complexity - Intervention design in the context of studying social accountability for reproductive health. Gates Open Res 2022; 5:107. [PMID: 35967957 PMCID: PMC9352917 DOI: 10.12688/gatesopenres.13260.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 08/31/2023] Open
Abstract
Background: Social accountability interventions aim to propel change by raising community voices and holding duty bearers accountable for delivering on rights and entitlements. Evidence on the role of such interventions for improving community health outcomes is steadily emerging, including for sexual and reproductive health and rights (SRHR). However, these interventions are complex social processes with numerous actors, multiple components, and a highly influential local context. Unsurprisingly, determining the mechanisms of change and what outcomes may be transferable to other similar settings can be a challenge. We report our methodological considerations to account for complexity in a social accountability intervention exploring contraceptive uptake and use in Ghana and Tanzania. Main Body: The Community and Provider driven Social Accountability Intervention (CaPSAI) study explores the relationship between a health facility-focused social accountability intervention and contraceptive service provision in two countries. This 24-month mixed-method quasi-experimental study, using an interrupted time series with a parallel control group, is being undertaken in 16 sites across Ghana and Tanzania in collaboration with local research and implementation partners. The primary outcomes include changes in contraceptive uptake and use. We also measure outcomes related to current social accountability theories of change and undertake a process evaluation. We present three design components: aspects of co-design, 'conceptual' fidelity, and how we aim to track the intervention as 'intended vs. implemented' to explore how the intervention could be responsive to the embedded routines, local contextual realities, and the processual nature of the social accountability intervention. Conclusions: Through a discussion of these design components and their rationale, we conclude by suggesting approaches to intervention design that may go some way in responding to recent challenges in accounting for social accountability interventions, bearing relevance for evaluating health system interventions.
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Affiliation(s)
- Heather McMullen
- Centre for Global Health, Institute of Population Health Sciences, Queen Mary, University of London, London, E1 4NS, UK
| | - Victoria Boydell
- Global Health Centre, Geneva Institute of International and Development Studies, Geneva, 1211, Switzerland
- Global Public Health, University of Essex, Wivenhoe Park, Colchester, UK
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
| | - Petrus S. Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
| | - James Kiarie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
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McMullen H, Boydell V, Cordero JP, Steyn PS, Kiarie J, Kinemo P, Monyo A, Addah MA, Ahuno JT, Gyamfi OB. Accounting for complexity – Intervention design in the context of studying social accountability for reproductive health. Gates Open Res 2022; 5:107. [PMID: 35967957 PMCID: PMC9352917 DOI: 10.12688/gatesopenres.13260.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Social accountability interventions aim to propel change by raising community voices and holding duty bearers accountable for delivering on rights and entitlements. Evidence on the role of such interventions for improving community health outcomes is steadily emerging, including for sexual and reproductive health and rights (SRHR). However, these interventions are complex social processes with numerous actors, multiple components, and a highly influential local context. Unsurprisingly, determining the mechanisms of change and what outcomes may be transferable to other similar settings can be a challenge. We report our methodological considerations to account for complexity in a social accountability intervention exploring contraceptive uptake and use in Ghana and Tanzania. Main Body: The Community and Provider driven Social Accountability Intervention (CaPSAI) study explores the relationship between a health facility-focused social accountability intervention and contraceptive service provision in two countries. This 24-month mixed-method quasi-experimental study, using an interrupted time series with a parallel control group, is being undertaken in 16 sites across Ghana and Tanzania in collaboration with local research and implementation partners. The primary outcomes include changes in contraceptive uptake and use. We also measure outcomes related to current social accountability theories of change and undertake a process evaluation. We present three design components: aspects of co-design, ‘conceptual’ fidelity, and how we aim to track the intervention as ‘intended vs. implemented’ to explore how the intervention could be responsive to the embedded routines, local contextual realities, and the processual nature of the social accountability intervention. Conclusions: Through a discussion of these design components and their rationale, we conclude by suggesting approaches to intervention design that may go some way in responding to recent challenges in accounting for social accountability interventions, bearing relevance for evaluating health system interventions.
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Affiliation(s)
- Heather McMullen
- Centre for Global Health, Institute of Population Health Sciences, Queen Mary, University of London, London, E1 4NS, UK
| | - Victoria Boydell
- Global Health Centre, Geneva Institute of International and Development Studies, Geneva, 1211, Switzerland
- Global Public Health, University of Essex, Wivenhoe Park, Colchester, UK
| | - Joanna Paula Cordero
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
| | - Petrus S. Steyn
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
| | - James Kiarie
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP Research), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, 1202, Switzerland
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Addanki S, Macedo L, MacDermid J, Moll S. Becoming peer educators in workplace mental health: Qualitative exploration of challenges and opportunities. Work 2022; 72:157-169. [DOI: 10.3233/wor-205084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Peer-led workplace mental health training programs informed by the principles of contact-based education have shown promising results, but research evidence largely focuses on measuring outcomes for service recipients with little attention to the experiences of peer educators in delivering these interventions. OBJECTIVE: To gain in-depth knowledge about the opportunities and challenges experienced peer educators recruited to lead a mental health literacy training program for healthcare workers. METHODS: An interpretive description approach was used to explore the experiences of peer educators in providing a structured two-day “Beyond Silence” workplace mental health training program. Peer educators were healthcare workers with personal mental health experience, who completed an additional leadership training. Semi-structured telephone interviews were conducted with seven peer educators. Data collection and analysis was concurrent and iterative, employing inductive analysis. RESULTS: Four overarching themes captured the key opportunities and challenges faced by peer educators: 1) the art and science of providing mental health literacy training, 2) power of personal stories, 3) competence as a journey or a destination and 4) the dual role of educator and advocate. CONCLUSIONS: Recommendations are provided for recruitment, training, and support for peer educators. Future research could focus on longitudinal evaluation of engagement and sustainability of peer educators in this role.
