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Giles L, Pearson N, Lamont H, Grady A, Yoong SL. A cross-sectional study assessing modifications to the delivery of a multi-component implementation strategy (the Get Outside, Get Active program) to improve child physical activity in early childhood education and care services. Health Promot J Austr 2024. [PMID: 39187302 DOI: 10.1002/hpja.920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 08/12/2024] [Accepted: 08/12/2024] [Indexed: 08/28/2024] Open
Abstract
ISSUE ADDRESSED The Get Outside, Get Active (GOGA) program is a randomised controlled trial which tested the impact of a multi-component implementation strategy to support early childhood education and care (ECEC) services to replace indoor-only free play with indoor-outdoor-free play. This cross-sectional study aims to describe the extent and nature of modifications made to implementation strategies and Behaviour Change Techniques (BCTs) using the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and to describe the fidelity of BCT delivery throughout GOGA. METHODS An audit of records was undertaken throughout the intervention delivery period in the intervention arm. GOGA included 14 standard BCTs within six implementation strategies. Modifications and BCT delivery were recorded by Health Promotion Officers via project records. Modifications were categorised according to the FRAME-IS. BCT delivery was recorded using a checklist. RESULTS Forty-four ECEC services received the GOGA program. Overall, 60 modifications were recorded. According to FRAME-IS categories, most modifications related to: content; format; pragmatic or practical considerations; tailoring/tweaking/refining in nature; fidelity was inconsistent; the goal was to increase the acceptability, appropriateness, or feasibility of the implementation effort; the rationale was at the practitioner level; and were unplanned/reactive. Overall, 96.4% of standard BCTs were delivered as intended. CONCLUSIONS GOGA was delivered with high fidelity to protocol as indicated by the level of BCT delivery. This article details a thorough approach to documenting modifications and provides guidance for future studies. SO WHAT?: This article contributes to the emerging evidence regarding documentation of adaptations and modifications to public health implementation interventions.
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Affiliation(s)
- Luke Giles
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Hannah Lamont
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Alice Grady
- Hunter New England Population Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Global Obesity Centre, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Jack HE, Giusto A, Rose AL, Mwamuka R, Brown I, Bere T, Verhey R, Wainberg M, Myers B, Kohrt B, Wingood G, DiClemente R, Magidson JF. Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure bidirectional learning and support during intervention adaptation. Glob Health Res Policy 2024; 9:25. [PMID: 38956652 PMCID: PMC11218126 DOI: 10.1186/s41256-024-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
Global health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of "development aid" or "reverse innovation". Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.
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Affiliation(s)
- Helen E Jack
- Division of General Internal Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Box 359780, Seattle, Washington, 325 9th Ave98104, USA.
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY, 10032, USA
| | - Alexandra L Rose
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Rukudzo Mwamuka
- Graduate School for Health Sciences, University of Bern, Uni Mittelstrasse, Mittelstrasse 43, Bern, 3012, Switzerland
| | - Imani Brown
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Tarisai Bere
- Mental Health Department, Faculty of Medicine, University of Zimbabwe, Mazowe Street, Avondale, Harare, Zimbabwe
| | - Ruth Verhey
- Friendship Bench Zimbabwe, 4 Weale Rd, Harare, Zimbabwe
| | - Milton Wainberg
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
| | - Bronwyn Myers
- Mental Health, Alcohol, Substance Use, and Tobacco Research Unit, South African Medical Research Council, Parow, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Neuroscience Institute, Groote Schuur Hospital, Observatory, Anzio Road, 1st Floor, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Brandon Kohrt
- Center for Global Mental Health Equity, The George Washington University School of Medicine and Health Sciences, 2120 L Street NW, 6th Floor, Washington, DC, 20037, USA
| | - Gina Wingood
- Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY, 10032, USA
| | - Ralph DiClemente
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Jessica F Magidson
- Department of Psychology, University of Maryland, 4094 Campus Dr, College Park, MD, 20742, USA
- Center for Substance Use, Addiction & Health Research (CESAR), University of Maryland College Park, 1114 Chincoteague Hall, 7401 Preinkert Drive, College Park, MD, 20742, USA
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Aly M, Schneider CR, Sukkar MB, Lucas C. Development of an adaptation framework to implement a new professional pharmacy service (PPS) to a new environment. Res Social Adm Pharm 2024; 20:165-169. [PMID: 38438294 DOI: 10.1016/j.sapharm.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
The effective provision of professional pharmacy services is critical to support the delivery of primary health care. Structured frameworks and theoretical strategies are required to facilitate successful service implementation processes, outcomes and sustainability. This commentary discusses the considerations of what framework (adoption versus adaptation) would be suitable when implementing a new professional pharmacy service to a new environment. Utilizing Minor Ailments Services (MASs) as an exemplar as a professional pharmacy service case study, the research that underpinned these considerations enabled the development of a sequential, phased framework. There is the potential to utilize this framework for future evolving professional pharmacy services in the new setting.
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Affiliation(s)
- Mariyam Aly
- Pharmaceutical Society of Australia, 32 Ridge St, North Sydney, New South Wales, Australia, 2060.
| | - Carl R Schneider
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Sydney New South Wales, Australia.
| | - Maria B Sukkar
- The University of Technology Sydney, School of Life Sciences, Faculty of Science, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Cherie Lucas
- The University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW, 2007, Australia; University of NSW (UNSW) Sydney, School of Population Health, Faculty of Medicine and Health, Sydney, NSW, Australia.
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Skivington K, Matthews L, Simpson SA, Craig P, Baird J, Blazeby JM, Boyd KA, Craig N, French DP, McIntosh E, Petticrew M, Rycroft-Malone J, White M, Moore L. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. Int J Nurs Stud 2024; 154:104705. [PMID: 38564982 DOI: 10.1016/j.ijnurstu.2024.104705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The UK Medical Research Council's widely used guidance for developing and evaluating complex interventions has been replaced by a new framework, commissioned jointly by the Medical Research Council and the National Institute for Health Research, which takes account of recent developments in theory and methods and the need to maximise the efficiency, use, and impact of research.
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Affiliation(s)
- Kathryn Skivington
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
| | - Lynsay Matthews
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sharon Anne Simpson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Jane M Blazeby
- Medical Research Council ConDuCT-II Hub for Trials Methodology Research and Bristol Biomedical Research Centre, Bristol, UK
| | - Kathleen Anne Boyd
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Emma McIntosh
- Health Economics and Health Technology Assessment Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mark Petticrew
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin White
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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5
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Schoenthaler A, De La Calle F, De Leon E, Garcia M, Colella D, Nay J, Dapkins I. Application of the FRAME-IS to a multifaceted implementation strategy. BMC Health Serv Res 2024; 24:695. [PMID: 38822342 PMCID: PMC11143702 DOI: 10.1186/s12913-024-11139-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/22/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Research demonstrates the importance of documenting adaptations to implementation strategies that support integration of evidence-based interventions into practice. While studies have utilized the FRAME-IS [Framework for Reporting Adaptations and Modifications for Implementation Strategies] to collect structured adaptation data, they are limited by a focus on discrete implementation strategies (e.g., training), which do not reflect the complexity of multifaceted strategies like practice facilitation. In this paper, we apply the FRAME-IS to our trial evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology-facilitated team care model for improved hypertension control within a federally qualified health center (FQHC). METHODS Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation. RESULTS We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process. CONCLUSION With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations. TRIAL REGISTRATION Clinicaltrials.gov NCT03713515, Registration date: October 19, 2018.
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Affiliation(s)
- Antoinette Schoenthaler
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 752, New York, NY, 10016, USA.
| | - Franze De La Calle
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 752, New York, NY, 10016, USA
| | - Elaine De Leon
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 752, New York, NY, 10016, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Masiel Garcia
- Family Health Centers at NYU Langone Health, Brooklyn, NY, 11209, USA
| | - Doreen Colella
- Family Health Centers at NYU Langone Health, Brooklyn, NY, 11209, USA
| | - Jacalyn Nay
- Family Health Centers at NYU Langone Health, Brooklyn, NY, 11209, USA
| | - Isaac Dapkins
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, 10016, USA
- Family Health Centers at NYU Langone Health, Brooklyn, NY, 11209, USA
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Pinto R, Canário C, Leijten P, Rodrigo MJ, Cruz O. Implementation of Parenting Programs in Real-World Community Settings: A Scoping Review. Clin Child Fam Psychol Rev 2024; 27:74-90. [PMID: 38062309 PMCID: PMC10920434 DOI: 10.1007/s10567-023-00465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 03/08/2024]
Abstract
Implementing parenting programs in real-world community settings is fundamental to making effective programs widely available and consequently improving the lives of children and their families. Despite the literature acknowledging that the high-quality implementation of parenting programs is particularly challenging in real-world community settings, little is known about how the programs are implemented in these settings. This scoping review followed the methodological framework described by the Joanna Briggs Institute to map evidence on how evidence-based parenting programs have been implemented under real-world conditions. A systematic search of 12 scientific databases, gray literature, and the reference lists of the included studies identified 1918 records, of which 145 were included in the review. Fifty-three parenting programs were identified in studies documenting implementation in real-world community settings worldwide. Most studies included families in psychosocial risk engaged with family-support agencies. The qualitative synthesis identified several implementation outcomes, adaptations, barriers, and facilitators. Most studies reported a maximum of two implementation outcomes, mainly fidelity and acceptability. Providers frequently made adaptations, mainly to bring down barriers and to tailor the program to improve its fit. Findings highlight the need for a more detailed description of the implementation of programs, with greater consistency in terminology, operationalization, and measurement of implementation outcomes across studies. This will promote a more transparent, consistent, and accurate evaluation and reporting of implementation and increase the public health impact of parenting programs. Future studies should also assess the impact of adaptations and the cost-effectiveness and sustainability of programs in real-world community settings.
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Affiliation(s)
- Rita Pinto
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
| | - Catarina Canário
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Patty Leijten
- Research Institute for Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria José Rodrigo
- Department of Developmental Psychology and Education, Faculty of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Orlanda Cruz
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Mutahi J, Kangwana B, Khasowa D, Muthoni I, Charo O, Muli A, Kumar M. Integrating Mental Health Management into Empowerment Group Sessions for Out-of-School Adolescents in Kenyan Informal Settlements: A Process Paper. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:223. [PMID: 38397712 PMCID: PMC10888709 DOI: 10.3390/ijerph21020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 02/25/2024]
Abstract
This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.
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Affiliation(s)
- Joan Mutahi
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Beth Kangwana
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Dorcas Khasowa
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
| | - Irene Muthoni
- Integrated Education for Community Empowerment, Nairobi P.O. Box 7631-00300, Kenya;
| | - Oliver Charo
- Rapid Effective Participatory Action in Community Theatre Education and Development, Nakuru P.O. Box 15614-20100, Kenya;
| | - Alfred Muli
- Population Council–Kenya-Avenue 5, 3rd Floor Rose Ave, Nairobi P.O. Box 17643-00500, Kenya; (B.K.); (A.M.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya; (J.M.); (D.K.)
