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Peters-Corbett A, Parke S, Bear H, Clarke T. Barriers and facilitators of implementation of evidence-based interventions in children and young people's mental health care - a systematic review. Child Adolesc Ment Health 2024; 29:242-265. [PMID: 37608642 DOI: 10.1111/camh.12672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Effective evidence-based practices (EBP) for children and young people's (CYP) mental health exist, however, there is low uptake in clinical practice and interventions do not always reach those in need. This review aimed to comprehensively identify and synthesise the barriers and facilitators to implementing EBP in CYP mental health care, mapped according to an implementation framework in order to make pragmatic recommendations for practitioners, commissioners and researchers. METHODS Following the PRISMA guidelines, an electronic search of PsycINFO, MEDLINE, CINAHL and Embase in 2021 yielded 1830 results. In total, 107 abstracts were screened, 57 of which were included for full-text review and 26 were included for data extraction and analysis. RESULTS We identified a number of organisational and clinician-level barriers which impede the implementation of evidence in 'real world' practice. Barriers included lack of access to funding; poor access to resources; clinician attitudes and flexibility of EBP. Facilitators included targeted funding and access to resources; supportive staff and leadership committed to innovation and skills in the EBP. CONCLUSIONS Although the process of translating research into practice is challenging and the solutions are not straightforward, we have identified a set of practical recommendations for ways in which implementation practices can improve. Researchers, commissioners, funders and practitioners can work together to improve the implementation of EBP in CYP mental health settings by ensuring funding is available, prioritise implementation beyond the end of trials, upskill staff on integrating EBP into care, ensure EBPs are flexible and are co-produced with service users. REGISTRATION This review was registered on PROSPERO international prospective register of systematic reviews (CRD42021252995).
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Affiliation(s)
| | - Sheryl Parke
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Holly Bear
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Timothy Clarke
- University of Cardiff, Cardiff, UK
- East of England NIHR Applied Research Collaborative, Norwich, UK
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Kang E, Chen J, Lipsey KL, Foster ER. Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review. Am J Occup Ther 2024; 78:7805205030. [PMID: 39197014 DOI: 10.5014/ajot.2024.050526] [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: 08/30/2024] Open
Abstract
IMPORTANCE Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary. OBJECTIVE To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy. DATA SOURCES PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science. STUDY SELECTION AND DATA COLLECTION We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis. FINDINGS Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups). CONCLUSIONS AND RELEVANCE We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.
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Affiliation(s)
- Eunyoung Kang
- Eunyoung Kang, PhD, BOT, is Postdoctoral Research Fellow, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO;
| | - Julie Chen
- Julie Chen, BS, is Occupational Therapy Student, Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Kim L Lipsey
- Kim L. Lipsey, MLS, is Medical Librarian, Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Erin R Foster
- Erin R. Foster, PhD, OTD, OTR/L, is Associate Professor, Program in Occupational Therapy, Departments of Neurology and Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, MO
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Dunsmore J, Duncan E, MacLennan S, N'Dow J, MacLennan S. Specifying behavioural and strategy components of de-implementation efforts targeting low-value prescribing practices in secondary health care. Implement Sci Commun 2024; 5:88. [PMID: 39113160 PMCID: PMC11304722 DOI: 10.1186/s43058-024-00624-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 07/27/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND /Aims De-implementation, including the removal or reduction of unnecessary or inappropriate prescribing, is crucial to ensure patients receive appropriate evidence-based health care. The utilization of de-implementation efforts is contingent on the quality of strategy reporting. To further understand effective ways to de-implement medical practices, specification of behavioural targets and components of de-implementation strategies are required. This paper aims to critically analyse how well the behavioural targets and strategy components, in studies that focused on de-implementing unnecessary or inappropriate prescribing in secondary healthcare settings, were reported. METHODS A supplementary analysis of studies included in a recently published review of de-implementation studies was conducted. Article text was coded verbatim to two established specification frameworks. Behavioural components were coded deductively to the five elements of the Action, Actor, Context, Target, Time (AACTT) framework. Strategy components were mapped to the nine elements of the Proctor's 'measuring implementation strategies' framework. RESULTS The behavioural components of low-value prescribing, as coded to the AACTT framework, were generally specified well. However, the Actor and Time components were often vague or not well reported. Specification of strategy components, as coded to the Proctor framework, were less well reported. Proctor's Actor, Action target: specifying targets, Dose and Justification elements were not well reported or varied in the amount of detail offered. We also offer suggestions of additional specifications to make, such as the 'interactions' participants have with a strategy. CONCLUSION Specification of behavioural targets and components of de-implementation strategies for prescribing practices can be accommodated by the AACTT and Proctor frameworks when used in conjunction. These essential details are required to understand, replicate and successfully de-implement unnecessary or inappropriate prescribing. In general, standardisation in the reporting quality of these components is required to replicate any de-implementation efforts. TRIAL REGISTRATION Not registered.
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Affiliation(s)
| | - Eilidh Duncan
- Health Service Research Unit, University of Aberdeen, Aberdeen, U.K
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, U.K
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, U.K
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Holtrop JS, Gurfinkel D, Nederveld A, Reedy J, Rubinson C, Kwan BM. What works in implementing shared medical appointments for patients with diabetes in primary care to enhance reach: a qualitative comparative analysis from the Invested in Diabetes study. Implement Sci Commun 2024; 5:82. [PMID: 39049078 PMCID: PMC11267890 DOI: 10.1186/s43058-024-00608-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Diabetes is a serious public health problem affecting 37.3 million Americans. Diabetes shared medical appointments (SMAs) are an effective strategy for providing diabetes self-management support and education in primary care. However, practices delivering SMAs experience implementation challenges. This analysis examined conditions associated with successful practice implementation of diabetes SMAs in the context of participation in a pragmatic trial. METHODS Mixed methods study using qualitative and quantitative data collected from interviews, observations, surveys, and practice-reported data, guided by the practical, robust implementation and sustainability model (PRISM). Data were analyzed using qualitative comparative analysis (QCA). Successful implementation was defined as meeting patient recruitment targets (Reach) during the study period. Participants were clinicians and staff members from 22 primary care practices in Colorado and Missouri, USA. RESULTS The first necessary condition identified from the QCA was the presence of additional resources for patients with diabetes in the practice. Within practices that had these additional resources, we found that a sufficiency condition was the presence of an effective key person to make things happen with the SMAs. A second QCA was conducted to determine conditions underlying the presence of the effective key person (often performing functions of an implementation champion), which revealed factors including low or managed employee turnover, a strong baseline practice culture, and previous experience delivering SMAs. CONCLUSIONS Identification of key factors necessary and sufficient for implementation of new care processes is important to enhance patient access to evidence-based interventions. This study suggests that practice features and resources have important implications for implementation of diabetes SMAs. There may be opportunities to support practices with SMA implementation by enabling the presence of skilled implementation champions. TRIAL REGISTRATION Registered at clinicaltrials.gov under trial ID NCT03590041, registered on July 18, 2018.
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Affiliation(s)
- Jodi Summers Holtrop
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA.
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA.
| | - Dennis Gurfinkel
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Andrea Nederveld
- Department of Family Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Julia Reedy
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
| | - Claude Rubinson
- Department of Social Sciences, University of Houston-Downtown, 1 Main Street, Houston, TX, 77009, USA
| | - Bethany Matthews Kwan
- University of Colorado Denver School of Medicine, ACCORDS, 1890 N Revere Ct, Aurora, CO, 80045, USA
- Department of Emergency Medicine, University of Colorado Denver School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, USA
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Haun JN, Melillo C, Schneider T, McDaniel J, McMahon-Grenz J, Benzinger RC, Nakase-Richardson R, Pugh MJV, Skop KM, Friedman Y, Sandoval R, Sabangan J, Samson K, Picon LM, Kean J. A Partner-Engaged Approach to Developing an Implementation Research Logic Model for a Traumatic Brain Injury-Intensive Evaluation and Treatment Program. J Head Trauma Rehabil 2024:00001199-990000000-00182. [PMID: 39038102 DOI: 10.1097/htr.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
BACKGROUND A partnered evaluation project with Veterans Health Administration Physical Medicine and Rehabilitation program office uses a partner-engaged approach to characterize and evaluate the national implementation of traumatic brain injury (TBI)Intensive Evaluation and Treatment Program (IETP). OBJECTIVE This paper illustrates a partner-engaged approach to contextualizing the IETP within an implementation research logic model (IRLM) to inform program sustainment and spread. SETTING The project was conducted at five IETP sites: Tampa, Richmond, San Antonio, Palo Alto, and Minneapolis. PARTICIPANTS Partners included national and site program leaders, clinicians, Department of Defense Referral Representatives, and researchers. Participants included program staff (n = 46) and Service Members/Veterans (n = 48). DESIGN This paper represents a component of a larger participatory-based concurrent mixed methods quality improvement project. MAIN MEASURES Participant scripts and demographic surveys. METHODS Datasets were analyzed using rapid iterative content analysis; IETP model was iteratively revised with partner feedback. Each site had an IETP clinical team member participate. The IRLM was contextualized within the Consolidated Framework for Implementation Research (CFIR); systematic consensus building expert reviewed implementation strategies; RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance); and Implementation Outcomes Framework (IOF). RESULTS Analyses and partner feedback identified key characteristics, determinants, implementation strategies, mechanisms, and outcomes. CONCLUSIONS This partner-engaged IRLM informs implementation and sustainment of a rehabilitation program for individuals with TBI. Findings will be leveraged to examine implementation, standardize core outcome measurements, and inform knowledge translation.
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Affiliation(s)
- Jolie N Haun
- Author Affiliations: Research Service, James A. Haley Veterans' Hospital, Tampa, Florida (Drs Haun, Melillo, and Schneider, and Mss McMahon-Grenz and Benzinger); Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah (Dr Haun); College of Public Health, University of South Florida, Tampa, Florida (Dr Schneider); School of Human Sciences, Southern Illinois University, Carbondale, Illinois (Dr McDaniel); Pulmonary/Sleep Medicine Division, Department of Internal Medicine, University of South Florida, Tampa, Florida (Dr Nakase-Richardson); James A. Haley Veterans' Hospital, Associate Chief of Staff Office, Tampa, Florida (Dr Nakase-Richardson); VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, Utah (Dr Pugh); Post-deployment Rehabilitation and Evaluation Program, Physical Medicine and Rehabilitation Services, James A Haley Veterans' Hospital, Tampa, Florida (Dr Skop and Ms Friedman); School of Physical Therapy, Morsani College of Medicine, University of South Florida, Tampa, Florida (Dr Skop); Post-deployment Acceleration Comprehensive Evaluation and Rehabilitation Program Polytrauma System of Care, South Texas Veterans Health Care System, Audie L. Murphy VAMC, San Antonio, Texas (Dr Sandoval); Intensive Evaluation & Treatment Program (IETP), Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, California (Drs Sabangan and Samson); Office of Rehabilitation and Prosthetic Services, Department of Veterans Affairs, Washington, District of Columbia (Ms Picon); and VA Salt Lake City Health Care System, VA Informatics and Computing Infrastructure, Salt Lake City, Utah (Dr Kean)
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Pickard KE, Hendrix NM, Greenfield ES, Yohannes M. Using Causative Methods to Determine System-Level Factors Driving the Uptake and Use of Evidence-Based Practices in a Public Early Intervention System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:554-566. [PMID: 38431889 DOI: 10.1007/s10488-024-01346-6] [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: 01/18/2024] [Indexed: 03/05/2024]
Abstract
Part C Early Intervention (EI) systems are an entry point to services for autistic toddlers and can be leveraged to facilitate access to autism evidence-based practices (EBPs). However, EI systems are complex and limited research has examined how an EI system's infrastructure (i.e. system-level factors) impacts the adoption and implementation of EBPs. To address this gap, 36 EI providers and 9 EI administrators completed a semi-structured interview or focus group about factors impacting the implementation of autism EBPs. Qualitative analysis included a combination of grounded theory and causative coding. Analyses were refined by input from providers, administrators, and family stakeholders in the form of round tables and presentations at the state's interagency coordinating council. Primary themes centered on: (1) the costs associated with independent contracting structures; (2) operational demands; (3) workforce stability; (4) communication consistency; and (5) implementation supports for EBP implementation. Causative coding helped to demonstrate the perceived relationships between these factors and underscored the important role of incentivization structures, collaboration opportunities, and championing in supporting the use of EBPs within a system that primarily uses independent contracting structures. The current study extends previous research by demonstrating how several system-level factors are perceived to play a role in the adoption and implementation of EBPs by independently contracted EI providers. These findings underscore the need for implementation strategies, such as incentivization strategies and social network building, to increase providers' implementation of autism EBPs within EI systems.
