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Toropova A, Rödlund A, Björklund C, Schäfer Elinder L, Jensen I, Kwak L. The effectiveness of implementing the Guideline for the Prevention of Mental Ill-health Problems at the Workplace on health-outcomes, organizational and social risk factors: a cluster-randomized controlled trial in Swedish schools. Scand J Work Environ Health 2023; 49:428-438. [PMID: 37481748 PMCID: PMC10821774 DOI: 10.5271/sjweh.4108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVES This study aimed to compare the effectiveness of the multifaceted implementation strategy (multifaceted group) versus a discrete implementation strategy (discrete group) for implementing the Swedish Guideline for the Prevention of Mental Ill-health Problems at the Workplace on the primary intervention outcome - exhaustion - and secondary outcomes of stress, health, recovery, psychosocial safety climate, and social and organizational risk factors. Another aim was to examine whether the primary and secondary outcomes differed on the basis of guideline adherence levels, irrespective of the group. METHODS A cluster-randomized waiting-list controlled trial with 6- and 12-months follow-up was conducted among 19 Swedish public schools. Primary and secondary outcomes as well as guideline adherence were assessed by self-reported questionnaire. Linear mixed modeling was used to compare differences in outcomes between the groups from baseline to 6 and 12 months, and in relation to different adherence levels. RESULTS The trial comprised 698 employees (83.1%) participated. There were no differences between groups in the primary and secondary outcomes at 6 months, while at 12 months differences were observed for some outcomes to the advantage of the discrete group. Better guideline adherence was associated with improvements in exhaustion at 12 months and the secondary outcomes of psychosocial safety climate, work organization and job content, interpersonal relations and leadership, and recovery over 6 and 12 months. CONCLUSION The multifaceted implementation strategy was no more effective than the discrete strategy in improving health outcomes or organizational and social work environment. However, higher adherence to the guideline was associated with larger improvements in health outcomes and organizational and social work environment, irrespective of the implementation strategy used.
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Affiliation(s)
| | | | | | | | | | - Lydia Kwak
- Unit of Intervention and Implementation Research for worker health, Institute for Environmental Medicine, Karolinska Institute, Stockholm 171 77, Sweden.
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Rommerskirch-Manietta M, Manietta C, Purwins D, Braunwarth JI, Quasdorf T, Roes M. Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia-a scoping review. Implement Sci Commun 2023; 4:104. [PMID: 37641142 PMCID: PMC10463361 DOI: 10.1186/s43058-023-00486-4] [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: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. METHODS We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). RESULTS We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. CONCLUSIONS We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. TRIAL REGISTRATION The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany.
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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Kwak L, Toropova A, Powell BJ, Lengnick-Hall R, Jensen I, Bergström G, Elinder LS, Stigmar K, Wåhlin C, Björklund C. A randomized controlled trial in schools aimed at exploring mechanisms of change of a multifaceted implementation strategy for promoting mental health at the workplace. Implement Sci 2022; 17:59. [PMID: 36050743 PMCID: PMC9438275 DOI: 10.1186/s13012-022-01230-7] [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: 05/10/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study will explore implementation mechanisms through which a single implementation strategy and a multifaceted implementation strategy operate to affect the implementation outcome, which is fidelity to the Guideline For The Prevention of Mental Ill Health within schools. The guideline gives recommendations on how workplaces can prevent mental ill health among their personnel by managing social and organizational risks factors in the work environment. Schools are chosen as the setting for the study due to the high prevalence of mental ill health among teachers and other personnel working in schools. The study builds on our previous research, in which we compared the effectiveness of the two strategies on fidelity to the guideline. Small improvements in guideline adherence were observed for the majority of the indicators in the multifaceted strategy group. This study will focus on exploring the underlying mechanisms of change through which the implementation strategies may operate to affect the implementation outcome. Methods We will conduct a cluster-randomized-controlled trial among public schools (n=55 schools) in Sweden. Schools are randomized (1:1 ratio) to receive a multifaceted strategy (implementation teams, educational meeting, ongoing training, Plan-Do-Study-Act cycles) or a single strategy (implementation teams, educational meeting). The implementation outcome is fidelity to the guideline. Hypothesized mediators originate from the COM-B model. A mixed-method design will be employed, entailing a qualitative study of implementation process embedded within the cluster-randomized controlled trail examining implementation mechanisms. The methods will be used in a complementary manner to get a full understanding of the implementation mechanisms. Discussion This implementation study will provide valuable knowledge on how implementation strategies work (or fail) to affect implementation outcomes. The knowledge gained will aid the selection of effective implementation strategies that fit specific determinants, which is a priority for the field. Despite recent initiatives to advance the understanding of implementation mechanisms, studies testing these mechanisms are still uncommon. Trial registration ClinicalTrials.org dr.nr 2020-01214. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01230-7.
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Affiliation(s)
- Lydia Kwak
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Toropova
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rebecca Lengnick-Hall
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm, Stockholm Region, Sweden
| | | | - Charlotte Wåhlin
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Christina Björklund
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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