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Gupte HA, D'Costa M, Gupta S, Sonawane V. Integration of a Tobacco Cessation Program into a Rural Community-Based Maternal and Child Health Program in India: A Stakeholders' Perspective on Task Shifting. Nicotine Tob Res 2024; 26:1209-1217. [PMID: 38477033 DOI: 10.1093/ntr/ntae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION According to the Global Adult Tobacco Survey-2, India, 7.5% of pregnant women are tobacco users with a high prevalence of smokeless tobacco use in rural India. Although pregnant women may receive advice to quit tobacco, lack of knowledge on providing cessation support among healthcare workers results in missed opportunities. Community Health Workers (CHWs) play a significant role in maternal and child health (MCH) programs. Thus, task-shifting for providing cessation support by CHWs was planned and the perceptions and attitudes of concerned stakeholders were explored. AIMS AND METHODS A pre-implementation qualitative study was conducted in four states of India within existing rural, community-based MCH program settings. Implementation research frameworks were used to develop data collection tools and for inductive and deductive thematic analysis. In-depth interviews were conducted with stakeholders (n = 28) like coordinators, pregnant women, and village functionaries of the government health system. Four focus groups were conducted with female CHWs (n = 24). RESULTS Stakeholders intended to adopt the intervention as objectives of the cessation intervention were aligned with the aims of the MCH program. CHWs related to their role in task-shifting and understood the context for implementing the intervention within the MCH program. Pregnant women expressed openness to receiving cessation support from CHWs acting as a facilitator for task-shifting. Barriers anticipated were the additional workload and time required for CHWs to implement the intervention. CONCLUSIONS Task-shifting to female CHWs for screening tobacco users, providing brief advice and cessation support within the MCH program was perceived to be acceptable, adoptable, and feasible. IMPLICATIONS The study builds insight into the process of developing a grounded approach for the integration of tobacco cessation intervention into a rural, community-based antenatal care setting by task shifting to female CHWs for providing cessation support to pregnant women. The study fills gaps in the literature related to establishing tobacco cessation interventions for pregnant women. The delineated efforts in integration of the intervention and task shifting can be replicated in other developing countries, especially in rural communities within South Asian and Southeast Asian regions having cultural practices, community-based healthcare structures, and tobacco consumption patterns that are comparable to India.
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Gago C, De Leon E, Mandal S, de la Calle F, Garcia M, Colella D, Dapkins I, Schoenthaler A. "Hypertension is such a difficult disease to manage": federally qualified health center staff- and leadership-perceived readiness to implement a technology-facilitated team-based hypertension model. Implement Sci Commun 2024; 5:49. [PMID: 38698497 PMCID: PMC11067286 DOI: 10.1186/s43058-024-00587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Despite decades of evidence demonstrating the efficacy of hypertension care delivery in reducing morbidity and mortality, a majority of hypertension cases remain uncontrolled. There is an urgent need to elucidate and address multilevel facilitators and barriers clinical staff face in delivering evidence-based hypertension care, patients face in accessing it, and clinical systems face in sustaining it. Through a rigorous pre-implementation evaluation, we aimed to identify facilitators and barriers bearing the potential to affect the planned implementation of a multilevel technology-facilitated hypertension management trial across six primary care sites in a large federally qualified health center (FQHC) in New York City. METHODS During a dedicated pre-implementation period (3-9 months/site, 2021-2022), a capacity assessment was conducted by trained practice facilitators, including (1) online anonymous surveys (n = 124; 70.5% of eligible), (2) hypertension training analytics (n = 69; 94.5% of assigned), and (3) audio-recorded semi-structured interviews (n = 67; 48.6% of eligible) with FQHC leadership and staff. Surveys measured staff sociodemographic characteristics, adaptive reserve, evidence-based practice attitudes, and implementation leadership scores via validated scales. Training analytics, derived from end-of-course quizzes, included mean score and number attempts needed to pass. Interviews assessed staff-reported facilitators and barriers to current hypertension care delivery and uptake; following audio transcription, trained qualitative researchers employed a deductive coding approach, informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS Most survey respondents reported moderate adaptive reserve (mean = 0.7, range = 0-1), evidence-based practice attitudes (mean = 2.7, range = 0-4), and implementation leadership (mean = 2.5, range = 0-4). Most staff passed training courses on first attempt and demonstrated high scores (means > 80%). Findings from interviews identified potential facilitators and barriers to implementation; specifically, staff reported that complex barriers to hypertension care, control, and clinical communication exist; there is a recognized need to improve hypertension care; in-clinic challenges with digital tool access imposes workflow delays; and despite high patient loads, staff are motivated to provide high-quality cares. CONCLUSIONS This study serves as one of the first to apply the CFIR to a rigorous pre-implementation evaluation within the understudied context of a FQHC and can serve as a model for similar trials seeking to identify and address contextual factors known to impact implementation success. TRIAL REGISTRATION ClinicalTrials.gov NCT03713515 , date of registration: October 19, 2018.