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Affiliation(s)
- Sheila Addanki
- School of Rehabilitation, McMaster University, Hamilton, ON, Canada
| | - Luciana Macedo
- School of Rehabilitation, McMaster University, Hamilton, ON, Canada
| | - Joy MacDermid
- School of Rehabilitation, McMaster University, Hamilton, ON, Canada
| | - Sandra Moll
- School of Rehabilitation, McMaster University, Hamilton, ON, Canada
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Logan V, Bamsey A, Carter N, Hughes D, Turner A, Jordan S. Clinical Impact of Implementing a Nurse-Led Adverse Drug Reaction Profile in Older Adults Prescribed Multiple Medicines in UK Primary Care: A Study Protocol for a Cluster-Randomised Controlled Trial. PHARMACY 2022; 10:pharmacy10030052. [PMID: 35645331 PMCID: PMC9149816 DOI: 10.3390/pharmacy10030052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Aims: Adverse drug reactions (ADRs) particularly affect older people prescribed multiple medicines. The professional bodies of nursing, medicine and pharmacy have issued guidelines on identification and management of ADRs; however, ADRs continue to account for ~10% unplanned hospital admissions in the UK. Current methods of ADR identification and management could be improved by multidisciplinary collaboration involving nurses. The aim of this study is to examine the impact of implementing the nurse-led Adverse Drug Reaction (ADRe) Profile in UK primary care. (2) Design: A pragmatic cluster-randomised controlled trial (RCT) followed by qualitative interviews in a sequential mixed-methods study. (3) Methods: For the cluster RCT, 60 patients aged ≥65 prescribed ≥5 regular medicines for long-term conditions will be recruited, 10 in each of 6 general practices. The intervention arm (n = 30) will complete the ADRe Profile, whilst the control participants (n = 30) continue to receive usual, standard care. Primary outcomes will include clinical impact on patients, benefit and prescription changes. On completion of the RCT, participants will be invited to semi-structured qualitative interviews, to evaluate the impact of the ADRe Profile from stakeholders’ perspectives, and to describe the contextual factors relevant to ADRe implementation. (4) Results: The findings of this study will evaluate the effectiveness of the ADRe Profile in identifying and resolving potential ADRs in primary care. Trial registration: This study was registered in ClinicalTrials.gov, registration number NCT04663360, date of registration—29 November 2021 (date of initial registration: 26 November 2020), protocol version 2, dated 8 January 2021.
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Affiliation(s)
- Vera Logan
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
- Correspondence: (V.L.); (S.J.); Tel.: +441-792-604-721 (V.L.); +441-792-518-541 (S.J.)
| | - Alexander Bamsey
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
- Mount Surgery, Swansea Bay University Health Board, Port Talbot SA13 2BN, UK
| | - Neil Carter
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
| | - David Hughes
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
| | - Adam Turner
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
| | - Sue Jordan
- Faculty of Medicine, Health and Life Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK; (A.B.); (N.C.); (D.H.); (A.T.)
- Correspondence: (V.L.); (S.J.); Tel.: +441-792-604-721 (V.L.); +441-792-518-541 (S.J.)
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Davis JL, Ayakaka I, Ggita JM, Ochom E, Babirye D, Turimumahoro P, Gupta AJ, Mugabe FR, Armstrong-Hough M, Cattamanchi A, Katamba A. Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda. Front Public Health 2022; 10:837211. [PMID: 35400072 PMCID: PMC8987305 DOI: 10.3389/fpubh.2022.837211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Since 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.
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Affiliation(s)
- J. Lucian Davis
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, United States
- Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, CT, United States
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
- *Correspondence: J. Lucian Davis
| | - Irene Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
- Liverpool School of Tropical Medicine, Liverpool School of Tropical Medicine (LSTM) International Multidisciplinary Programme to Address Lung Health and TB in Africa (IMPALA) Program, Liverpool, United Kingdom
| | - Joseph M. Ggita
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Ochom
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Diana Babirye
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Patricia Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amanda J. Gupta
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Mari Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, United States
| | - Adithya Cattamanchi
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
- Curry International Tuberculosis Center, University of California, San Francisco, San Francisco, CA, United States
- Division of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Achilles Katamba
- Uganda Tuberculosis Implementation Research Consortium, College of Health Sciences, Makerere University, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Richter A, Sjunnestrand M, Romare Strandh M, Hasson H. Implementing School-Based Mental Health Services: A Scoping Review of the Literature Summarizing the Factors That Affect Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063489. [PMID: 35329175 PMCID: PMC8948726 DOI: 10.3390/ijerph19063489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
Background: Mental illness in children and youths has become an increasing problem. School-based mental health services (SBMHS) are an attempt to increase accessibility to mental health services. The effects of these services seem positive, with some mixed results. To date, little is known about the implementation process of SBMHS. Therefore, this scoping review synthesizes the literature on factors that affect the implementation of SBMHS. Methods: A scoping review based on four stages: (a) identifying relevant studies; (b) study selection; (c) charting the data; and (d) collating, summarizing, and reporting the results was performed. From the searches (4414 citations), 360 were include in the full-text screen and 38 in the review. Results: Implementation-related factors were found in all five domains of the Consolidated Framework for Implementation Research. However, certain subfactors were mentioned more often (e.g., the adaptability of the programs, communication, or engagement of key stakeholders). Conclusions: Even though SBMHS differed in their goals and way they were conducted, certain common implementation factors were highlighted more frequently. To minimize the challenges associated with these types of interventions, learning about the implementation of SBMHS and using this knowledge in practice when introducing SBMHS is essential to achieving the best possible effects with SMBHSs.
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Affiliation(s)
- Anne Richter
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
- Correspondence: ; Tel.: +46-732-60-30-63
| | - My Sjunnestrand
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
| | - Maria Romare Strandh
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Reproductive Health Research Group, Department of Women’s and Children’s Health, Uppsala University Hospital, 751 85 Uppsala, Sweden
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden; (M.S.); (M.R.S.); (H.H.)