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, US-550 First Avenue New York, New York, NY 10016, USA
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Pettersson K, Liedgren P, Lyon AR, Hasson H, von Thiele Schwarz U. Fidelity-consistency and deliberateness of modifications in parenting programs. Implement Sci Commun 2024; 5:13. [PMID: 38351018 PMCID: PMC10865709 DOI: 10.1186/s43058-024-00545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent-child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? METHODS In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. RESULTS A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. CONCLUSIONS These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.
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Affiliation(s)
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, SE, Sweden
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
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9
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Schoenthaler A, De La Calle F, Leon E, Garcia M, Colella D, Nay J, Dapkins I. Application of the FRAME-IS to a Multifaceted Implementation Strategy. RESEARCH SQUARE 2024:rs.3.rs-3931349. [PMID: 38410454 PMCID: PMC10896377 DOI: 10.21203/rs.3.rs-3931349/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Background Research demonstrates the importance of documenting adaptations to implementation strategies that support integration of evidence-based interventions into practice. While studies have utilized the FRAME-IS [Framework for Reporting Adaptations and Modifications for Implementation Strategies] to collect structured adaptation data, they are limited by a focus on discrete implementation strategies (e.g., training), which do not reflect the complexity of multifaceted strategies like practice facilitation (PF). In this paper, we apply the FRAME-IS to our trial evaluating the effectiveness of PF on implementation fidelity of an evidence-based technology-facilitated team care model for improved hypertension control within a federally qualified health center (FQHC). Methods Three data sources are used to document adaptations: (1) implementation committee meeting minutes, (2) narrative reports completed by practice facilitators, and (3) structured notes captured on root cause analysis and Plan-Do-Study-Act worksheets. Text was extracted from the data sources according to the FRAME-IS modules and inputted into a master matrix for content analysis by two authors; a third author conducted member checking and code validation. Results We modified the FRAME-IS to include part 2 of module 2 (what is modified) to add greater detail of the modified strategy, and a numbering system to track adaptations across the modules. This resulted in identification of 27 adaptations, of which 88.9% focused on supporting practices in identifying eligible patients and referring them to the intervention. About half (52.9%) of the adaptations were made to modify the context of the PF strategy to include a group-based format, add community health workers to the strategy, and to shift the implementation target to nurses. The adaptations were often widespread (83.9%), affecting all practices within the FQHC. While most adaptations were reactive (84.6%), they resulted from a systematic process of reviewing data captured by multiple sources. All adaptations included the FQHC in the decision-making process. Conclusion With modifications, we demonstrate the ability to document our adaptation data across the FRAME-IS modules, attesting to its applicability and value for a range of implementation strategies. Based on our experiences, we recommend refinement of tracking systems to support more nimble and practical documentation of iterative, ongoing, and multifaceted adaptations. Trial Registration clinicaltrials.gov NCT03713515, Registration date: October 19, 2018.
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10
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Jang Y, Hepburn K, Haley WE, Park J, Park NS, Ko LK, Kim MT. Examining cultural adaptations of the savvy caregiver program for Korean American caregivers using the framework for reporting adaptations and modifications-enhanced (FRAME). BMC Geriatr 2024; 24:79. [PMID: 38245703 PMCID: PMC10800033 DOI: 10.1186/s12877-024-04715-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/16/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) is a tool that systematically guides decision-making and reporting of adaptations made to evidence-based interventions. Using FRAME, we documented the process and outcomes of adapting the Savvy Caregiver Program (SCP) for Korean American dementia caregivers. METHODS Sequential adaptation was initiated with linguistic attunement, followed by pilot implementation and full adaptation. Our data-driven adaptation with multiple data sources and a feedback loop among multiple stakeholders yielded a total of 32 modifications, and each was coded according to the eight domains of FRAME: (1) what was modified, (2) who participated in recommending and deciding the modification to be made, (3) when the modification occurred, (4) whether the modification was planned, (5) whether the modification was fidelity-consistent, (6) whether the modification was temporary, (7) at what level of delivery, the modification was made, and (8) why the modification was made. RESULTS The areas of adaptation were evenly distributed across context (37.5%), content (31.2%), and training (31.2%). The primary reasons for modification were for engagement (62.5%), followed by fit with recipients (43.8%) and outcome improvement (31.1%). About 66% of the modifications were applied to the entire target group, and all modifications were fidelity-consistent. CONCLUSIONS The FRAME categorization provided a detailed understanding of the process and nature of adapting the SCP and served as a foundation for further implementation and scale-up. FRAME not only serves as a guide for adapting evidence-based interventions but also promotes their replicability and scalability.
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Affiliation(s)
- Yuri Jang
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA.
- Department of Social Welfare, Ewha Womans University, Seoul, South Korea.
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | - William E Haley
- School of Aging Studies, University of South Florida, Tampa, USA
| | - Juyoung Park
- Edward R. Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, USA
| | - Nan Sook Park
- School of Social Work, University of South Florida, Tampa, USA
| | - Linda K Ko
- Department of Health Systems and Population Health, University of Washington, Seattle, USA
| | - Miyong T Kim
- School of Nursing, University of Texas at Austin, Austin, USA
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Pineda R, Kellner P, Gruskin BA, Smith J. Organizational Barriers to and Facilitators of the Successful Implementation and Sustainability of the Supporting and Enhancing NICU Sensory Experiences (SENSE) Program. Am J Occup Ther 2024; 78:7801205180. [PMID: 38271664 DOI: 10.5014/ajot.2024.050450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
IMPORTANCE The Supporting and Enhancing NICU Sensory Experiences (SENSE) program is an evidence-based intervention that promotes daily, positive sensory exposures for infants in the neonatal intensive care unit (NICU). Understanding program implementation across sites may aid in optimizing strategies for uptake of the program and subsequently improve outcomes for infants and families. OBJECTIVE To investigate health care professionals' perceptions of implementing the SENSE program. DESIGN The SENSE Program Implementation Survey was developed using Proctor et al.'s model and the BARRIERS scale to probe organizational practices across sites worldwide. SETTING Survey distributed to 211 hospitals with a SENSE program license obtained before March 2020. PARTICIPANTS One hundred fourteen NICU personnel (response rate = 54%). OUTCOMES AND MEASURES The survey sought to understand barriers and facilitators, adaptations during implementation, and associated costs. RESULTS Of the 53% (n = 57 of 107) of respondents who had implemented the SENSE program, many (n = 14; 31%) experienced quick timing (<1 mo) to use, including spread to nearly all infants in their NICU within 6 mo (n = 18; 35%). Most reported the program was used to educate families ≤3 days of birth (n = 20/59; 34%). Most of the sensory interventions in the program were performed by parents (n = 38; 67%) and therapists (n = 44; 77%). Barriers and facilitators at the organizational and individual levels were identified. No additional staff were hired to implement the program. CONCLUSIONS AND RELEVANCE Given perceived successes and challenges, strategic enhancement of implementation can inform future administrations of the SENSE program. Plain-Language Summary: This study provides occupational therapists who are interested in implementing the SENSE program (Supporting and Enhancing NICU Sensory Experiences) with an understanding of common barriers, facilitators, costs, and adaptations, which can be used to advocate for program implementation in NICUs to improve outcomes for preterm infants worldwide.
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Affiliation(s)
- Roberta Pineda
- Roberta Pineda, PhD, OTR/L, CNT, is Associate Professor, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles; Department of Pediatrics and Neonatology, Keck School of Medicine and Children's Hospital of Los Angeles, Los Angeles, CA; Gehr Family Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles; and Adjunct Faculty, Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO;
| | - Polly Kellner
- Polly Kellner, MSOT, OTR/L, is Clinical Research Specialist and Occupational Therapist, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Bethany A Gruskin
- Bethany A. Gruskin, MSOT, OTR/L, is PhD Student, Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
| | - Joan Smith
- Joan Smith, PhD, RN, NNP-BC, FAAN, is Director, Department of Quality, Safety, and Practice Excellence, St. Louis Children's Hospital, St. Louis, MO
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Chan ACY, Piehler TF. Evaluation of Prevention Programs for Grandparent Caregivers: a Systematic Review. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:137-154. [PMID: 37837520 PMCID: PMC10830810 DOI: 10.1007/s11121-023-01594-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
This systematic review critically evaluates 21 grandparent-focused prevention programs designed to benefit grandparent caregivers or target grandparent caregivers as agents of change for grandchild development. These grandparent programs were published in 35 peer-reviewed articles in the last 31 years. For each program, we described the phase of development of program (i.e., feasibility, pilot, and efficacy), delivery characteristics, and adaptations of existing evidence-based programs to meet the needs of grandparent caregivers in diverse sociocultural backgrounds. For programs tested under a controlled trial design, we evaluated core components and preliminary effects on targeted outcomes. Most studies targeted grandparents who served as primary or custodial caregivers in the USA, while limited studies targeted supplementary grandparent caregivers. Thirteen programs which were evaluated using pretest-posttest designs demonstrated feasibility and acceptability of the grandparent programs. Moreover, eight programs which were evaluated using randomized-controlled trials (RCTs; 5 pilot and 3 full-scale efficacy trials) demonstrated promising outcomes. Additionally, we identified six core components and 17 specific elements in eight programs evaluated using RCT designs. Overall, we provide a comprehensive critique of this body of literature as well as directions for future studies, including the need to develop programing tailored to grandparent caregivers with unique needs.
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Affiliation(s)
- Athena Chung Yin Chan
- Department of Human Development and Family Sciences, Texas Tech University, P.O. Box 41230, Lubbock, TX, 79409, USA.
| | - Timothy F Piehler
- Deparment of Family Social Science, University of Minnesota, 290 McNeal Hall, 1985 Buford Avenue, Saint Paul, MN, 55108, USA
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Miller CJ, Sullivan JL, Connolly SL, Richardson EJ, Stolzmann KL, Brown M, Bailey HM, Weaver K, Sippel L, Kim B. Adaptation for sustainability in an implementation trial of team-based collaborative care. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231226197. [PMID: 38322803 PMCID: PMC10807389 DOI: 10.1177/26334895231226197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background Sustaining healthcare interventions once they have been implemented is a pivotal public health endeavor. Achieving sustainability requires context-sensitive adaptations to evidence-based practices (EBPs) or the implementation strategies used to ensure their adoption. For replicability of adaptations beyond the specific setting in question, the underlying logic needs to be clearly described, and adaptations themselves need to be plainly documented. The goal of this project was to describe the process by which implementation facilitation was adapted to improve the uptake of clinical care practices that are consistent with the collaborative chronic care model (CCM). Method Quantitative and qualitative data from a prior implementation trial found that CCM-consistent care practices were not fully sustained within outpatient general mental health teams that had received 1 year of implementation facilitation to support uptake. We undertook a multistep consensus process to identify adaptations to implementation facilitation based on these results, with the goal of enhancing the sustainability of CCM-based care in a subsequent trial. The logic for these adaptations, and the resulting adaptations themselves, were documented using two adaptation-oriented implementation frameworks (the iterative decision-making for evaluation of adaptations [IDEA] and the framework for reporting adaptations and modifications to evidence-based implementation strategies [FRAME-IS], respectively). Results Three adaptations emerged from this process and were documented using the FRAME-IS: (a) increasing the scope of implementation facilitation within the medical center, (b) having the internal facilitator take a greater role in the implementation process, and (c) shortening the implementation timeframe from 12 to 8 months, while increasing the intensity of facilitation support during that time. Conclusions EBP sustainability may require careful adaptation of EBPs or the implementation strategies used to get them into routine practice. Recently developed frameworks such as the IDEA and FRAME-IS may be used to guide decision-making and document resulting adaptations themselves. An ongoing funded study is investigating the utility of the resulting adaptations for improving healthcare.
