Criteria for evaluating transferability of health interventions: a systematic review and thematic synthesis

Process Evaluation and Investigation of Cultural Adaptations for an Online Parent-Based Intervention Using a Mixed-Method Approach

Most alcohol intervention research focuses on program efficacy, yet few studies have investigated the acceptability of a program's design and implementation to the target population or adapting existing alcohol interventions to different populations. To address these gaps in the literature, we (1) examined participant responsiveness to and implementation quality of FITSTART+, a web-app delivered parent-based alcohol intervention designed for incoming first-year college students in the United States, and (2) gathered feedback on how this intervention could be adapted to other populations of parents. A sample of U.S. parents of 17-20-year-old first-year college students (N = 109) participated in FITSTART+ during their child's first year of college and completed a survey about parents' responsiveness to the app and its quality. Next, a sample of non-U.S. parents of adolescents aged 13 to 19 (N = 44) participated in one of 11 focus groups in which they briefly explored the app and then discussed how it could be adapted to be applicable and culturally relevant for them and their context. Results revealed that U.S. parents rated the intervention's quality as high and parents were responsive to the web-app's content, but some did not visit one of the most critical aspects of the intervention (i.e., alcohol-related parenting resources). Non-U.S. participants provided a range of suggestions for adapting the intervention to their context, which varied by culture. Results identify areas for improvement, particularly regarding the use of alcohol-related parenting resources, in this intervention and for web-delivered PBIs more broadly.

Establishing evidence criteria for implementation strategies in the US: a Delphi study for HIV services

BACKGROUND

There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies.

METHODS

We developed the Best Practices Tool from 2022-2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria.

RESULTS

Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies.

CONCLUSIONS

We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.

Lessons for the UK on implementation and evaluation of breastfeeding support: evidence syntheses and stakeholder engagement

Background

Breastfeeding impacts positively on multiple health outcomes, but < 50% of UK women breastfeed at 8 weeks. Women with long-term conditions face additional challenges in breastfeeding.

Objectives

To synthesise global and UK evidence to co-create an implementation and evaluation toolkit for cost-effective breastfeeding support in the NHS.

Design

Evidence syntheses with stakeholder engagement.

Review methods

Systematic reviews examined effectiveness of breastfeeding support for (1) healthy women and (2) women with long-term conditions using Cochrane Pregnancy and Childbirth Group methods. Mixed-methods systematic reviews synthesised process evaluations of effective breastfeeding support interventions for healthy women and experiences of receiving/providing support for breastfeeding women with long-term conditions. Cross-study synthesis integrated qualitative and quantitative findings. Systematic reviews synthesised evidence on the incremental costs and cost-effectiveness of breastfeeding support following National Institute for Health and Care Excellence guidance. All searches were conducted from May 2021 to October 2022. Stakeholder engagement and toolkit development comprised online discussions, a modified Delphi study, focus groups and four workshops. Participants were 23 stakeholders, 16 parents in the parents' panels, 15 women in the focus groups and 87 stakeholders who attended the workshops.

Results

We found considerably more interventions designed for healthy women (review 1) than aimed at women with long-term conditions (reviews 1 and 4); approximately half of the studies were targeted at groups at higher risk of poor breastfeeding outcomes, and the impact of support may be different in these populations. Despite this, studies from review 2 found that women perceived the provision of support as positive, important and needed. Studies from review 5 echoed a range of suggestions from participants regarding potential strategies to improve breastfeeding support, with the most widely reported being the need to acknowledge the role and influence of other sources of support (e.g. partners, family, friends, peers, external professionals, web-based resources) and involving these sources in the provision of breastfeeding support for women with long-term conditions. In reviews 3 and 6, there was uncertainty about the cost-effectiveness of breastfeeding support interventions due to the limited number of studies and lack of good-quality evidence.

Limitations

There was a lack of evidence for the effectiveness and cost-effectiveness of breastfeeding interventions in the UK. There was often insufficient information reported about intervention characteristics.

Conclusions

'Breastfeeding only' support probably reduces the number of women stopping any or exclusive breastfeeding. The evidence for 'breastfeeding plus' interventions is less consistent, but these may reduce the number of women stopping exclusive breastfeeding at 4-6 weeks and at 6 months. We found no evidence of differential intervention effects regarding mode of provision or provider. Cost-effectiveness is uncertain due to the lack of good-quality evidence. Key enablers of successful implementation were responsiveness and tailoring of interventions to both women's and supporters' needs. Breastfeeding support as delivered in the included studies probably has little to no effect on breastfeeding outcomes for women with long-term conditions. The mixed-methods synthesis and stakeholder work identified that existing interventions may not address the complex needs of these women. The main study output is a co-produced toolkit to guide implementation and evaluation of breastfeeding support services in the UK.

Future work

Evaluation of breastfeeding support for all women, particularly those at risk of poor breastfeeding outcomes (e.g. long-term conditions, deprivation). This could involve tailoring the toolkit to local contexts via implementation and effectiveness studies or using quality improvement studies.

Study registration

This study is registered as PROSPERO CRD42022337239, CRD42021229769 and CRD42022374509. The reviews of economic evidence were not registered; however, the review protocol can be accessed via the repository held by Queen's University Belfast Research Portal (https://pure.qub.ac.uk/).

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR130995) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 20. See the NIHR Funding and Awards website for further award information.

Transferability of the NHS low-calorie diet programme: A qualitative exploration of factors influencing the programme's transfer ahead of wide-scale adoption

INTRODUCTION

Although behavioural interventions have been found to help control type 2 diabetes (T2D), it is important to understand how the delivery context can influence implementation and outcomes. The NHS committed to testing a low-calorie diet (LCD) programme designed to support people living with excess weight and T2D to lose weight and improve diabetes outcomes. Understanding what influenced implementation during the programme pilot is important in optimising rollout. This study explored the transferability of the NHS LCD Programme prior to wider adoption.

METHODS

Twenty-five interviews were undertaken with stakeholders involved in implementing the LCD programme in pilot sites (health service leads, referring health professionals and programme deliverers). Interviews with programme participants (people living with T2D) were undertaken within a larger programme of work, exploring what worked, for whom and why, which is reported separately. The conceptual Population-Intervention-Environment-Transfer Model of Transferability (PIET-T) guided study design and data collection. Constructs of the model were also used as a deductive coding frame during data analysis. Key themes were identified which informed recommendations to optimise programme transfer.

RESULTS

Population: Referral strategies in some areas lacked consideration of population characteristics. Many believed that offering a choice of delivery model would promote acceptability and accessibility of the eligible population.

INTERVENTION

Overall, stakeholders had confidence in the LCD programme due to the robust evidence base along with anecdotal evidence, but some felt the complex referral process hindered engagement from GP practices.

ENVIRONMENT

Stakeholders described barriers to accessing the programme, including language and learning difficulties. Transferability: Multidisciplinary working and effective communication supported successful implementation.

CONCLUSION

Referral strategies to reach underrepresented groups should be considered during programme transfer, along with timely data from service providers on access and programme benefits. A choice of delivery models may optimise uptake. Knowledge sharing between sites on good working practices is encouraged, including increasing engagement with key stakeholders.

Pilot study of a health promotion intervention in sports clubs

Sports clubs (SCs) are an ideal setting for promoting health. However existing health promotion (HP) interventions in SCs mainly target a single health behavior and men who do sports, and evaluations of such interventions provides little information about their deployment. To overcome these limitations, the PROSCeSS intervention was co-constructed based on the theoretical model of the health-promoting SC and multi-level, multi-determinant health strategies. The aim of this pilot study was to evaluate the deployment of the PROSCeSS intervention and identify the factors influencing its deployment. A qualitative study, using recordings of meetings, email and telephone exchanges, and interviews with project leaders of fourteen SC, was carried out. Although a low number of SCs had completed the intervention, they all considered that they have a role to play in helping their members maintain good health. Their ability to develop HP activities and to implement the intervention was influenced by the resources available, the support they received from their sports federation, and the ability of each project leader to get involved in the intervention. The SCs that deployed the intervention implemented several strategies enabling them to integrate health into the organizational, social, economic, and environmental habits of the SCs and to develop new HP activities, such as adapted sports activity sessions and activities to teach members about first aid, nutrition, and good practices for warming up. This study highlights the importance of understanding the specificities of the contexts in which HP interventions are deployed. Having led to a reworking of the intervention steps and the development of an appropriate evaluation design, it also highlights the essential role of pilot studies in the development and evaluation of interventions.