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, 171 29 Stockholm, Sweden
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Siraneh Y, Woldie M, Birhanu Z. End-Users Satisfaction with Positive Deviance Approach as an Intervention to Promote Exclusive Breastfeeding in Jimma, Ethiopia: A Multi-Level Analysis. Int J Womens Health 2022; 14:179-197. [PMID: 35177939 PMCID: PMC8846610 DOI: 10.2147/ijwh.s349053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Positive deviance approach (PDA) was implemented as an intervention strategy to address the poor practice of exclusive breastfeeding (EBF) in Jimma town, Ethiopia. Understanding the end-users satisfaction and its drivers is essential to determine whether this approach will be viable in the long run. Therefore, we determined the level of users' satisfaction with the intervention and identified multi-level predictors to explain variability. METHODS The data for this follow-up study were collected from September 01 to 25, 2020 among the study participants who were living in the intervention clusters of an earlier trial. A sample of 260 participants were invited to respond to an interviewer-administered structured questionnaire that assessed both individual and community-level variables. The developed tool was refined using experts' view (face validity) and using factor analysis (FA) to validate the satisfaction measurement scales (construct validity). The mean scores were standardized using Percentages Scale Mean Score (PSMS) formulae. Two-level mixed-effects linear regression (linear mixed models) were performed to fit individual, community, and mixed-level variables. All assumptions were checked for each analysis as appropriate and β-estimates at 95% CI and p-value of <0.05 were considered to declare a level of significance. RESULTS The overall level of end-users' satisfaction (PSMS) with PDA as an intervention to improve EBF was 50.9% with a maximum score of 99% and a minimum of 8%. Of the emerged satisfaction measuring scales, the standardized mean score for the user empowerment scale was the highest (53.7%). Five scales were emerged with 84.2% of the total variability explained in users' satisfaction. The mixed-effect model revealed that age, occupation, experience of breastfeeding (BF), knowledge, attitude, self-efficacy, main source of BF information, previous home visit/support received from HEPs, participation in any social activities, and perceived community support for BF were independent two-level predictors of satisfaction. CONCLUSION As an intermediate outcome, more than half of the end-users of the PDA intervention were satisfied. End-users' satisfaction with PDA as an intervention to promote EBF was predicted by multi-level factors. If they chose to use PDA as an intervention, Health program managers should be mindful of the two-level factors identified in this study.
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Affiliation(s)
- Yibeltal Siraneh
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Mirkuzie Woldie
- Department of Health Policy and Management, Faculty of Public Health, Jimma University, Jimma, Ethiopia.,Fenot Project, Department of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Zewdie Birhanu
- Department of Health, Behavior and Society, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Ingman BC, Loecke C, Belansky ES. A Partnership Among Local Public Health Agencies, Elementary Schools, and a University to Address Childhood Obesity: A Scalable Model of the Assess, Identify, Make It Happen Process. FRONTIERS IN HEALTH SERVICES 2022; 2:816536. [PMID: 36925837 PMCID: PMC10012628 DOI: 10.3389/frhs.2022.816536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/27/2022] [Indexed: 11/13/2022]
Abstract
Background One pathway to addressing childhood obesity is through implementing evidence-based practices (EBPs) shown to promote nutrition and physical activity in K-12 school settings. Assess, Identify, Make it happen (AIM) is a strategic planning process to engage stakeholders in implementing EBPs in their K-12 schools. Local Public Health Agencies (LPHAs) are a potential partner to facilitate this process to a broader audience of rural school communities. Methods A process and outcome evaluation design was applied in this study to examine the extent to which LPHAs effectively implemented AIM with rural/frontier schools in comparison to university staff. Data collection included post-meeting surveys completed by facilitators, a post-intervention interview with facilitators, a survey of school task force members at the end of the AIM process, and systematic documentation of the intervention. Results Reach -Among the 26 eligible elementary schools, 18 (69%) agreed to participate. Effect -In total, schools facilitated by LPHAs fully implemented an average of 4.0 changes per school, while schools facilitated by the university staff fully implemented an average of 3.7 changes. Adoption -Among the five LPHAs in the target region, all five agreed to partner on the initiative, but some agencies were unable to identify sufficient personnel to facilitate all schools in their catchment area. Implementation -(1) In total, 89 of 94 (95%) meetings scheduled by LPHA facilitators occurred. 47 of 48 (98%) meetings scheduled by the university staff occurred. (2) The university staff self-reported 93% of agenda items in the AIM process as "completely" followed while LPHA facilitators reported 41% of agenda items as "completely" followed. (3) Task force satisfaction with the AIM process and facilitator showed limited variance across LPHAs and university-facilitated schools. Maintenance -Of the 16 school districts that agreed to participate in the school-based version of AIM, 9 (56%) also participated in a district-wide version of AIM 2 years later. Conclusion AIM is an effective process for implementing EBPs in elementary schools when facilitated by LPHAs. Effective partnerships, a nuanced approach to fidelity, scalability considerations, and the role of technical assistance and training all contributed to the successful implementation of this LPHA-Elementary school partnership.
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Affiliation(s)
- Benjamin C Ingman
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
| | - Carla Loecke
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
| | - Elaine S Belansky
- Center for Rural School Health and Education, Morgridge College of Education, University of Denver, Denver, CO, United States
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Shalev L, Rudolf MCJ, Spitzer S. Better safe than sorry: Evaluating the implementation process of a home-visitation intervention aimed at preventing unintentional childhood injuries in the hospital setting. FRONTIERS IN HEALTH SERVICES 2022; 2:944367. [PMID: 36925878 PMCID: PMC10012825 DOI: 10.3389/frhs.2022.944367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022]
Abstract
Background Child home injuries prevention interventions have rarely been implemented in hospitals. The SHABI program ("Keeping our Children Safe"; in Hebrew: "SHomrim Al BetIchut Yeladenu") recruits at-risk families arriving with child injury to the Emergency Department. Medical/nursing students conduct two home visits four months apart, providing safety equipment and guidance. One hundred thirty-five families had a first visit and 98 completed the second. Fifty percentage of families were ultra-Orthodox Jews, 11% Arab, and 28% had ≥3 preschool children. We investigated SHABI's implementation using the Consolidated Framework for Implementation Research (CFIR). Methods Between May 2018 and March 2021 SHABI was implemented in the Emergency Department of a hospital in Israel's northern periphery, an area with high child injury rates. The Implementation process was examined through Emergency Department medical records and tracking registries, hospital management, nurses', and home visitors' meetings notes (n = 9), and a research diary. Hospital's inner setting and SHABI's characteristics were evaluated through interviews with hospital management, nurses, and home visitors 8 months after baseline (n = 18). Home visitors' characteristics were evaluated through interviews, post-visit questionnaire on challenges encountered (n = 233), families' perceptions of SHABI and home visitors' skills through telephone interviews (n = 212); and home visitors awareness of dangers at home (n = 8) baseline and 8 months later. Qualitative data were analyzed through explanatory content analysis according to CFIR constructs. Quantitative data were analyzed using X2 and Wilcoxon test for dependent subgroups. Results Despite alignment between SHABI and the hospital's mission, structural hospital-community disconnect prevented implementation as planned, requiring adaptation and collaboration with the medical school to overcome this barrier. Recruitment was included in the initial patient triage process but was only partially successful. Medical/nursing students were recruited as home visitors, and following training proved competent. Children were a distraction during the visits, but home visitors developed strategies to overcome this. Conclusions Injury prevention programs in hospitals have significant benefits. Identifying implementation barriers and facilitators allowed implementers to make adaptations and cope with the innovative implementation setting. Models of cooperation between hospital, community and other clinical settings should be further examined.