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Affiliation(s)
- Christopher J. Miller
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Jennifer L. Sullivan
- Center of Innovation in Long Term Services and Supports (LTSS COIN), VA Providence Healthcare System Capt. Jonathan H. Harwood Jr. Center for Research, Providence, RI, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Samantha L. Connolly
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Eric J. Richardson
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelly L. Stolzmann
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Madisen Brown
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Hannah M. Bailey
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
| | - Kendra Weaver
- U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention, Washington, DC, USA
| | - Lauren Sippel
- U.S. Department of Veterans Affairs Office of Mental Health and Suicide Prevention, Washington, DC, USA
- Department of Veterans Affairs Northeast Program Evaluation Center, West Haven, Connecticut, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Bo Kim
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Green F, Axford N, Eastmond N, Berry V, Mannes J, Allen K, Callaghan L, Hobbs T. Transporting an Evidence-based Youth Development Program to a New Country: A Narrative Description and Analysis of Pre-implementation Adaptation. JOURNAL OF PREVENTION (2022) 2023; 44:729-747. [PMID: 37768424 PMCID: PMC10638196 DOI: 10.1007/s10935-023-00742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/29/2023]
Abstract
There is a pressing need to prevent and address youth crime and violence owing to its prevalence, harms and cost to society. Interventions with proven effectiveness in doing this exist. Adopting and adapting them in new contexts is potentially cost-effective. However, more research is needed into how to make adaptations that enhance intervention implementation, effectiveness and maintenance in new settings. This article reports the pre-implementation adaptation work involved in transporting Becoming a Man (BAM) from the US to the UK. BAM is a selective school-based youth development program for 12-18 year-old boys that aims to improve school engagement and reduce interactions with the criminal justice system. We describe the nature of and rationale for adaptations and identify learning for future adaptation efforts. An adaptation team comprising the intervention developers, new providers and the evaluators met weekly for 10 weeks, applying a structured, pragmatic and evidence-informed approach to adapt the BAM curriculum and implementation process. Changes were informed by documentary analysis, group-based discussions and site visits. The group agreed 27 changes to the content of 17/30 lessons, at both surface (e.g., cultural references) and deep (key mechanisms or concepts) levels. Of 28 contextual factors considered, 15 discrepancies between the US and UK were identified and resolved (e.g., differences in staffing arrangements). Strengths of the process were the blend of expertise on the adaptation team in the program and local context, and constant reference to and ongoing refinement of the program theory of change. Limitations included the lack of involvement of school staff or students. Further research is needed into potential conflicts between stakeholder perspectives during adaptation and whose views to prioritise and when.
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Affiliation(s)
- Finlay Green
- Dartington Service Design Lab, Buckfastleigh, UK
| | | | | | | | - Julia Mannes
- Dartington Service Design Lab, Buckfastleigh, UK
| | | | | | - Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, UK
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15
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van der Feltz-Cornelis CM, Shepherd J, Gevaert J, Van Aerden K, Vanroelen C, Cepa OB, Recio LG, Bernard RM, Vorstenbosch E, Cristóbal-Narváez P, Felez-Nobrega M, de Miquel C, Merecz-Kot D, Staszewska K, Sinokki M, Naumanen P, Roijen LHV, van Krugten F, de Mul M, Haro JM, Olaya B. Design and development of a digital intervention for workplace stress and mental health (EMPOWER). Internet Interv 2023; 34:100689. [PMID: 38054076 PMCID: PMC10694565 DOI: 10.1016/j.invent.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/13/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023] Open
Abstract
Purpose We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.
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Affiliation(s)
| | - Jessie Shepherd
- MHARG, Department of Health Sciences, Hull York Medical School, University of York, York, United Kingdom
| | - Jessie Gevaert
- Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karen Van Aerden
- Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | | | - Ellen Vorstenbosch
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Paula Cristóbal-Narváez
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Mireia Felez-Nobrega
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | | | | | - Marjo Sinokki
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Päivi Naumanen
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Frédérique van Krugten
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Marleen de Mul
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Spain
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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Simione M, Aschbrenner K, Farrar-Muir H, Luo M, Granadeno J, Caballero-Gonzalez A, Price SN, Torres C, Boudreau AA, Fiechtner L, Hambidge SJ, Sease K, Taveras EM. Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic. Implement Sci Commun 2023; 4:139. [PMID: 37974245 PMCID: PMC10652425 DOI: 10.1186/s43058-023-00523-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention. The objective of this study is to describe the planned adaptation process to ensure continued and equitable program uptake during the pandemic. METHODS Guided by adaptation frameworks, we identified the core functions and forms of Connect for Health and then adapted the intervention in response to a changing healthcare context. We engaged stakeholders and surveyed parents of children with a BMI ≥ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management. RESULTS We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child's health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. Informed by the surveys and stakeholder input, we made clinician- and family-level adaptations while retaining the program's function. CONCLUSIONS By engaging stakeholders and adapting the program for telehealth, we optimized the reach and fit of Connect for Health to ensure its continued uptake. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations in response to changing healthcare contexts. TRIAL REGISTRATION Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019.
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Affiliation(s)
- Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Kelly Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Haley Farrar-Muir
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Man Luo
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Jazmin Granadeno
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Ariadne Caballero-Gonzalez
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
| | - Carlos Torres
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- MGH Chelsea HealthCare Center, Chelsea, MA, USA
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Simon J Hambidge
- Ambulatory Care Services, Denver Health, Denver, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kerry Sease
- Department of Pediatrics, University of South Carolina School of Medicine, Greenville, SC, USA
- Prisma Health, Greenville, SC, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Mass General for Children, 125 Nashua St, Suite 860, Boston, MA, 02114, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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18
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Weber MB, Rhodes EC, Ranjani H, Jeemon P, Ali MK, Hennink MM, Anjana RM, Mohan V, Narayan KMV, Prabhakaran D. Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial. Implement Sci Commun 2023; 4:134. [PMID: 37957783 PMCID: PMC10642065 DOI: 10.1186/s43058-023-00516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential. METHODS The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at 11 large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, and peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. RESULTS Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add a wider variety of exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. CONCLUSION This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. TRIAL REGISTRATION Clinicaltrials.gov NCT02813668. Registered June 27, 2016.
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Affiliation(s)
- Mary Beth Weber
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harish Ranjani
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Monique M Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ranjit M Anjana
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
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Shin SS, Shah A, North-Kabore J, Rowthorn V, Fiori KP, Dudding R, Plum RA, Parke DM, George C, Thomas S, Pinkett R, Porter KMP, Sirois A, Cordeiro V, Ogbolu Y. Global Learning for Health Equity: A Survey of Five Global Learning Sites in the United States. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023:2752535X231210046. [PMID: 37947506 DOI: 10.1177/2752535x231210046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Global learning is the practice of adopting and adapting global ideas to local challenges. To advance the field of global learning, we performed a case study of five communities that had implemented global health models to advance health equity in a U.S. setting. Surveys were developed using a Consolidated Framework for Implementation Research (CFIR) framework, and each site completed surveys to characterize their global learning experience with respect to community context, the learning and implementation process, implementation science considerations, and health equity. The immense diversity of sites and their experiences underscored the heterogenous nature of global learning. Nonetheless, all cases highlighted core themes of addressing social determinants of health through strong community engagement. Cross-sector participation and implementation science evaluation were strategies applied by many but not all sites. We advocate for continued global learning that advances health equity and fosters equitable partnerships with mutual benefits to origination and destination sites.
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Affiliation(s)
- Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ami Shah
- Consultant, Global Learning for Health Equity Network, Los Angeles, CA, USA
| | | | - Virginia Rowthorn
- Center for Global Engagement, University of Maryland Baltimore, Baltimore, MD, USA
| | - Kevin P Fiori
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Community Health Systems Lab, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
| | - Ruth Dudding
- Athens City County Health Department, Athens, OH, USA
| | | | - Dana M Parke
- Population Health Management, Henry Ford Health, Detroit, MI, USA
| | - Carmen George
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Stephen Thomas
- Center for Health Equity, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam Sirois
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | | | - Yolanda Ogbolu
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA
- Center for Health Equity and Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA
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20
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Zhu EM, Buljac-Samardžić M, Ahaus K, Sevdalis N, Huijsman R. Implementation and dissemination of home- and community-based interventions for informal caregivers of people living with dementia: a systematic scoping review. Implement Sci 2023; 18:60. [PMID: 37940960 PMCID: PMC10631024 DOI: 10.1186/s13012-023-01314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Informal caregivers of people with dementia (PwD) living at home are often the primary source of care, and, in their role, they often experience loss of quality of life. Implementation science knowledge is needed to optimize the real-world outcomes of evidence-based interventions (EBIs) for informal caregivers. This scoping review aims to systematically synthesize the literature that reports implementation strategies employed to deliver home- and community-based EBIs for informal caregivers of PwD, implementation outcomes, and the barriers and facilitators to implementation of these EBIs. METHODS Embase, MEDLINE, Web of Science, and Cochrane Library were searched from inception to March 2021; included studies focused on "implementation science," "home- and community-based interventions," and "informal caregivers of people with dementia." Titles and abstracts were screened using ASReview (an innovative AI-based tool for evidence reviews), and data extraction was guided by the ERIC taxonomy, the Implementation Outcome Framework, and the Consolidated Framework for Implementation Science Research; each framework was used to examine a unique element of implementation. RESULTS Sixty-seven studies were included in the review. Multicomponent (26.9%) and eHealth (22.3%) interventions were most commonly reported, and 31.3% of included studies were guided by an implementation science framework. Training and education-related strategies and provision of interactive assistance were the implementation strategy clusters of the ERIC taxonomy where most implementation strategies were reported across the reviewed studies. Acceptability (82.1%), penetration (77.6%), and appropriateness (73.1%) were the most frequently reported implementation outcomes. Design quality and packaging (intervention component suitability) and cosmopolitanism (partnerships) constructs, and patient's needs and resources and available resources (infrastructure) constructs as per the CFIR framework, reflected the most frequently reported barriers and facilitators to implementation. CONCLUSION Included studies focused largely on intervention outcomes rather than implementation outcomes and lacked detailed insights on inner and outer setting determinants of implementation success or failure. Recent publications suggest implementation science in dementia research is developing but remains in nascent stages, requiring future studies to apply implementation science knowledge to obtain more contextually relevant findings and to structurally examine the mechanisms through which implementation partners can strategically leverage existing resources and regional networks to streamline local implementation. Mapping local evidence ecosystems will facilitate structured implementation planning and support implementation-focused theory building. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Eden Meng Zhu
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | | | - Kees Ahaus
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Nick Sevdalis
- Centre for Behavioural and Implementation Science Interventions, National University of Singapore, Singapore, Singapore
| | - Robbert Huijsman
- Erasmus School of Health Policy & Management, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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21
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Sierra-Velez D, Gundewar A, Persaud A, Simione M, Castro I, Perkins M, Lindros J, Salmon J, Smith JD, Taveras EM, Fiechtner L. Stakeholders' perception of factors influencing adoption of a pediatric weight management intervention: a qualitative study. Front Public Health 2023; 11:1045618. [PMID: 37900042 PMCID: PMC10613059 DOI: 10.3389/fpubh.2023.1045618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Childhood obesity is highly prevalent in the United States and disproportionately impacts communities of color and low-income populations; these disparities have worsened during the COVID-19 pandemic. Adoption of effective pediatric weight management interventions (PWMIs) that have been evaluated among low-income diverse populations is needed. The Healthy Weight Clinic PWMI, a package co-developed by the American Academy of Pediatrics and Massachusetts General Hospital, helps health centers establish multidisciplinary Healthy Weight Clinics based on previous randomized controlled trials which demonstrated effectiveness. We sought to identify the factors influencing successful adoption of this PWMI and understand adaptations needed prior to implementation in new sites. Methods We interviewed 20 stakeholders, 10 from two health centers in Mississippi where the Healthy Weight Clinic PWMI will be piloted (pre-implementation sites) and 10 from health centers that have previously implemented it (sites in maintenance stages). Separate interview guides informed by the Consolidated Framework for Implementation Research (CFIR) were developed for the pre-implementation sites and those in maintenance stages, including questions related to adaptations of the PWMI in response to the COVID-19 pandemic. Qualitative data analysis was conducted using directed content analysis based on CFIR constructs. Adaptations in response to the pandemic were categorized using Framework for Reporting Adaptations and Modifications-Expanded (FRAME). Results In pre-implementation sites, an inner setting facilitator mentioned was a positive learning climate. Characteristics of individuals that can facilitate adoption include staff willingness to learn, valuing evidence-based care for childhood obesity, and culturally and weight-sensitive staff. In terms of patient needs and resources (outer setting), social drivers of health are barriers to adoption, but creative solutions were suggested to mitigate these. Other facilitators related to the intervention included its multidisciplinary model and adaptability. Similar themes were elicited from sites in maintenance stages; adaptations brought on by the pandemic, such as telehealth visits and content modification to align with distancing guidelines and the effects of social isolation were also described. Conclusion Understanding the factors influencing adoption of an evidence-based PWMI informs necessary adaptations and implementation strategies required to facilitate nationwide dissemination of PWMIs, with the goal of reaching the populations most at-risk.