The causation-prevention chain in infrastructure safety measures: A consideration of four types of policy lock-ins

Safety policies typically follow Lasswell's linear decision cycle paradigm: diagnostics, prescription, application, monitoring, and appraisal. Contemporary policy research highlights the existence of complexities in policy-making, which trigger policy lock-ins. We consider four cases in which the complex nature of the causation-prevention discourse leads to decision-making lock-ins, which deter safety progress. The four cases are conflicting narratives, missing causation inferences, prevention and mobility mismatch, and a tension between policy transfer and existing policy environments. The cases are demonstrated on recent examples of infrastructure measures that were observed in Israeli practice, which are, respectively: adding a motorway illumination, setting bus priority routes, safety improvements of multi-lane urban roads, and establishing traffic calming areas. While the four case-studies are region-specific, the discussion is relevant to other road safety measures and countries with similar policy-making problems. The consideration highlights the importance of policy-making dynamics to increase the resilience of the Safe System approach.

Development of an integrated and decentralised skin health strategy to improve experiences of skin neglected tropical diseases and other skin conditions in Atwima Mponua District, Ghana

Integrated strategies are recommended to tackle neglected tropical diseases of the skin (skin NTDs), which pose a substantial health and economic burden in many countries, including Ghana. We describe the development of an integrated and decentralised skin health strategy designed to improve experiences of skin NTDs in Atwima Mponua district in Ashanti Region. A multidisciplinary research team led an iterative process to develop an overall strategy and specific interventions, based on a theory of change informed by formative research conducted in Atwima Mponua district. The process involved preparatory work, four co-development workshops (August 2021 to November 2022), collaborative working groups to operationalise intervention components, and obtaining ethical approval. Stakeholders including affected individuals, caregivers, other community members and actors from different levels of the health system participated in co-development activities. We consulted these stakeholders at each stage of the research process, including discussion of study findings, development of our theory of change, identifying implementable solutions to identified challenges, and protocol development. Participants determined that the intervention should broadly address wounds and other skin conditions, rather than only skin NTDs, and should avoid reliance on non-governmental organisations and research teams to ensure sustainable implementation by district health teams and transferability elsewhere. The overall strategy was designed to focus on a decentralised model of care for skin conditions, while including other interventions to support a self-care delivery pathway, community engagement, and referral. Our theory of change describes the pathways through which these interventions are expected to achieve the strategy's aim, the assumptions, and problems addressed. This complex intervention strategy has been designed to respond to the local context, while maximising transferability to ensure wider relevance. Implementation is expected to begin in 2023.

Expectations of general practitioners on a practice based research network in Germany- a qualitative study within the Bavarian Research Practice Network (BayFoNet)

BACKGROUND

Despite general practitioners' (GPs') key role in Germany`s primary health care, clinical research in general practice is scarce. Clinical research is mainly conducted at inpatient facilities, although their results are rarely transferable. German GPs have no extra time or funding for research, as well as limited research training. To support clinical research in German primary health care, practice-based research networks (PBRNs) are developed. As they will be based on an active involvement of GPs, we need more information on GPs` participation-readiness. The aim of this study was to explore facilitators and barriers to participation in the Bavarian Research Practice Network (BayFoNet) from the GPs`perspective before clinical trials will be performed.

METHODS

We have performed semi-structured qualitative interviews with a purposive sample of 20 Bavarian GPs in 2022 under the application of the consolidated framework for implementation research (CFIR). Transcriptions were analysed according to Kuckartz` qualitative content analysis. The five domains of the CFIR framework served as initial deductive codes.

RESULTS

N = 14 interviewees already agreed to participate in BayFoNet, whereas n = 6 interviewees opted not to participate in BayFoNet at the time of data collection. Main facilitators to conduct clinical research within BayFoNet were the motivation to contribute to evidence strength and quality in general practice, professional development and training of practice staff, as well as networking. Barriers for an active participation were bad experiences with previous clinical studies and lack of resources.

CONCLUSIONS

PBRNS in Germany have to be promoted and the entire practice team has to be involved at an early stage of development. Professional training of general practice staff and a living network might enhance engagement. Participatory approaches could help to develop acceptable and feasible study designs. Furthermore, PBRNs should support patient recruitment and data collection in general practices and disseminate the results of their research projects regularly to maintain GPs` engagement.

TRIAL REGISTRATION

DRKS00028805, NCT05667207.

Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study

OBJECTIVES

This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation.

DESIGN

We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)) and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads).

SETTING

Four NHS Scotland territorial health boards.

PARTICIPANTS

51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews).

RESULTS

Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management and (3) strengths and limitations of existing Long COVID rehabilitation services.

CONCLUSIONS

Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.

Assessing healthcare capacity crisis preparedness: development of an evaluation tool by a Canadian health authority

Introduction

The COVID-19 pandemic presented health systems across the globe with unparalleled socio-political, ethical, scientific, and economic challenges. Despite the necessity for a unified, innovative, and effective response, many jurisdictions were unprepared to such a profound health crisis. This study aims to outline the creation of an evaluative tool designed to measure and evaluate the Vitalité Health Network's (New Brunswick, Canada) ability to manage health crises.

Methods

The methodology of this work was carried out in four stages: (1) construction of an evaluative framework; (2) validation of the framework; (3) construction of the evaluative tool for the Health Authority; and (4) evaluation of the capacity to manage a health crisis.

Results

The resulting evaluative tool incorporated 8 dimensions, 74 strategies, and 109 observable elements. The dimensions included: (1) clinical care management; (2) infection prevention and control; (3) governance and leadership; (4) human and logistic resources; (5) communication and technologies; (6) health research; (7) ethics and values; and (8) training. A Canadian Health Authority implemented the tool to support its future preparedness.

Conclusion

This study introduces a methodological strategy adopted by a Canadian health authority to evaluate its capacity in managing health crises. Notably, this study marks the first instance where a Canadian health authority has created a tool for emergency healthcare management, informed by literature in the field and their direct experience from handling the SARS-CoV-2 pandemic.

The need to strengthen the evaluation of the impact of Artificial Intelligence-based decision support systems on healthcare provision

Despite the renewed interest in Artificial Intelligence-based clinical decision support systems (AI-CDS), there is still a lack of empirical evidence supporting their effectiveness. This underscores the need for rigorous and continuous evaluation and monitoring of processes and outcomes associated with the introduction of health information technology. We illustrate how the emergence of AI-CDS has helped to bring to the fore the critical importance of evaluation principles and action regarding all health information technology applications, as these hitherto have received limited attention. Key aspects include assessment of design, implementation and adoption contexts; ensuring systems support and optimise human performance (which in turn requires understanding clinical and system logics); and ensuring that design of systems prioritises ethics, equity, effectiveness, and outcomes. Going forward, information technology strategy, implementation and assessment need to actively incorporate these dimensions. International policy makers, regulators and strategic decision makers in implementing organisations therefore need to be cognisant of these aspects and incorporate them in decision-making and in prioritising investment. In particular, the emphasis needs to be on stronger and more evidence-based evaluation surrounding system limitations and risks as well as optimisation of outcomes, whilst ensuring learning and contextual review. Otherwise, there is a risk that applications will be sub-optimally embodied in health systems with unintended consequences and without yielding intended benefits.