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Affiliation(s)
- Ligat Shalev
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Mary C J Rudolf
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Sivan Spitzer
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Ellingson CL, Edwards K, Roehrig GH, Hoelscher MC, Haroldson RA, Dubinsky JM. Connecting the Dots from Professional Development to Student Learning. CBE LIFE SCIENCES EDUCATION 2021; 20:ar57. [PMID: 34546098 PMCID: PMC8715783 DOI: 10.1187/cbe.21-02-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
Following professional development (PD), implementation of contemporary topics into high school biology requires teachers to make critical decisions regarding integration of novel content into existing course scope and sequence. Often exciting topics, such as neuroscience, do not perfectly align with standards. Despite commitment to enacting what was learned in the PD, teachers must adapt novel content to their perceptions of good teaching, local context, prior knowledge of their students, and state and district expectations. How teachers decide to integrate curricula encountered from PD programs may affect student outcomes. This mixed-methods study examined the relationship between curricular application strategies following an inquiry-based neuroscience PD and student learning. Post-PD curricular implementation was measured qualitatively through analysis of teacher action plans and classroom observations and quantitatively using hierarchical linear modeling to determine the impact of implementation on student performance. Participation in neuroscience PD predicted improved student learning compared with control teachers. Of the two distinct curricular implementation strategies, enacting a full unit produced significantly greater student learning than integrating neuroscience activities into existing biology units. Insights from this analysis should inform teacher implementation of new curricula after PD on other contemporary biology topics.
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Affiliation(s)
| | | | | | | | | | - Janet M. Dubinsky
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455
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Taliep N, Ismail G, Bulbulia S. Fidelity of implementation of the building bridges mentoring intervention to prevent violence among youth in low income settings. Int J Inj Contr Saf Promot 2021; 29:42-55. [PMID: 34702147 DOI: 10.1080/17457300.2021.1995441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Violence among youth is a major health and safety burden globally. There is a dearth in the development and evaluation of targeted interventions that addresses the multi-faceted nature of youth violence to ensure effectiveness and replicability. This study aims to systematically evaluate the fidelity of implementation of the Building Bridges Mentoring intervention that focuses on the prevention of youth violence in two low-income communities in South Africa. This study employed a mixed methods concurrent triangulation design. Qualitative data were analysed using deductive thematic analysis, and quantitative data using descriptive statistics and T-tests. The results indicate that for all the intervention components, implementation fidelity (i.e. adherence, exposure, quality of programme delivery, and participant responsiveness) was generally moderate to high, suggesting a 'good' implementation of the programme in the real world. Evaluating the fidelity of implementation is vital to obtain a comprehensive insight into whether an intervention was implemented according to its design, and to verify and validate the findings and outcomes, and accord credibility and integrity of the study.
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Affiliation(s)
- Naiema Taliep
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa.,Masculinity and Health Research Unit (MaHRU), South African Medical Research Council-University of South Africa (SAMRC-Unisa), Pretoria, South Africa
| | - Ghouwa Ismail
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa.,Masculinity and Health Research Unit (MaHRU), South African Medical Research Council-University of South Africa (SAMRC-Unisa), Pretoria, South Africa
| | - Samed Bulbulia
- Institute for Social and Health Sciences, University of South Africa, Pretoria, South Africa.,Masculinity and Health Research Unit (MaHRU), South African Medical Research Council-University of South Africa (SAMRC-Unisa), Pretoria, South Africa
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Kirk JW, Nilsen P, Andersen O, Stefánsdóttir NT, Grønfeldt B, Brødsgaard R, Pedersen BS, Bandholm T, Tjørnhøj-Thomsen T, Pedersen MM. Adaptations and modifications to a co-designed intervention and its clinical implementation: a qualitative study in Denmark. BMC Health Serv Res 2021; 21:1108. [PMID: 34656126 PMCID: PMC8520628 DOI: 10.1186/s12913-021-07142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a long-standing debate in implementation research on whether adaptations to evidence-based interventions (EBIs) are desirable in health care. If an intervention is adapted and not delivered as conceived and planned, it is said to have low fidelity. The WALK-Cph project was developed based on the assumption that involving stakeholders in co-design processes would facilitate the fidelity of an intervention to increase the mobility of acutely admitted older medical patients and its implementation in two hospitals in Denmark. The purpose of this study is to describe and analyse adaptations and modifications that were made to the co-designed WALK-Cph intervention and its implementation. METHODS This study used a qualitative design. An ethnographic field study was performed using participant observations, workshops and semi-structured interviews. Data were analysed twice using the Framework Method. The first analysis was based on the frameworks from Stirman, Moore and Proctor. The second analysis, a retrospective modifications analysis, was based on the Adaptation-Impact Framework. RESULTS Many different types of adaptations and modifications were made to the WALK-Cph intervention and its implementation plan. Most of the modifications were made on the contents of the intervention. In total, 44 adaptations and modifications were made, of which 21 were planned (adaptations) and 23 were made haphazardly (modifications). Most of the content and context adaptations and modifications made on the intervention had a mixed result regarding enhanced fidelity. The retrospective modifications analysis showed that modifications were ongoing and both situationally and contextually shaped. CONCLUSIONS Although an extensive co-design process was carried out to facilitate the fidelity of the WALK-Cph intervention, this study showed that many adaptations and modifications were still made to both the intervention and its implementation plan. It could indicate that the co-design process had a small effect or that adaptations and modifications are ongoing and both situationally and contextually shaped, which challenge the assumption and the desire to be able to plan and control changes.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark. .,Department of Public Health, Nursing, Aarhus University, Nordre Ringgade 1, 8000, Aarhus, Denmark.