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Affiliation(s)
- Cristina Gago
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA.
| | - Elaine De Leon
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Soumik Mandal
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Franze de la Calle
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
| | - Masiel Garcia
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | | | - Isaac Dapkins
- Family Health Centers at NYU Langone, Brooklyn, NY, USA
| | - Antoinette Schoenthaler
- Institute for Excellence in Health Equity, NYU Langone Health, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA
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Rizzo A, Alparone D. Surfing Alone: From Internet Addiction to the Era of Smartphone Dependence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:436. [PMID: 38673347 PMCID: PMC11050602 DOI: 10.3390/ijerph21040436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/28/2024]
Abstract
Technological addiction refers to behavior characterized by excessive and prolonged use of technological devices; reactions of anger, frustration, or panic when unable to use them; and unsuccessful attempts to reduce the time spent on them [...].
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Affiliation(s)
- Amelia Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
- Department of Cognitive Sciences, Psychological, Educational, and Cultural Studies, University of Messina, 98122 Messina, Italy
| | - Dario Alparone
- Department of Psychology, Faculty of Letters and Human Sciences, University of Western Brittany, 20 rue Duquesne, CEDEX 3, 29238 Brest, France;
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Morse RM, Lang I, Rapaport P, Poppe M, Morgan-Trimmer S, Cooper C. How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program. BMC Geriatr 2024; 24:188. [PMID: 38408902 PMCID: PMC10895907 DOI: 10.1186/s12877-024-04762-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Over 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials. METHODS We conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis. RESULTS We interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients. CONCLUSION This study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.
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Affiliation(s)
- Rachel M Morse
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Iain Lang
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
- UK National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (NIHR PenARC), Exeter , UK
| | - Penny Rapaport
- Division of Psychiatry, University College London, London, UK
| | - Michaela Poppe
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sarah Morgan-Trimmer
- Department of Health and Community Sciences, University of Exeter Medical School , Exeter, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Vorkoper S, Korn AR, Maruvada P, Nicastro HL, Shi S. NIH-supported implementation science and nutrition research: a portfolio review of the past decade. Front Public Health 2023; 11:1235164. [PMID: 37915813 PMCID: PMC10616832 DOI: 10.3389/fpubh.2023.1235164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Objective This portfolio analysis aims to describe the scope of NIH-funded extramural research grants at the intersection of nutrition research and implementation science (IS) from 2011 to 2022 and to offer insights into future research opportunities relevant to the Strategic Plan for NIH Nutrition Research 2020-2030. Methods A portfolio analysis of funded grants using NIH reporting systems was conducted to identify nutrition research and IS awarded between fiscal years 2011 and 2022. The authors screened the titles and abstracts for inclusion criteria: research and career development awards involved a nutrition and/or dietary intervention and measured a stated implementation outcome or used an IS theory, model, or framework. Results In total, 33 NIH-funded awards met the inclusion criteria. Almost half of the awards (48.5%) were investigator-initiated research projects compared to research career awards and cooperative agreements. While studies were predominantly conducted in the United States, 15.2% were conducted in low- and middle-income countries in Africa, Latin America, and Asia. Adults aged 19-64 years and children aged 2-11 years represented most of the study populations (45.5 and 15.2%, respectively). Studies provided nutrition/dietary guidelines and created culturally tailored interventions, which were then adapted in collaboration with community partners in schools, hospitals, and religious settings. The most cited IS outcomes were feasibility, costs, adoption, and acceptability. Sixteen awards (48.5%) used an IS theory, model, or framework to guide their work. Discussion The findings show the breadth of NIH-funded nutrition and implementation research and highlight potential research opportunities.