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Affiliation(s)
- Katherine E Pickard
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA.
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Nicole M Hendrix
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Elizabeth S Greenfield
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
| | - Millena Yohannes
- Department of Pediatrics, Division of Autism and Related Disabilities, Emory University School of Medicine, Atlanta, USA
- Marcus Autism Center, Children's Healthcare of Atlanta, Atlanta, USA
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Mendieta MJ, Goderis G, Zeller A, Yip O, Siqeca F, Zúñiga F, Zullig LL, De Geest SM, Deschodt M, Flamaing J, Dhaini S. Mapping implementation strategies to reach community-dwelling older adults in Northwest Switzerland. Implement Sci 2024; 19:44. [PMID: 38926758 PMCID: PMC11210125 DOI: 10.1186/s13012-024-01374-8] [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: 06/20/2023] [Accepted: 06/16/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In Northwestern Switzerland, recent legislation tackles the needs of community-dwelling older adults by creating Information and Advice Centers (IACs). IACs are a new service in the community that aims to assess the needs and provide information on age-related issues to community-dwelling older adults and their families. Previous studies reported difficulties in reaching community-dwelling older adults for community-based programs. We aimed to: 1) systematically identify implementation strategies to promote the IAC among community care providers, older adults and informal caregivers; 2) monitor the delivery of these strategies by the IAC management; and 3) describe the impact of those strategies on reach of community-dwelling older adults. This study was conducted as part of the TRANS-SENIOR project. METHODS As part of the INSPIRE feasibility assessment, we conducted a pre-test post-test study between March and September 2022. The sample included 8,840 older adults aged 65 + visiting/calling or being referred to the IAC for the first time. Implementation strategies were selected using implementation mapping and organized in bundles for each group of community care providers and older adults/caregivers. Our evaluation included: estimation of fidelity to the delivery of implementation strategies and bundles by the IAC management and their coverage; referral source of older adults to the IAC; and impact of the strategies on reach of the IAC on the 65 + population living in the care region. Adaptations to the strategies were documented using the FRAME-IS. Descriptive statistics were calculated and reported. RESULTS Seven implementation strategies were selected and organized in bundles for each community care provider and older adults and their caregivers. The lowest fidelity score was found in implementation strategies selected for nursing homes whereas the highest score corresponded to strategies targeting older adults and caregivers. "Informational visits" was the strategy with the lowest coverage (2.5% for nursing homes and 10.5% for hospitals and specialized clinics). The main referral sources were self-referrals and referrals by caregivers, followed by nursing homes. The IAC reach among the 65 + population was 5.4%. CONCLUSION We demonstrated the use of implementation mapping to select implementation strategies to reach community-dwelling older adults. The reach was low suggesting that higher fidelity to the delivery of the strategies, and reflection on the causal pathway of the implementation strategies might be needed.
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Affiliation(s)
- Maria Jose Mendieta
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium
| | - Geert Goderis
- Academic Center of General Practice, Department of Public Health and Primary Care, KU, Louvain, Belgium
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Olivia Yip
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Flaka Siqeca
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Leah L Zullig
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, UK
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, UK
| | - Sabina M De Geest
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Louvain, Belgium.
| | - Mieke Deschodt
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Competence Center of Nursing, University Hospitals Leuven, Louvain, Belgium
| | - Johan Flamaing
- Gerontology and Geriatrics, Department of Public Health and Primary Care, KU, Louvain, Belgium
- Department of Geriatric Medicine, University Hospital Leuven, Louvain, Belgium
| | - Suzanne Dhaini
- Nursing Science, Medizinische Fakultät, Department of Public Health (DPH), Universität Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
- University Children's Hospital Zurich, The Eleonore Foundation, Zurich, Switzerland
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Weaver SJ, Breslau ES, Russell LE, Zhang A, Sharma R, Bass EB, Marsteller JA, Snyder C. Health-care organization characteristics in cancer care delivery: an integrated conceptual framework with content validation. J Natl Cancer Inst 2024; 116:800-811. [PMID: 38419574 DOI: 10.1093/jnci/djae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/01/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
Context can influence cancer-related outcomes. For example, health-care organization characteristics, including ownership, leadership, and culture, can affect care access, communication, and patient outcomes. Health-care organization characteristics and other contextual factors can also influence whether and how clinical discoveries reduce cancer incidence, morbidity, and mortality. Importantly, policy, market, and technology changes are transforming health-care organization design, culture, and operations across the cancer continuum. Consequently, research is essential to examine when, for whom, and how organizational characteristics influence person-level, organization-level, and population-level cancer outcomes. Understanding organizational characteristics-the structures, processes, and other features of entities involved in health care delivery-and their dynamics is an important yet understudied area of care delivery research across the cancer continuum. Research incorporating organizational characteristics is critical to address health inequities, test care delivery models, adapt interventions, and strengthen implementation. The field lacks conceptual grounding, however, to help researchers identify germane organizational characteristics. We propose a framework identifying organizational characteristics relevant for cancer care delivery research based on conceptual work in health services, organizational behavior, and management science and refined using a systematic review and key informant input. The proposed framework is a tool for organizing existing research and enhancing future cancer care delivery research. Following a 2012 Journal of the National Cancer Institute monograph, this work complements National Cancer Institute efforts to stimulate research addressing the relationship between cancer outcomes and contextual factors at the patient, provider, team, delivery organization, community, and health policy levels.
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Affiliation(s)
- Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Erica S Breslau
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Rockville, MD, USA
| | - Lauren E Russell
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Allen Zhang
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ritu Sharma
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Eric B Bass
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
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Wandersman A, Scheier LM. Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. Eval Health Prof 2024; 47:143-153. [PMID: 38790113 DOI: 10.1177/01632787241248768] [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] [Indexed: 05/26/2024]
Abstract
Hundreds of millions of dollars are spent each year by U.S. federal agencies for training and technical assistance (TTA) to be delivered by training and technical assistance centers (TTACs) to "delivery system organizations" (e.g., federally qualified health centers, state departments of health, substance abuse treatment centers, schools, and healthcare organizations). TTACs are often requested to help delivery system organizations implement evidence-based interventions. Yet, counterintuitively, TTACs are rarely required to use evidence-based approaches when supporting delivery systems (in the use of evidence-based programs). In fact, evaluations of TTAC activities tend to be minimal; evaluation of technical assistance (if conducted at all) often emphasizes outputs (number of encounters), satisfaction, and self-reports of knowledge gained-more substantive outcomes are not evaluated. The gap between (a) the volume of TTA services being funded and provided and (b) the evaluation of those services is immense and has the potential to be costly. The basic question to be answered is: how effective are TTA services? This article introduces the special issue on Strengthening the Science and Practice of Implementation Support: Evaluating the Effectiveness of Training and Technical Assistance Centers. The special issue promotes 1) knowledge of the state of the art of evaluation of TTACs and 2) advances in what to evaluate in TTA. A major goal of the issue is to improve the science and practice of implementation support, particularly in the areas of TTA.
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Ataman R, Ahmed S, Berta W, Thomas A. Sustainability of an outcome measure in outpatient stroke rehabilitation: A realist evaluation. J Eval Clin Pract 2024; 30:559-574. [PMID: 38361260 DOI: 10.1111/jep.13972] [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: 10/13/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024]
Abstract
RATIONALE Only half of newly implemented evidence-based practices are sustained. Though poor sustainment can lead to negative consequences for clinical teams, organizations and patients, the causal explanations of sustainment are largely unknown. AIMS AND OBJECTIVES We aimed to ascertain how (mechanisms) and in what circumstances (context) a newly implemented outcome measure in rehabilitation was sustained or not (outcome). METHODOLOGY Informed by an integrated knowledge translation approach, we conducted a realist evaluation using a mixed method, embedded single case study design with data collection up to 18 months following the implementation of the Mayo-Portland Adaptability Inventory - version 4 (MPAI-4), a rehabilitation outcome measure. Quantitative data (survey and patient charts) was analysed using descriptive statistics, then integrated with qualitative data (interviews with 10 key informants) and analysed using inductive and deductive retroduction. We integrated the data to develop a case description and ultimately, to refine the programme theory to better understand the sustainability of the MPAI-4. RESULTS We linked context, mechanisms and outcomes, and also emphasized sustainability strategies in 18 explanations of how sustainability works. These explanations provide evidence for four overarching patterns: (1) implementation and sustainability phases are interconnected, (2) outcomes build on each other recursively, with patient benefits as the keystone outcome, (3) sustainment is achieved to varying levels across different sustainability outcomes [e.g., high level (e.g., rate of MPAI-4 scoring: 77.7%) to low level (e.g., rate of MPAI-4 application to clinical decision-making: 3.7%)] and (4) the work of sustaining the MPAI-4 is shared amongst different stakeholders. CONCLUSION Implementation teams can draw from this programme theory to improve the sustainment of outcomes measures while researchers could continue to refine the theory. Continued investigation of sustainability, including diverse and continuous sustainability outcomes, is needed to understand how to maintain improvements in quality of care and patient outcomes.
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Affiliation(s)
- Rebecca Ataman
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Constance Lethbridge Rehabilitation Center, CIUSSS Centre-Ouest de l'Îile de Montreal, Montreal, Quebec, Canada
- Clinical Epidemiology, Center for Outcome Research and Evaluation (CORE), McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
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11
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Kirk JW, Stefansdottir NT, Andersen O, Lindstroem MB, Powell B, Nilsen P, Tjørnhøj-Thomsen T, Broholm-Jørgensen M. How do oilcloth sessions work? A realist evaluation approach to exploring ripple effects in an implementation strategy. J Health Organ Manag 2024; 38:195-215. [PMID: 38825598 PMCID: PMC11346207 DOI: 10.1108/jhom-01-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 06/04/2024]
Abstract
PURPOSE To explore the mechanisms of the implementation strategy, "oilcloth sessions" and understand and explain the ripple effects of oilcloth sessions as a strategy to implement a new emergency department. DESIGN/METHODOLOGY/APPROACH A qualitative design was used whereby data were collected using field notes from an ethnographic study of the oilcloth sessions and follow-up semi-structured interviews with staff, managers and key employees who participated in the oilcloth sessions. The data analysis was inspired by the realist evaluation approach of generative causality proposed by Pawson and Tilley. FINDINGS The primary ripple effect was that the oilcloth sessions were used for different purposes than the proposed program theory, including being used as: (1) a stage, (2) a battlefield, (3) a space for imagination and (4) a strategic management tool influencing the implementation outcomes. The results bring essential knowledge that may help to explain why and how a well-defined implementation strategy has unplanned outcomes. ORIGINALITY/VALUE Unintended outcomes of implementation strategies are an underexplored issue. This study may help implementation researchers rethink the activities required to reduce unintended negative outcomes or explore potential unplanned outcomes and, in this way, hinder or enhance outcomes, effectiveness and sustainability. Future studies within implementation research should incorporate attention to unintended outcomes to fully understand the impact of implementation strategies.
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Affiliation(s)
- Jeanette Wassar Kirk
- Clinical Research Department, Hvidovre
Hospital, Hvidovre, Denmark
- Department of Health and Social Context, National
Institute of Public Health, University of
Southern Denmark, Copenhagen, Denmark
| | | | - Ove Andersen
- Clinical Research Department, Hvidovre
Hospital, Hvidovre, Denmark
- Emergency Department, Hvidovre Hospital,
Hvidovre, Denmark
- Department of Clinical Medicine, University of
Copenhagen, Copenhagen, Denmark
| | | | - Byron Powell
- Center for Mental Health Services
Research, Brown School,
Washington University in St Louis, St Louis,
Missouri, USA
- Center for Dissemination and
Implementation, Institute for Public
Health, Washington University in St
Louis, St Louis, Missouri, USA
- John T. Milliken Department of Medicine, Division of
Infectious Diseases, School of
Medicine, Washington University in St
Louis, St Louis, Missouri, USA
| | - Per Nilsen
- Department of Medicine, Health and Caring Sciences,
Linköping University, Linköping,
Sweden
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National
Institute of Public Health, University of
Southern Denmark, Copenhagen, Denmark
| | - Marie Broholm-Jørgensen
- Department of Health and Social Context, National
Institute of Public Health, University of
Southern Denmark, Copenhagen, Denmark
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12
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Levine R, Zingelman S, McSween MP, Shrubsole K, Hill AJ, Copland DA. Allied Health Clinicians' Uptake of Evidence in Stroke Rehabilitation: A Systematic Review of Determinants Targeted in Implementation Studies. Arch Phys Med Rehabil 2024; 105:988-999. [PMID: 37666287 DOI: 10.1016/j.apmr.2023.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE This study aimed to determine whether targeting specific implementation determinants is associated with allied health clinicians' uptake of evidence when implemented within stroke rehabilitation settings. DATA SOURCES 7 key databases were searched to identify articles published between 1990 and 2022 for inclusion. Reference lists of relevant articles were hand searched. STUDY SELECTION Studies were independently screened by 2 authors and included if the implementation intervention targeted allied health clinical practice in any stroke rehabilitation context and reported at least 1 quantitative measure of evidence uptake. Thirty studies met inclusion criteria. DATA EXTRACTION Data were independently extracted by the first and second author. Implementation outcomes for each study were categorized as either mostly successful, partially successful, or not successful based on the degree of evidence uptake achieved. Determinants targeted were categorized using the Consolidated Framework for Implementation Research (CFIR). DATA SYNTHESIS Patterns between the degree of evidence uptake and determinants targeted across studies were analyzed by the first and second authors in 1 of 3 groups: A (pre-post statistical analysis), B (pre-post descriptive analysis), or C (post-only descriptive analysis). Patterns between evidence uptake and determinants targeted were first identified within groups A and B, with group C consulted to support findings. All studies categorized as "mostly successful" targeted facilitation in combination with establishing face-to-face networks and communication strategies. Conversely, no studies rated "not successful" targeted either of these determinants. Studies rated "partially successful" targeted either 1, but seldom both, of these determinants. CONCLUSIONS This review has provided descriptive evidence of determinants which may be important to target for allied health clinicians' uptake of evidence within stroke rehabilitation settings.