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Affiliation(s)
- Desiree Sierra-Velez
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
| | - Anisha Gundewar
- Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Alicia Persaud
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
| | - Jeanne Lindros
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Jeremiah Salmon
- Institute for Healthy Childhood Weight, American Academy of Pediatrics, Itasca, IL, United States
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Lauren Fiechtner
- Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, United States
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, MA, United States
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22
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Weber MB, Rhodes EC, Ranjani H, Jeemon P, Ali MK, Hennink MM, Anjana RM, Mohan V, Narayan KV, Prabhakaran D. Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial. RESEARCH SQUARE 2023:rs.3.rs-3143470. [PMID: 37577514 PMCID: PMC10418536 DOI: 10.21203/rs.3.rs-3143470/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Delivery of proven structured lifestyle change education for reducing the burden of cardiometabolic diseases such as diabetes at worksites could overcome barriers to program adoption and improve sustainability and reach of these programs; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at eleven large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. Results Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. Conclusion This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. Trial Registration Clinicaltrial.gov NCT02813668, registered June 27, 2016.
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23
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Harms LSE, van Assema P, Gubbels JS, Gerards SMPL, Linssen E, Vonken L, Bessems KMHH. Context matters-the phased development of an adaptable food literacy intervention: Up for Cooking. Health Promot Int 2023; 38:daad071. [PMID: 37449817 PMCID: PMC10347970 DOI: 10.1093/heapro/daad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Adapting interventions to the context increases the impact and sustainability of interventions. Literature acknowledges the need to adapt existing interventions and that these adaptations should be clearly reported. However, little is known about how to incorporate adaptation from the beginning. This paper argues that interventions should be developed and adaptations should be made using an ongoing non-linear approach. An action-oriented research approach with feedback loops is proposed. We illustrate this with the development of a food literacy intervention 'Up for Cooking' (Dutch: Zin in Koken) and present lessons learned in developing, implementing and studying such adaptable interventions. Interventions should clearly define and differentiate the intervention function and form. Implementers, in turn, should be encouraged to tailor interventions within a form that fits with a specific context. Sufficient time, continuous adaptation based on co-creation, feedback loops and interdisciplinary collaboration are important prerequisites for the development of adaptable interventions.
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Affiliation(s)
| | - Patricia van Assema
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Jessica S Gubbels
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Sanne M P L Gerards
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Evelyne Linssen
- Department of Knowledge & Innovation, Public Health Service South Limburg, PO Box 33, 6400 AA Heerlen, The Netherlands
| | - Lieve Vonken
- Department of Health Promotion, School of Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Kathelijne M H H Bessems
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
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24
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Lim N, O'Reilly M, Russell-George A, Londoño FV. A Meta-Analysis of Parenting Interventions for Immigrants. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1152-1173. [PMID: 36633767 DOI: 10.1007/s11121-022-01488-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
In light of increasing migration rates and the unique experiences of immigrants, this meta-analysis examined the effects of parenting interventions for immigrants. Specifically, we described the characteristics of parenting interventions for immigrants, examined cultural and/or linguistic adaptations made to the interventions, analyzed intervention effects, and examined potential moderating variables. Four electronic databases were searched in February 2021 for peer-reviewed articles published in English. Studies that involved immigrant parents, used an experimental design, and investigated an intervention targeting skills that parents could use directly with their children were included. Sixteen group design and two single-case design studies met inclusion criteria. The risk of publication bias was examined using funnel plots and found to be low. Overall, most parenting interventions for immigrants focused on young children and were delivered in groups. Interventions produced small to moderate effects on parent and child outcomes, which is comparable to those for the general population. All studies made cultural adaptations, with the most common being language. Moderator analyses indicate that the effects of interventions with surface structure adaptations were similar to those with deep structure adaptations. Limitations included the low methodological rigor of included studies and the exclusion of grey literature. More works of research on the relative effects of specific adaptations, such as ethnicity matching, are needed to better serve this population.
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Affiliation(s)
- Nataly Lim
- The University of Texas at Austin, Speedway, Austin, TX, USA.
| | - Mark O'Reilly
- The University of Texas at Austin, Speedway, Austin, TX, USA
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25
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Kroll-Desrosiers A, Finley EP, Hamilton AB, Cabassa LJ. Evidence-Based Intervention Adaptations Within the Veterans Health Administration: a Scoping Review. J Gen Intern Med 2023; 38:2383-2395. [PMID: 37254009 PMCID: PMC10406758 DOI: 10.1007/s11606-023-08218-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/21/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Veterans receiving care within the Veterans Health Administration (VA) are a unique population with distinctive cultural traits and healthcare needs compared to the civilian population. Modifications to evidence-based interventions (EBIs) developed outside of the VA may be useful to adapt care to the VA healthcare system context or to specific cultural norms among veterans. We sought to understand how EBIs have been modified for veterans and whether adaptations were feasible and acceptable to veteran populations. METHODS We conducted a scoping review of EBI adaptations occurring within the VA at any time prior to June 2021. Eligible articles were those where study populations included veterans in VA care, EBIs were clearly defined, and there was a comprehensive description of the EBI adaptation from its original context. Data was summarized by the components of the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME). FINDINGS We retrieved 922 abstracts based on our search terms. Following review of titles and abstracts, 49 articles remained for full-text review; eleven of these articles (22%) met all inclusion criteria. EBIs were adapted for mental health (n = 4), access to care and/or care delivery (n = 3), diabetes prevention (n = 2), substance use (n = 2), weight management (n = 1), care specific to cancer survivors (n = 1), and/or to reduce criminal recidivism among veterans (n = 1). All articles used qualitative feedback (e.g., interviews or focus groups) with participants to inform adaptations. The majority of studies (55%) were modified in the pre-implementation, planning, or pilot phases, and all were planned proactive adaptations to EBIs. IMPLICATIONS FOR D&I RESEARCH The reviewed articles used a variety of methods and frameworks to guide EBI adaptations for veterans receiving VA care. There is an opportunity to continue to expand the use of EBI adaptations to meet the specific needs of veteran populations.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Erin P Finley
- UT Health San Antonio, San Antonio, TX, USA
- VA Greater Los Angeles, Los Angeles, CA, USA
| | - Alison B Hamilton
- VA Greater Los Angeles, Los Angeles, CA, USA
- University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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26
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McDonald MD, Hunt K, Moullin J, Kerr D, Ntoumanis N, Quested E. 'A Different Ball Game': Adaptation of a men's health program for implementation in rural Australia. BMC Public Health 2023; 23:1387. [PMID: 37468854 DOI: 10.1186/s12889-023-16247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/05/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Men residing in rural areas are less likely to participate in weight management interventions than women, and few men-specific programs target rural areas. Aussie-Fans in Training (Aussie-FIT) is an evidence-based weight management intervention that uses professional Australian Football club affiliations and settings as a 'hook' to engage urban-residing men. The aim of this study is to report on how findings from rural stakeholder focus groups were used to inform the adaptation of Aussie-FIT for implementation in rural areas. METHODS Seven focus groups with stakeholders (n = 24) in three rural towns explored existing weight management and physical activity provisions, barriers and facilitators to engaging men, and considerations for adapting Aussie-FIT for implementation in rural contexts. Qualitative data were analysed using the framework approach. Adaptations made to the Aussie-FIT program and strategies to implement the program in rural contexts were reported using a structured framework. RESULTS Themes generated from our analysis include limited appealing services for men, Australian Football as a 'common language', the influence of the 'smaller fishpond'(population), considerations for program inclusivity, and the importance of local partner organisations for sustainability. We adapted the recruitment and marketing strategies, delivery settings, football program theme and partnerships for rural implementation. Stakeholders advised that an Australian Football program theme without specific local club affiliations would be important to avoid alienating men with differing club allegiances or non-sporting backgrounds. A multi-component recruitment strategy utilising local trusted sources, and program marketing that aligns with masculine ideals were considered important by stakeholders in small communities where 'people talk'. CONCLUSIONS Rural areas were described as 'a different ball game' due to limited local services and resources in comparison to metropolitan areas. Study findings have synergies with previous studies undertaken in rural contexts including in relation to the power of word of mouth, the importance of trust, and local partner organisations. Findings have implications for engaging rural men in health interventions in rural contexts where professional sporting contexts are not available. Assessing the extent to which the adapted Aussie-FIT program can reach and engage men in rural Australia, and exploring the barriers and facilitators to delivering the program in rural contexts is required.
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Affiliation(s)
- Matthew D McDonald
- Curtin School of Population Health, Curtin University, Perth, Australia.