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Affiliation(s)
- Susan Vorkoper
- Fogarty International Center, National Institutes of Health, Bethesda, MD, United States
| | - Ariella R. Korn
- Cancer Prevention Fellowship Program, Implementation Science Team, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Padma Maruvada
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Holly L. Nicastro
- Office of Nutrition Research, National Institutes of Health, Bethesda, MD, United States
| | - Scarlet Shi
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Oluwoye O, Weeks DL, McDonell MG. An unexplored equity factor: differential beliefs and attitudes toward contingency management by providers' ethnicity. BMC Health Serv Res 2023; 23:902. [PMID: 37612684 PMCID: PMC10464444 DOI: 10.1186/s12913-023-09878-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Although considered one of the most effective interventions for substance use disorders (SUD), the widespread implementation of contingency management (CM) has remained limited. In more recent years there has been surge in the implementation of CM to address increasing rates of substance use. Prior studies at the provider-level have explored beliefs about CM among SUD treatment providers and have tailored implementation strategies based on identified barriers and training needs, to promote implementation of CM. However, there have been no implementation strategies that have actively sought to identify or address potential differences in the beliefs about CM that could be influenced by the cultural background (e.g., ethnicity) of treatment providers. To address this knowledge gap, we examined beliefs about CM among a sample of inpatient and outpatient SUD treatment providers. METHODS A cross-sectional survey of SUD treatment providers was completed by 143 respondents. The survey asked respondents about their attitudes toward CM using the Contingency Management Beliefs Questionnaire (CMBQ). Linear mixed models examined the effect of ethnicity (non-Hispanic White and Hispanic) on CMBQ subscale (general barriers, training-related barriers, CM positive-statements) scores. RESULTS Fifty-nine percent of respondents to the CMBQ self-identified as non-Hispanic White and 41% as Hispanic. Findings revealed that treatment providers who identified as Hispanic had significantly higher scores on the general barriers (p < .001) and training-related barriers (p = .020) subscales compared to the non-Hispanic White treatment providers. Post-hoc analyses identified differences in the endorsement of specific individual scale items on the general barriers (e.g., CM interventions create extra work for me) and training-related (e.g., I want more training before implementing CM) subscales. CONCLUSIONS Dissemination and implementation strategies for CM need to consider equity-related factors at the provider-level that may be associated with the adoption and uptake of CM.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA.
| | - Douglas L Weeks
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA
| | - Michael G McDonell
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, 99202, USA
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Hyde AM, Johnson E, Luig T, Schroeder D, Carbonneau M, Campbell-Scherer D, Tandon P. Implementing a cirrhosis order set in a tertiary healthcare system: a theory-informed formative evaluation. BMC Health Serv Res 2023; 23:636. [PMID: 37316822 DOI: 10.1186/s12913-023-09632-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/01/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Standardized order sets are a means of increasing adherence to clinical practice guidelines and improving the quality of patient care. Implementation of novel quality improvement initiatives like order sets can be challenging. Before the COVID-19 pandemic, we conducted a formative evaluation to understand healthcare providers' perspectives on implementing clinical changes and the individual, collective and organizational contextual factors that might impact implementation at eight hospital sites in Alberta, Canada. METHODS We utilized concepts from the Consolidated Framework for Implementation Research (CFIR) and Normalisation Process Theory (NPT) to understand the context, past implementation experiences, and perceptions of the cirrhosis order set. Eight focus groups were held with healthcare professionals caring for patients with cirrhosis. Data were coded deductively using relevant constructs of NPT and CFIR. A total of 54 healthcare professionals, including physicians, nurses, nurse practitioners, social workers and pharmacists and a physiotherapist, participated in the focus groups. RESULTS Key findings revealed that participants recognized the value of the cirrhosis order set and its potential to improve the quality of care. Participants highlighted potential implementation challenges, including multiple competing quality improvement initiatives, feelings of burnout, lack of communication between healthcare provider groups, and a lack of dedicated resources to support implementation. CONCLUSIONS Implementing a complex improvement initiative across clinician groups and acute care sites presents challenges. This work yielded insights into the significant influence of past implementation of similar interventions and highlighted the importance of communication between clinician groups and resources to support implementation. However, by using multiple theoretical lenses to illuminate what and how contextual and social processes will influence uptake, we can better anticipate challenges during the implementation process.