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Affiliation(s)
- Rachel Levine
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia.
| | - Sally Zingelman
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Marie-Pier McSween
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - Kirstine Shrubsole
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia; Faculty of Health, Southern Cross University, Bilinga, Queensland Australia
| | - Annie Jane Hill
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia; STARS Education and Research Alliance, The University of Queensland and Metro North Health, Queensland, Australia
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13
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Luke DA, Powell BJ, Paniagua-Avila A. Bridges and Mechanisms: Integrating Systems Science Thinking into Implementation Research. Annu Rev Public Health 2024; 45:7-25. [PMID: 38100647 DOI: 10.1146/annurev-publhealth-060922-040205] [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] [Indexed: 12/17/2023]
Abstract
We present a detailed argument for how to integrate, or bridge, systems science thinking and methods with implementation science. We start by showing how fundamental systems science principles of structure, dynamics, information, and utility are relevant for implementation science. Then we examine the need for implementation science to develop and apply richer theories of complex systems. This can be accomplished by emphasizing a causal mechanisms approach. Identifying causal mechanisms focuses on the "cogs and gears" of public health, clinical, and organizational interventions. A mechanisms approach focuses on how a specific strategy will produce the implementation outcome. We show how connecting systems science to implementation science opens new opportunities for examining and addressing social determinants of health and conducting equitable and ethical implementation research. Finally, we present case studies illustrating successful applications of systems science within implementation science in community health policy, tobacco control, health care access, and breast cancer screening.
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Affiliation(s)
- Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School; Center for Dissemination & Implementation, Institute for Public Health; and Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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14
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Youn SJ, Boswell JF, Douglas S, Harris BA, Aajmain S, Arnold KT, Creed TA, Gutner CA, Orengo-Aguayo R, Oswald JM, Stirman SW. Implementation Science and Practice-Oriented Research: Convergence and Complementarity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:336-347. [PMID: 37646966 DOI: 10.1007/s10488-023-01296-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
Implementation science is the scientific study of methods to promote the uptake of research findings and other evidence-based practices in routine care, with the goal of improving the quality and effectiveness of health services (Bauer et al., 2015). In addition to this common goal, practice-oriented psychotherapy research (and researchers) and implementation science (and scientists) share a common focus on the people and the places where treatment happens. Thus, there exists strong potential for combining these two approaches. In this article, we provide a primer on implementation science for psychotherapy researchers and highlight important areas and examples of convergence and complementarity between implementation science and practice-oriented psychotherapy research. Specifically, we (a) define and describe the core features of implementation science; (b) discuss similarities and areas of complementarity between implementation science and practice-oriented psychotherapy research; (c) discuss a case example that exemplifies the integration of implementation science and practice-oriented research; and (d) propose directions for future research and collaborations that leverage both implementation science and practice-oriented research.
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Affiliation(s)
- Soo Jeong Youn
- Reliant Medical Group, OptumCare, Harvard Medical School, Worcester, MA, USA.
| | - James F Boswell
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Bethany A Harris
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Syed Aajmain
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Kimberly T Arnold
- Whole Health Equity Lab, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Torrey A Creed
- Penn Collaborative for CBT and Implementation Science, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cassidy A Gutner
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rosaura Orengo-Aguayo
- Medical University of South Carolina (MUSC), National Crime Victims Research & Treatment Center, Charleston, SC, USA
| | | | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD, VA Palo Alto Healthcare System, Department of Psychiatry and Behavioral Sciences, Stanford University, Menlo Park, CA, USA
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15
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Owens-Jasey C, Chen J, Xu R, Angier H, Huebschmann AG, Ito Fukunaga M, Chaiyachati KH, Rendle KA, Robien K, DiMartino L, Amante DJ, Faro JM, Kepper MM, Ramsey AT, Bressman E, Gold R. Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review. JMIR Cancer 2024; 10:e49002. [PMID: 38687595 PMCID: PMC11094604 DOI: 10.2196/49002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/29/2023] [Accepted: 03/04/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. OBJECTIVE This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. METHODS Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). RESULTS A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2%) involved electronic health record-based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2%), followed by studies related to breast cancer screening (28/101, 27.7%), and cervical cancer screening (19/101, 18.8%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67% of colorectal cancer-relevant studies; 9/14, 64% of breast cancer-relevant studies; and 7/10, 70% of cervical cancer-relevant studies). Most studies (79/101, 78.2%) reported on the reach of certain interventions, while 17.8% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8% (24/101) of the included studies. CONCLUSIONS There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations.
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Affiliation(s)
- Constance Owens-Jasey
- BRIDGE-C2 Implementation Science Center in Cancer Control, Oregon Health & Science University, Portland, OR, United States
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, VA, United States
- OCHIN, Inc, Portland, OR, United States
| | - Jinying Chen
- Department of Preventive Medicine and Epidemiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- Data Science Core, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, United States
- iDAPT Implementation Science Center for Cancer Control, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Ran Xu
- Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Amy G Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, Ludeman Family Center for Women's Health Research, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mayuko Ito Fukunaga
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States
| | - Krisda H Chaiyachati
- Penn Implementation Science Center in Cancer Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Verily Life Sciences, South San Francisco, CA, United States
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
| | - Katharine A Rendle
- Penn Implementation Science Center in Cancer Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kim Robien
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Lisa DiMartino
- RTI International, Research Triangle Park, NC, United States
- UT Southwestern Medical Center, University of Texas, Dallas, TX, United States
| | - Daniel J Amante
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Jamie M Faro
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States
| | - Maura M Kepper
- Brown School, Washington University, St. Louis, MO, United States
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric Bressman
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel Gold
- BRIDGE-C2 Implementation Science Center in Cancer Control, Oregon Health & Science University, Portland, OR, United States
- OCHIN, Inc, Portland, OR, United States
- Kaiser Permanente Center for Health Research, Portland, OR, United States
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16
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Johnson C, Chen J, McGowan MP, Tricou E, Card M, Pettit AR, Klaiman T, Rader DJ, Volpp KG, Beidas RS. Family cascade screening for equitable identification of familial hypercholesterolemia: study protocol for a hybrid effectiveness-implementation type III randomized controlled trial. Implement Sci 2024; 19:30. [PMID: 38594685 PMCID: PMC11003060 DOI: 10.1186/s13012-024-01355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/25/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Familial hypercholesterolemia (FH) is a heritable disorder affecting 1.3 million individuals in the USA. Eighty percent of people with FH are undiagnosed, particularly minoritized populations including Black or African American people, Asian or Asian American people, and women across racial groups. Family cascade screening is an evidence-based practice that can increase diagnosis and improve health outcomes but is rarely implemented in routine practice, representing an important care gap. In pilot work, we leveraged best practices from behavioral economics and implementation science-including mixed-methods contextual inquiry with clinicians, patients, and health system constituents-to co-design two patient-facing implementation strategies to address this care gap: (a) an automated health system-mediated strategy and (b) a nonprofit foundation-mediated strategy with contact from a foundation-employed care navigator. This trial will test the comparative effectiveness of these strategies on completion of cascade screening for relatives of individuals with FH, centering equitable reach. METHODS We will conduct a hybrid effectiveness-implementation type III randomized controlled trial testing the comparative effectiveness of two strategies for implementing cascade screening with 220 individuals with FH (i.e., probands) per arm identified from a large northeastern health system. The primary implementation outcome is reach, or the proportion of probands with at least one first-degree biological relative (parent, sibling, child) in the USA who is screened for FH through the study. Our secondary implementation outcomes include the number of relatives screened and the number of relatives meeting the American Heart Association criteria for FH. Our secondary clinical effectiveness outcome is post-trial proband cholesterol level. We will also use mixed methods to identify implementation strategy mechanisms for implementation strategy effectiveness while centering equity. DISCUSSION We will test two patient-facing implementation strategies harnessing insights from behavioral economics that were developed collaboratively with constituents. This trial will improve our understanding of how to implement evidence-based cascade screening for FH, which implementation strategies work, for whom, and why. Learnings from this trial can be used to equitably scale cascade screening programs for FH nationally and inform cascade screening implementation efforts for other genetic disorders. TRIAL REGISTRATION ClinicalTrials.gov, NCT05750667. Registered 15 February 2023-retrospectively registered, https://clinicaltrials.gov/study/NCT05750667 .
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Affiliation(s)
- Christina Johnson
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jinbo Chen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary P McGowan
- Family Heart Foundation, Fernandina Beach, FL, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Eric Tricou
- Family Heart Foundation, Fernandina Beach, FL, USA
| | - Mary Card
- Family Heart Foundation, Fernandina Beach, FL, USA
| | | | - Tamar Klaiman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel J Rader
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin G Volpp
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, USA
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Longman J, Paul C, Cashmore A, Twyman L, Barnes LAJ, Adams C, Bonevski B, Milat A, Passey ME. Protocol for the process evaluation of an intervention to improve antenatal smoking cessation support (MOHMQuit) in maternity services in New South Wales, Australia. BMJ Open 2024; 14:e081208. [PMID: 38508650 PMCID: PMC10952879 DOI: 10.1136/bmjopen-2023-081208] [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: 10/25/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION Smoking cessation in pregnancy remains a public health priority. Our team used the Behaviour Change Wheel to develop the Midwives and Obstetricians Helping Mothers to Quit smoking (MOHMQuit) intervention with health system, leader (including managers and educators) and clinician components. MOHMQuit addresses a critical evidence to practice gap in the provision of smoking cessation support in antenatal care. It involves nine maternity services in New South Wales in a cluster randomised stepped-wedge controlled trial of effectiveness. This paper describes the design and rationale for the process evaluation of MOHMQuit. The process evaluation aims to assess to what extent and how MOHMQuit is being implemented (acceptability; adoption/uptake; appropriateness; feasibility; fidelity; penetration and sustainability), and the context in which it is implemented, in order to support further refinement of MOHMQuit throughout the trial, and aid understanding and interpretation of the results of the trial. METHODS AND ANALYSIS The process evaluation is an integral part of the stepped-wedge trial. Its design is underpinned by implementation science frameworks and adopts a mixed methods approach. Quantitative evidence from participating leaders and clinicians in our study will be used to produce individual and site-level descriptive statistics. Qualitative evidence of leaders' perceptions about the implementation will be collected using semistructured interviews and will be analysed descriptively within-site and thematically across the dataset. The process evaluation will also use publicly available data and observations from the research team implementing MOHMQuit, for example, training logs. These data will be synthesised to provide site-level as well as individual-level implementation outcomes. ETHICS AND DISSEMINATION The study received ethical approval from the Population Health Services Research Ethics Committee for NSW, Australia (Reference 2021/ETH00887). Results will be communicated via the study's steering committee and will also be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Trials Registry ACTRN12622000167763. https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12622000167763.