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Sandbäcksgatan 7, 582 25, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Nina Thórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Birk Grønfeldt
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Rasmus Brødsgaard
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark
| | - Britt Stævnsbo Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Copenhagen Neuromuscular Center, Rigshospitalet, Inge Lehmanns Vej 8, 2100, Copenhagen Ø, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Orthopedic Surgery, and Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Kettegaards alle 30, 2650, Hvidovre, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard alle 30, 2650, Hvidovre, Danmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
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Piamjariyakul U, Smothers A, Young S, Morrissey E, Petitte T, Wen S, Zulfikar R, Sangani R, Shafique S, Smith CE, Bosak K. Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results. Res Nurs Health 2021; 44:854-863. [PMID: 34196013 PMCID: PMC8440457 DOI: 10.1002/nur.22166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/05/2021] [Accepted: 06/10/2021] [Indexed: 11/06/2022]
Abstract
Fidelity (consistency of intervention implementation) is essential to rigorous research. Intervention fidelity maintains study internal validity, intervention reproducibility, and transparency in the research conduct. The purpose of this manuscript is to describe intervention fidelity strategies/procedures developed for a pilot study testing a new palliative care nursing intervention (FamPALcare) for families managing advanced lung disease. The procedures described herein are based on the fidelity best practices recommendations from the NIH Consortium. An evidence-based checklist guided observational ratings of the fidelity procedures used and the intervention content implemented in each intervention session. Descriptive data on how participants understood (received), enacted, or used the intervention information were summarized. The fidelity checklist observational scores found ≥93% of the planned intervention content was implemented, and the fidelity strategies were adhered to consistently during each intervention session. The small variation (7%) in implementation was expected and related to participants' varying experiences, input, and/or questions. The helpfulness scale items include participants' ability to use home care resources, to anticipate and manage end-of-life symptoms, and to use Advance Directive forms. The high ratings (M = 4.4) on the 1-5 (very helpful) Likert Helpfulness Scale verified participants utilized the information from the intervention. Furthermore, there was an improvement in patients' breathlessness scores and completion of Advance Directive forms at 3 months after baseline. It is essential to plan intervention fidelity strategies to use throughout a study and to report fidelity results.
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Affiliation(s)
| | | | | | - Elizabeth Morrissey
- West Virginia University, School of Nursing
- West Virginia University Hospital
| | | | - Sijin Wen
- West Virginia University, Department of Biostatistics School of Public Health
| | - Rafia Zulfikar
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Rahul Sangani
- West Virginia University, Section of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine
| | - Saima Shafique
- West Virginia University, Department of Epidemiology School of Public Health
| | - Carol E Smith
- University of Kansas Medical Center, School of Nursing
- University of Kansas Medical Center, School of Preventive Medicine
| | - Kelly Bosak
- University of Kansas Medical Center, School of Nursing
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Janse van Rensburg A, Kathree T, Breuer E, Selohilwe O, Mntambo N, Petrus R, Bhana A, Lund C, Fairall L, Petersen I. Fuzzy-set qualitative comparative analysis of implementation outcomes in an integrated mental healthcare trial in South Africa. Glob Health Action 2021; 14:1940761. [PMID: 34402770 PMCID: PMC8381905 DOI: 10.1080/16549716.2021.1940761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Integrating mental health services into primary healthcare platforms is an established health systems strategy in low-to-middle-income countries. In South Africa, this was pursued through the Programme for Improving Mental Health Care (PRIME), a multi-country initiative that relied on task-sharing as a principle implementation strategy. Towards better describing the implementation processes, qualitative comparative analysis was adopted to explore causal pathways in the intervention. OBJECTIVE This study aimed to explore factors that could have influenced key outcomes of an integrated mental healthcare intervention in South Africa. METHODS Drawing from an embedded multiple case study design, the analysis used qualitative comparative analysis. Focusing on nine PHC clinics in the Dr Kenneth Kaunda District as cases, with depression reduction scores set as outcome measures, trial data variables were modelled in a hypothetical causal process. A fuzzy-set qualitative comparative analysis was performed by 1) developing the research questions, 2) developing the fuzzy set, 3) testing necessity and 4) testing sufficiency. These steps were undertaken collaboratively among the research team. RESULTS The data were calibrated during several meetings among team members to gain a degree of consensus. Necessity analyses suggested that none of the causal conditions exceeded the threshold of necessity and triviality, and confirmed the inclusion of relevant variables in line with the proposed models. Sufficiency analyses produced two configurations, which were subjected to standard and specific analyses. Ultimately, the results suggested that none of the causal conditions were necessary for a reduction in depression scores to occur, while programme fidelity was identified as a sufficient condition for a reduction in scores to occur. CONCLUSIONS The study highlights the importance of understanding implementation pathways to enable better integration of mental health services within primary healthcare in low-to-middle-income settings. It underlines the importance of programme fidelity in achieving the goals of implementation.
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Affiliation(s)
- André Janse van Rensburg
- Centre for Rural Health, University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa
| | - Tasneem Kathree
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Erica Breuer
- Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - One Selohilwe
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ntokozo Mntambo
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Ruwayda Petrus
- Department of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Arvin Bhana
- Centre for Rural Health, University of KwaZulu-Natal & South African Medical Research Council, Durban, South Africa
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, University of Cape Town & Centre for Global Mental Health, King's College London, Cape Town, South Africa
| | - Lara Fairall
- Centre for Knowledge Translation, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
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Rosewarne E, Moore M, Chislett WK, Jones A, Trieu K, Webster J. An evaluation of the Victorian Salt Reduction Partnership's advocacy strategy for policy change. Health Res Policy Syst 2021; 19:100. [PMID: 34266477 PMCID: PMC8281636 DOI: 10.1186/s12961-021-00759-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/05/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Public health advocacy strategies facilitate policy change by bringing key health issues to the forefront of public and political discourse, influencing decision-makers and public opinion, and increasing policy demand. The Victorian Salt Reduction Partnership (VSRP) was established in 2014 in response to inadequate government action to improve population diets in Australia. This study aimed to evaluate the success of the VSRP's advocacy strategy in achieving policy change. METHODS Documentation of VSRP activities and outputs were collected, and semi-structured interviews conducted as part of a comprehensive process evaluation. For this study, the Kotter Plus 10-step public health advocacy evaluation framework was used to guide data extraction, analysis, and synthesis. RESULTS A sense of urgency for salt reduction was generated by producing evidence and outlining the potential impact of a state-based salt reduction programme. This enabled the creation of a coalition with diverse skills and expertise, which facilitated the development of an innovative and collaborative advocacy action plan. A clear change vision was established, but communication of the vision to decision-makers was lacking, which reduced the impact of the programme as decision-makers were not provided with a clear incentive for policy change. As a result, while programme outputs were achieved, these did not translate to achieving broader strategic goals during a limited-term intervention in a political climate unconcerned with salt. CONCLUSIONS The Kotter Plus 10-step framework was a useful tool for evaluating the success of the VSRP advocacy strategy. The framework enabled the identification of key strengths, including the creation of the guiding coalition, and areas where efforts could be improved in future similar strategies, such as effective communication within partnerships and to decision-makers, to better influence policy and improve public health impact.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia.