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Affiliation(s)
- A M Hyde
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada
| | - E Johnson
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada
| | - T Luig
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - D Schroeder
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | | | - D Campbell-Scherer
- Physician Learning Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.
- Office of Lifelong Learning and Physician Learning Program, Edmonton Clinic Health Academy (ECHA), 2-590, Edmonton, AB, T6G 1C9, Canada.
| | - P Tandon
- Division of Gastroenterology (Liver Unit), Faculty of Medicine & Dentistry, University of Alberta, 8540 112 St NW, Edmonton, AB, T6G 2P8, Canada.
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Fischer R, Hartle L. Effective interventions to reduce loneliness in big cities. Curr Opin Psychiatry 2023; 36:206-212. [PMID: 36728699 DOI: 10.1097/yco.0000000000000844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW Loneliness is a state of distress or discomfort between the desired and experienced level of connectedness to others. These feelings may be particular salient in urban environments that seemingly offer more opportunities for social contact, highlighting the discrepancy. The topic of loneliness has received increased attention because of its negative impact on mental and physical health combined with concerns of increased loneliness due to lockdowns and social distancing regulations during the coronavirus disease 2019 pandemic. We provide a bibliometric and random-effects meta-analysis of clinical trials published since 2020 and available via PubMed. RECENT FINDINGS Loneliness interventions have predominantly focused on elderly in the community. Adolescents and young adults as a second group at risk have received much less attention. On average across 44 effect sizes studied in 38 trials, interventions show moderate levels of effectiveness but are characterized by high heterogeneity and trials are often underpowered and use low quality designs. Multidimensional interventions show promise for alleviating loneliness, but the intervention context needs greater attention. SUMMARY Scalable and effective interventions for the general population and at-risk groups of loneliness are still scarce. Some promising interventions have been trialled and merit further attention.
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Affiliation(s)
- Ronald Fischer
- Institute D'Or for Research and Teaching, Rio de Janeiro, Brazil
- Victoria University of Wellington, Wellington, New Zealand
| | - Larissa Hartle
- Institute D'Or for Research and Teaching, Rio de Janeiro, Brazil
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Oluwoye O, Weeks DL, McDonell MG. An Unexplored Equity Factor During Pre-Implementation of Contingency Management: Differential Beliefs and Attitudes by Providers' Ethnicity. RESEARCH SQUARE 2023:rs.3.rs-2719994. [PMID: 37131593 PMCID: PMC10153393 DOI: 10.21203/rs.3.rs-2719994/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background Although considered one of the most effective interventions for substance use disorders (SUD), the widespread uptake of contingency management (CM) has remained limited. Prior studies at the provider-level have explored beliefs about CM among SUD treatment providers and have tailored implementation strategies based on identified barriers and training needs. However, there have been no implementation strategies that have actively sought to identify or address potential differences in the beliefs about CM that could be influenced by the cultural background (e.g., ethnicity) of treatment providers. To address this knowledge gap, we examined beliefs about CM among a sample of inpatient and outpatient SUD treatment providers. Methods A cross-sectional survey of SUD treatment providers was completed by 143 respondents. The survey asked respondents about their attitudes toward CM using the Contingency Management Beliefs Questionnaire (CMBQ). Linear mixed models were used to examine the effect of ethnicity on CMBQ subscale (general barriers, training-related barriers, CM positive-statements) scores. Results Fifty-nine percent of respondents self-identified as non-Hispanic White and 41% as Hispanic. Findings revealed that SUD providers who identified as Hispanic had significantly higher scores on the general barriers (p < .001) and training-related barriers (p = .020) subscales compared to the non-Hispanic White SUD providers. Post-hoc analyses identified differences in the endorsement of specific individual scale items on the general barriers and training-related subscales. Conclusions Dissemination and implementation strategies for CM among treatment providers need to consider equity-related factors at the provider-level that may be associated with the adoption and uptake CM.