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Affiliation(s)
- Jo Longman
- University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Aaron Cashmore
- Centre for Epidemiology and Evidence, NSW Health, St Leonards, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Laura Twyman
- Tobacco Control Unit, Cancer Prevention Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Larisa A J Barnes
- University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Adams
- Clinical Excellence Commission, NSW Health, St Leonards, New South Wales, Australia
| | - Billie Bonevski
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Andrew Milat
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan E Passey
- Daffodil Centre and the University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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18
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Smith KA, Carlton EF, Rider E, Whittington T, Gorga SM. Prevalence of hospital websites with Post-Intensive Care Syndrome-pediatrics (PICS-p) information. Pediatr Res 2024; 95:590-592. [PMID: 37865709 DOI: 10.1038/s41390-023-02867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Affiliation(s)
- Kristen A Smith
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Erin F Carlton
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Erica Rider
- Department of Pediatrics, Pediatric Critical Care Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Stephen M Gorga
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
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19
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Lyon AR, Cook CR, Larson M, Hugh ML, Dopp A, Hamlin C, Reinke P, Bose M, Law A, Goosey R, Goerdt A, Morrell N, Wackerle-Hollman A, Pullmann MD. Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming. Implement Sci 2024; 19:2. [PMID: 38167046 PMCID: PMC10763475 DOI: 10.1186/s13012-023-01330-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: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. METHODS This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. DISCUSSION This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- Character Strong, 4227 S Meridian, Puyallup, WA, 98373, USA
| | | | - Maria L Hugh
- University of Kansas, 1122 W Campus Rd, Lawrence, KS, 66045, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 91604, USA
| | - Corinne Hamlin
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Peter Reinke
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Mahasweta Bose
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Amy Law
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Roger Goosey
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Annie Goerdt
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Nicole Morrell
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | | | - Michael D Pullmann
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
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Mody A, Filiatreau LM, Goss CW, Powell BJ, Geng EH. Instrumental variables for implementation science: exploring context-dependent causal pathways between implementation strategies and evidence-based interventions. Implement Sci Commun 2023; 4:157. [PMID: 38124203 PMCID: PMC10731809 DOI: 10.1186/s43058-023-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The impact of both implementation strategies (IS) and evidence-based interventions (EBI) can vary across contexts, and a better understanding of how and why this occurs presents fundamental but challenging questions that implementation science as a field will need to grapple with. We use causal epidemiologic methods to explore the mechanisms of why sharp distinctions between implementation strategies (IS) and efficacy of an evidence-based intervention (EBI) may fail to recognize that the effect of an EBI can be deeply intertwined and dependent on the context of the IS leading to its uptake. METHODS We explore the use of instrumental variable (IV) analyses as a critical tool for implementation science methods to isolate three relevant quantities within the same intervention context when exposure to an implementation strategy is random: (1) the effect of an IS on implementation outcomes (e.g., uptake), (2) effect of EBI uptake on patient outcomes, and (3) overall effectiveness of the IS (i.e., ~ implementation*efficacy). We discuss the mechanisms by which an implementation strategy can alter the context, and therefore effect, of an EBI using the underlying IV assumptions. We illustrate these concepts using examples of the implementation of new ART initiation guidelines in Zambia and community-based masking programs in Bangladesh. RESULTS Causal questions relevant to implementation science are answered at each stage of an IV analysis. The first stage assesses the effect of the IS (e.g., new guidelines) on EBI uptake (e.g., same-day treatment initiation). The second stage leverages the IS as an IV to estimate the complier average causal effect (CACE) of the EBI on patient outcomes (e.g., effect of same-day treatment initiation on viral suppression). The underlying assumptions of CACE formalize that the causal effect of EBI may differ in the context of a different IS because (1) the mechanisms by which individuals uptake an intervention may differ and (2) the subgroup of individuals who take up an EBI may differ. IV methods thus provide a conceptual framework for how IS and EBIs are linked and that the IS itself needs to be considered a critical contextual determinant. Moreover, it also provides rigorous methodologic tools to isolate the effect of an IS, EBI, and combined effect of the IS and EBI. DISCUSSION Leveraging IV methods when exposure to an implementation strategy is random helps to conceptualize the context-dependent nature of implementation strategies, EBIs, and patient outcomes. IV methods formalize that the causal effect of an EBI may be specific to the context of the implementation strategy used to promote uptake. This integration of implementation science concepts and theory with rigorous causal epidemiologic methods yields novel insights and provides important tools for exploring the next generation of questions related to mechanisms and context in implementation science.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA.
| | - Lindsey M Filiatreau
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Byron J Powell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
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Sarkies M, Francis-Auton E, Long J, Roberts N, Westbrook J, Levesque JF, Watson DE, Hardwick R, Sutherland K, Disher G, Hibbert P, Braithwaite J. Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms. Implement Sci 2023; 18:71. [PMID: 38082301 PMCID: PMC10714549 DOI: 10.1186/s13012-023-01324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Unwarranted clinical variation in hospital care includes the underuse, overuse, or misuse of services. Audit and feedback is a common strategy to reduce unwarranted variation, but its effectiveness varies widely across contexts. We aimed to identify implementation strategies, mechanisms, and contextual circumstances contributing to the impact of audit and feedback on unwarranted clinical variation. METHODS Realist study examining a state-wide value-based healthcare program implemented between 2017 and 2021 in New South Wales, Australia. Three initiatives within the program included audit and feedback to reduce unwarranted variation in inpatient care for different conditions. Multiple data sources were used to formulate the initial audit and feedback program theory: a systematic review, realist review, program document review, and informal discussions with key program stakeholders. Semi-structured interviews were then conducted with 56 participants to refute, refine, or confirm the initial program theories. Data were analysed retroductively using a context-mechanism-outcome framework for 11 transcripts which were coded into the audit and feedback program theory. The program theory was validated with three expert panels: senior health leaders (n = 19), Agency for Clinical Innovation (n = 11), and Ministry of Health (n = 21) staff. RESULTS The program's audit and feedback implementation strategy operated through eight mechanistic processes. The strategy worked well when clinicians (1) felt ownership and buy-in, (2) could make sense of the information provided, (3) were motivated by social influence, and (4) accepted responsibility and accountability for proposed changes. The success of the strategy was constrained when the audit process led to (5) rationalising current practice instead of creating a learning opportunity, (6) perceptions of unfairness and concerns about data integrity, 7) development of improvement plans that were not followed, and (8) perceived intrusions on professional autonomy. CONCLUSIONS Audit and feedback strategies may help reduce unwarranted clinical variation in care where there is engagement between auditors and local clinicians, meaningful audit indicators, clear improvement plans, and respect for clinical expertise. We contribute theoretical development for audit and feedback by proposing a Model for Audit and Feedback Implementation at Scale. Recommendations include limiting the number of audit indicators, involving clinical staff and local leaders in feedback, and providing opportunities for reflection.
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Affiliation(s)
- Mitchell Sarkies
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
- School of Health Sciences, University of Sydney, Sydney, Australia.
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jean-Frederic Levesque
- Centre for Primary Health Care and Equity, University of New South Wales, Kensington, NSW, Australia
- NSW Agency for Clinical Innovation, Sydney, Australia
| | - Diane E Watson
- Bureau of Health Information, St Leonards, NSW, Australia
| | - Rebecca Hardwick
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | | | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Rochette C, Mériade L, Cassière F. A grounded theory-based qualitative approach for examining local implementation of public health policies during crises. MethodsX 2023; 11:102439. [PMID: 38023318 PMCID: PMC10630630 DOI: 10.1016/j.mex.2023.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Background COVID-19's emergence questions the agility of health policy deployment in a context of urgency. This exceptional pandemic offers a unique Implementation Science study opportunity. It reveals how actors adapt, coordinate, and mitigate an unknown global threat to safeguard populations from an initially mysterious virus. Limited research has explored how involved players act and adapt their practices to fulfil health protection missions during a global health crisis. Bridging the gap between public policy expectations and achievements requires a methodology for stakeholder identification and implementation practice description. Objective Focusing on COVID-19 management in France's second-largest region, we investigate ministerial recommendation implementation and the emergence of new links, coordination modes, and practices. Methods Due to the novel subject, we adopted grounded theory. Initial documentary data collection identifies stakeholders for subsequent interviews. Open-ended coding of collected discourse enables content analysis. Results Findings reveal a crisis-driven re-evaluation of stakeholder relationships. This research identifies three levels of implementation of health policies at the local level (administrative, organizational and operational) and reveals different types of coordination specific to each of these levels. Our results provide insights on how to better coordinate and implement healthcare policies in a period of crisis. Recommendations include real-life simulations of large-scale crises. Conclusion Our work establishes a methodological foundation for analysing coordination dynamics. Future research could compare these findings with other unpredictable health emergencies, such as episiotomic veterinary health crises.•The first step of the method is to analyse the guidelines of health policy implementation during the Covid-19 crisis and to identify the main stakeholders in charge of the local health policy implementation.•The second step consists of interviewing these stakeholders using a co-constructed sample and structural coding of their speech to reveal the forms of coordination between stakeholders.
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Affiliation(s)
- Corinne Rochette
- IAE Clermont Auvergne – ClerMa, Research Chair "Santé et Territoires" University Clermont Auvergne, 11 Boulevard Charles de Gaulle, Clermont-Ferrand 63 000, France
| | - Laurent Mériade
- IAE Clermont Auvergne – ClerMa, Research Chair "Santé et Territoires" University Clermont Auvergne, 11 Boulevard Charles de Gaulle, Clermont-Ferrand 63 000, France
| | - François Cassière
- IAE Clermont Auvergne – ClerMa, Research Chair "Santé et Territoires" University Clermont Auvergne, 11 Boulevard Charles de Gaulle, Clermont-Ferrand 63 000, France
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23
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Akiba CF, Go VF, Powell BJ, Muessig K, Golin C, Dussault JM, Zimba CC, Matewere M, Mbota M, Thom A, Masa C, Malava JK, Gaynes BN, Masiye J, Udedi M, Hosseinipour M, Pence BW. Champion and audit and feedback strategy fidelity and their relationship to depression intervention fidelity: A mixed method study. SSM - MENTAL HEALTH 2023; 3:100194. [PMID: 37485235 PMCID: PMC10358176 DOI: 10.1016/j.ssmmh.2023.100194] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Background Globally, mental health disorders rank as the greatest cause of disability. Low and middle-income countries (LMICs) hold a disproportionate share of the mental health burden, especially as it pertains to depression. Depression is highly prevalent among those with non-communicable diseases (NCDs), creating a barrier to successful treatment. While some treatments have proven efficacy in LMIC settings, wide dissemination is challenged by multiple factors, leading researchers to call for implementation strategies to overcome barriers to care provision. However, implementation strategies are often not well defined or documented, challenging the interpretation of study results and the uptake and replication of strategies in practice settings. Assessing implementation strategy fidelity (ISF), or the extent to which a strategy was implemented as designed, overcomes these challenges. This study assessed fidelity of two implementation strategies (a 'basic' champion strategy and an 'enhanced' champion + audit and feedback strategy) to improve the integration of a depression intervention, measurement based care (MBC), at 10 NCD clinics in Malawi. The primary goal of this study was to assess the relationship between the implementation strategies and MBC fidelity using a mixed methods approach. Methods We developed a theory-informed mixed methods fidelity assessment that first combined an implementation strategy specification technique with a fidelity framework. We then created corresponding fidelity indicators to strategy components. Clinical process data and one-on-one in-depth interviews with 45 staff members at 6 clinics were utilized as data sources. Our final analysis used descriptive statistics, reflexive-thematic analysis (RTA), data merging, and triangulation to examine the relationship between ISF and MBC intervention fidelity. Results Our mixed methods analysis revealed how ISF may moderate the relationship between the strategies and MBC fidelity. Leadership engagement and implementation climate were critical for clinics to overcome implementation barriers and preserve implementation strategy and MBC fidelity. Descriptive statistics determined champion strategy fidelity to range from 61 to 93% across the 10 clinics. Fidelity to the audit and feedback strategy ranged from 82 to 91% across the 5 clinics assigned to that condition. MBC fidelity ranged from 54 to 95% across all clinics. Although correlations between ISF and MBC fidelity were not statistically significant due to the sample of 10 clinics, associations were in the expected direction and of moderate effect size. A coefficient for shared depression screening among clinicians had greater face validity compared to depression screening coverage and functioned as a proximal indicator of implementation strategy success. Conclusion Fidelity to the basic and enhanced strategies varied by site and were influenced by leadership engagement and implementation climate. Champion strategies may benefit from the addition of leadership strategies to help address implementation barriers outside the purview of champions. ISF may moderate the relationship between strategies and implementation outcomes.