| | - Michael Moore
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Wai-Kwan Chislett
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Alexandra Jones
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
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Knott CL, Chen C, Bowie JV, Mullins CD, Slade JL, Woodard N, Robinson-Shaneman BJR, Okwara L, Huq MR, Williams R, He X. Cluster-randomized trial comparing organizationally tailored versus standard approach for integrating an evidence-based cancer control intervention into African American churches. Transl Behav Med 2021; 12:673-682. [PMID: 34255087 DOI: 10.1093/tbm/ibab088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The field of implementation science has devoted increasing attention to optimizing the fit of evidence-based interventions to the organizational settings in which they are delivered. Institutionalization of health promotion into routine organizational operations is one way to achieve this. However, less is known about how to maximize fit and achieve institutionalization, particularly in settings outside of the healthcare system. This paper reports on findings from a parallel cluster-randomized trial that compared an organizationally tailored with a standard (core components only) approach for institutionalizing ("integrating") an evidence-based cancer control intervention into African American churches. Churches randomized to the organizationally tailored condition identified three or more implementation strategies from a menu of 20, with an implementation time frame for each. The primary study outcome was assessed through the Faith-Based Organization Health Integration Inventory, a measure of institutionalization of health promotion activities in church settings, completed by pastors at baseline and 12-month follow-up. Seventeen churches were randomized and 14 were analyzed as 3 did not implement the study protocol. Though the percent increase in total integration score was greater in the tailored condition (N = 9; 18%) than in the standard condition (N = 5; 12%), linear mixed-effect models did not detect a statistically significant group × time interaction. Despite the challenges of integrating health promotion activities outside of healthcare organizations, the current approach shows promise for fostering sustainable health promotion in community settings and merits further study.
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Affiliation(s)
- Cheryl L Knott
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Chang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
| | - Janice V Bowie
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - C Daniel Mullins
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, MD, USA
| | - Jimmie L Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, USA
| | - Nathaniel Woodard
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | | | - Leonore Okwara
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Maisha R Huq
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD , USA
| | - Ralph Williams
- Access to Wholistic and Productive Living, Inc., Colmar Manor, MD, USA
| | - Xin He
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA
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Copeland L, Littlecott H, Couturiaux D, Hoddinott P, Segrott J, Murphy S, Moore G, Evans R. The what, why and when of adapting interventions for new contexts: A qualitative study of researchers, funders, journal editors and practitioners' understandings. PLoS One 2021; 16:e0254020. [PMID: 34242280 PMCID: PMC8270163 DOI: 10.1371/journal.pone.0254020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The adaptation of interventions for new contexts is a rapidly developing research area. To date there is no consensus-based guidance to support decision-making and recommend adaptation processes. The ADAPT study is developing such guidance. This aim of the qualitative component of the study was to explore stakeholders' understandings of adaptation, as to date there has limited consideration of how different concepts and meanings shape decision-making and practice. METHODS A case study research design was used. Participants/cases were purposefully sampled based on study outcome, study design, expertise, context and country. Semi-structured interviews were conducted with a sample of researchers (n = 23); representatives from research funding panels (n = 6); journal editors (n = 5) and practitioners (n = 3). Data were analysed using the Framework approach. Overarching themes were discussed with the ADAPT study team, with further iterative refinement of subthemes. RESULTS The results generated four central themes. Four themes related to stakeholders' understanding: 1) definitions of adaptation and related concepts; 2) rationales for undertaking adaptation; 3) the appropriate timing for adaptation; and 4) ensuring fidelity when implementing adapted interventions. CONCLUSION The findings highlight the lack of clarity around key concepts and uncertainty about central decision-making processes, notably why interventions should be adapted, when and to what extent. This has informed the ADAPT study's guidance, shaping the scope and nature of recommendations to be included and surfacing key uncertainties that require future consideration.
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Affiliation(s)
- Lauren Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Hannah Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Danielle Couturiaux
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Pat Hoddinott
- Primary Care, Stirling University, Stirling, Scotland, United Kingdom
| | - Jeremy Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Centre for Trials Research, Cardiff University, Cardiff, Wales, United Kingdom
| | - Simon Murphy
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
| | - Rhiannon Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, Wales, United Kingdom
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Mwaikambo L, Brittingham S, Ohkubo S, Salem R, Sama DJ, Sow F, Mathur D, Anieto NN. Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia. Global Health 2021; 17:75. [PMID: 34217354 PMCID: PMC8254949 DOI: 10.1186/s12992-021-00717-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.