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Affiliation(s)
- Oladunni Oluwoye
- Elson S. Floyd College of Medicine at Washington State University
| | - Douglas L Weeks
- Elson S. Floyd College of Medicine at Washington State University
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Gallant NL, Hadjistavropoulos T, Stopyn RJN, Feere EK. Integrating Technology Adoption Models Into Implementation Science Methodologies: A Mixed-Methods Preimplementation Study. THE GERONTOLOGIST 2023; 63:416-427. [PMID: 35810405 PMCID: PMC10028232 DOI: 10.1093/geront/gnac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sustainable implementation of patient-oriented technologies in health care settings is challenging. Preimplementation studies guided by the Consolidated Framework for Implementation Research (CFIR) can provide opportunities to address barriers and leverage facilitators that can maximize the likelihood of successful implementation. When looking to implement patient-oriented technologies, preimplementation studies may also benefit from guidance from a conceptual framework specific to technology adoption such as the Unified Theory of Acceptance and Use of Technology. This study was, therefore, aimed at identifying determinants for the successful implementation of a patient-oriented technology (i.e., automated pain behavior monitoring [APBM] system) within a health care setting (i.e., long-term care [LTC] facility). RESEARCH DESIGN AND METHODS Using a mixed-methods study design, 164 LTC nurses completed a set of questionnaires and 68 LTC staff participated in individual interviews involving their perceptions of an APBM system in LTC environments. Quantitative data were analyzed using a series of mediation analyses and narrative responses were examined using directed content analysis. RESULTS Performance expectancy and effort expectancy partially and fully mediated the influence of implementation, readiness for organizational change, and technology readiness constructs on behavioral intentions to use the APBM system in LTC environments. Findings from the qualitative portion of this study provide guidance for the development of an intervention that is grounded in the CFIR. DISCUSSION AND IMPLICATIONS Based on our results, we offer recommendations for the implementation of patient-oriented technologies in health care settings.
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Affiliation(s)
- Natasha L Gallant
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Rhonda J N Stopyn
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
- Centre on Aging and Health, University of Regina, Regina, Saskatchewan, Canada
| | - Emma K Feere
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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Ellis J, Kinsella K, James E, Cheetham‐Blake T, Lambrou M, Ciccognani A, Rogers A, Band R. Examining the optimal factors that promote implementation and sustainability of a network intervention to alleviate loneliness in community contexts. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4144-e4154. [PMID: 35470919 PMCID: PMC10084283 DOI: 10.1111/hsc.13808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 01/18/2022] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Community environments have the potential to alleviate loneliness and social isolation as they offer opportunity for sociality and to expand personal social network connections. Implementing a social network intervention in community environments to connect people to who are at risk of loneliness or social isolation could help alleviate these concerns. However, implementing interventions in community environments is made difficult by the interplay between the community context and intervention. Thus, to support implementation a detailed understanding of the types of community contexts is required. To examine the optimal factors that promote the implementation of a social network designed to alleviate loneliness and social isolation intervention in the community observations, interviews and documentary analysis were conducted. The Consolidated Framework for Implementation Research and a typology of community contexts were used to inform the data analysis and interpret the findings. Key factors were found to affect the implementation of the intervention in the different community contexts. These inter-related factors operated across three domains. Service User Needs affected intervention take up as its suitability varied. The stability of the workforce and nature of everyday work also impacted on implementation. Finally, the fluctuating capacity of organisations and the organisational culture were also influential. No single community environment was found to have all of the optimal factors required for implementation and sustainably. The UK policy agenda of austerity had negatively affected community environments' capacity to deliver such intervention through increasing service user needs and reducing available resources. Trial registration: ISRCTN19193075.
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Affiliation(s)
- Jaimie Ellis
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Karina Kinsella
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Elizabeth James
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | | | | | | | - Anne Rogers
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Rebecca Band
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
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Implementation Science for the Prevention and Treatment of HIV among Adolescents and Young Adults in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:7-23. [PMID: 35947233 DOI: 10.1007/s10461-022-03770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/01/2022]
Abstract
Despite many evidence-based adolescent and young adult (AYA) HIV interventions, few are implemented at scale in sub-Saharan Africa (SSA). A growing implementation science literature provides important context for scaling up AYA HIV interventions in this high HIV-burden region. This scoping review examined the use of implementation research in AYA HIV studies conducted in SSA. We searched five databases and included articles which focused on AYA (10-24 years old), addressed HIV prevention or treatment, were conducted exclusively in SSA countries, and included an implementation science outcome. We included 44 articles in 13 SSA countries. Most were in East (52.3%) and South Africa (27.3%), and half focused exclusively on HIV prevention components of the care continuum. Acceptability and feasibility were the most cited implementation science outcomes. Only four articles used an established implementation science framework. The findings informed our recommendations to guide the design, implementation, and dissemination of further studies and health policymaking.