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Affiliation(s)
- Christopher F. Akiba
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Byron J. Powell
- Brown School at Washington University in St. Louis, MSC 1196-251-46, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Kate Muessig
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Josée M. Dussault
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - Chifundo C. Zimba
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Maureen Matewere
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - MacDonald Mbota
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Annie Thom
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Cecilia Masa
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Jullita K. Malava
- Malawi Epidemiology and Intervention Research Unit (MEIRU), P.O. Box 46, Chilumba, Karonga District, Malawi
| | - Bradley N. Gaynes
- Division of Global Mental Health, Department of Psychiatry, UNC School of Medicine, 101 Manning Dr # 1, Chapel Hill, NC, 27514, USA
| | - Jones Masiye
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
| | - Michael Udedi
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
| | - Mina Hosseinipour
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall CB #7435, Chapel Hill, NC, 27599-7435, USA
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Sagatun Å, Engell T, Brekke M, Sjølie H, Ekornes SM, Waldum-Grevboe KS, Pape K, Kvaløy K, Jeneson A, Trøan AS, Askeland AL, Stien L, Holen S. Guideline evaluation and implementation mechanisms in school health services (GuideMe): protocol for a hybrid randomized factorial trial. BMC Health Serv Res 2023; 23:1259. [PMID: 37968693 PMCID: PMC10652429 DOI: 10.1186/s12913-023-10179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. METHODS The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. DISCUSSION The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. TRAIL REGISTRATION ISRCTN24173836. Registration date 8 August 2022.
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Affiliation(s)
- Åse Sagatun
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway.
- VID Specialized University (VID), Oslo, Norway.
| | - Thomas Engell
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
| | - Malene Brekke
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
- VID Specialized University (VID), Oslo, Norway
| | - Hege Sjølie
- VID Specialized University (VID), Oslo, Norway
| | - Stine M Ekornes
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Kristine Pape
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kirsti Kvaløy
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Annette Jeneson
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
| | - Anna Stigum Trøan
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
| | - Anne Liv Askeland
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
| | - Line Stien
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Solveig Holen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP/PILAR), Oslo, Norway
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Woodfield MJ, Phillips ST, Cargo T, Merry SN, McNeil CB, Hetrick SE. Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction Therapy (PCIT). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:976-998. [PMID: 37691065 PMCID: PMC10543774 DOI: 10.1007/s10488-023-01298-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven 're-implementation' intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) 'Environmental Context and Resources', specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) 'Social/Professional Role and Identity', with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.
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Affiliation(s)
- Melanie J. Woodfield
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Te Whatu Ora (Health New Zealand), Te Toka Tumai Auckland, Auckland, New Zealand
| | | | - Tania Cargo
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Department of Psychology, University of Auckland, Auckland, New Zealand
| | - Sally N. Merry
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
| | - Cheryl B. McNeil
- Department of Psychology, West Virginia University, Morgantown, USA
- Department of Psychiatry, University of Florida, Gainesville, USA
| | - Sarah E. Hetrick
- Te Ara Hāro-Centre for Infant, Child and Adolescent Mental Health, Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142 New Zealand
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Lovero KL, Kemp CG, Wagenaar BH, Giusto A, Greene MC, Powell BJ, Proctor EK. Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review. Implement Sci 2023; 18:56. [PMID: 37904218 PMCID: PMC10617067 DOI: 10.1186/s13012-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. METHODS We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. RESULTS The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings (n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1-46 strategies) included in each study. Most studies (n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. CONCLUSIONS While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. TRIAL REGISTRATION PROSPERO, CRD42021268374.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Greene
- Program On Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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Kim B, Cruden G, Crable EL, Quanbeck A, Mittman BS, Wagner AD. A structured approach to applying systems analysis methods for examining implementation mechanisms. Implement Sci Commun 2023; 4:127. [PMID: 37858215 PMCID: PMC10588196 DOI: 10.1186/s43058-023-00504-5] [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: 04/08/2023] [Accepted: 09/23/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND It is challenging to identify and understand the specific mechanisms through which an implementation strategy affects implementation outcomes, as implementation happens in the context of complex, multi-level systems. These systems and the mechanisms within each level have their own dynamic environments that change frequently. For instance, sequencing may matter in that a mechanism may only be activated indirectly by a strategy through another mechanism. The dosage or strength of a mechanism may vary over time or across different health care system levels. To elucidate the mechanisms relevant to successful implementation amidst this complexity, systems analysis methods are needed to model and manage complexity. METHODS The fields of systems engineering and systems science offer methods-which we refer to as systems analysis methods-to help explain the interdependent relationships between and within systems, as well as dynamic changes to systems over time. When applied to studying implementation mechanisms, systems analysis methods can help (i) better identify and manage unknown conditions that may or may not activate mechanisms (both expected mechanisms targeted by a strategy and unexpected mechanisms that the methods help detect) and (ii) flexibly guide strategy adaptations to address contextual influences that emerge after the strategy is selected and used. RESULTS In this paper, we delineate a structured approach to applying systems analysis methods for examining implementation mechanisms. The approach includes explicit steps for selecting, tailoring, and evaluating an implementation strategy regarding the mechanisms that the strategy is initially hypothesized to activate, as well as additional mechanisms that are identified through the steps. We illustrate the approach using a case example. We then discuss the strengths and limitations of this approach, as well as when these steps might be most appropriate, and suggest work to further the contributions of systems analysis methods to implementation mechanisms research. CONCLUSIONS Our approach to applying systems analysis methods can encourage more mechanisms research efforts to consider these methods and in turn fuel both (i) rigorous comparisons of these methods to alternative mechanisms research approaches and (ii) an active discourse across the field to better delineate when these methods are appropriate for advancing mechanisms-related knowledge.
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Affiliation(s)
- Bo Kim
- VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA, 02130, USA.
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Gracelyn Cruden
- Chestnut Health Systems, Lighthouse Institute-Oregon Group, 1255 Pearl Street, Eugene, OR, 97401, USA
| | - Erika L Crable
- UC San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Andrew Quanbeck
- University of Wisconsin-Madison, 610 North Whitney Way, Madison, WI, 53705, USA
| | - Brian S Mittman
- Kaiser Permanente Southern California, 200 North Lewis Street, Orange, CA, 92868, USA
- University of Southern California, 2025 Zonal Avenue, Los Angeles, CA, 90089, USA
- UCLA, 405 Hilgard Avenue, Los Angeles, CA, 90095, USA
| | - Anjuli D Wagner
- University of Washington, 3980 15Th Avenue NE, Seattle, WA, 98195, USA
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Allen CG, Sterba K, Norman S, Jackson A, Hunt KJ, McMahon L, Judge DP. Use of a multi-phased approach to identify and address facilitators and barriers to the implementation of a population-wide genomic screening program. Implement Sci Commun 2023; 4:122. [PMID: 37821977 PMCID: PMC10566189 DOI: 10.1186/s43058-023-00500-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Population-wide genomic screening for CDC Tier-1 conditions offers the ability to identify the 1-2% of the US population at increased risk for Hereditary Breast and Ovarian Cancer, Lynch Syndrome, and Familial Hypercholesterolemia. Implementation of population-wide screening programs is highly complex, requiring engagement of diverse collaborators and implementation teams. Implementation science offers tools to promote integration of these programs through the identification of determinants of success and strategies to address potential barriers. METHODS Prior to launching the program, we conducted a pre-implementation survey to assess anticipated barriers and facilitators to reach, effectiveness, adoption, implementation, and maintenance (RE-AIM), among 51 work group members (phase 1). During the first year of program implementation, we completed coding of 40 work group meetings guided by the Consolidated Framework for Implementation Research (CFIR) (phase 2). We matched the top barriers to implementation strategies identified during phase 2 using the CFIR-ERIC (Expert Recommendation for Implementing Change) matching tool. RESULTS Staffing and workload concerns were listed as the top barrier in the pre-implementation phase of the program. Top barriers during implementation included adaptability (n = 8, 20%), complexity (n = 14, 35%), patient needs and resources (n = 9, 22.5%), compatibility (n = 11, 27.5%), and self-efficacy (n = 9, 22.5%). We identified 16 potential implementation strategies across six ERIC clusters to address these barriers and operationalized these strategies for our specific setting and program needs. CONCLUSION Our findings provide an example of successful use of the CFIR-ERIC tool to guide implementation of a population-wide genomic screening program.
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Affiliation(s)
- Caitlin G Allen
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Katherine Sterba
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Samantha Norman
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
| | - Amy Jackson
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly J Hunt
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Lori McMahon
- Research Office, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel P Judge
- In Our DNA SC, Medical University of South Carolina, Charleston, SC, USA
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Baynes C, Kanté AM, Exavery A, Tani K, Sikustahili G, Mushi H, Baraka J, Ramsey K, Sherr K, Weiner BJ, Phillips JF. The implementation and effectiveness of multi-tasked, paid community health workers on maternal and child health: A cluster-randomized pragmatic trial and qualitative process evaluation in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002050. [PMID: 37725612 PMCID: PMC10508634 DOI: 10.1371/journal.pgph.0002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/22/2023] [Indexed: 09/21/2023]
Abstract
Community health worker programs have proliferated worldwide based on evidence that they help prevent mortality, particularly among children. However, there is limited evidence from randomized studies on the processes and effectiveness of implementing community health worker programs through public health systems. This paper describes the results of a cluster-randomized pragmatic implementation trial (registration number ISRCTN96819844) and qualitative process evaluation of a community health worker program in Tanzania that was implemented from 2011-2015. Program effects on maternal, newborn and child health service utilization, childhood morbidity and sick childcare seeking were evaluated using difference-in-difference regression analysis with outcomes measured through pre- and post-intervention household surveys in intervention and comparison trial arms. A qualitative process evaluation was conducted between 2012 and 2014 and comprised of in-depth interviews and focus group discussions with community health workers, community members, facility-based health workers and staff of district health management teams. The community health worker program reduced incidence of illness and improved access to timely and appropriate curative care for children under five; however, there was no effect on facility-based maternal and newborn health service utilization. The positive outcomes occurred because of high levels of acceptability of community health workers within communities, as well as the durability of community health workers' motivation and confidence. Implementation factors that generated these effects were the engagement of communities in program startup; the training, remuneration and supervision of the community health workers from the local health system and community. The lack of program effects on maternal and newborn health service utilization at facilities were attributed to lapses in the availability of needed care at facilities. Strategies that strengthen and align communities' and health systems core capacities, and their ability to learn, adapt and integrate evidence-based interventions, are needed to maximize the health impact of community health workers.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Almamy Malick Kanté
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States of America
| | | | - Kassimu Tani
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Kate Ramsey
- Scope Impact, Brooklyn, NY, United States of America
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - James F. Phillips
- Department of Population and Family Health, Columbia University, New York, NY, United States of America
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Wang Y, Wong ELY, Nilsen P, Chung VCH, Tian Y, Yeoh EK. A scoping review of implementation science theories, models, and frameworks - an appraisal of purpose, characteristics, usability, applicability, and testability. Implement Sci 2023; 18:43. [PMID: 37726779 PMCID: PMC10507824 DOI: 10.1186/s13012-023-01296-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/26/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND A proliferation of theories, models, and frameworks (TMFs) have been developed in the implementation science field to facilitate the implementation process. The basic features of these TMFs have been identified by several reviews. However, systematic appraisals on the quality of these TMFs are inadequate. To fill this gap, this study aimed to assess the usability, applicability, and testability of the current TMFs in a structured way. METHODS A scoping review method was employed. Electronic databases were searched to locate English and Chinese articles published between January 2000 and April 2022. Search terms were specific to implementation science. Additionally, hand searches were administered to identify articles from related reviews. Purpose and characteristics such as the type of TMF, analytical level, and observation unit were extracted. Structured appraisal criteria were adapted from Birken et al.'s Theory Comparison and Selection Tool (T-CaST) to conduct an in-depth analysis of the TMFs' usability, applicability, and testability. RESULTS A total of 143 TMFs were included in this analysis. Among them, the most common purpose was to identify barriers and facilitators. Most TMFs applied the descriptive method to summarize the included constructs or the prescriptive method to propose courses of implementation actions. TMFs were mainly mid-range theories built on existing conceptual frameworks or demonstrated grand theories. The usability of the TMFs needs to be improved in terms of the provision of conceptually matched strategies to barriers and facilitators and instructions on the TMFs usage. Regarding the applicability, little attention was paid to the constructs of macro-level context, stages of scale-up and sustainability, and implementation outcomes like feasibility, cost, and penetration. Also, fewer TMFs could propose recommended research and measurement methods to apply the TMFs. Lastly, explicit hypotheses or propositions were lacking in most of the TMFs, and empirical evidence was lacking to support the claimed mechanisms between framework elements in testability. CONCLUSIONS Common limitations were found in the usability, application, and testability of the current TMFs. The findings of this review could provide insights for developers of TMFs for future theoretical advancements.