The ethical challenges of personalized digital health

Personalized digital health systems (pHealth) bring together in sharp juxtaposition very different yet hopefully complementary moral principles in the shared objectives of optimizing health care and the health status of individual citizens while maximizing the application of robust clinical evidence through harnessing powerful and often complex modern data-handling technologies. Principles brought together include respecting the confidentiality of the patient-clinician relationship, the need for controlled information sharing in teamwork and shared care, benefitting from healthcare knowledge obtained from real-world population-level outcomes, and the recognition of different cultures and care settings. This paper outlines the clinical process as enhanced through digital health, reports on the examination of the new issues raised by the computerization of health data, outlines initiatives and policies to balance the harnessing of innovation with control of adverse effects, and emphasizes the importance of the context of use and citizen and user acceptance. The importance of addressing ethical issues throughout the life cycle of design, provision, and use of a pHealth system is explained, and a variety of situation-relevant frameworks are presented to enable a philosophy of responsible innovation, matching the best use of enabling technology with the creation of a culture and context of trustworthiness.

Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions

BACKGROUND

Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions.

METHODS

This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate.

RESULTS

Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building.

CONCLUSIONS

This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.

The Impact of the Swedish Care Coordination Act on Hospital Readmission and Length-of-Stay among Multi-Morbid Elderly Patients: A Controlled Interrupted Time Series Analysis

Coordinating follow-up care after discharge from hospital is critical to ensuring good outcomes for patients, but is difficult when multiple care providers are involved. In 2018, Sweden adopted the Care Coordination Act, which modified economic incentives to reduce discharge delays and mandated a discharge planning process for patients requiring post-discharge social- or primary care services. This study evaluates the impact of this reform on hospital length-of-stay and unplanned readmissions among multi-morbid elderly patients. Interrupted time series analysis of all in-patient care episodes involving multi-morbid elderly patients in Sweden from 2015 - 2019 (n = 2 386 039) was performed. Secondary analyses using case-mix adjustment and controlled interrupted time series analysis were employed to assess for bias. Average length of stay decreased during the post-reform period, corresponding to 248 521 saved care days. Unplanned readmissions meanwhile increased, corresponding to 7 572 excess unplanned readmissions. While reductions in length-of-stay were concentrated among patients targeted by the reform, increases in readmission rates were similar in patients not targeted by the reform, indicating potential confounding. The reform thus appears to have achieved its goal of decreasing in-patient length of stay, but a robust effect on readmissions, outpatient visits, or mortality was not found. This may be due to lackluster implementation or an ineffective mandated intervention.

Health Care Professionals' Experiences of Facilitating Patient Activation and Empowerment in Chronic Illness using a Person-Centered and Strengths-Based Self-Management Program

OBJECTIVE

Patients with chronic illness who are empowered and activated are more likely to engage in self-management in order to stabilise their condition and enhance their quality of life. This study aimed to explore Health Care Professional's (HCP) assessment of a person-centered intervention called 'The Bodyknowledging Program' (BKP) for the facilitation of empowerment and patient activation in the context of chronic illness.

METHODS

This study employed a qualitative process evaluation after programme completion. Data was collected through focus-groups and individual interviews with HCPs and content analysis was used in the analysis.

RESULTS

Four themes were identified: 1) Shifts towards the patient-perspective, 2) The value of a patient-centered conceptual framework, 3) Patient activation through dialogue based support and 4) Challenging competencies. Discussion: This study introduces 'The Bodyknowledging Program' as a useful tool to uncover patients' needs and to activate and empower them to take more responsibility for their health through self-care management. The usability of the new intervention depends on HCP's ability to develop their counselling skills and changing their approach towards utilising patients' individual resources in the promotion of their health.

Assessing the quality of reporting on quality improvement initiatives in plastic surgery: A systematic review

BACKGROUND

There has been a recent increase in the number and complexity of quality improvement studies in plastic surgery. To assist with the development of thorough quality improvement reporting practices, with the goal of improving the transferability of these initiatives, we conducted a systematic review of studies describing the implementation of quality improvement initiatives in plastic surgery. We used the SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence) guideline to appraise the quality of reporting of these initiatives.

METHODS

English-language articles published in Embase, MEDLINE, CINAHL, and the Cochrane databases were searched. Quantitative studies evaluating the implementation of quality improvement initiatives in plastic surgery were included. The primary endpoint of interest in this review was the distribution of studies per SQUIRE 2.0 criteria scores in proportions. Abstract screening, full-text screening, and data extraction were completed independently and in duplicate by the review team.

RESULTS

We screened 7046 studies, of which 103 full texts were assessed, and 50 met inclusion criteria. In our assessment, only 7 studies (14%) met all 18 SQUIRE 2.0 criteria. SQUIRE 2.0 criteria that were met most frequently were abstract, problem description, rationale, and specific aims. The lowest SQUIRE 2.0 scores appeared in funding, conclusion, and interpretation criteria.

CONCLUSIONS

Improvements in QI reporting in plastic surgery, especially in the realm of funding, costs, strategic trade-offs, project sustainability, and potential for spread to other contexts, will further advance the transferability of QI initiatives, which could lead to significant strides in improving patient care.

Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study

BACKGROUND

Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial.

METHODS

Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms.

RESULTS

The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility).

CONCLUSIONS

Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.

Evaluation of implementation and effects of a health-promoting sports club intervention using a mixed-method design: PROSCeSS protocol

Public authorities and academics have advocated for applying been advocating for the application of the setting-based approach to sports clubs. However, studies have shown that existing health promotion (HP) interventions in sports clubs poorly understand and apply this approach. Moreover, methods used to evaluate these interventions do not inform their implementation process, limiting the generation effectiveness’ proofs. This study aims at evaluating the implementation process and effectiveness of an HP intervention in sports clubs (PROmotion de la Santé dans les ClubS de Spor; PROSCeSS), based on the health-promoting sports club (HPSC) model.

A type 3 hybrid design, using a multiphase mixed-method: QUAN→QUAL→ QUAN+QUAL (qual)→QUAL (quan+qual), will be used. Phase A will be a pre–post–quantitative study with one HP officer, five managers and five coaches from 30 sports clubs exploring the effects of the PROSCeSS intervention on HP perceptions and health literacy. Phase B will be focus groups with participants from HP initiatives that the 30 sports clubs will have previously put in place to detect changes in health. Phase C will explain the results of phases A and B by choice of strategies and adherence to standardised steps, measured through semistructured interviews and implementation data collection. Phase D will cross-reference the semistructured interviews, the sports club characteristics questionnaire and the implementation data collection to study the relationships between the context and the implementation process. This protocol will identify ‘what works’, ‘for whom’, in ‘what context’ in terms of HPSC and clarify which intervention components are more effective at improving HP. This evaluation design will help to develop appropriate approaches to evaluate HP interventions.

Availability and implementation of guidelines in European child primary health care: how can we improve?

BACKGROUND

Clinical guidelines are important for providing high-quality child primary health care. We aimed to assess the availability, use and achieved delivery of guidelines in the European Union (EU).

METHODS

We used a case study design to ascertain expert views on guidelines in six countries representing the EU. The experts completed an online questionnaire (response 49%), asking about their perception of guideline availability and implementation regarding three topics that represent prevention and care, i.e. vaccination, assessment of mental health and asthma care.

RESULTS

According to the respondents all countries had guidelines available for asthma care. For vaccination and mental health assessment respondents agreed to a lesser degree that guidelines were available. Implementation of guidelines for vaccination was mostly perceived as intended, but implementation of the guidelines for mental health assessment and asthma care was limited. Notable barriers were complexity of performance, and lack of training of professionals and of financial resources. Important facilitators for guideline implementation were the fit with routine practice, knowledge and skills of professionals and policy support. We found no clear relationship of guideline availability and implementation with type of child primary health care system of countries, but strong governance and sufficient financial resources seemed important for guideline availability.