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Affiliation(s)
- Lisa Mwaikambo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA.
| | | | - Saori Ohkubo
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Ruwaida Salem
- The Challenge Initiative, Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Denis Joel Sama
- The Challenge Initiative, East Africa Hub, Jhpiego, Kampala, Uganda
| | - Fatimata Sow
- The Challenge Initiative, Francophone West Africa Hub, IntraHealth International, Dakar, Senegal
| | - Deepti Mathur
- The Challenge Initiative for Healthy Cities, India Hub, Population Services International, Delhi, India
| | - Nneoma Nonyelum Anieto
- The Challenge Initiative, Nigeria Hub, Johns Hopkins Center for Communication Programs, Abuja, Nigeria
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Nally S, Carlin A, Blackburn NE, Baird JS, Salmon J, Murphy MH, Gallagher AM. The Effectiveness of School-Based Interventions on Obesity-Related Behaviours in Primary School Children: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2021; 8:489. [PMID: 34201145 PMCID: PMC8228296 DOI: 10.3390/children8060489] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/11/2022]
Abstract
School-based interventions are promising for targeting a change in obesity-related behaviours in children. However, the efficacy of school-based interventions to prevent obesity remains unclear. This review examined the effectiveness of school-based interventions at changing obesity-related behaviours (increased physical activity, decreased sedentary behaviour and improved nutrition behaviour) and/or a change in BMI/BMI z-score. Following PRISMA guidelines, seven databases were systematically searched from 1 January 2009 to 31 December 2020. Two review authors independently screened studies for eligibility, completed data extraction and assessed the risk of bias of each of the included studies. Forty-eight studies met the inclusion criteria and were included in a narrative synthesis. Thirty-eight studies were eligible for inclusion in a meta-analysis. The findings demonstrate that interventions in children when compared to controls resulted in a small positive treatment effect in the control group (2.14; 95% CI = 0.77, 3.50). There was no significant effect on sedentary behaviour, energy intake and fruit and vegetable intake. Significant reductions were found between groups in BMI kg/m2 (-0.39; 95% CI = -0.47, -0.30) and BMI z-score (-0.05; 95% CI = -0.08, -0.02) in favour of the intervention. The findings have important implications for future intervention research in terms of the effectiveness of intervention components and characteristics.
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Affiliation(s)
- Sarah Nally
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Nicole E. Blackburn
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, School of Health Sciences, University of Ulster, Newtownabbey BT37 0QB, UK;
| | - Judith S. Baird
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Coleraine Campus, University of Ulster, Coleraine BT52 1SA, UK; (J.S.B.); (A.M.G.)
| | - Jo Salmon
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong 3217, Australia;
| | - Marie H. Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Jordanstown Campus, University of Ulster, Newtownabbey BT37 0QB, UK; (A.C.); (M.H.M.)
| | - Alison M. Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Biomedical Sciences Research Institute, Coleraine Campus, University of Ulster, Coleraine BT52 1SA, UK; (J.S.B.); (A.M.G.)
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Brick K, Cooper JL, Mason L, Faeflen S, Monmia J, Dubinsky JM. Tiered Neuroscience and Mental Health Professional Development in Liberia Improves Teacher Self-Efficacy, Self-Responsibility, and Motivation. Front Hum Neurosci 2021; 15:664730. [PMID: 34045949 PMCID: PMC8144652 DOI: 10.3389/fnhum.2021.664730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 01/29/2023] Open
Abstract
After acquiring knowledge of the neuroscience of learning, memory, stress and emotions, teachers incorporate more cognitive engagement and student-centered practices into their lessons. However, the role understanding neuroscience plays in teachers own affective and motivational competencies has not yet been investigated. The goal of this study was to investigate how learning neuroscience effected teachers' self-efficacy, beliefs in their ability to teach effectively, self-responsibility and other components of teacher motivation. A pilot training-of-trainers program was designed and delivered in Liberia combining basic neuroscience with information on social, emotional, behavioral and mental health issues faced by students. Tier I of the professional development was a 2 weeks workshop led by a visiting neuroscientist. A subset of the 24 Tier I secondary science teachers formed a Leadership Team who adapted the content to the Liberian context and subsequently led additional workshops and follow-up sessions for the Tier II secondary science teachers. Science teachers in both tiers completed the affective-motivational scales from the internationally vetted, multiscale Innovative Teaching for Effective Learning Teacher Knowledge Survey from the OECD. Tier II teachers completed the survey in a pre-post-delayed post design. Tier I teachers completed the survey after the workshop with their attitudes at that time and separately with retrospective projections of their pre-workshop attitudes. Ten of the 92 Tier II teachers participated in structured interviews at follow-up. Statistical analysis of survey data demonstrated improved teacher self-efficacy, self-responsibility for student outcomes, and motivation to teach. Qualitatively, teachers expressed more confidence in their ability to motivate students, engage them through active learning, and manage the class through positive rather than negative reinforcement. Teachers' own self-regulation improved as they made efforts to build supporting relationships with students. Together, these results demonstrated that (i) teacher affective-motivational attitudes can be altered with professional development, (ii) basic neuroscience, as knowledge of how students learn, can improve teacher competency, and (iii) a training-of-trainers model can be effective in a low and middle income country for disseminating neuroscience knowledge, increasing teachers' knowledge of students' social and emotional needs, and promoting educational improvement.
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Affiliation(s)
- Kara Brick
- The Carter Center Mental Health Program, Monrovia, Liberia
- Peace Corps Liberia, Monrovia, Liberia
| | | | - Leona Mason
- The Carter Center Mental Health Program, Monrovia, Liberia
| | | | - Josiah Monmia
- The Carter Center Mental Health Program, Monrovia, Liberia
| | - Janet M. Dubinsky
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
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Rosewarne E, Chislett WK, McKenzie B, Reimers J, Jolly KA, Corben K, Trieu K, Webster J. Stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership: a qualitative study. BMC Nutr 2021; 7:12. [PMID: 33883029 PMCID: PMC8061028 DOI: 10.1186/s40795-021-00414-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interventions to reduce population salt intake are feasible and cost-effective. The Victorian Salt Reduction Partnership implemented a complex, multi-faceted salt reduction intervention between 2014 and 2020 in the Australian state of Victoria. This study aimed to understand stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership. METHODS Semi-structured interviews were conducted with Partnership and food industry stakeholders. The Consolidated Framework for Implementation Research was adapted for the Partnership intervention and used to guide the qualitative analysis. RESULTS Fourteen Partnership and seven food industry stakeholders were interviewed. The Partnership was viewed as essential for intervention planning and decision-making and an enabler for intervention delivery. The goals of capacity building and collaborative action were perceived to have been achieved. The implementation team executed intended intervention activities and outputs, with some adaptations to strategy. Barriers and enablers to implementation were identified by interviewees, such as compatibility of individual, organisational and Partnership values and building positive relationships between the Partnership and food industry, respectively. Legal, political, social, environmental, technological and economic factors affecting intervention design, delivery and outcomes were identified. CONCLUSIONS Establishing a Partnership with diverse skills and experience facilitated collaborative action, capacity building and execution of the intervention. Monitoring and evaluating implementation informed strategy adaptations, which allowed optimisation of Partnership strategy. The importance of developing strong communication networks between strategic and implementation-levels was a key lesson.
