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Persaud A, Castro I, Simione M, Smith JD, O'Connor G, Sharifi M, Perkins M, Torres S, Taveras EM, Kuhlthau K, Fiechtner L. Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention. Front Public Health 2022; 10:954063. [PMID: 36091513 PMCID: PMC9454190 DOI: 10.3389/fpubh.2022.954063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/25/2022] [Indexed: 01/24/2023] Open
Abstract
Background Multi-sector stakeholder engagement is essential in the successful implementation, dissemination, and sustainability of pediatric weight management interventions (PWMI), particularly in low-income settings where sustainability relies on external policies and reimbursement. The objective of this study was to engage stakeholders (1) to inform the creation of the intervention with adaptations needed for a successful PWMI in a primary care and community setting and (2) to identify barriers and facilitators to implementation and dissemination. Methods We sought to examine the perspectives of local, state, and national clinic and community stakeholders during the pre-implementation period of a two-arm, randomized trial of a Health Weight Clinic PWMI conducted in two health centers and a modified-Healthy Weight and Your Child PWMI at two local YMCAs that serve a predominantly lower income, Hispanic community. The Consolidated Framework for Implementation Research interview guide served as a template for the study but was modified to fit the PWMIs and the various professional roles. Interviews were transcribed and analyzed using the framework analysis approach and themes were linked to the CFIR domains and constructs. Results Twenty-six stakeholders perceived the following as needed components of a PWMI: a formal curriculum with illustrative examples, a patient- and family-centered program, group visits, and high-quality multidisciplinary personnel. These findings led to the creation of a group visit curriculum, implementation trainings and cross-site collaborative technical assistance. Additionally, creating partnerships between community and clinical organizations, and addressing patient barriers and unmet social needs (i.e., transportation, food) were identified as facilitators to successful implementation. These results led to the creation of community resource guides, connections to community organizations, and screening and referring for unmet social needs. Perceived facilitators of dissemination included proving cost-effectiveness of the PWMI to inform insurance reimbursement for long-term sustainability. Therefore, we collected cost data and engaged with Medicaid officials to discuss reimbursement. Conclusion Findings highlight the importance of engaging multi-sector stakeholders pre-implementation to ensure the components valued are included, ensuring the program minimizes barriers to participation, considering how staff training can improve implementation and how collected outcomes can inform sustainability and dissemination of PWMIs in clinic and community settings.
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Affiliation(s)
- Alicia Persaud
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Ines Castro
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Meg Simione
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Justin D. Smith
- Division of Health Systems Innovation and Research, Department of Population Health Sciences, School of Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, UT, United States
| | - Giselle O'Connor
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, United States
| | - Meghan Perkins
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Shioban Torres
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA, United States
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, Boston, MA, United States
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Foster BA, Seeley K, Davis M, Boone-Heinonen J. Positive deviance in health and medical research on individual level outcomes - a review of methodology. Ann Epidemiol 2022; 69:48-56. [PMID: 34915122 PMCID: PMC9081135 DOI: 10.1016/j.annepidem.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research. METHODS We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement. RESULTS Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely. CONCLUSIONS Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.
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Affiliation(s)
- Byron A Foster
- Department of Pediatrics, Oregon Health & Science University, Portland, OR; School of Public Health, Portland State University and Oregon Health & Science University.
| | - Kylie Seeley
- Department of Pediatrics, Stanford University, Stanford School of Medicine, Palo Alto, CA
| | - Melinda Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, OR
| | - Janne Boone-Heinonen
- School of Public Health, Portland State University and Oregon Health & Science University
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