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Australia.
| | - Kate Hunt
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Joanna Moullin
- Curtin School of Population Health, Curtin University, Perth, Australia
| | - Deborah Kerr
- Curtin School of Population Health, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | - Nikos Ntoumanis
- Danish Centre for Motivation and Behaviour Change, University of Southern Denmark, Odense, Denmark
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eleanor Quested
- Curtin School of Population Health, Curtin University, Perth, Australia
- Physical Activity and Well-Being Research Group, enAble Institute, Curtin University, Perth, Australia
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Wu E, Lee YG, Vinogradov V, Kali S, Yelkeyev A, Goddard-Eckrich DA, Dasgupta A, Hess L. Intervention Adaptation and Implementation Method for Real-World Constraints and Using New Technologies. RESEARCH ON SOCIAL WORK PRACTICE 2023; 33:562-570. [PMID: 37575669 PMCID: PMC10419326 DOI: 10.1177/10497315221120605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose Rigorous adaptation methods are needed to revise existing evidence-based behavioral interventions for implementation for new target populations, revised/updated outcomes, new delivery modalities, recent advances, and new technologies. We describe an adaptation method designed to overcome the real-world challenges of having very limited existing expertise, resources, and time. Method This adaptation method and accompanying visualization tool ("Deconstruction/Reconstruction Matrix") preserves theoretical mechanisms of behavior change, accounts for challenges in utilizing new technologies, and strengthens clinical processes, with an emphasis on safety. Results The adaptation of an in-person HIV behavioral intervention for sexual and gender diverse men in Kazakhstan to one delivered remotely via telecommunication and social media technologies exemplifies the process and strengths of the method, concomitantly resulting in recommendations for adaptation and implementation of mobile health (mHealth) and digital health interventions. Discussion This method allows researchers and clinicians to adapt interventions rapidly and rigorously and to benefit from new technologies.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Yong Gun Lee
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Sultana Kali
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Aidar Yelkeyev
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Anindita Dasgupta
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | - Leona Hess
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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28
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Darling KE, Hayes JF, Evans EW, Sanchez I, Chachra J, Grenga A, Elwy AR, Jelalian E. Engaging Stakeholders to Adapt an Evidence-Based Family Healthy Weight Program. Transl Behav Med 2023; 13:423-431. [PMID: 36893021 PMCID: PMC10314725 DOI: 10.1093/tbm/ibac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
Childhood obesity is associated with negative physical and psychosocial outcomes, especially for children from low-income backgrounds. It is critical to adapt evidence-based family healthy weight programs to meet the needs of this population. The Framework for Reporting Adaptations and Modifications to Evidence-Based Interventions was used to describe the process of using qualitative data from community and intervention stakeholders, children with overweight or obesity from low-income backgrounds, and caregivers to guide adaptations to the JOIN for ME pediatric weight management intervention. Qualitative interviews were conducted with key community and intervention stakeholders (e.g., nurse care managers, prior JOIN for ME coaches; N = 21). Focus groups were conducted in both Spanish and English with children with overweight or obesity from low-income backgrounds (N = 35) and caregivers of children with overweight or obesity from low-income backgrounds (N = 71). Qualitative data analysis informed modifications including content adaptations to simplify and tailor materials, contextual adaptations to improve intervention engagement and framing, resource awareness, and modality of delivery, training adaptations, and implementation/scale-up activities to increase connections with community partners. The process of engaging multiple stakeholder perspectives to tailor an existing intervention can provide a model for future researchers to improve the potential disseminability of an intervention.
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Affiliation(s)
- Katherine E Darling
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jacqueline F Hayes
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - E Whitney Evans
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Irene Sanchez
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Jessica Chachra
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - Andrea Grenga
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
| | - A Rani Elwy
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Elissa Jelalian
- 1Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
- 2Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903USA
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29
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Ayele RA, Rabin BA, McCreight M, Battaglia C. Editorial: Understanding, assessing, and guiding adaptations in public health and health systems interventions: current and future directions. Front Public Health 2023; 11:1228437. [PMID: 37457241 PMCID: PMC10338220 DOI: 10.3389/fpubh.2023.1228437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Roman Aydiko Ayele
- Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, CO, United States
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Borsika Adrienn Rabin
- Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, CO, United States
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, La Jolla, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Marina McCreight
- Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Catherine Battaglia
- Seattle-Denver Center of Innovation, VA Eastern Colorado Health Care System, Denver, CO, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Gueta K, Harel-Fisch Y, Walsh SD. Cultural accommodation of internet-based interventions for substance use and related disorders: a proposed comprehensive framework based on a pilot study and a literature review. Front Psychol 2023; 14:1063200. [PMID: 37416542 PMCID: PMC10321598 DOI: 10.3389/fpsyg.2023.1063200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 05/17/2023] [Indexed: 07/08/2023] Open
Abstract
Despite the low utilization rates of substance use and related disorders services, and the ability of internet-based interventions for substance use and related disorders (IBIS) to address challenges related to service engagement, limited attention has been placed on the processes for the accommodation of these interventions to diverse cultural settings. This study aimed to develop a framework for the cultural accommodation of IBIS across populations based on a pilot study and a literature review. A pilot study of cultural accommodation of an existing internet intervention for alcohol use was carried out in Israel, which involved focus groups and daily online surveys of prospective consumers (N = 24) as well as interviews with experts (N = 7) in the substance abuse treatment field. Thematic analysis revealed a range of themes that relate to the general Israeli culture and the specific Israeli drinking subculture, identified as needing to be addressed in the process of intervention accommodation. A comprehensive framework for cultural accommodation of IBIS is suggested, consisting of five stages: Technical and cultural feasibility; Engagement of target group; Identification of accommodation variables, Accommodation, and evaluation of the accommodated intervention. In addition, the framework consists of four dimensions of accommodation: Barriers and facilitators; Audio-visual materials and language; Mechanisms of change; Intersectional factors. We suggest that the proposed framework may serve as a guide for the cultural accommodation of existing internet-based interventions for substance use and related disorders across a range of cultural and geographical settings, thus augmenting the ecological validity of internet-based interventions for substance use and related disorders, expanding cross-cultural intervention research, and reducing health disparities worldwide.
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Affiliation(s)
- Keren Gueta
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
| | - Yossi Harel-Fisch
- The International Research Program on Adolescent Well-Being and Health, School of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Sophie D. Walsh
- Department of Criminology, Bar-Ilan University, Ramat Gan, Israel
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Levinson J, Hickey E, Fuchu P, Chu A, Barnett M, Stadnick NA, Feinberg E, Broder-Fingert S. Recommendations for post-implementation adaptations to optimize family navigation in pediatric primary care: a qualitative study with parents and navigators. BMC PRIMARY CARE 2023; 24:123. [PMID: 37328810 PMCID: PMC10273746 DOI: 10.1186/s12875-023-02072-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Family Navigation (FN) is an evidence-based care management intervention designed to reduce disparities in access to care by providing families with individually tailored support and care coordination. Early data suggest FN is effective, but effectiveness is significantly influenced by both contextual (e.g. setting) and individual (e.g., ethnicity) variables. To better understand how FN could be tailored to address this variability in effectiveness, we set forth to explore proposed adaptations to FN by both navigators and families who received FN. METHODS This study was a nested qualitative study set within a larger randomized clinical trial of FN to improve access to autism diagnostic services in urban pediatric primary care practices in Massachusetts, Pennsylvania, and Connecticut serving low-income, racial and ethnic minority families. Following FN implementation, key informant interviews were conducted based on the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) with a purposeful sample of parents of children who received FN (n = 21) and navigators (n = 7). Interviews were transcribed verbatim and were coded using framework-guided rapid analysis to categorize proposed adaptations to FN. RESULTS Parents and navigators proposed 38 adaptations in four domains: 1) content of the intervention (n = 18), 2) context of the intervention (n = 10), 3) training and evaluation (n = 6), and 4) implementation and scale-up (n = 4). The most frequently endorsed adaptation recommendations focused on content (e.g., lengthening FN, providing parents with additional education on autism and parenting children with autism) and implementation (e.g., increasing access to navigation). Although probes targeted critical feedback, parents and navigators were overwhelmingly positive about FN. CONCLUSIONS This study builds upon prior FN effectiveness and implementation research by providing concrete areas for adaptation and refinement of the intervention. Recommendations by parents and navigators have the potential to inform improvement of existing navigation programs and development of new programs in similarly underserved populations. These findings are critical as adaptation (cultural and otherwise) is an important principle in the field of health equity. Ultimately, adaptations will need to be tested to determine clinical and implementation effectiveness. TRIAL REGISTRATION ClinicalTrials.gov, registration number NCT02359084, February 9, 2015.
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Affiliation(s)
| | | | - Plyce Fuchu
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA.
| | | | - Miya Barnett
- University of California, Santa Barbara, Santa Barbara, USA
| | | | - Emily Feinberg
- Boston Medical Center, Boston, USA
- Boston University School of Medicine, Boston, USA
| | - Sarabeth Broder-Fingert
- University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01605, USA
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Allen CG, Judge DP, Nietert PJ, Hunt KJ, Jackson A, Gallegos S, Sterba KR, Ramos PS, Melvin CL, Wager K, Catchpole K, Ford M, McMahon L, Lenert L. Anticipating adaptation: tracking the impact of planned and unplanned adaptations during the implementation of a complex population-based genomic screening program. Transl Behav Med 2023; 13:381-387. [PMID: 37084411 PMCID: PMC10255754 DOI: 10.1093/tbm/ibad006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
In 2021, the Medical University of South Carolina (MUSC) launched In Our DNA SC. This large-scale initiative will screen 100,000 individuals in South Carolina for three preventable hereditary conditions that impact approximately two million people in the USA but often go undetected. In anticipation of inevitable changes to the delivery of this complex initiative, we developed an approach to track and assess the impact of evaluate adaptations made during the pilot phase of program implementation. We used a modified version of the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) and Adaptations to code adaptations made during the 3-month pilot phase of In Our DNA SC. Adaptations were documented in real-time using a REDCap database. We used segmented linear regression models to independently test three hypotheses about the impact of adaptations on program reach (rate of enrollment in the program, rate of messages viewed) and implementation (rate of samples collected) 7 days pre- and post-adaptation. Effectiveness was assessed using qualitative observations. Ten adaptations occurred during the pilot phase of program implementation. Most adaptations (60%) were designed to increase the number and type of patient contacted (reach). Adaptations were primarily made based on knowledge and experience (40%) or from quality improvement data (30%). Of the three adaptations designed to increase reach, shortening the recruitment message potential patients received significantly increased the average rate of invitations viewed by 7.3% (p = 0.0106). There was no effect of adaptations on implementation (number of DNA samples collected). Qualitative findings support improvement in effectiveness of the intervention after shortening the consent form and short-term positive impact on uptake of the intervention as measured by team member's participation. Our approach to tracking adaptations of In Our DNA SC allowed our team to quantify the utility of modifications, make decisions about pursuing the adaptation, and understand consequences of the change. Streamlining tools for tracking and responding to adaptations can help monitor the incremental impact of interventions to support continued learning and problem solving for complex interventions being delivered in health systems based on real-time data.