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Affiliation(s)
- Emalie Rosewarne
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia.
| | - Wai-Kwan Chislett
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Briar McKenzie
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Jenny Reimers
- Victorian Health Promotion Foundation, Melbourne, VIC, 3053, Australia
| | - Kellie-Ann Jolly
- National Heart Foundation of Australia, Melbourne, VIC, 3008, Australia
| | - Kirstan Corben
- Victorian Health Promotion Foundation, Melbourne, VIC, 3053, Australia
| | - Kathy Trieu
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
| | - Jacqui Webster
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW, 2006, Australia
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To Adapt or Not to Adapt: The Association between Implementation Fidelity and the Effectiveness of Diabetes Self-Management Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084095. [PMID: 33924494 PMCID: PMC8069177 DOI: 10.3390/ijerph18084095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre–post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.
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Luecking CT, Vaughn AE, Burney R, Hennink-Kaminski H, Hales D, Ward DS. Fidelity and factors influencing implementation of Healthy Me, Healthy: process evaluation of a social marketing campaign for diet and physical activity behaviors of children in childcare. Transl Behav Med 2021; 11:733-744. [PMID: 33538306 PMCID: PMC8034246 DOI: 10.1093/tbm/ibab001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The effectiveness of interventions targeting children's eating and physical activity behaviors through childcare settings is inconsistent. To enhance public health impact, it is imperative to evaluate fidelity of implementing complex interventions in real-world settings. This study evaluated fidelity and contextual factors influencing implementation of Healthy Me, Healthy We (HMHW). HMHW was an 8-month social marketing campaign delivered through childcare to support children's healthy eating and physical activity. HMHW required two levels of implementation support (research team and childcare providers) and two levels of campaign delivery (childcare providers and parents). Process evaluation was conducted among childcare centers in the intervention group (n=48) of the cluster-randomized control trial. Measures included attendance logs, self-report surveys, observation checklists, field notes, and semi-structured interviews. A 35-item fidelity index was created to assess fidelity of implementation support and campaign delivery. The fidelity with which HMHW was implemented by childcare providers and parents was low (mean 17.4 out of 35) and decreased between childcare providers and parents. Childcare providers had high acceptability of the program and individual components (80 - 93%). Only half of parents felt intervention components were acceptable. Frequently cited barriers to implementation by childcare providers included time constraints, parent engagement, staff turnover, and restrictive policies. The lack of observable effect of HMHW on children's dietary or physical activity behaviors may be due to inadequate implementation at multiple levels. Different or additional strategies are necessary to support implementation of multilevel interventions, particularly when individuals are expected to deliver intervention components and support others in doing so.
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Affiliation(s)
- Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, USA
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Regan Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heidi Hennink-Kaminski
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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von Thiele Schwarz U, Giannotta F, Neher M, Zetterlund J, Hasson H. Professionals' management of the fidelity-adaptation dilemma in the use of evidence-based interventions-an intervention study. Implement Sci Commun 2021; 2:31. [PMID: 33726864 PMCID: PMC7962232 DOI: 10.1186/s43058-021-00131-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
Background Evidence-based interventions (EBIs) can be effective tools for the prevention of disease and health promotion. However, their implementation often requires a delicate balance between the need to adjust the intervention to the context in which it is implemented and the need to keep the core components that make the intervention effective. This so-called dilemma between fidelity and adaptation is often handled by health professionals in the sustainment phase of an implementation (i.e., once the intervention has been adopted and institutionalized in an organization), but not much is known about how and to what extent health professionals are affected by this dilemma. Focusing on the sustainment phase, this project aims to study (1) how fidelity and adaptation are managed by professionals using an EBI, (2) how the fidelity–adaptation dilemma affects professionals’ psychosocial working conditions, and (3) how a structured decision support influences professionals’ management of the dilemma and their psychosocial working conditions. Methods The study is set in Sweden, and the EBI in focus is a parental program (All Children in Focus). A longitudinal within-person intervention design is used, combined with a cross-sectional survey design. Data sources include web-based questionnaires, brief interviews, fidelity ratings, paper-and-pen questionnaires, and written documentation, collected at multiple time points with both group leaders and parents as respondents. Discussion This project approaches fidelity and adaptation from the perspective of the professionals that manage EBIs during the sustainment phase of implementation. Although it is well known that EBIs continue to change over time, it remains to be understood how the fidelity–adaptation dilemma can be managed so that the effectiveness of interventions is retained or improved, not diluted. Moreover, the project adds to the literature by presenting an occupational health perspective on the fidelity–adaptation dilemma. It is acknowledged that fidelity and adaptation may have consequences for not only clients but also the occupational wellbeing of the professionals managing the dilemma, and subsequently, their willingness and ability to deliver EBIs in a sustainable way. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00131-y.
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Affiliation(s)
- Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden. .,Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.
| | - Fabrizia Giannotta
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Margit Neher
- Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.,Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Johanna Zetterlund
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, Sweden
| | - Henna Hasson
- Procome, Medical Management Centre, Karolinska Institute, Stockholm, Sweden.,Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
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Movsisyan A, Arnold L, Copeland L, Evans R, Littlecott H, Moore G, O’Cathain A, Pfadenhauer L, Segrott J, Rehfuess E. Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice. Health Res Policy Syst 2021; 19:13. [PMID: 33546707 PMCID: PMC7863549 DOI: 10.1186/s12961-020-00668-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research. METHODS We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes. RESULTS We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how. CONCLUSIONS Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions. Registration Open Science Framework, 2019, osf.io/udzma.
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Affiliation(s)
- A. Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - L. Arnold
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - L. Copeland
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD Wales UK
| | - R. Evans
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD Wales UK
| | - H. Littlecott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD Wales UK
| | - G. Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD Wales UK
| | - A. O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - L. Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - J. Segrott
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD Wales UK
- Centre for Trials Research, Cardiff University, 4th floor Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS Wales UK
| | - E. Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
- Pettenkofer School of Public Health, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
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