CONCLUSIONS

Availability and implementation of clinical guidelines in child primary health care vary between EU countries. Implementation conditions can be strongly improved by adequate training of professionals, stronger governance and sufficient financial resources as facilitating factors. This can yield major gains in child health across Europe.

Role of Local Evidence in Transferring Evidence-Based Interventions to Low- and Middle-Income Country Settings: Application to Global Cancer Prevention and Control

PURPOSE

Although the global burden of cancer falls increasingly on low- and middle-income countries (LMICs), much of the evidence for cancer prevention and control comes from high-income countries and may not be directly applicable to LMIC settings. In this paper, we focus on the following question: When the majority of the evidence supporting an evidence-based intervention or implementation strategy comes from high-income countries, what local, contextual evidence is needed when transferring and adapting an intervention or strategy to a specific LMIC setting?

METHODS

We draw on an existing framework (the Population, Intervention, Environment, Transfer-T process model) for assessing transferability of interventions between distinct settings and apply the model to two case studies as learning examples involving implementation of tobacco use treatment guidelines and self sampling for human papillomavirus DNA in cervical cancer screening.

RESULTS

These two case studies illustrate how researchers, policymakers, practitioners, and consumers may approach the need for local evidence from different perspectives and with different priorities. As uses and expectations around local evidence may be different for different groups, aligning these priorities through multistakeholder engagement in which all parties participate in defining the questions and cocreating the solutions is critical, along with promoting standardized reporting of contextual factors.

CONCLUSION

Local, contextual evidence can be important for both researchers and practitioners, and its absence may hinder translation of research and implementation efforts across different settings. However, it is essential for researchers, practitioners, and other stakeholders to be able to clearly articulate the type of data needed and why it is important. In particular, where resources are limited, evidence generation should be prioritized to address real needs and gaps in knowledge.

Realist evaluation of the impact, viability and transferability of an alcohol harm reduction support programme based on mental health recovery: the Vitae study protocol

INTRODUCTION

Addiction is considered a chronic disease associated with a high rate of relapse as a consequence of the addictive condition. Most of the current therapeutic work focuses on the notion of relapse prevention or avoidance and the control of its determinants. Since only a small portion of patients can access alcohol addiction treatment, it is crucial to find a way to offer new support towards safe consumptions, reductions or cessations. The harm reduction (HR) approach and mental health recovery perspective offers another way to support the patient with alcohol addiction. Vitae is a realist evaluation of the impact, viability and transferability of the IACA! programme, an HR programme based on the principle of psychosocial recovery for people with alcohol use disorders.

METHODS AND ANALYSIS

The Vitae study adheres to the theory-driven evaluation framework where the realist evaluation method and contribution analysis are used to explore the effects, mechanisms and influence of context on the outcomes and to develop and adjust an intervention theory. This study is a 12-month, multi-case, longitudinal descriptive pilot study using mixed methods. It is multi-centred, and carried out in 10 addiction treatment or prevention centres. In this study, outcomes are related to the evolution of alcohol use and the beneficiaries trajectory in terms of psychosocial recovery during these 12 months after the start of IACA!. The target number of participants are 100 beneficiaries and 23 professionals.

ETHICS AND DISSEMINATION

This research was approved by the Committee for the Protection of Persons Ouest V n°: 21/008-3HPS and was reported to the French National Agency for the Safety of Health Products. All participants will provide consent prior to participation. The results will be reported in international peer-reviewed journals and presented at scientific and public conferences.

TRIAL REGISTRATION NUMBERS

NCT04927455; ID-RCB2020-A03371-38.

Priority setting and cross-country learning: the relevance of TO-REACH for primary care

Aim:

To inform the primary care community about priorities for research in primary care as came up from the European project TO-REACH and to discuss transferability of service and policy innovations between countries.

Background:

TO-REACH stands for Transfer of Organizational innovations for Resilient, Effective, equitable, Accessible, sustainable and Comprehensive Health services and systems. This EU-funded project has put health systems and services research higher on the European agenda and has led to the current development of a European ‘Partnership Transforming Health and Care Systems’.

Methods:

To identify research priorities, both qualitative and quantitative approaches were used. Policy documents and strategic roadmaps were searched, and priorities were mapped. Stakeholders were involved through national roundtable consultations and online consultations. Regarding transferability, we carried out a review of the literature, guided by a conceptual framework, and using a snowballing approach.

Findings:

Primary care emerged as an important priority from the inventory, as are areas that are conducive to strengthening primary care, such as workforce policies. The large variation in service organisation and policy around primary care in Europe is a huge potential for cross-country learning. However, the simple transfer of primary care service and policy arrangements from one health system to another has a big chance to fail, unless known conditions for successful transfer are taken into account and gaps in our knowledge about transfer are resolved.

Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries

Introduction

Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs.

Methods

We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms “tobacco” and “HIV” and “cessation” over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings.

Conclusion

There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.

General practitioners' willingness to participate in research networks in Germany

OBJECTIVES

To investigate general practitioners' (GPs') willingness to participate in long-term medical research and in research networks (RNs).

DESIGN AND SETTING

Cross-sectional survey among German GPs around Halle-Wittenberg and Leipzig in 2020.

SUBJECTS

Random sample of 905 GPs.

MAIN OUTCOME MEASURES AND RESULTS

Response rate 37%, 69% female. Overall, 57% were interested in participating in medical research, 34% in an active role in a RN. Interest in RN participation was positively associated with male sex, younger age, previous experiences in medical research, being involved in teaching undergraduates, and having qualification in a further specialty. Main motivators were improving patient care, giving a more realistic picture of GP care, and carrying out research on topics within their own interest areas and a reliable contact person at the leading institution. Most GPs were not afraid of reduced earnings; however, time investment was the main barrier for participation. GPs were willing to dedicate twice as much time to research when remuneration was offered. High rated topics were polypharmacy, chronic diseases, drug safety and adverse drug reactions.

CONCLUSION

GPs are interested to participate in practice-based research. The study results providing useful and generalizable insights in barriers and motivators should be considered when building and running GP-RNs.KEY POINTSThere is a difference between general practitioners' (GPs') overall interest in clinical research and their job and socio-demographic related readiness to participate in research networks (RNs).GPs are interested in RNs when it is a resource of and leading to enhanced patient-oriented care.GPs are willing to dedicate twice as much time to research when remunerated.GPs need a reliable counterpart within the leading institution.

Artificial intelligence in Emergency Medical Services dispatching: assessing the potential impact of an automatic speech recognition software on stroke detection taking the Capital Region of Denmark as case in point

BACKGROUND AND PURPOSE

Stroke recognition at the Emergency Medical Services (EMS) impacts the stroke treatment and thus the related health outcome. At the EMS Copenhagen 66.2% of strokes are detected by the Emergency Medical Dispatcher (EMD) and in Denmark approximately 50% of stroke patients arrive at the hospital within the time-to-treatment. An automatic speech recognition software (ASR) can increase the recognition of Out-of-Hospital cardiac arrest (OHCA) at the EMS by 16%. This research aims to analyse the potential impact an ASR could have on stroke recognition at the EMS Copenhagen and the related treatment.

METHODS

Stroke patient data (n = 9049) from the years 2016-2018 were analysed retrospectively, regarding correlations between stroke detection at the EMS and stroke specific, as well as personal characteristics such as stroke type, sex, age, weekday, time of day, year, EMS number contacted, and treatment. The possible increase in stroke detection through an ASR and the effect on stroke treatment was calculated based on the impact of an existing ASR to detect OHCA from CORTI AI.

RESULTS

The Chi-Square test with the respective post-hoc test identified a negative correlation between stroke detection and females, the 1813-Medical Helpline, as well as weekends, and a positive correlation between stroke detection and treatment and thrombolysis. While the association analysis showed a moderate correlation between stroke detection and treatment the correlation to the other treatment options was weak or very weak. A potential increase in stroke detection to 61.19% with an ASR and hence an increase of thrombolysis by 5% in stroke patients calling within time-to-treatment was predicted.