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Affiliation(s)
- Caitlin G Allen
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Daniel P Judge
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paul J Nietert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Kelly J Hunt
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Amy Jackson
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Sam Gallegos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Katherine R Sterba
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Paula S Ramos
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Cathy L Melvin
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Karen Wager
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Ken Catchpole
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Marvella Ford
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Lori McMahon
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
| | - Leslie Lenert
- Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
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Chambers DA. Advancing adaptation of evidence-based interventions through implementation science: progress and opportunities. FRONTIERS IN HEALTH SERVICES 2023; 3:1204138. [PMID: 37342795 PMCID: PMC10277471 DOI: 10.3389/frhs.2023.1204138] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023]
Abstract
While the recognition of the need to adapt interventions to improve their fit with populations and service systems has been well established within the scientific community, limited consideration of the role of adaptation within implementation science has impeded progress toward optimal uptake of evidence-based care. This article reflects on the traditional paths through which adapted interventions were studies, progress made in recent years toward better integration of the science of adaptation within implementation studies with reference to a special publication series, and next steps for the field to continue to build a robust knowledge base on adaptation.
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Mclaughlin M, Nathan A, Thornton A, Schipperijn J, Trost SG, Christian H. Adaptations to scale-up an early childhood education and care physical activity intervention for real-world availability - Play Active. Int J Behav Nutr Phys Act 2023; 20:65. [PMID: 37264433 DOI: 10.1186/s12966-023-01457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Adaptations for scale-up are ubiquitous but are rarely described in detail. Adaptations may be a key reason for the "scale-up penalty" which is when there is a reduction in intervention effect size following scale-up. The Play Active intervention consists of a physical activity policy for early childhood education and care (ECEC) services, with accompanying implementation support strategies. It was first implemented with 81 ECEC services in Perth, Western Australia, in 2021 - with significant positive changes in physical activity practice uptake. The aim of this paper is to describe the extent, type, fidelity consistency, goals, size, scope, and proposed impact of proposed adaptations to the implementation support strategies for scaling-up Play Active. METHODS Proposed adaptations were defined as planned changes, made prior to making the intervention available. The authors created a list of adaptations from a comparison of the Play Active implementation support strategies, before and after adaptation for proposed statewide availability across Western Australia, Queensland and South Australia, Australia. We used the Framework for Reporting Adaptations and Modifications-Enhanced Implementation Strategies (FRAME-IS) to code adaptations to implementation support strategies. Three authors coded each adaptation and rated their size, scope and proposed impact. RESULTS Fifty-three adaptations to Play Active were identified. Most (68%) were proposed for the 'content' of implementation strategies, including aspects of their delivery. In practice, this involved changing the delivery mode of implementation support strategies from phone call and email support, to website-based delivery. More than half (56%) of adaptations involved 'adding elements' for scale-up. Most adaptations were 'fidelity consistent' (95%). The main goals for adaptations were related to 'increasing the acceptability, appropriateness, or feasibility' (45%), 'decreasing the costs' (19%) and 'increasing adoption of the evidence-based practice' (19%). Adaptations were small to medium in size, with most proposed to have a positive (87%) or neutral (8%) effect on the effectiveness of the intervention, rather than negative (4%). CONCLUSIONS A large number of small, fidelity-consistent, adaptations were proposed for Play Active scale-up. Overall, the process of reporting adaptations was found to be feasible. To understand the impact of these adaptations, it will be important to re-evaluate implementation, effectiveness and process outcomes, at-scale.
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Affiliation(s)
- Matthew Mclaughlin
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Andrea Nathan
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Ashleigh Thornton
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Division of Pediatrics, School of Medicine, The University of Western Australia, Perth, Australia
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Stewart G Trost
- School of Human Movement and Nutrition Sciences, The University of Queensland, Queensland, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- School of Population and Global Health, The University of Western Australia, Perth, Australia
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Khan B, Hameed W, Avan BI. Psychosocial support during childbirth: Development and adaptation of WHO's Mental Health Gap Action Programme (mhGAP) for maternity care settings. PLoS One 2023; 18:e0285209. [PMID: 37216373 DOI: 10.1371/journal.pone.0285209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Poor psychosocial support and lack of respectful care for women during childbirth are commonplace in health facilities in low- and middle-income countries. While WHO recommends providing supportive care to pregnant women, there is a scarcity of material for building the capacity of maternity staff to provide systematic and inclusive psychosocial support to women in the intrapartum phase, and prevent work stress and burnout in maternity teams. To address this need we adapted WHO's mhGAP for maternity staff to provide psychosocial support in labour room settings in Pakistan. Mental Health Gap Action Programme (mhGAP) is an evidence-based guidance which provides psychosocial support in resource-limited health care settings. This paper aims to describe the adaptation of mhGAP to develop psychosocial support capacity building materials for maternity staff to provide support to maternity patients, and also to staff, in the labour room context. METHODS Adaptation was conducted within the Human-Centered-Design framework in three phases: inspiration, ideation, and implementation feasibility. In inspiration, a review of national-level maternity service-delivery documents and in-depth interviews of maternity staff were conducted. Ideation involved a multidisciplinary team to develop capacity-building materials by adapting mhGAP. This phase was iterative and included cycles of pretesting, deliberations, and revision of materials. In implementation feasibility, materials were tested via the training of 98 maternity staff and exploring system feasibility via post-training visits to health facilities. RESULTS Inspiration phase identified gaps in policy directives and implementation and formative study identified limited understanding and skills of staff to assess patients' psychosocial needs and provide appropriate support. Also, it became evident that staff themselves needed psychosocial support. In ideation, team developed capacity-building materials comprising two modules: one dedicated to conceptual understanding, the other to implementing psychosocial support in collaboration with maternity staff. In implementation feasibility, staff found the materials relevant and feasible for the labour room setting. Finally, users and experts endorsed usefulness of the materials. CONCLUSION Our work in developing psychosocial-support training materials for maternity staff extends the utility of mhGAP to maternity care settings. These materials can be used for capacity-building of maternity staff and their effectiveness can be assessed in diverse maternity care settings.
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Affiliation(s)
- Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Iwelunmor J, Ezechi O, Obiezu-Umeh C, Gbaja-Biamila T, Musa AZ, Nwaozuru U, Obasi N, Ojo V, Xian H, Oladele D, Airhihenbuwa CO, Muessig K, Rosenberg N, Conserve DF, Ong JJ, Nkengasong S, Tahlil KM, BeLue R, Engelhart A, Mason S, Tang W, Ogedegbe G, Tucker JD. Tracking adaptation strategies of an HIV prevention intervention among youth in Nigeria: a theoretically informed case study analysis of the 4 Youth by Youth Project. Implement Sci Commun 2023; 4:44. [PMID: 37101190 PMCID: PMC10131455 DOI: 10.1186/s43058-023-00404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/27/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth. METHODS The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications - Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria-an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals. RESULTS Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention's feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group. CONCLUSIONS Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.
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Affiliation(s)
- Juliet Iwelunmor
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA.
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Titilola Gbaja-Biamila
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Adesola Z Musa
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nnamdi Obasi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Victor Ojo
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Federal University of Technology Akure, Akure, Ondo State, Nigeria
| | - Hong Xian
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - David Oladele
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Collins O Airhihenbuwa
- Heath Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Kathryn Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nora Rosenberg
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Clinical Research Department, London, School of Hygiene and Tropical Medicine, London, UK
| | - Susan Nkengasong
- Clinical Research Department, London, School of Hygiene and Tropical Medicine, London, UK
| | - Kadija M Tahlil
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rhonda BeLue
- Community and Policy, College for Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Alexis Engelhart
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Stacey Mason
- College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, USA
| | - Weiming Tang
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, New York University School of Medicine, NY, New York, NY, USA
| | - Joseph D Tucker
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Fry J, Wilkinson SA, Willcox J, Henny M, McGuire L, Guthrie TM, Meloncelli N, de Jersey S. Improving Engagement in Antenatal Health Behavior Programs-Experiences of Women Who Did Not Attend a Healthy Lifestyle Telephone Coaching Program. Nutrients 2023; 15:nu15081860. [PMID: 37111079 PMCID: PMC10146126 DOI: 10.3390/nu15081860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/06/2023] [Accepted: 04/08/2023] [Indexed: 04/29/2023] Open
Abstract
Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behavior intervention that has been shown to improve healthy eating behaviors and physical activity levels during pregnancy. However, one-third of eligible, referred women did not engage with or dropped out of the service. This study aimed to explore the experiences and perceptions of women who were referred but did not attend or complete the LWdP program to inform service improvements and adaptations required for scale and spread and improve the delivery of patient-centered antenatal care. Semi-structured telephone interviews were conducted with women who attended ≤2 LWdP appointments after referral. The interviews were thematically analyzed and mapped to the Theoretical Domains Framework and Behavior Change Wheel/COM-B Model to identify the barriers and enablers of program attendance and determine evidence-based interventions needed to improve service engagement and patient-centered antenatal care. Three key themes were identified: (1) the program content not meeting women's expectations and goals; (2) the need for flexible, multimodal healthcare; and (3) information sharing throughout antenatal care not meeting women's information needs. Interventions to improve women's engagement with LWdP and patient-centered antenatal care were categorized as (1) adaptations to LWdP, (2) training and support for program dietitians and antenatal healthcare professionals, and (3) increased promotion of positive health behaviors during pregnancy. Women require flexible and personalized delivery of the LWdP that is aligned with their individual goals and expectations. The use of digital technology has the potential to provide flexible, on-demand access to and engagement with the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviors in pregnancy, with the ongoing training and support necessary to maintain clinician confidence and knowledge of healthy eating, physical activity, and weight gain during pregnancy.
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Affiliation(s)
- Jessica Fry
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Mothers, Babies and Women's Theme, Mater Research Institute-The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jane Willcox
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD 4072, Australia
- Impact Obesity, South Melbourne, VIC 3205, Australia
| | - Michaela Henny
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Lisa McGuire
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Taylor M Guthrie
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
| | - Nina Meloncelli
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
- Office of the Chief Allied Health Practitioner, Metro North Health, Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia
| | - Susan de Jersey
- Dietetics and Foodservices, Royal Brisbane and Women's Hospital, James Mayne Building Level 2, Butterfield Street, Herston, QLD 4029, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia
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Gupta J, Dalpe J, Kanselaar S, Ramanadhan S, Boa PC, Williams MS, Wachter K. Ea$ing into the USA: study protocol for adapting the Economic and Social Empowerment (EA$E) intervention for US-based, forcibly based populations. BMJ Open 2023; 13:e069069. [PMID: 37012007 PMCID: PMC10083755 DOI: 10.1136/bmjopen-2022-069069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Immigrant and forcibly displaced women and girls are disproportionately impacted by the harmful health consequences of intimate partner violence (IPV) in the USA. Economic and Social Empowerment (EA$E), a women's protection and empowerment intervention, has shown promising reductions in IPV and gender inequities among forcibly displaced populations (FDPs) in low-income and middle-income countries. However, research on the integration of gender equity interventions into economic empowerment programming for FDPs within the USA is lacking. Additionally, there is growing interest in integrating gender equity programmes among US-based refugee resettlement organisations, including the International Rescue Committee (IRC). We describe our study protocol for examining the feasibility, acceptability and appropriateness of EA$E for use with US-based FDPs, and recommendations for adaptation. METHODS AND ANALYSIS This is a convergent parallel study to guide the adaptation of EA$E for use with US-based FDPs. Mixed methods (quantitative and qualitative) will be used for the adaptation research. Quantitative data will consist of brief surveys, and qualitative data will consist of focus group discussions (FGDs). Our research will be guided by the 'administration' phase of the ADAPT-ITT framework, which entails pretesting the intervention with the new target audience and implementation context to examine acceptability, appropriateness and feasibility to receive feedback to inform modifications of the original intervention. This is done via theatre testing, an innovative approach to pretesting that allows the new target audience to experience the intervention and provide feedback. We will conduct FGDs with IRC staff (n=4, total of 24 participants) and refugee clients (n=8, total of 48 participants, women and men, French and English speaking). ETHICS AND DISSEMINATION The study has received approval from the George Mason University Human Subjects Committee (#1686712-7) and IRC (via reliance agreement). Results will be made available to refugee resettlement organisations, policymakers, funders and other researchers. This study has been registered in Open Science Framework (https://doi.org/10.17605/OSF.IO/SZDVY).