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Affiliation(s)
- Yingxuan Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eliza Lai-Yi Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Vincent Chi-Ho Chung
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yue Tian
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eng-Kiong Yeoh
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Dunsmore J, Duncan E, MacLennan S, N'Dow J, MacLennan S. Effectiveness of de-implementation strategies for low-value prescribing in secondary care: a systematic review. Implement Sci Commun 2023; 4:115. [PMID: 37723589 PMCID: PMC10507868 DOI: 10.1186/s43058-023-00498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND/AIMS Considerable efforts have been made to improve guideline adherence in healthcare through de-implementation, such as decreasing the prescription of inappropriate medicines. However, we have limited knowledge about the effectiveness, barriers, facilitators and consequences of de-implementation strategies targeting inappropriate medication prescribing in secondary care settings. This review was conducted to understand these factors to contribute to better replication and optimisation of future de-implementation efforts to reduce low-value care. METHODS A systematic review of randomised control trials was conducted. Papers were identified through CINAHL, EMBASE, MEDLINE and Cochrane register of controlled trials to February 2021. Eligible studies were randomised control trials evaluating behavioural strategies to de-implement inappropriate prescribing in secondary healthcare. Risk of bias was assessed using the Cochrane Risk of Bias tool. Intervention characteristics, effectiveness, barriers, facilitators and consequences were identified in the study text and tabulated. RESULTS Eleven studies were included, of which seven were reported as effectively de-implementing low-value prescribing. Included studies were judged to be mainly at low to moderate risk for selection biases and generally high risk for performance and reporting biases. The majority of these strategies were clinical decision support at the 'point of care'. Clinical decision support tools were the most common and effective. They were found to be a low-cost and simple strategy. However, barriers such as clinician's reluctance to accept recommendations, or the clinical setting were potential barriers to their success. Educational strategies were the second most reported intervention type however the utility of educational strategies for de-implementation remains varied. Multiple barriers and facilitators relating to the environmental context, resources and knowledge were identified across studies as potentially influencing de-implementation. Various consequences were identified; however, few measured the impact of de-implementation on usual appropriate practice. CONCLUSION This review offers insight into the intervention strategies, potential barriers, facilitators and consequences that may affect the de-implementation of low-value prescribing in secondary care. Identification of these key features helps understand how and why these strategies are effective and the wider (desirable or undesirable) impact of de-implementation. These findings can contribute to the successful replication or optimisation of strategies used to de-implement low-value prescribing practices in future. TRIAL REGISTRATION The review protocol was registered at PROSPERO (ID: CRD42021243944).
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Affiliation(s)
| | - Eilidh Duncan
- Health Service Research Unit, University of Aberdeen, Aberdeen, UK
| | - Sara MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
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Palinkas LA, Belanger R, Newton S, Saldana L, Landsverk J, Dubowitz H. Assessment of Adoption and Early Implementation Barriers and Facilitators of the Safe Environment for Every Kid (SEEK) Model. Acad Pediatr 2023; 23:1434-1445. [PMID: 37354951 PMCID: PMC10592284 DOI: 10.1016/j.acap.2023.06.024] [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: 12/27/2022] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Although the use of interventions for screening for social determinants of health of families in pediatric primary care clinics has increased in the past decade, research on the barriers and facilitators of implementing such interventions has been limited. We explored barriers, facilitators, and the mechanisms clarifying their roles in the adoption and implementation of the Safe Environment for Every Kid (SEEK) model, an approach for strengthening families, promoting children's health and development, and preventing child maltreatment. METHODS A total of 28 semistructured interviews were completed with 9 practice champions, 11 primary care professionals, 5 behavioral health professionals, and 3 nursing/administrative staff representing 12 pediatric primary care practices participating in a larger randomized control trial of implementing SEEK. RESULTS We identified several barriers and facilitators in the stages of SEEK's adoption and early implementation. Barriers associated with outer and inner setting determinants and poor innovation-organization fit declined in importance over time, while facilitators associated with SEEK characteristics increased in importance based on participants' responses. Barriers and facilitators were linked by mechanisms of comparison and contrast of burdens and benefits, and problem-solving to address limited capacity with available resources. CONCLUSIONS Any screening for and addressing social determinants of health demands greater attention to adoption and implementation mechanisms and the processes by which primary care professionals assess and utilize facilitators to address barriers. This occurs in a context defined by perceived burdens and benefits of innovation adoption and implementation, the capacity of the practice, and changes in perception with experiencing the innovation.
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Affiliation(s)
- Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work (LA Palinkas), University of Southern California, Los Angeles, Calif.
| | - Rosemarie Belanger
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
| | - Stacey Newton
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
| | - Lisa Saldana
- Oregon Social Learning Center (L Saldana and J Landsverk), Eugene, Ore
| | - John Landsverk
- Oregon Social Learning Center (L Saldana and J Landsverk), Eugene, Ore
| | - Howard Dubowitz
- Department of Pediatrics (R Belanger, S Newton, and H Dubowitz), University of Maryland School of Medicine, Baltimore, MD
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de Rondão CA, Mota MP, Esteves D. Physical activity interventions in older adults with a cognitive impairment: A critical review of reviews. Aging Med (Milton) 2023; 6:290-306. [PMID: 37711255 PMCID: PMC10498829 DOI: 10.1002/agm2.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 09/16/2023] Open
Abstract
This critical review explores the review material on physical activity combined with cognitive stimulation interventions in older adults with cognitive impairment and/or dementia. A critical, systematic, review of the review method was used, considering four electronic databases: WEB OF SCIENCE, SCOPUS, MEDLINE, and the COCHRANE ELECTRONIC LIBRARY. The search terms "exercise," "physical activity," "cognitive impairment," "dementia," and "systematic review" were used. All available reviews were marked against predetermined inclusion and exclusion criteria. There were 32 reviews that met the inclusion criteria. A combination of various types of training and aerobic exercises were the most frequently reported interventions; meanwhile, dual task training programs (combining physical exercise with cognitive stimulation), functional training programs along with exercises combination, aerobic exercise as well as strength, stretching, or balance workouts were also reported. The evidence is compelling; exercise can improve physical health by ensuring cognitive, psychological, and behavioral benefits. Overall, exercise can improve the physical and mental health of people living with dementia: there is sufficient evidence to recommend multimodal exercise.
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Affiliation(s)
| | - Maria Paula Mota
- University of Trás‐os Montes e Alto DouroVila RealPortugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD)Vila RealPortugal
| | - Dulce Esteves
- University Beira InteriorCovilhãPortugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD)Vila RealPortugal
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [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: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Itanyi IU, Viglione C, Rositch AF, Olawepo JO, Olakunde BO, Ikpeazu A, Nwokwu U, Lasebikan N, Ezeanolue EE, Aarons GA. Rapid implementation mapping to identify implementation determinants and strategies for cervical cancer control in Nigeria. Front Public Health 2023; 11:1228434. [PMID: 37663856 PMCID: PMC10469679 DOI: 10.3389/fpubh.2023.1228434] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Cervical cancer constitutes a huge burden among women in Nigeria, particularly HIV-infected women. However, the provision and uptake of cervical cancer screening and treatment is limited in Nigeria. Understanding implementation determinants is essential for the effective translation of such evidence-based interventions into practice, particularly in low-resource settings. COVID-19 pandemic necessitated online collaboration making implementation mapping challenging in some ways, while providing streamlining opportunities. In this study, we describe the use of a virtual online approach for implementation mapping (steps 1-3) to identify implementation determinants, mechanisms, and strategies to implement evidence-based cervical cancer screening and treatment in existing HIV infrastructure in Nigeria. Methods This study used a mixed methods study design with a virtual modified nominal group technique (NGT) process aligning with Implementation Mapping steps 1-3. Eleven stakeholders (six program staff and five healthcare providers and administrators) participated in a virtual NGT process which occurred in two phases. The first phase utilized online surveys, and the second phase utilized an NGT and implementation mapping process. The Exploration, Preparation, Implementation and Sustainment (EPIS) framework was used to elicit discussion around determinants and strategies from the outer context (i.e., country and regions), inner organizational context of existing HIV infrastructure, bridging factors that relate to bi-directional influences, and the health innovation to be implemented (in this case cervical cancer screening and treatment). During the NGT, the group ranked implementation barriers and voted on implementation strategies using Mentimeter. Results Eighteen determinants to integrating cervical cancer screening and treatment into existing comprehensive HIV programs were related to human resources capacity, access to cervical cancer services, logistics management, clinic, and client-related factors. The top 3 determinants included gaps in human resources capacity, poor access to cervical cancer services, and lack of demand for services resulting from lack of awareness about the disease and servicesA set of six core implementation strategies and two enhanced implementation strategies were identified. Conclusions Rapid Implementation Mapping is a feasible and acceptable approach for identifying and articulating implementation determinants, mechanisms, and strategies for complex healthcare interventions in LMICs.
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Affiliation(s)
- Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Clare Viglione
- UC San Diego Altman Clinical and Translational Research Institute (ACTRI) Dissemination and Implementation Science Center, La Jolla, CA, United States
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | - John Olajide Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Babayemi Oluwaseun Olakunde
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Akudo Ikpeazu
- National AIDS, Viral Hepatitis and STIs Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Uche Nwokwu
- National Cancer Control Programme, Federal Ministry of Health, Abuja, Nigeria
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Oncology Center, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- HealthySunrise Foundation, Las Vegas, NV, United States
| | - Gregory A. Aarons
- UC San Diego Altman Clinical and Translational Research Institute (ACTRI) Dissemination and Implementation Science Center, La Jolla, CA, United States
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
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Calvert HG, McQuilkin M, Havlicak A, Lewis T, Turner L. Acceptability, appropriateness, and feasibility of Rural School Support Strategies for behavioral interventions: a mixed methods evaluation over two years of a hybrid type 3 implementation-effectiveness trial. Implement Sci Commun 2023; 4:92. [PMID: 37568206 PMCID: PMC10416374 DOI: 10.1186/s43058-023-00478-4] [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: 10/21/2022] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Positive Behavioral Interventions and Supports (PBIS) is a framework for implementing evidence-based interventions for preventing behavioral issues and improving climate in schools. The implementation of school-wide PBIS with fidelity is complex, requiring leadership commitment, teaming, and coordination of systems for tracking behaviors and consequences. Putting these components in place while ensuring alignment with the values and needs of the school community can be difficult for schools with fewer resources, such as rural schools. Implementation supports are needed, including strategies such as technical assistance, but it is unclear whether lower-cost modalities such as virtual support are acceptable, appropriate, and feasible and whether perceptions vary throughout the implementation process. METHODS A type 3 hybrid implementation-effectiveness trial is taking place in 40 Idaho schools, testing a bundle of implementation supports selected to meet the needs of schools in rural areas. Supports include technical assistance from an implementation support practitioner (ISP), didactic trainings, virtual learning sessions, and an online resource portal. Surveys and interviews in the first 2 years of implementation (fall 2019 to spring 2021) explored outcomes of acceptability, appropriateness, and feasibility regarding the implementation supports among more than 150 school stakeholders. RESULTS Evaluations showed high acceptability and appropriateness of the PBIS concepts and training. The 20 schools receiving additional implementation support rated the technical assistance and support from the project's ISPs as the most acceptable and appropriate resource. Reasons for acceptability were the relationship built with the ISP, the ISP's expertise, and being a "neutral party." Although in-person support from the ISP was preferred, remote support was acceptable and increased feasibility of attendance. Virtual learning sessions were acceptable for learning and collaboration, particularly in the second year of implementation, once ISPs had developed closer relationships with school teams. CONCLUSIONS School staff found training, technical assistance, and virtual learning sessions to be acceptable and appropriate. Virtual formats of training and technical assistance decreased in acceptability but increased feasibility of attendance. In-person support was preferred during initial implementation, and virtual support was more acceptable thereafter. TRIAL REGISTRATION This trial was prospectively registered on ClinicalTrials.gov ( NCT03736395 ), on November 9, 2018.