CONCLUSIONS

An ASR can potentially improve stroke recognition by EMDs and subsequent stroke treatment at the EMS Copenhagen. Based on the analysis results improvement of stroke recognition is particularly relevant for females, younger stroke patients, calls received through the 1813-Medical Helpline, and on weekends.

TRIAL REGISTRATION

This study was registered at the Danish Data Protection Agency (PVH-2014-002) and the Danish Patient Safety Authority (R-21013122).

A Guideline for Contextual Adaptation of Community-Based Health Interventions

In Southeast Asia, community-based health interventions (CBHIs) are often used to target non-communicable diseases (NCDs). CBHIs that are tailored to sociocultural aspects of health and well-being: local language, religion, customs, traditions, individual preferences, needs, values, and interests, may promote health more effectively than when no attention is paid to these aspects. In this study, we aimed to develop a guideline for the contextual adaption of CBHIs. We developed the guideline in two stages: first, a checklist for contextual and cultural adaptation; and second, a guideline for adaptation. We performed participatory action research, and used the ‘Appraisal of Guidelines for Research & Evaluation (AGREE) II’ tool as methodological basis to develop the guideline. We conducted a narrative literature review, using a conceptual framework based on the six dimensions of ‘Positive Health’ and its determining contexts to theoretically underpin a checklist. we pilot tested a draft version of the guideline and included a total of 29 stakeholders in five informal meetings, two stakeholder meetings, and an expert review meeting. This yielded a guideline, addressing three phases: the preparation phase, the assessment phase, and the adoption phase, with integrated checklists comprising 34 cultural and contextual aspects for the adaption of CBHIs based on general health directives or health models. The guideline provides insight into how CBHIs can be tailored to the health perspectives of community members, and into the context in which the intervention is implemented. This tool can help to effect behavioral change, and improve the prevention and management of NCDs.

Indirectness (transferability) is critical when considering existing economic evaluations for GRADE Clinical Practice Guidelines: A systematic review

OBJECTIVE

GRADE practice guideline developers often perform systematic reviews of potential economic evaluations to inform recommendation decision-making. We aimed to identify indirectness characteristics of economic evaluations, related to GRADE evidence-to-decision (EtD) theoretical frameworks, that influence selection of these articles.

STUDY DESIGN AND SETTING

MEDLINE, EMBASE, CINAHL and EconLit were systematically searched to May 2020 to identify indirectness characteristics relevant for economic evaluation transferability to GRADE evidence-to-decision (EtD) theoretical frameworks. Four reviewers screened citations to identify articles of any type that explored study characteristics most important or relevant to economic evaluation transferability, restricted to English language We generated frequencies of article features, used thematic analysis to summarize study characteristics and assessed certainty in the evidence using GRADE-CERQual.

RESULTS

We included 57 articles, with a dearth of empirical literature - some may have been missed. We identified 8 general themes and 28 sub-themes most important to transferability from 41% of articles. Moderate-to-high confidence evidence suggested that GRADE EtD domains of population, intervention and comparison research question elements, resource use estimation and methodology, and provider and decision-maker acceptability are most important indirectness study characteristics that economists consider when choosing economic evaluation outcomes for use in recommendation decision-making.

CONCLUSION

We have identified factors important for guideline developers to consider when selecting economic evaluations as research evidence. An economic competency on the development team facilitates these endeavors. This supports the GRADE Working Group's tenant of transparent reporting or availability of sufficient information elsewhere to assess indirectness.

Implementation of a novel malaria management strategy based on self-testing and self-treatment in remote areas in the Amazon (Malakit): confronting a-priori assumptions with reality

Background

A novel strategy to combat malaria was tested using a methodology adapted to a complex setting in the Amazon region and a hard-to-reach, mobile community. The intervention strategy tested was the distribution, after training, of malaria self-management kits to gold miners who cross the Surinamese and Brazilian borders with French Guiana to work illegally in the remote mining sites in the forest of this French overseas entity.

Main text

This article aims at presenting all process and implementation outcomes following the Conceptual Framework of Implementation Fidelity i.e. adherence, including content and exposure, and moderators, comprising participant responsiveness, quality of delivery, facilitation strategies, and context. The information sources are the post-intervention survey, data collected longitudinally during the intervention, a qualitative study, data collected during an outreach mission to a remote gold mining site, supervisory visit reports, in-depth feedback from the project implementers, and videos self-recorded by facilitators based on opened ended questions.

As expected, being part of or close to the study community was an essential condition to enable deliverers, referred to as “facilitators”, to overcome the usual wariness of this gold mining population. Overall, the content of the intervention was in line with what was planned. With an estimated one third of the population reached, exposure was satisfactory considering the challenging context, but improvable by increasing ad hoc off-site distribution according to needs. Participant responsiveness was the main strength of the intervention, but could be enhanced by reducing the duration of the process to get a kit, which could be disincentive in some places. Regarding the quality of delivery, the main issue was the excess of information provided to participants rather than a lack of information, but this was corrected over time. The expected decrease in malaria incidence became a source of reduced interest in the kit. Expanding the scope of facilitators’ responsibilities could be a suitable response. Better articulation with existing malaria management services is recommended to ensure sustainability.

Conclusions

These findings supplement the evaluation outcomes for assessing the relevance of the strategy and provide useful information to perpetuate and transfer it in comparable contexts.

Trial registration

ClinicalTrials.gov. NCT03695770. 10/02/2018 “Retrospectively registered”.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12801-0.

Tools for assessing the scalability of innovations in health: a systematic review

BACKGROUND

The last decade has seen growing interest in scaling up of innovations to strengthen healthcare systems. However, the lack of appropriate methods for determining their potential for scale-up is an unfortunate global handicap. Thus, we aimed to review tools proposed for assessing the scalability of innovations in health.

METHODS

We conducted a systematic review following the COSMIN methodology. We included any empirical research which aimed to investigate the creation, validation or interpretability of a scalability assessment tool in health. We searched Embase, MEDLINE, CINAHL, Web of Science, PsycINFO, Cochrane Library and ERIC from their inception to 20 March 2019. We also searched relevant websites, screened the reference lists of relevant reports and consulted experts in the field. Two reviewers independently selected and extracted eligible reports and assessed the methodological quality of tools. We summarized data using a narrative approach involving thematic syntheses and descriptive statistics.

RESULTS

We identified 31 reports describing 21 tools. Types of tools included criteria (47.6%), scales (33.3%) and checklists (19.0%). Most tools were published from 2010 onwards (90.5%), in open-access sources (85.7%) and funded by governmental or nongovernmental organizations (76.2%). All tools were in English; four were translated into French or Spanish (19.0%). Tool creation involved single (23.8%) or multiple (19.0%) types of stakeholders, or stakeholder involvement was not reported (57.1%). No studies reported involving patients or the public, or reported the sex of tool creators. Tools were created for use in high-income countries (28.6%), low- or middle-income countries (19.0%), or both (9.5%), or for transferring innovations from low- or middle-income countries to high-income countries (4.8%). Healthcare levels included public or population health (47.6%), primary healthcare (33.3%) and home care (4.8%). Most tools provided limited information on content validity (85.7%), and none reported on other measurement properties. The methodological quality of tools was deemed inadequate (61.9%) or doubtful (38.1%).

CONCLUSIONS

We inventoried tools for assessing the scalability of innovations in health. Existing tools are as yet of limited utility for assessing scalability in health. More work needs to be done to establish key psychometric properties of these tools. Trial registration We registered this review with PROSPERO (identifier: CRD42019107095).

Evaluation in Life Cycle of Information Technology (ELICIT) framework: Supporting the innovation life cycle from business case assessment to summative evaluation

OBJECTIVE

Our objective was to develop an evaluation framework for electronic health record (EHR)-integrated innovations to support evaluation activities at each of four information technology (IT) life cycle phases: planning, development, implementation, and operation.