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Gallant N, Hadjistavropoulos T, Winters EM, Feere EK, Wickson-Griffiths A. Development, evaluation, and implementation of an online pain assessment training program for staff in rural long-term care facilities: a case series approach. BMC Geriatr 2022; 22:336. [PMID: 35436906 PMCID: PMC9016985 DOI: 10.1186/s12877-022-03020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain among long-term care (LTC) residents, and especially residents with dementia, is often underassessed and this underassessment has been attributed, in part, to gaps in front-line staff education. Furthermore, although evidence-based clinical guidelines for pain assessment in LTC are available, pain assessment protocols are often inconsistently implemented and, when they are implemented, it is usually within urban LTC facilities located in large metropolitan centers. Implementation science methodologies are needed so that changes in pain assessment practices can be integrated in rural facilities. Thus, our purpose was to evaluate an online pain assessment training program and implement a standardized pain assessment protocol in rural LTC environments. Methods During the baseline and implementation periods, we obtained facility-wide pain-related quality indicators from seven rural LTC homes. Prior to implementing the protocol, front-line staff completed the online training program. Front-line staff also completed a set of self-report questionnaires and semi-structured interviews prior to and following completion of the online training program. Results Results indicated that knowledge about pain assessment significantly increased following completion of the online training program. Implementation of the standardized protocol resulted in more frequent pain assessments on admission and on a weekly basis, although improvements in the timeliness of follow-up assessments for those identified as having moderate to severe pain were not as consistent. Directed content analysis of semi-structured interviews revealed that the online training program and standardized protocol were well-received despite a few barriers to effective implementation. Conclusions In conclusion, we demonstrated the feasibility of the remote delivery of an online training program and implementation of a standardized protocol to address the underassessment of pain in rural LTC facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03020-8.
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Affiliation(s)
- Natasha Gallant
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada. .,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada.
| | - Thomas Hadjistavropoulos
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Emily M Winters
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Emma K Feere
- Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada
| | - Abigail Wickson-Griffiths
- Centre on Aging and Health, University of Regina, Regina, SK, S4S 0A2, Canada.,Faculty of Nursing, University of Regina, Regina, SK, S4S 0A2, Canada
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Rogers L, De Brún A, Birken SA, Davies C, McAuliffe E. Context counts: a qualitative study exploring the interplay between context and implementation success. J Health Organ Manag 2021; ahead-of-print. [PMID: 33682395 PMCID: PMC9073593 DOI: 10.1108/jhom-07-2020-0296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Implementing change in healthcare is difficult to accomplish due to the unpredictability associated with challenging the status quo. Adapting the intervention/practice/program being implemented to better fit the complex context is an important aspect of implementation success. Despite the acknowledged influence of context, the concept continues to receive insufficient attention at the team-level within implementation research. Using two heterogeneous multidisciplinary healthcare teams as implementation case studies, this study evaluates the interplay between context and implementation and highlights the ways in which context influences the introduction of a collective leadership intervention in routine practice. DESIGN/METHODOLOGY/APPROACH The multiple case study design adopted, employed a triangulation of qualitative research methods which involved observation (Case A = 16 h, Case B = 15 h) and interview data (Case A = 13 participants, Case B = 12 participants). Using an inductive approach, an in-depth thematic analysis of the data outlined the relationship between team-level contextual factors and implementation success. FINDINGS Themes are presented under the headings: (1) adapting to the everyday realities, a key determinant for implementation success and (2) implementation stimulating change in context. The findings demonstrate a dynamic relationship between context and implementation. The challenges of engaging busy healthcare professionals emphasised that mapping the contextual complexity of a site and adapting implementation accordingly is essential to enhance the likelihood of successful implementation. However, implementation also altered the surrounding context, stimulating changes within both teams. ORIGINALITY/VALUE By exposing the reciprocal relationship between team-level contextual factors and implementation, this research supports the improved design of implementation strategies through better understanding the interplay and mutual evolution of evidence-based healthcare interventions within different contexts.
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Affiliation(s)
- Lisa Rogers
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Sarah A Birken
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Carmel Davies
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin, Ireland
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