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Affiliation(s)
- Hannah G Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA.
| | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Ashley Havlicak
- School of Public and Population Health, College of Health Sciences, Boise State University, 1910 W University Dr, Boise, ID, 83725-1742, USA
| | - Teri Lewis
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
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Proctor EK, Bunger AC, Lengnick-Hall R, Gerke DR, Martin JK, Phillips RJ, Swanson JC. Ten years of implementation outcomes research: a scoping review. Implement Sci 2023; 18:31. [PMID: 37491242 PMCID: PMC10367273 DOI: 10.1186/s13012-023-01286-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on conceptualization, measurement, and theory building. Ten years later, this paper maps the field's progress in implementation outcomes research. This scoping review describes how each implementation outcome has been studied, research designs and methods used, and the contexts and settings represented in the current literature. We also describe the role of implementation outcomes in relation to implementation strategies and other outcomes. METHODS Arksey and O'Malley's framework for conducting scoping reviews guided our methods. Using forward citation tracing, we identified all literature citing the 2011 paper. We conducted our search in the Web of Science (WOS) database and added citation alerts sent to the first author from the publisher for a 6-month period coinciding with the WOS citation search. This produced 1346 titles and abstracts. Initial abstract screening yielded 480 manuscripts, and full-text review yielded 400 manuscripts that met inclusion criteria (empirical assessment of at least one implementation outcome). RESULTS Slightly more than half (52.1%) of included manuscripts examined acceptability. Fidelity (39.3%), feasibility (38.6%), adoption (26.5%), and appropriateness (21.8%) were also commonly examined. Penetration (16.0%), sustainability (15.8%), and cost (7.8%) were less frequently examined. Thirty-two manuscripts examined implementation outcomes not included in the original taxonomy. Most studies took place in healthcare (45.8%) or behavioral health (22.5%) organizations. Two-thirds used observational designs. We found little evidence of progress in testing the relationships between implementation strategies and implementation outcomes, leaving us ill-prepared to know how to achieve implementation success. Moreover, few studies tested the impact of implementation outcomes on other important outcome types, such as service systems and improved individual or population health. CONCLUSIONS Our review presents a comprehensive snapshot of the research questions being addressed by existing implementation outcomes literature and reveals the need for rigorous, analytic research and tests of strategies for attaining implementation outcomes in the next 10 years of outcomes research.
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Affiliation(s)
- Enola K Proctor
- The Brown School, Shanti Khinduka Distinguished Professor Emerita, Washington University in St. Louis, St. Louis, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | | | - Donald R Gerke
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - Jared K Martin
- College of Education & Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Rebecca J Phillips
- College of Liberal Arts & Sciences, Western Oregon University, Monmouth, OR, USA
| | - Julia C Swanson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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McKenna S, Piper S, Capon W, Crowley A, Lira L, LaMonica HM, Chong MK, Scott E, Hickie I, Iorfino F. The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study. JMIR Hum Factors 2023; 10:e42993. [PMID: 37490321 PMCID: PMC10410532 DOI: 10.2196/42993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/30/2023] [Accepted: 04/30/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. OBJECTIVE This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. METHODS An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. RESULTS After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). CONCLUSIONS This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician's underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question.
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Affiliation(s)
- Sarah McKenna
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Sarah Piper
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - William Capon
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | | | - Lucas Lira
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Haley M LaMonica
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Min Kyung Chong
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Elizabeth Scott
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Ian Hickie
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Frank Iorfino
- Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, Camperdown, Australia
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Egeland KM, Borge RH, Peters N, Bækkelund H, Braathu N, Sklar M, Aarons GA, Skar AMS. Individual-level associations between implementation leadership, climate, and anticipated outcomes: a time-lagged mediation analysis. Implement Sci Commun 2023; 4:75. [PMID: 37434244 DOI: 10.1186/s43058-023-00459-7] [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: 12/21/2022] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Leaders can improve implementation outcomes by developing an organizational climate conducive to the implementation of evidence-based practices (EBP). This study tested the lagged associations between individual-level perceptions of implementation leadership, implementation climate, and three anticipated implementation outcomes, that is EBP acceptability, appropriateness, and feasibility. METHODS Screening tools and treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample of 494 child and adult mental health care professionals (M = 43 years, 78% female) completed surveys addressing perceptions of first-level leaders' (n = 47) implementation leadership and their clinics' implementation climate. Single-level structural equation models estimating both direct, indirect, and total effects were used to investigate whether perceived implementation climate mediated the association between perceived implementation leadership and perceived acceptability, appropriateness, and feasibility of screening tools and treatment methods. RESULTS Regarding the treatment methods, implementation leadership was associated with therapists' perceptions of acceptability, appropriateness, and feasibility. Implementation climate also mediated between implementation leadership and the outcomes. Regarding the screening tools, implementation leadership was not associated with the outcomes. However, implementation climate mediated between implementation leadership and therapists' perceptions of acceptability and feasibility, but not appropriateness. Analyses with the implementation climate subscales showed stronger associations for therapists' perceptions of the treatment methods than of screening tools. CONCLUSIONS Leaders may promote positive implementation outcomes, both directly and through implementation climate. With regard to the effect sizes and explained variance, results indicated that both implementation leadership and implementation climate were more strongly associated with the therapists' perceptions of the treatment methods, implemented by one group of therapists, than the screening tools, implemented by all therapists. This may imply that implementation leadership and climate may have stronger effects for smaller implementation teams within a larger system than for system-wide implementations or when the clinical interventions being implemented are more complex rather than simple ones. TRIAL REGISTRATION ClinicalTrials NCT03719651, 25 October 2018.
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Affiliation(s)
- Karina Myhren Egeland
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway.
| | - Randi Hovden Borge
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
- National Institute of Occupational Health, Gydas vei 8, 0363, Oslo, Norway
| | - Nadina Peters
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Harald Bækkelund
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Nora Braathu
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Marisa Sklar
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- Diego ACTRI Dissemination and Implementation Science Center, UC San, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- Diego ACTRI Dissemination and Implementation Science Center, UC San, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Ane-Marthe Solheim Skar
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
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Hasan MM, Rafferty MR, Tawfik S, Tawfik A, Beestrum M, Smith JD, Hirschhorn LR, Roth EJ, Woods DM. Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review. JMIR Res Protoc 2023; 12:e47009. [PMID: 37432721 PMCID: PMC10369311 DOI: 10.2196/47009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. OBJECTIVE The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. METHODS This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. RESULTS The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. CONCLUSIONS This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47009.
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Affiliation(s)
- Mohamed Mosaad Hasan
- Center for Healthcare Studies, Institute of Public Health and Medicine, Feniberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Miriam R Rafferty
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sara Tawfik
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, United States
| | - Ahmed Tawfik
- The Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville, KY, United States
| | - Molly Beestrum
- Galter Health Sciences Library & Learning Center, Northwestern University, Chicago, IL, United States
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Elliot J Roth
- Shirley Ryan AbilityLab, Chicago, IL, United States
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Donna M Woods
- Department of Pediatrics, Feinberg School of Medicine, Chicago, IL, United States
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Chapman A, Rankin NM, Jongebloed H, Yoong SL, White V, Livingston PM, Hutchinson AM, Ugalde A. Overcoming challenges in conducting systematic reviews in implementation science: a methods commentary. Syst Rev 2023; 12:116. [PMID: 37420258 PMCID: PMC10327144 DOI: 10.1186/s13643-023-02285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Consolidation of the literature using systematic reviews is a critical way to advance a discipline and support evidence-based decision-making in healthcare. However, unique challenges exist that impact the conduct of systematic reviews in implementation science. In this commentary, we reflect on our combined experience to describe five key challenges unique to systematic reviews of primary implementation research. These challenges include (1) descriptors used in implementation science publications, (2) distinction between evidence-based interventions and implementation strategies, (3) assessment of external validity, (4) synthesis of implementation studies with substantial clinical and methodological diversity, and (5) variability in defining implementation 'success'. We outline possible solutions and highlight resources that can be used by authors of primary implementation research, as well as systematic review and editorial teams, to overcome the identified challenges and optimise the utility of future systematic reviews in implementation science.
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Affiliation(s)
- Anna Chapman
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Nicole M. Rankin
- School of Population and Global Health, Centre for Health Policy, University of Melbourne, Melbourne, VIC Australia
| | - Hannah Jongebloed
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC Australia
| | - Patricia M. Livingston
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - Alison M. Hutchinson
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
- Barwon Health, Geelong, VIC Australia
| | - Anna Ugalde
- Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Faculty of Health, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
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Amenta E, Grigoryan L, Rajan SS, Ramsey D, Kramer JR, Walder A, Chou A, Van JN, Krein SL, Hysong S, Naik AD, Trautner BW. Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e115. [PMID: 37502251 PMCID: PMC10369447 DOI: 10.1017/ash.2023.198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 07/29/2023]
Abstract
Objective The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metrics and clinical outcomes and (2) the cost of implementation. Design/Setting/Participants A central site facilitated a multimodality intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB at 4 Veterans Affairs medical centers. Methods The intervention consisted of a decision support aid algorithm and interactive teaching cases that provided in the moment audit and feedback on how to manage ASB. Implementation outcomes included minutes spent in intervention delivery, number of healthcare professionals reached, and number of sessions delivered. Clinical outcomes included days of antibiotic therapy (DOT), length of antibiotic therapy (LOT), and number of urine cultures ordered per 1000 bed days. Personnel reported weekly time logs. Results Minutes spent in intervention delivery were inversely correlated with two clinical outcomes, DOT (R -0.3, P = .04) and LOT (R -0.3, P = .02). Number of healthcare professionals reached and number of sessions delivered were not correlated with clinical outcomes of DOT (R -0.003, P = .98, R = -0.059, P = .69) or LOT (R +0.073, P = .62, R -0.102, P = .49). Physician champions spent an average of 3.8% of effort on the intervention. The implementation cost was USD 22,299/year per site on average. Conclusions The amount of time local teams spent in delivery of an antibiotic stewardship intervention was correlated with the desired decrease in antibiotic use. Implementing this successful antibiotic stewardship intervention required minimal time.
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Affiliation(s)
- Eva Amenta
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Larissa Grigoryan
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Suja S. Rajan
- UTHealth Science Center, Institute for Stroke and Cerebral Vascular Disease, Houston, TX, USA
| | - David Ramsey
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer R. Kramer
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Annette Walder
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Andrew Chou
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John N. Van
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
| | - Sarah L. Krein
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sylvia Hysong
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aanand D. Naik
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Department of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA
- UTHealth Consortium on Aging, University of Texas Health Science Center, Houston, TX, USA
| | - Barbara W. Trautner
- Michael E. DeBakey Veteran Affairs Medical Center, Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Houston, TX, USA
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Söling S, Demirer I, Köberlein-Neu J, Hower KI, Müller BS, Pfaff H, Karbach U. Complex implementation mechanisms in primary care: do physicians' beliefs about the effectiveness of innovation play a mediating role? Applying a realist inquiry and structural equation modeling approach in a formative evaluation study. BMC PRIMARY CARE 2023; 24:131. [PMID: 37369994 DOI: 10.1186/s12875-023-02081-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The adoption of digital health technologies can improve the quality of care for polypharmacy patients, if the underlying complex implementation mechanisms are better understood. Context effects play a critical role in relation to implementation mechanisms. In primary care research, evidence on the effects of context in the adoption of digital innovation for polypharmacy management is lacking. STUDY AIM This study aims to identify contextual factors relevant to physician behavior and how they might mediate the adoption process. METHODS The physicians who participated in this formative evaluation study (n = 218) were part of the intervention group in a cluster-randomized controlled trial (AdAM). The intervention group implemented a digital innovation for clinical decision making in polypharmacy. A three-step methodological approach was used: (1) a realist inquiry approach, which involves the description of a context-mechanism-outcome configuration for the primary care setting; (2) a belief elicitation approach, which involves qualitative content analysis and the development of a quantitative latent contextualized scale; and (3) a mediation analysis using structural equation modeling (SEM) based on quantitative survey data from physicians to assess the mediating role of the contextualized scale (n = 179). RESULTS The key dimensions of a (1) context-mechanism-outcome model were mapped and refined. A (2) latent construct of the physicians' innovation beliefs related to the effectiveness of polypharmacy management practices was identified. Innovation beliefs play a (3) mediating role between the organizational readiness to implement change (p < 0.01) and the desired behavioral intent of physicians to adopt digital innovation (p < 0.01; R2 = 0.645). Our contextualized model estimated significant mediation, with a relative size of 38% for the mediation effect. Overall, the model demonstrated good fit indices (CFI = 0.985, RMSEA = 0.034). CONCLUSION Physician adoption is directly affected by the readiness of primary care organizations for the implementation of change. In addition, the mediation analysis revealed that this relationship is indirectly influenced by primary care physicians' beliefs regarding the effectiveness of digital innovation. Both individual physician beliefs and practice organizational capacity could be equally prioritized in developing implementation strategies. The methodological approach used is suitable for the evaluation of complex implementation mechanisms. It has been proven to be an advantageous approach for formative evaluation. TRIAL REGISTRATION NCT03430336 . First registration: 12/02/2018. CLINICALTRIALS gov.