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Affiliation(s)
- Jhumka Gupta
- College of Public Health, Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Jessica Dalpe
- International Rescue Committee, New York, New York, USA
| | - Samantha Kanselaar
- College of Public Health, Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Michelle S Williams
- College of Public Health, Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Karin Wachter
- School of Social Work, Arizona State University, Phoenix, Arizona, USA
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Hwang GL, Vilendrer S, Amano A, Brown-Johnson C, Kling SM, Faust A, Willis MH, Larson DB. From Acceptable to Superlative: Scaling a Technologist Coaching Intervention to Improve Image Quality. J Am Coll Radiol 2023. [DOI: 10.1016/j.jacr.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Madrigal C, Mills WL, Keleher VC, Pimentel CB, Hartmann CW, Snow AL, Camp C, Hilgeman MM. A Spotlight on Adaptation: Preimplementation of Montessori-Based Activity Programming in Long-Term Care Using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME). THE GERONTOLOGIST 2023; 63:589-603. [PMID: 36000697 DOI: 10.1093/geront/gnac133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet underexamined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e., community living centers [CLCs]). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap in adapting interventions through a detailed examination of the adaptation process in NHs. RESEARCH DESIGN AND METHODS Qualitative and quantitative data were collected across 8 CLCs (e.g., advisory panel, staff interviews, training evaluations, field notes, and fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting. RESULTS Thirty-six adaptations were made. Most adaptions occurred during the preimplementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention. DISCUSSION AND IMPLICATIONS CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions.
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Affiliation(s)
- Caroline Madrigal
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Whitney L Mills
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Virginia C Keleher
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
| | - Camilla B Pimentel
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - A Lynn Snow
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Cameron Camp
- Center for Applied Research in Dementia, Solon, Ohio, USA
| | - Michelle M Hilgeman
- Research and Development Service, Tuscaloosa VA Medical Center, Tuscaloosa, Alabama, USA
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama, USA
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Ray AE, Mun EY, Lewis MA, Litt DM, Stapleton JL, Tan L, Buller DB, Zhou Z, Bush HM, Himelhoch S. Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial. JMIR Res Protoc 2023; 12:e43986. [PMID: 36716301 PMCID: PMC10131715 DOI: 10.2196/43986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/04/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43986.
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Affiliation(s)
- Anne E Ray
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Eun-Young Mun
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Dana M Litt
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Jerod L Stapleton
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Lin Tan
- Department of Health Behavior and Health Systems, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | | | - Zhengyang Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - Heather M Bush
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Seth Himelhoch
- Department of Psychiatry, College of Medicine, University of Kentucky, Lexington, KY, United States
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Strand E, Murta F, Tupetz A, Barcenas L, Phillips AJ, Farias AS, Santos AC, Rocha GDS, Staton CA, Ramos FR, Machado VA, Wen FH, Vissoci JR, Sachett J, Monteiro W, Gerardo CJ. Perspectives on snakebite envenoming care needs across different sociocultural contexts and health systems: A comparative qualitative analysis among US and Brazilian health providers. Toxicon X 2023; 17:100143. [PMID: 36578905 PMCID: PMC9791583 DOI: 10.1016/j.toxcx.2022.100143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
With the advancements in therapeutics and available treatment options, almost all deaths and permanent disabilities from snakebite envenoming (SBE) are preventable. The challenge lies in implementing these evidence-based treatments and practices across different settings and populations. This study aims to compare data on provider perceptions of SBE care across health systems and cultural contexts to inform potential implementation science approaches. We hypothesize different health systems and cultural contexts will influence specific perceived needs to provide adequate snakebite care within central tenets of care delivery (e.g., cost, access, human resources). We previously conducted exploratory descriptive studies in the US and Brazil in order to understand the experience, knowledge, and perceptions of health professionals treating SBE. In the US, in-depth interviews were performed with emergency physicians from January 2020 to March 2020. In BR, focus group discussions were conducted with health professionals from community health centers at the end of June 2021. The focus group discussions (BR) were originally analyzed through an inductive thematic analysis approach. We conducted a secondary qualitative analysis in which this codebook was then applied to the interviews (US) in a deductive content analysis. The analysis concluded in August 2022. Brazil participants were physicians (n=5) or nurses (n=20) from three municipalities in the State of Amazonas with an average of three years of professional experience. US participants were emergency physicians (n=16) with an average of 15 years of professional experience. Four main themes emerged: 1) barriers to adequate care on the patient and/or community side and 2) on the health system side, 3) perceived considerations for how to address SBE, and 4) identified needs for improving care. There were 25 subthemes within the four themes. These subthemes were largely the same across the Brazil and US data, but the rationale and content within each shared subtheme varied significantly. For example, the subtheme "role of health professionals in improving care" extended across Brazil and the US. Brazil emphasized the need for task-shifting and -sharing amongst health care disciplines, whereas the US suggested specialized approaches geared toward increasing access to toxicologists and other referral resources. Despite similar core barriers to adequate snakebite envenoming care and factors to consider when trying to improve care delivery, health professionals in different health systems and sociocultural contexts identified different needs. Accounting for, and understanding, these differences is crucial to the success of initiatives intended to strengthen snakebite envenoming care. Implementation science efforts, with explicit health professional input, should be applied to develop new and/or adapt existing evidence-based treatments and practices for SBE.
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Affiliation(s)
- Eleanor Strand
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Felipe Murta
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Anna Tupetz
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Loren Barcenas
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Altair Seabra Farias
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alícia Cacau Santos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Gisele dos Santos Rocha
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Flávia Regina Ramos
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Vinícius Azevedo Machado
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - João R.N. Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação Em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Charles J. Gerardo
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States
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Reback CJ, Lin C, Larkins S, Vi VTT, Diep NTN, Lai N, Dung DV. Adaptation of the U.S.-oriented evidence-based intervention TransAction for transgender women in Vietnam. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:215-232. [PMID: 38681497 PMCID: PMC11044755 DOI: 10.1080/26895269.2023.2169217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: Trans women in Vietnam are among the most vulnerable groups with high HIV risk and limited access to care. TransAction is an evidence-based intervention to reduce trans women's HIV risks and increase social support and access to care.Aims: The aim of this study was to adapt TransAction to the specific needs of trans women in Vietnam. Methods: This study was conducted in Ho Chi Minh City from November 2020 through June 2021 Using the ADAPT-ITT framework, interviews, focus groups, and community advisory board meetings were conducted with trans women, service providers, and community members to better understand Vietnamese contexts of gender transition, HIV risks, and service gaps. Feedback was solicited on TransAction content and format adaptation. Results: Trans women in Vietnam faced unique challenges related to family norms, policy and regulatory constraints, and limited transgender-specific or gender-inclusive services. TransAction was modified to accommodate identified challenges and needs, and intervention components to enhance family support were added. Strategies to cope with stigma and seek support and services were adapted to Vietnamese culture and policies. Discussion: Post-adaptation interviews and focus groups demonstrated strong feasibility and acceptability for the adapted intervention, which can potentially be used to reduce Vietnamese trans women's HIV risks and increase their social support.
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Affiliation(s)
- Cathy J. Reback
- Friends Research Institute, Center for HIV Identification, Prevention and Treatment Services, University of California, Los Angeles, Los Angeles, California, USA
| | - Chunqing Lin
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Sherry Larkins
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
| | - Vu Thi Tuong Vi
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Nguyen Ly Lai
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Do Van Dung
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
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McGee RE, Patel A, Drzymalla EM, Anderson M, Johnson EK, Thompson NJ, Escoffery C. Project UPLIFT: Adoption and implementation experiences of an epilepsy self-management program. Epilepsy Behav 2023; 138:109001. [PMID: 36495799 DOI: 10.1016/j.yebeh.2022.109001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/06/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
RATIONALE Project UPLIFT is an evidence-based epilepsy self-management program shown to prevent and treat depression through an 8-session, group telehealth intervention. Since 2012, the program has been disseminated by training community-based providers to deliver UPLIFT to people with epilepsy (PWE). Limited research has described the adoption, implementation, and practice-based maintenance of self-management programs like UPLIFT. We sought to gain a better understanding of this process from trained program adopters. METHODS A cross-sectional evaluation of adoption and implementation experiences was conducted. An online survey with closed- and open-ended questions was distributed to 120 UPLIFT program adopters to collect information about reasons for being trained and experiences implementing the program. Survey items were developed based on the RE-AIM model to assess program reach, effectiveness, adoption, implementation, and maintenance. For closed-ended responses, frequencies and cross-tabs were calculated. Open-ended responses were reviewed and grouped by theme. RESULTS 41 respondents completed the survey (34% response rate). Respondents were from a variety of organizations including clinical (39%, n = 16), educational/research (17%, n = 7), and Epilepsy Foundation affiliates/chapters (12%, n = 5), among others. The most frequently endorsed reason for training in UPLIFT was an interest in supporting PWE (73%, n = 30). Most respondents rated delivering UPLIFT as very important (49%, n = 20) or important (32%, n = 13) to the organization. Sixty-one percent (n = 25) of respondents reported implementing (implementors) UPLIFT. Of those who had not yet implemented UPLIFT, 50% (n = 8) planned on implementing it at some point. Among program implementors, the most frequently reported implementation facilitators included participant interest (68%, n = 17), training (68%, n = 17), and organizational support (64%, n = 16). Program implementors indicated having program champions (80%, n = 20). The most frequently reported implementation challenge reported was recruitment (72%, n = 18). In open-ended responses, funding was a key theme that would facilitate continued implementation, but 48% (n = 12) responded that did not have access to resources and/or funding to help continue offering UPLIFT. Developing partnerships was recommended to improve the reach and maintenance of the program. Despite challenges, implementors agreed (44%, n = 11) or strongly agreed (36%, n = 9) that UPLIFT was effective in addressing mental health problems among program participants, and 76% (n = 19) plan on continuing to offer UPLIFT. CONCLUSION Implementation surveys increase understanding of program adoption and impact for dissemination trainees. Implementation benefits from program champions, strong partnerships, and sustained funding. Continued refinement of implementation support, such as developing a sustained referral system, maintaining relationships with trainees, supporting evaluation activities, and exploring opportunities for program updates to further enhance adoption, implementation, and maintenance.