METHODS

The evaluation framework was developed based on a review of existing evaluation frameworks from health informatics and other domains (human factors engineering, software engineering, and social sciences); expert consensus; and real-world testing in multiple EHR-integrated innovation studies.

RESULTS

The resulting Evaluation in Life Cycle of IT (ELICIT) framework covers four IT life cycle phases and three measure levels (society, user, and IT). The ELICIT framework recommends 12 evaluation steps: (1) business case assessment; (2) stakeholder requirements gathering; (3) technical requirements gathering; (4) technical acceptability assessment; (5) user acceptability assessment; (6) social acceptability assessment; (7) social implementation assessment; (8) initial user satisfaction assessment; (9) technical implementation assessment; (10) technical portability assessment; (11) long-term user satisfaction assessment; and (12) social outcomes assessment.

DISCUSSION

Effective evaluation requires a shared understanding and collaboration across disciplines throughout the entire IT life cycle. In contrast with previous evaluation frameworks, the ELICIT framework focuses on all phases of the IT life cycle across the society, user, and IT levels. Institutions seeking to establish evaluation programs for EHR-integrated innovations could use our framework to create such shared understanding and justify the need to invest in evaluation.

CONCLUSION

As health care undergoes a digital transformation, it will be critical for EHR-integrated innovations to be systematically evaluated. The ELICIT framework can facilitate these evaluations.

Do manual therapies have a specific autonomic effect? An overview of systematic reviews

Background

The impact of manual therapy interventions on the autonomic nervous system have been largely assessed, but with heterogeneous findings regarding the direction of these effects. We conducted an overview of systematic reviews to describe if there is a specific autonomic effect elicited by manual therapy interventions, its relation with the type of technique used and the body region where the intervention was applied.

Methods

We conducted an overview according to a publicly registered protocol. We searched the Cochrane Database of Systematic Reviews, MEDLINE, EPISTEMONIKOS and SCOPUS, from their inception to march 2021. We included systematic reviews for which the primary aim of the intervention was to assess the autonomic effect elicited by a manual therapy intervention in either healthy or symptomatic individuals. Two authors independently applied the selection criteria, assessed risk of bias from the included reviews and extracted data. An established model of generalisation guided the data analysis and interpretation.

Results

We included 12 reviews (5 rated as low risk of bias according the ROBIS tool). The findings showed that manual therapies may have an effect on both sympathetic and parasympathetic systems. However, the results from included reviews were inconsistent due to differences in their methodological rigour and how the effects were measured. The reviews with a lower risk of bias could not discriminate the effects depending on the body region to which the technique was applied.

Conclusion

The magnitude of the specific autonomic effect elicited by manual therapies and its clinical relevance is uncertain. We point out some specific recommendations in order to improve the quality and relevance of future research in this field.

Mechanisms and context in the San Patrignano drug recovery community, Italy: a qualitative study to inform transfer to Scotland

The San Patrignano drug recovery community, Italy, is regarded as one of the most successful in the world. However, if this model is to be transferred to other countries, it is necessary to clarify its underlying mechanisms and how far their success is context dependent. This qualitative study investigated these features of the San Patrignano model. Data collection included semi-structured interviews with six key stakeholders and 10 days’ observational field notes. Data were synthesised using frameworks and analysis was informed by realist principles. Individual level mechanisms include: commitment to change, removal from former social environment, communal living, peer mentor with lived experience and meaningful work. These operate in the context of a free of charge, long term (3–4 year) residential community. Organisational level mechanisms are: visionary leadership, staff dedication, social enterprise and adaptable learning. Organisational contextual factors include: a gap in suitable provision for drug recovery and the region’s high level of social capital. Articulating the programme theory of the recovery model and its contextual dependency helps clarify which elements should be transferred and how far they need to be adapted for different socio-cultural settings. The recognition of context is crucial when considering transfer of effective complex interventions across countries.

Factors influencing the uptake of evidence in child health policy-making: results of a survey among 23 European countries

Background

The ability to successfully transfer knowledge across international boundaries to improve health across the European Region is dependent on an in-depth understanding of the many factors involved in policy creation. Across countries we can observe various approaches to evidence usage in the policy-making process. This study, which was a part of the Models of Child Health Appraised (MOCHA) project assessing patterns of children’s primary care in Europe, focused on how and what kind of evidence is used in child health policy-making processes in European countries and how it is applied to inform policy and practice.

Method

In this study, a qualitative approach was used. The data were analysed in accordance with the thematic analysis protocol. The MOCHA project methodology relies on experienced country agents (CA) recruited for the project and paid to deliver child health data in each of 30 European countries. CAs are national experts in the child health field who defined the country-specific structured information and data. A questionnaire designed as a semi-structured survey instrument asked CAs to indicate the sources of evidence used in the policy-making process and what needed to be in place to support evidence uptake in policy and practice.

Results

In our data we observed two approaches to evidence usage in child health policy formulation. The scientific approach in our understanding refers to the so-called bottom-up initiatives of academia which identify and respond to the population’s needs. Institutional approaches can be informed by scientific resources as well; however, the driving forces here are governmental institutions, whose decisions and choices are based not only on the population needs but also on political, economic and organizational factors. The evidence used in Europe can also be of an external or internal nature. Various factors can affect the use of evidence in child health policy-making. Facilitators are correlated with strong scientific culture development, whereas barriers are defined by a poor tradition of implementing changes based on reliable evidence.

Conclusions

Focusing on the facilitators and actively working to reduce the barriers can perceivably lead to faster and more robust policy-making, including the development of a culture of scientific grounding in policy creation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00786-y.

Evidence-based policymaking when evidence is incomplete: The case of HIV programme integration

Jan Hontelez and co-authors discuss the use of different types of evidence to inform HIV program integration.

How might the 'Icelandic model' for preventing substance use among young people be developed and adapted for use in Scotland? Utilising the consolidated framework for implementation research in a qualitative exploratory study

Background

Substance use among young people is a significant public health concern, particularly in Scotland. Primary prevention activities are essential in delaying young people’s substance use and reducing the harms associated with use. However, such prevention activities are generally lacking. The Icelandic Model (IM) has received increasing attention and has been associated with improvements in substance use in Iceland since the 1990s. There is interest in implementing the IM in Scotland but concerns regarding transferability. This research study aimed to address a gap in the evidence base by providing insight into stakeholders’ views of the IM in Dundee and more widely in Scotland.

Methods

Qualitative data were collected via semi-structured telephone interviews with 16 stakeholders. Data were analysed using Framework Analysis in NVivo, informed by the Consolidated Framework for Implementation Research.

Results

Participants were keen for more prevention activities to be delivered in Scotland and were generally supportive of the IM, given the high rates of substance use and related harm. A range of positive factors were identified, including the evidence base, the multi-component nature of the IM, and availability of current services that could be embedded into delivery. Several barriers were noted, relating to funding, the franchise model, support and buy-in and cultural differences.

Conclusions

Our findings provide insight into the views of a range of stakeholders regarding the potential implementation of the IM in Scotland, and perceived barriers and facilitators. There is a desire for primary prevention activities in Scotland, driven by concerns about high rates of substance use and related harms, and a general lack of effective and evidence based prevention activities across the country. Several key barriers would need to be addressed in order for implementation to be successful, and participants were clear that initial piloting is required. Future research and evaluation is required to examine its potential and the outcomes of the approach in Scotland.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11828-z.

Tailored communication methods as key to implementation of evidence-based solutions in primary child health care

Background

Evidence-based policies should underpin successful implementation of innovations within child health care. The EU-funded Models of Child Health Appraised project enabled research into effective methods to communicate research evidence. The objective of this study was to identify and categorize methods to communicate evidence-based research recommendations and means to tailor this to stakeholder audiences.

Methods

We conducted an online survey among national stakeholders in child health. Analysis of the most effective strategies to communicate research evidence and reach the target audience was carried out in order to ensure implementation of optimal child health care models at a national level.