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Affiliation(s)
- Sara Söling
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Sciences, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
| | - Ibrahim Demirer
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Sciences, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Kira Isabel Hower
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Sciences, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Beate Sigrid Müller
- Institute for General Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Sciences, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Sciences, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Czosnek L, Rankin NM, Cormie P, Murnane A, Turner J, Richards J, Rosenbaum S, Zopf EM. "Now is the time for institutions to be investing in growing exercise programs as part of standard of care": a multiple case study examining the implementation of exercise oncology interventions. Support Care Cancer 2023; 31:422. [PMID: 37358744 DOI: 10.1007/s00520-023-07844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Implementation science seeks to systematically identify determinants, strategies, and outcomes within a causal pathway to help explain successful implementation. This process is applied to evidence-based interventions (EBIs) to improve their adoption, implementation, and sustainment. However, this method has not been applied to exercise oncology services, meaning we lack knowledge about implementing exercise EBIs in routine practice. This study aimed to develop causal pathways from the determinants, strategies (including mechanism of change), and implementation outcomes to explain exercise EBIs implementation in routine cancer care. METHODS A multiple-case study was conducted across three healthcare sites in Australia. Sites selected had implemented exercise within routine care for people diagnosed with cancer and sustained the delivery of services for at least 12 months. Four data sources informed the study: semi-structured interviews with staff, document reviews, observations, and the Program Sustainability Assessment Tool (survey). Framework analysis was applied to understand the findings. The Implementation Research Logic Model was used to identify commonalities in implementation across sites and develop causal pathways. RESULTS Two hundred and eighteen data points informed our findings. Across sites, 18 determinants and 22 implementation strategies were consistent. Sixteen determinants and 24 implementation strategies differed across sites and results of implementation outcomes varied. We identified 11 common pathways that when combined, help explain implementation processes. The mechanisms of implementation strategies operating within the pathways included (1) knowledge, (2) skills, (3) secure resources, (4) optimism, and (5) simplified decision-making processes associated with exercise; (6) relationships (social and professional) and support for the workforce; (7) reinforcing positive outcomes; (8) capability to action plan through evaluations and (9) interactive learning; (10) aligned goals between the organisation and the EBI; and (11) consumer-responsiveness. CONCLUSION This study developed causal pathways that explain the how and why of successful implementation of exercise EBIs in cancer care. These findings can support future planning and optimisation activities by creating more opportunities for people with cancer to access evidence-based exercise oncology services. IMPLICATIONS FOR CANCER SURVIVORS Understanding how to implement exercise within routine cancer care successfully is important so cancer survivors can experience the benefits of exercise.
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Affiliation(s)
- Louise Czosnek
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Nicole M Rankin
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Prue Cormie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Murnane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jane Turner
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Justin Richards
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia
- School of Health Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Cabrini Cancer Institute, Department of Medical Oncology, Cabrini Health, Melbourne, Victoria, Australia
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McGuier EA, Aarons GA, Wright JD, Fortney JC, Powell BJ, Rothenberger SD, Weingart LR, Miller E, Kolko DJ. Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children's Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial. Implement Sci Commun 2023; 4:58. [PMID: 37237302 PMCID: PMC10214641 DOI: 10.1186/s43058-023-00437-z] [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: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jaely D Wright
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John C Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Kengne Talla P, Thomas A, Ataman R, Auger C, McKerral M, Wittich W, Poncet F, Ahmed S. Evaluating the implementation of the Mayo-Portland Adaptability Inventory-4 (MPAI-4) in three rehabilitation settings in Quebec: a mixed-methods study protocol. BMJ Open 2023; 13:e068866. [PMID: 37221032 DOI: 10.1136/bmjopen-2022-068866] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Stroke is a leading cause of morbidity and mortality worldwide, placing an immense burden on patients and the health system. Timely access to rehabilitation services can improve stroke survivors' quality of life. The use of standardised outcome measures is endorsed for optimising patient rehabilitation outcomes and improving clinical decision-making. This project results from a provincially mandated recommendation to use the fourth version of the Mayo-Portland Adaptability Inventory (MPAI-4) to measure changes in social participation of stroke survivors and to maintain commitment to evidence-informed practices in stroke care. This protocol outlines the implementation process of the MPAI-4 for three rehabilitation centres. The objectives are to: (a) describe the context of MPAI-4 implementation; (b) determine clinical teams' readiness for change; (c) identify barriers and enablers to implementing the MPAI-4 and match the implementation strategies; (d) evaluate the MPAI-4 implementation outcomes including the degree of integration of the MPAI-4 into clinical practice and (e) explore participants' experiences using the MPAI-4. METHODS AND ANALYSIS We will use a multiple case study design within an integrated knowledge translation (iKT) approach with active engagement from key informants. Each case is a rehabilitation centre implementing MPAI-4. We will collect data from clinicians and programme managers using mixed methods guided by several theoretical frameworks. Data sources include surveys, focus groups and patient charts. We will conduct descriptive, correlational and content analyses. Ultimately, we will analyse, integrate data from qualitative and quantitative components and report them within and across participating sites. Results will provide insights about iKT within stroke rehabilitation settings that could be applied to future research projects. ETHICS AND DISSEMINATION The project received Institutional Review Board approval from the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal. We will disseminate results in peer-reviewed publications and at local, national and international scientific conferences.
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Affiliation(s)
- Pascaline Kengne Talla
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre Ouest-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
| | - Aliki Thomas
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Faculty of Education, McGill University, Montreal, Quebec, Canada
- Integrated Health and Social Services Centre of Laval (CISSS de Laval), Laval, Quebec, Canada
| | - Rebecca Ataman
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre Ouest-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Claudine Auger
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- École de la réadaptation, Faculte de Medecine, Université de Montreal, Montreal, Quebec, Canada
- Integrated University Health and Social Services Centre for South-Central Montreal (Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada
| | - Michelle McKerral
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- Integrated University Health and Social Services Centre for South-Central Montreal (Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal), Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Walter Wittich
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- School of Optometry, Université de Montreal, Montreal, Quebec, Canada
- Institut Nazareth et Louis-Braille, Integrated Health and Social Services Centre of Montérégie-Centre (CISSS de la Montérégie-Centre), Montérégie, Quebec, Canada
| | - Frédérique Poncet
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre Ouest-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
- School of Optometry, Université de Montreal, Montreal, Quebec, Canada
| | - Sara Ahmed
- Centre de recherche interdisciplinaire en readaptation du Montreal metropolitain, Montreal, Quebec, Canada
- Lethbridge-Layton-Mackay Rehabilitation Centre, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) du Centre Ouest-de-l'Ile-de-Montréal, Montreal, Quebec, Canada
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Walsh-Bailey C, Gilbert A, Shato T, Sandler B, Baumann AA, Bradley CD, McLoughlin GM, McGuire FH, Fort MP, Tabak RG. Protocol for a scoping review of health equity frameworks and models applied in empirical studies of chronic disease prevention and control. Syst Rev 2023; 12:83. [PMID: 37170261 PMCID: PMC10176929 DOI: 10.1186/s13643-023-02240-2] [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: 05/09/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Chronic diseases, such as cancers and cardiovascular diseases, present the greatest burden of morbidity and mortality worldwide. This burden disproportionately affects historically marginalized populations. Health equity is rapidly gaining increased attention in public health, health services, and implementation research, though many health inequities persist. Health equity frameworks and models (FM) have been called upon to guide equity-focused chronic disease and implementation research. However, there is no clear synthesis of the health equity FM used in chronic disease research or how these are applied in empirical studies. This scoping review seeks to fill this gap by identifying and characterizing health equity FM applied in empirical studies along the chronic disease prevention and control continuum, describing how these FM are used, and exploring potential applications to the field of implementation science. METHODS We follow established guidance for conducting scoping reviews, which includes six stages: (1) identify the research question; (2) identify relevant studies; (3) select studies for inclusion; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) consultation. This protocol presents the iterative, collaborative approach taken to conceptualize this study and develop the search strategy. We describe the criteria for inclusion in this review, methods for conducting two phases of screening (title and abstract, full text), data extraction procedures, and quality assurance approaches taken throughout the project. DISCUSSION The findings from this review will inform health-equity focused chronic disease prevention and control research. FM identified through this review will be added to an existing website summarizing dissemination and implementation science frameworks, and we will offer case examples and recommendations for utilizing a health equity FM in empirical studies. Our search strategy and review methodology may serve as an example for scholars seeking to conduct reviews of health equity FM in other health disciplines. SYSTEMATIC REVIEW REGISTRATION Open Science Framework Registration https://doi.org/10.17605/OSF.IO/SFVE6.
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Affiliation(s)
- Callie Walsh-Bailey
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA.
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
| | - Amanda Gilbert
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Thembekile Shato
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Brittney Sandler
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
- Bernard Becker Medical Library, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Ana A Baumann
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Cory D Bradley
- Division of Infectious Diseases, Washington University School of Medicine, 600 S. Taylor Ave, St. Louis, MO, 63110, USA
| | - Gabriella M McLoughlin
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- College of Public Health, Temple University, 1800 N. Broad St, Philadelphia, PA, 19121, USA
| | - F Hunter McGuire
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
| | - Meredith P Fort
- Department of Health Systems, Management and Policy, Colorado School of Public Health, 13055 E. 17Th Ave, Aurora, CO, 80045, USA
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA
- Implementation Science Center for Cancer Control and Prevention Research Center, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
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48
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Lawson GM, Mandell DS, Tomczuk L, Fishman J, Marcus SC, Pellecchia M. Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:357-365. [PMID: 36525093 PMCID: PMC10191901 DOI: 10.1007/s10488-022-01243-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] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.
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Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, 2716 South St, 8th Floor, Philadelphia, Pennsylvania, 19146, United States.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Liza Tomczuk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- Annenberg School, University of Pennsylvania, Pennsylvania, United States
| | - Steven C Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
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Magsamen S, Golden TL, Towriss CA, Allen J. The impact thinking framework: a process for advancing research-to-practice initiatives in neuroaesthetics. Front Psychol 2023; 14:1129334. [PMID: 37179869 PMCID: PMC10167006 DOI: 10.3389/fpsyg.2023.1129334] [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: 12/21/2022] [Accepted: 03/31/2023] [Indexed: 05/15/2023] Open
Abstract
Neuroaesthetics research explores brain, body and behavioral responses to engagement with the arts and other aesthetic sensory experiences. Evidence indicates that such experiences can help address various psychological, neurological and physiological disorders, and that they can support mental and physical well-being and learning in the general population. The interdisciplinary nature of this work contributes to its impact and promise; however, it also creates challenges as various disciplines approach and define research and practice in varied ways. Recent field-wide reports have noted that a consensus translational framework is needed to support further neuroaesthetics research that can deliver meaningful knowledge and interventions. The Impact Thinking Framework (ITF) was designed to meet this need. Through a description of the framework's nine iterative steps and a presentation of three case studies, this paper posits that the ITF can support researchers and practitioners in understanding and applying aesthetic experiences and the arts to advance health, well-being, and learning.
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Affiliation(s)
- Susan Magsamen
- The International Arts + Mind Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tasha L. Golden
- The International Arts + Mind Lab, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Joy Allen
- Berklee College of Music, Boston, MA, United States
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50
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Kokole D, Jané-Llopis E, Mercken L, Natera Rey G, Arroyo M, Pérez Gómez A, Mejía-Trujillo J, Piazza M, Bustamante I, O'Donnell A, Kaner E, Schulte B, de Vries H, Anderson P. Protocol for a process evaluation of SCALA study - Intervention targeting scaling up of primary health care-based prevention and management of heavy drinking and comorbid depression in Latin America. EVALUATION AND PROGRAM PLANNING 2023; 97:102217. [PMID: 36603348 DOI: 10.1016/j.evalprogplan.2022.102217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/18/2020] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
This paper describes the plan for a process evaluation of a quasi-experimental study testing the municipal level scale-up of primary health care-based measurement and brief advice programmes to reduce heavy drinking and comorbid depression in Colombia, Mexico, and Peru. The main aims of the evaluation are to assess the implementation of intervention components; mechanisms of impact that influenced the outcomes; and characteristics of the context that influenced implementation and outcomes. Based on this information, common drivers of successful outcomes will be identified. A range of data collection methods will be used: questionnaires; interviews; observations; logbooks; and document analysis. All participating providers will complete a pen-and-paper questionnaire at recruitment and two time points during the implementation period. Providers attending training will complete post-training questionnaires. Additionally, 1080 patients will be invited to self-complete a patient questionnaire. One-in-ten participating providers and fifteen other key stakeholders will participate in semi-structured interviews. Training sessions and community advisory board meetings will be observed by a neutral observer. Logbooks will be kept by local research teams to document events affecting the implementation. Project related documentation and other relevant reports describing the context will be examined.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Univ. Ramon Llull, ESADE, Avenida de Pedralbes, 60, 62, 08034 Barcelona, Spain; Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada.
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Department of Health Psychology, Open University, Valkenburgerweg 1776419 AT Heerlen, the Netherlands.
| | - Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calz México-Xochimilco 101, Huipulco, 14370 Ciudad de México, CDMX, Mexico.
| | | | | | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Ave. Honorio Delgado 430, Urb. Ingeniería, S.M.P. Lima - Perú.
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
| | - Bernd Schulte
- Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands.
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, the Netherlands; Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
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