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Affiliation(s)
- Robin E McGee
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States.
| | - Archna Patel
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Emily M Drzymalla
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Molly Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Erica K Johnson
- Department of Rehabilitation Medicine/Epilepsy Center, University of Washington, 325 9th Avenue, Seattle, WA 98104, United States.
| | - Nancy J Thompson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30322, United States
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Lee CN, Matthew RA, Orpinas P. Design, implementation, and evaluation of community health worker training programs in Latinx communities: A scoping review. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:382-405. [PMID: 35716392 PMCID: PMC10084025 DOI: 10.1002/jcop.22910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/04/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
This review examines the current reporting trends of program design, implementation, and evaluation of training programs for Latinx community health workers. Five scholarly databases were searched using a scoping review methodology to identify articles describing training programs for Latinx community health workers. The timeframe was 2009 to 2021. We identified 273 articles, with 59 meeting inclusion criteria. Researchers thematically coded the articles to identify reporting strategies related to program design, implementation, and evaluation. Findings suggest a lack of consensus in reporting elements critical to program resources, instructor qualifications, frequency and length of training implementation, theoretical background, and pedagogical tools associated with the training program. We offer detailed reporting recommendations of community health worker training programs to support the consistent dissemination of promising practices and facilitate the initiation of new programs for Latinx community health workers.
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Affiliation(s)
- Christina N. Lee
- Department of Anthropology, Franklin College of Arts and ScienceUniversity of GeorgiaAthensGeorgiaUSA
| | | | - Pamela Orpinas
- Department of Health Promotion and Behavior, College of Public HealthUniversity of GeorgiaAthensGeorgiaUSA
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Treichler EBH, Mercado R, Oakes D, Perivoliotis D, Gallegos-Rodriguez Y, Sosa E, Cisneros E, Spaulding WD, Granholm E, Light GA, Rabin B. Using a stakeholder-engaged, iterative, and systematic approach to adapting collaborative decision skills training for implementation in VA psychosocial rehabilitation and recovery centers. BMC Health Serv Res 2022; 22:1543. [PMID: 36528579 PMCID: PMC9759039 DOI: 10.1186/s12913-022-08833-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adaptation of interventions is inevitable during translation to new populations or settings. Systematic approach to adaptation can ensure that fidelity to core functions of the intervention are preserved while optimizing implementation feasibility and effectiveness for the local context. In this study, we used an iterative, mixed methods, and stakeholder-engaged process to systematically adapt Collaborative Decision Skills Training for Veterans with psychosis currently participating in VA Psychosocial Rehabilitation and Recovery Centers. METHODS A modified approach to Intervention Mapping (IM-Adapt) guided the adaptation process. An Adaptation Resource Team of five Veterans, two VA clinicians, and four researchers was formed. The Adaptation Resource Team engaged in an iterative process of identifying and completing adaptations including individual qualitative interviews, group meetings, and post-meeting surveys. Qualitative interviews were analyzed using rapid matrix analysis. We used the modified, RE-AIM enriched expanded Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to document adaptations. Additional constructs included adaptation size and scope; implementation of planned adaptation (yes-no); rationale for non-implementation; and tailoring of adaptation for a specific population (e.g., Veterans). RESULTS Rapid matrix analysis of individual qualitative interviews resulted in 510 qualitative codes. Veterans and clinicians reported that the intervention was a generally good fit for VA Psychosocial Rehabilitation and Recovery Centers and for Veterans. Following group meetings to reach adaptation consensus, 158 adaptations were completed. Most commonly, adaptations added or extended a component; were small in size and scope; intended to improve the effectiveness of the intervention, and based on experience as a patient or working with patients. Few adaptations were targeted towards a specific group, including Veterans. Veteran and clinician stakeholders reported that these adaptations were important and would benefit Veterans, and that they felt heard and understood during the adaptation process. CONCLUSIONS A stakeholder-engaged, iterative, and mixed methods approach was successful for adapting Collaborative Decision Skills Training for immediate clinical application to Veterans in a psychosocial rehabilitation center. The ongoing interactions among multiple stakeholders resulted in high quality, tailored adaptations which are likely to be generalizable to other populations or settings. We recommend the use of this stakeholder-engaged, iterative approach to guide adaptations.
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Affiliation(s)
- Emily B. H. Treichler
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Robert Mercado
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - David Oakes
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Dimitri Perivoliotis
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Yuliana Gallegos-Rodriguez
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Elijah Sosa
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Erin Cisneros
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - William D. Spaulding
- grid.24434.350000 0004 1937 0060Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE 68588 USA
| | - Eric Granholm
- grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.410371.00000 0004 0419 2708Center of Recovery Education, VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA
| | - Gregory A. Light
- Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego, 3500 La Jolla Village Drive, San Diego, CA 92161 USA ,grid.266100.30000 0001 2107 4242Department of Psychiatry, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
| | - Borsika Rabin
- grid.266100.30000 0001 2107 4242Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA ,grid.266100.30000 0001 2107 4242Clinical and Translational Research Center Dissemination and Implementation Science Center, UC San Diego Altman, UC San Diego, 9500 Gillman Drive, La Jolla, CA 92037 USA
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Balis LE, Houghtaling B, Harden SM. Using implementation strategies in community settings: an introduction to the Expert Recommendations for Implementing Change (ERIC) compilation and future directions. Transl Behav Med 2022; 12:965-978. [PMID: 36039843 DOI: 10.1093/tbm/ibac061] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this commentary, we introduce public health practitioners and researchers to implementation science through an established compilation of implementation strategies. We provide terminology and examples for community settings so public health practitioners and researchers can use implementation strategies and document efforts using standard terminology. We also discuss the need for future work to determine the extent to which these implementation strategies work and are most useful in community settings, and ultimately, how health behaviors are impacted. We intend this commentary to serve as a dissemination strategy for implementation strategies and to contribute to knowledge in the growing field of implementation science in community settings.
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Affiliation(s)
- Laura E Balis
- Louisville Center, Pacific Institute for Research and Evaluation, Louisville, Kentucky, USA
| | - Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska, USA.,Louisiana State University (LSU) and LSU Agricultural Center, Baton Rouge, Louisiana, USA
| | - Samantha M Harden
- Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virgina, USA
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Nelson LA, Roddy MK, Bergner EM, Gonzalez J, Gentry C, LeStourgeon LM, Kripalani S, Hull PC, Mayberry LS. Exploring determinants and strategies for implementing self-management support text messaging interventions in safety net clinics. J Clin Transl Sci 2022; 6:e126. [PMID: 36590364 PMCID: PMC9794969 DOI: 10.1017/cts.2022.503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/28/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Text message-delivered interventions for chronic disease self-management have potential to reduce health disparities, yet limited research has explored implementing these interventions into clinical care. We partnered with safety net clinics to evaluate a texting intervention for type 2 diabetes called REACH (Rapid Encouragement/Education And Communications for Health) in a randomized controlled trial. Following evaluation, we explored potential implementation determinants and recommended implementation strategies. Methods We interviewed clinic staff (n = 14) and a subset of intervention participants (n = 36) to ask about REACH's implementation potential. Using the Consolidated Framework for Implementation Research (CFIR) as an organizing framework, we coded transcripts and used thematic analysis to derive implementation barriers and facilitators. We integrated the CFIR-ERIC (Expert Recommendations for Implementing Change) Matching Tool, interview feedback, and the literature to recommend implementation strategies. Results Implementation facilitators included low complexity, strong evidence and quality, available clinic resources, the need for a program to support diabetes self-management, and strong fit between REACH and both the clinics' existing workflows and patients' needs and resources. The barriers included REACH only being available in English, a lack of interoperability with electronic health record systems, patients' concerns about diabetes stigma, limited funding, and high staff turnover. Categories of recommended implementation strategies included training and education, offering flexibility and adaptation, evaluating key processes, and securing funding. Conclusion Text message-delivered interventions have strong potential for integration in low-resource settings as a supplement to care. Pursuing implementation can ensure patients benefit from these innovations and help close the research to practice gap.
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Affiliation(s)
- Lyndsay A. Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - McKenzie K. Roddy
- Quality Scholars Program, VA Tennessee Valley Healthcare System, US Department of Veteran Affairs, Nashville, TN, USA
| | - Erin M. Bergner
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jesus Gonzalez
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Chad Gentry
- Department of Pharmacy, College of Pharmacy and Health Sciences, Lipscomb University, Nashville, TN, USA
| | | | - Sunil Kripalani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Pamela C. Hull
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Lindsay S. Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Valente JY, Galvão PPDO, Gusmoes JDSP, Sanchez ZM. Revisão sistemática sobre o efeito do programa escolar de prevenção ao uso de drogas Keepin’ it REAL: traduzido e implementado no Brasil pelo PROERD. CIENCIA & SAUDE COLETIVA 2022; 27:4175-4189. [DOI: 10.1590/1413-812320222711.07162022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
Resumo O Programa Educacional de Resistência às Drogas (PROERD) é o programa escolar de prevenção mais disseminado no Brasil, seu atual currículo é baseado no programa norte-americano Keepin’it REAL (kiR). Não há na literatura evidência de efetividade do PROERD na prevenção ao uso de drogas, sendo necessários estudos complementares que auxiliem a compreensão desses achados. O objetivo do presente estudo é realizar uma síntese das evidências do efeito do currículo que deu origem ao PROERD: o kiR. Através de revisão sistemática encontrou-se 17 estudos que reportaram resultados de efeito de diferentes versões do kiR no uso de drogas e/ou violência. Com exceção do estudo brasileiro, não foram encontrados estudos que avaliassem o efeito no uso de drogas da versão aplicada por policiais (DARE-kiR), a mesma implementada pelo PROERD. Foram encontradas evidências favoráveis do kiR na prevenção ao uso de drogas para o currículo do 7º ano, que contrariam os resultados de efeito nulo do PROERD. Não foram encontradas evidências internacionais do efeito do kiR no currículo do 5º ano, assim como o estudo do PROERD. Sugere-se que revisões no currículo do 7º ano do PROERD para que ele possa refletir os resultados internacionais e que o currículo do 5º ano posso ser repensado considerando as evidências negativas internacionais.
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Valente JY, Galvão PPDO, Gusmoes JDSP, Sanchez ZM. A systematic review of the effect of the school-based drug prevention program Keepin’ it REAL: translated and implemented in Brazil by PROERD. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222711.07162022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract The Drug Resistance Educational Program (PROERD) is Brazil’s most widespread school-based prevention program; its current curriculum is based on the North American Keepin’ it REAL (kiR) program. There is no evidence of the effectiveness of PROERD in preventing drug use, pointing to the need for further studies to understand these findings. The aim of the study was to synthesis the evidence of the effect of the kiR curriculum (PROERD) through a systematic review. We found 17 studies that reported the effects of different versions of kiR on drug use and/or violence. Except for the Brazilian study, no studies were found that assessed the effect on drug use of the version applied by police officers (DARE-kiR), the same one implemented by PROERD. Favorable evidence of kiR in drug use prevention was found for the 7th-grade curriculum, which contradicts the PROERD’s null-effect results. No international evidence of the effect of kiR was found in the 5th-grade curriculum, in the same line as the PROERD’s study. It is suggested that PROERD’s 7th-grade curriculum should be revised to reflect international results and that the 5th-grade curriculum should be reconsidered in light of the negative international evidence.
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