Results

Representatives of stakeholders from 21 of the then 30 EU MS and EEA countries responded to the questionnaire. Three main approaches in defining the strategies for effective communication of research recommendations were observed, namely: dissemination of information, involvement of stakeholders and active attitude towards change expressed in actions. The target audience for communicating recommendations was divided into two layers: proximal, which includes those who are remaining in close contact with the child, and distal, which contains those who are institutionally responsible for high quality of child health services. They should be recipients of evidence-based results communicated by different formats, such as scientific, administrative, popular and personal.

Conclusions

Influential stakeholders impact the process of effective research dissemination and guide necessary actions to strengthen the process of effective communication of recommendations. Communication of evidence-based results should be targeted to each audience’s profile, both professional and non-professionals, by adjusting appropriate communication formats.

Identifying relevant factors for successful implementation into routine practice: expert interviews to inform a heart failure self-care intervention (ACHIEVE study)

Background

Adherence to heart failure (HF) self-care behaviours has been found to be effective for alleviating illness symptoms, increasing quality of life and reducing hospital re-admissions and mortality. However, many patients fail to implement on-going self-care into their daily lives. It is therefore crucial to improve the behaviour of HF patients to increase self-care adherence. The aim of this study is to identify relevant factors to successfully implement a complex, theory-based HF self-care intervention into routine practice.

Methods

We conducted semi-structured interviews to obtain key stakeholders’ opinions on previously developed behaviour change techniques for enhancing HF patients’ self-care behaviours, in order to optimise implementation of these techniques in an intervention. The interview topic guide was developed based on the Normalisation Process Theory (NPT), a tool that takes into account the feasibility of implementation and the acceptability to stakeholders. Interviews were analysed using thematic analysis and supported by MAXQDA 2020, a software for qualitative research.

Results

Interview participants included 18 key stakeholders consisting of three crucial groups: clinical experts (n = 7), patients (n = 3) and high calibre policy makers/potential funders (n = 8). The interviews revealed numerous factors to consider for successful implementation of an intervention into routine practice. The findings are presented according to two major categories: (1) themes within the NPT framework and (2) themes beyond the NPT framework. Themes within the NPT component ‘Coherence’ include three sub-themes: ‘understandability’, ‘value beyond existing interventions’ and ‘perceived benefits’. The NPT component ‘Cognitive participation’ revealed two sub-themes: ‘time resources’ and ‘financial sustainability’. Finally, the NPT component ‘Collective action’ uncovered three sub-themes: ‘need for training’, ‘compatibility with existing practice’ and ‘influence on roles’. A further two themes were identified beyond the NPT framework, namely: ‘structural challenges’ and (2) ‘role of carers’.

Conclusions

Factors identified previously by NPT were validated, but stakeholders further identified relevant aspects beyond NPT. Based on these findings, we suggest the existing NPT framework could be expanded to include a fifth component: questions considering specific environmental factors (contextual considerations). Sensitising researchers to these issues at an early stage when designing an intervention can facilitate its later success.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06596-w.

Precision cancer medicine: What has translated into clinical use in Belgium?

RATIONALE

In 2016, Belgium launched the Next Generation Sequencing (NGS) Roadbook, consisting in 10 Actions, across the health care system, to facilitate the uptake of NGS in routine clinical practice. We compiled feedback on deployment of the NGS Roadbook from governmental stakeholders and beneficiaries: health policy makers, insurance providers, pathologists, geneticists, and oncologists.

MAIN FINDINGS

The Roadbook ensured the establishment of a Commission on Personalized Medicine and NGS testing guidelines. A national benchmarking trial ensued, and 10 networks of hospitals and laboratories adopted a reimbursement convention with the Belgian Health Insurance Agency. The Healthdata.be platform centralizes the collection of NGS metrics, and citizens were consulted on their views about NGS and genomics.

CONCLUSION

The Roadbook facilitated the implementation of NGS in routine (hemato-)oncology care in Belgium. Some challenges remain linked to data sharing and access by a wider range of stakeholders. Next steps include continuous monitoring of health outcomes and the budgetary impact.

Health-care professionals' assessment of a person-centred intervention to empower self-management and health across chronic illness: Qualitative findings from a process evaluation study

Background

Person‐centred care (PCC) empowers patients to manage their chronic illness and promote their health in accordance with their own beliefs, values and preferences. Drawing on health‐care professional's (HCP’s) experiences implementing an empowerment‐focused, person‐centred intervention called the Bodyknowledging Program (BKP), we undertook a process evaluation that aimed to assess the impact on patient health and well‐being.

Methods

We used individual in‐depth interviews and semi‐structured focus groups comprising n = 8 interprofessional HCP who facilitated intervention sessions with n = 58 patients situated in Norwegian specialist care sites. Content analysis was used to analyse the data and summarize major themes.

Results

Health‐care professional interviews revealed four main ways in which the intervention operated in support of health‐related patient outcomes: (i) addressing the whole person; (ii) hope and affirmation; (iii) expanding recovery; and (iv) social support and revitalized relationships. The intervention provided new tools for patients to understand the social, emotional and physical impact of their illness. Health‐care professional reported new insights to facilitate patient engagement and to promote patients’ health.

Conclusions

The Bodyknowledging Program facilitated patient engagement through the promotion of patient‐centred care while developing the patients’ ability to exploit their own resources for effectively managing their health within illness. The process evaluation supported the underlying theoretical basis of the intervention and was suggestive of its potential transferability elsewhere.

Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process

Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people’s everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population–Intervention–Environment–Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.

[Development of intervention databases to promote evidence-based prevention and health promotion-methodological considerations]

Municipal actors do not experience sufficient scientific support in the development and selection of preventive and health promoting interventions. Intervention databases can remedy this by presenting scientifically validated and well-documented interventions. This allows local decisions to be informed by scientific evidence on the effectiveness of interventions. The databases can also be used to promote quality development of interventions.This paper explains methodological and conceptual considerations on how preventive and health-promoting interventions can be identified for databases and how they can be classified in terms of their effectiveness and prepared in a way that is appropriate for the target group. It is based on findings from the public health literature and the project "Ageing in Balance" ("Älter werden in Balance") of the Bundeszentrale für gesundheitliche Aufklärung (BZgA).Systematic reviews are of limited use in the search for suitable interventions for the database, partly because the types of interventions listed in them are limited and information relevant to implementation is often incompletely presented. However, it seems promising to include interventions from practice in the database if they are additionally classified with regard to their effectiveness or if consequences for further development and evaluation are formulated. In addition, as much information as possible should be provided on the practical implementation of interventions. A first suggestion shows what a description of the measures could look like. In addition, manuals for the implementation of measures should be available.

Étude sur la transférabilité d’une intervention d’éducation en santé dans le parc HLM : une méthode de recherche à l’épreuve du transfert pour décrire autrement les fonctions-clés

La transférabilité des interventions en santé est un enjeu essentiel à la réduction des inégalités sociales de santé. Mais ces interventions sont complexes et leur efficacité n’est pas garantie lors d’un transfert d’un contexte à l’autre. La description des fonctions-clés des interventions concourt à une meilleure transférabilité. Toutefois, celle-ci repose rarement sur une méthode permettant de concevoir l’intervention en situation de transfert.

Cet article explicite le processus méthodologique permettant l’identification des fonctions-clés de l’intervention en situation de transfert, et leurs déclinaisons nommées : « éléments de passation » (EP).

Nous nous sommes appuyés sur une recherche collaborative orientée par la conception (RoC) visant à concevoir une intervention d’éducation pour les locataires âgés du parc social, leur permettant de décider et d’agir pour adapter leur logement à leurs besoins.

Deux cycles de recherche sont menés au sein d’entreprises sociales pour l’habitat (ESH) avec des comités de recherche réunissant chercheurs, locataires et professionnels. Plusieurs étapes collaboratives ont été nécessaires : l’étude du contexte de l’ESH1 et la création d’une culture commune ; la formation des professionnels impliqués dans l’intervention d’éducation ; la déclinaison du modèle selon les critères de transférabilité d’ASTAIRE (outil pour l’analyse de la transferabilité des interventions en promotion de la santé) ; l’identification des variations et des éléments stables du modèle au moment du transfert vers deux autres ESH ; l’identification des fonctions-clés du modèle et de ses « éléments de passation ».

À l’épreuve du transfert, l’intervention est décrite en quatre catégories de fonctions-clés, déclinées en EP. Les EP sont des résultats issus de la RoC jugés signifiants par les acteurs de la recherche. Ce sont des phénomènes explicatifs révélant des situations à prévoir pour réussir le transfert et rendre l’intervention efficace. Ils permettent de donner sens aux fonctions-clés pour que les acteurs souhaitant transférer l’intervention dans leur contexte puissent mieux s’y préparer.

Women in Relationships and Their Pornography Use: A Systematic Review and Thematic Synthesis

A systematic review and thematic synthesis were conducted on the motivations, purposes, and influence of pornography use among women who are in committed relationships. Pornography use was identified as having both positive and negative outcomes for women's sexual and relationship lives. Women watched pornography for diverse reasons: to feel sexually empowered, to enhance sexual arousal, and for masturbation purposes. Shared use of pornography with partners provided variety in sexual activities, could aid communication about sexual issues and helped improve intimacy. Pornography use can help some women feel sexually empowered, relaxed and better able to enjoy their sexual lives.

Relationship between Urban Green Spaces and Cancer: A Scoping Review

This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use.

Soil and Water Bioengineering Applications in Central and South America: A Transferability Analysis

The present work describes a transferability analysis for soil and water bioengineering techniques as an instrument for sustainable erosion control in Central and South America based on an empirical data base from the last decades. In total, 31 case studies in Mexico, Nicaragua, Guatemala, Colombia, Ecuador and Brazil generated a database from an area where soil and water bioengineering techniques are not commonly used. The Transferability Analysis is structured in seven steps: (1) Objectives of the procedure, (2) Impacts of the measure, (3) Identification of up-scaling/down-scaling needs (4) Identification of the main phases and its components, (5) Identification of the level of importance of the components, (6) Assessment of the components in the context of the Take-Up Site and (7) Conclusions. For the assessment of soil and water bioengineering via the Transferability Analysis, in step 4 the following main phases have been identified from the data base: (a) Planning Phase, (b) Construction Phase, (c) Use Phase, as well as (d) End of Life Phase of a construction. Within these categories, 14 components have been defined: (a) know-how of soil and water bioengineering techniques, local climate conditions, botany, hydraulics, pedology; (b) materials, qualified labor, equipment and mechanical instruments, economic resources; (c) monitoring, efficiency, sustainability, maintenance; (d) replicability. The following assessment of the components allowed to determine key barriers, as well as key support factors for the transfer of soil and water bioengineering. As a result, barriers appeared to be the components qualified labor, equipment/mechanical instruments, hydraulics, know-how in soil and water bioengineering and pedology. Neither barriers, nor supporting key factors resulted to be the components local climate conditions, economic resources and efficiency. Supporting key factors for the transfer were materials, monitoring, sustainability, maintenance and replicability. The most important key factor of success was assessed to be botany, as various plant species with important characteristics for soil and water bioengineering are available in Central and South America, able to compensate the constraints through barriers in certain cases.

Limited evidence of benefits of patient operated intelligent primary care triage tools: findings of a literature review

Introduction

There is consistent evidence that the workload in general practices is substantially increasing. The digitalisation of healthcare including the use of artificial intelligence has been suggested as a solution to this problem. We wanted to explore the features of intelligent online triage tools in primary care by conducting a literature review.

Method

A systematic literature search strategy was formulated and conducted in the PubMed database and the Cochrane Library. Articles were selected according to inclusion/exclusion criteria. Results and data were systematically extracted and thematically analysed. 17 articles of that reported large multimethod studies or smaller diagnostic accuracy tests on clinical vignettes were included. Reviews and expert opinions were also considered.

Results

There was limited evidence on the actual effects and performance of triage tools in primary care. Several aspects can guide further development: concepts of system design, system implementation and diagnostic performance. The most important findings were: a need to formulate evaluation guidelines and regulations; their assumed potential has not yet been met; a risk of increased or redistribution of workloads and the available symptom checker systems seem overly risk averse and should be tested in real-life settings.

Conclusion

This review identified several features associated with the design and implementation of intelligent online triage tools in a primary care context, although most of the investigated systems seemed underdeveloped and offered limited benefits. Current online triage systems should not be used by individuals who have reasonable access to traditional healthcare. Systems used should be strictly evaluated and regulated like other medical products.

Determinants of usefulness in professional behaviour change interventions: observational study of a 15-year national program

OBJECTIVE

Educational, and audit and feedback interventions are effective in promoting health professional behaviour change and evidence adoption. However, we lack evidence to pinpoint which particular features make them most effective. Our objective is to identify determinants of quality in professional behaviour change interventions, as perceived by participants.

DESIGN

We performed a comparative observational study using data from the Veterans' Medicines Advice and Therapeutics Education Services program, a nation-wide Australian Government Department of Veterans' Affairs funded program that provides medicines advice and promotes physician adoption of best practices by use of a multifaceted intervention (educational material and a feedback document containing individual patient information).

SETTING

Primary care practices providing care to Australian veterans.

PARTICIPANTS

General practitioners (GPs) targeted by 51 distinct behaviour change interventions, implemented between November 2004 and June 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

We extracted features related to presentation (number of images, tables and characters), content (polarity and subjectivity using sentiment analysis, number of external links and medicine mentions) and the use of five behaviour change techniques (prompt/cues, goal setting, discrepancy between current behaviour and goal, information about health consequences, feedback on behaviour). The main outcome was perceived usefulness, extracted from postintervention survey.

RESULTS

On average, each intervention was delivered to 9667 GPs. Prompt and goal setting strategies in the audit and feedback were independently correlated to perceived usefulness (p=0.030 and p=0.005, respectively). The number of distinct behaviour change techniques in the audit and feedback was correlated with improved usefulness (Pearson's coefficient 0.45 (0.19, 0.65), p=0.001). No presentation or content features in the educational material were correlated with perceived usefulness.

CONCLUSIONS

The finding provides additional evidence encouraging the use of behaviour change techniques, in particular prompt and goal setting, in audit and feedback interventions.

Assessing context suitability (generalizability, external validity, applicability or transferability) of findings in evidence syntheses in healthcare-An integrative review of methodological guidance

BACKGROUND

Evidence syntheses provide the basis for evidence-based decision making in healthcare. To judge the certainty of findings for the specific decision context evidence syntheses should consider context suitability (ie, generalizability, external validity, applicability or transferability). Our objective was to determine the status quo and to provide a comprehensive overview of existing methodological recommendations of Health Technology Assessment (HTA) and Systematic Review (SR) producing organizations in assessing context suitability of evidence on effectiveness of health care interventions. Additionally, we analyzed similarities and differences between the recommendations.

METHODS

In this Integrative Review we performed a structured search for methods documents from evidence synthesis producing organizations that include recommendations on appraising context suitability in effectiveness assessments. Two reviewers independently selected documents according to predefined eligibility criteria. Data were extracted in standardized and piloted tables by one reviewer and verified by a second reviewer. We performed a thematic analysis to identify and summarize the main themes and categories regarding recommended context suitability assessments.

RESULTS

We included 14 methods documents of 12 organizations in our synthesis. Assessment approaches are very heterogeneous both regarding the general concepts (eg, integration in the evidence synthesis preparation process) and the content of assessments (eg, assessment criteria).

CONCLUSION

Some heterogeneity seems to be justified because of the need to tailor the assessment to different settings and medical areas. However, most differences were inexplicable. More harmonization is desirable and appears possible.