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Garcia DS, Camacho Carr K, Yuwen W. Exploring readiness for implementing best practices: A mixed methods study. J Eval Clin Pract 2021; 27:1085-1095. [PMID: 33274556 DOI: 10.1111/jep.13520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
RATIONALE Evidence-based practice (EBP) can improve health care in underprivileged countries. Bolivia's EBP movement is nascent and the factors contributing to better implementation in nursing are unknown. AIM To explore Bolivian nurses' readiness to engage in EBP while highlighting the facilitators and barriers for pursuing EBP. METHOD The study used a sequential explanatory mixed methods study. First, general trends were disclosed via a survey of 170 nurses in La Paz, Bolivia, holding at least a baccalaureate regarding their perceived beliefs about EBP. The survey identified facilitators and barriers for implementing EBP in acute and ambulatory settings. Second, qualitative data was gathered via a focus group of nine nurses with the purpose of enhancing the survey results. RESULTS The survey results showed that nurses believe that engaging in EBP can improve their clinical practice. However, the nurses' research behaviors were found to be infrequent. Lack of support from the nurses' clinics and hospitals and from non-nursing professionals were identified as barriers for engaging in EBP. The qualitative results revealed underlying limitations to nurses' clinical practice, including "feeling undervalued". CONCLUSIONS There is a dearth of EBP knowledge among Bolivian nurses stemming from a lack of preparation in EBP environments, including EBP training opportunities. This situation affects nurses' professional dimensions of relational work, power, and collaboration. Collaborative research among educators, professional nursing societies, and local and international organizations could provide initiatives for implementing EBP, based on local health profiles.
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Affiliation(s)
- Daisy S Garcia
- College of Nursing, Seattle University, Seattle, Washington, USA
| | | | - Weichao Yuwen
- School of Nursing and Healthcare Leadership, University of Washington, Tacoma, Washington, USA
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Budd EL, Ying X, Stamatakis KA, deRuyter AJ, Wang Z, Sung P, Pettman T, Armstrong R, Reis R, Brownson RC. Developing a Survey Tool to Assess Implementation of Evidence-Based Chronic Disease Prevention in Public Health Settings Across Four Countries. Front Public Health 2019; 7:152. [PMID: 31245349 PMCID: PMC6579827 DOI: 10.3389/fpubh.2019.00152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 05/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding the contextual factors that influence the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) interventions in public health settings across countries could inform strategies to support the dissemination and implementation of EBCDP interventions globally and more effectively prevent chronic diseases. A survey tool to use across diverse countries is lacking. This study describes the development and reliability testing of a survey tool to assess the stage of dissemination, multi-level contextual factors, and individual and agency characteristics that influence the dissemination and implementation of EBCDP interventions in Australia, Brazil, China, and the United States. Methods: Development of the 26-question survey included, a narrative literature review of extant measures in EBCDP; qualitative interviews with 50 chronic disease prevention practitioners in Australia, Brazil, China, and the United States; review by an expert panel of researchers in EBCDP; and test-retest reliability assessment. Results: A convenience sample of practitioners working in chronic disease prevention in each country completed the survey twice (N = 165). Overall, this tool produced good to moderately reliable responses. Generally, reliability of responses was higher among practitioners from Australia and the United States than China and Brazil. Conclusions: Reliability findings inform the adaptation and further development of this tool. Revisions to four questions are recommended before use in China and revisions to two questions before use in Brazil. This survey tool can contribute toward an improved understanding of the contextual factors that public health practitioners in Australia, Brazil, China, and the United States face in their daily chronic disease prevention work related to the dissemination and implementation of EBCDP interventions. This understanding is necessary for the creation of multi-level strategies and policies that promote evidence-based decision-making and effective prevention of chronic diseases on a more global scale.
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Affiliation(s)
- Elizabeth L. Budd
- Prevention Science Institute, College of Education, University of Oregon, Eugene, OR, United States
| | - Xiangji Ying
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Katherine A. Stamatakis
- College for Public Health and Social Justice, St. Louis University, St. Louis, MO, United States
| | - Anna J. deRuyter
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Zhaoxin Wang
- Tongji University School of Medicine, Shanghai, China
| | - Pauline Sung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, China
| | - Tahna Pettman
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rebecca Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rodrigo Reis
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- School of Health and Biosciences, Pontifical Catholic University of Parana, Curitiba, Brazil
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Furtado KS, Budd EL, Armstrong R, Pettman T, Reis R, Sung-Chan P, Wang Z, Brownson RC. A cross-country study of mis-implementation in public health practice. BMC Public Health 2019; 19:270. [PMID: 30841888 PMCID: PMC6404329 DOI: 10.1186/s12889-019-6591-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/25/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Mis-implementation (i.e., the premature termination or inappropriate continuation of public health programs) contributes to the misallocation of limited public health resources and the sub-optimal response to the growing global burden of chronic disease. This study seeks to describe the occurrence of mis-implementation in four countries of differing sizes, wealth, and experience with evidence-based chronic disease prevention (EBCDP). METHODS A cross-sectional study of 400 local public health practitioners in Australia, Brazil, China, and the United States was conducted from November 2015 to April 2016. Online survey questions focused on how often mis-termination and mis-continuation occur and the most common reasons programs end and continue. RESULTS We found significant differences in knowledge of EBCDP across countries with upwards of 75% of participants from Australia (n = 91/121) and the United States (n = 83/101) reporting being moderately to extremely knowledgeable compared with roughly 60% (n = 47/76) from Brazil and 20% (n = 21/102) from China (p < 0.05). Far greater proportions of participants from China thought effective programs were never mis-terminated (12.2% (n = 12/102) vs. 1% (n = 2/121) in Australia, 2.6% (n = 2/76) in Brazil, and 1.0% (n = 1/101) in the United States; p < 0.05) or were unable to estimate how frequently this happened (45.9% (n = 47/102) vs. 7.1% (n = 7/101) in the United States, 10.5% (n = 8/76) in Brazil, and 1.7% (n = 2/121) in Australia; p < 0.05). The plurality of participants from Australia (58.0%, n = 70/121) and the United States (36.8%, n = 37/101) reported that programs often mis-continued whereas most participants from Brazil (60.5%, n = 46/76) and one third (n = 37/102) of participants from China believed this happened only sometimes (p < 0.05). The availability of funding and support from political authorities, agency leadership, and the general public were common reasons programs continued and ended across all countries. A program's effectiveness or evidence-base-or lack thereof-were rarely reasons for program continuation and termination. CONCLUSIONS Decisions about continuing or ending a program were often seen as a function of program popularity and funding availability as opposed to effectiveness. Policies and practices pertaining to programmatic decision-making should be improved in light of these findings. Future studies are needed to understand and minimize the individual, organizational, and political-level drivers of mis-implementation.
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Affiliation(s)
- Karishma S. Furtado
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | | | - Rebecca Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
| | - Tahna Pettman
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, 3010 Australia
| | - Rodrigo Reis
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | - Pauline Sung-Chan
- Hong Kong University of Science & Technology, Clear Water Bay, Kowloon, Hong Kong
| | | | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine; Washington University in St. Louis, St. Louis, MO 63130 USA
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Budd EL, deRuyter AJ, Wang Z, Sung-Chan P, Ying X, Furtado KS, Pettman T, Armstrong R, Reis RS, Shi J, Mui T, Saunders T, Becker L, Brownson RC. A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries. BMC Health Serv Res 2018; 18:233. [PMID: 29609621 PMCID: PMC5880066 DOI: 10.1186/s12913-018-3054-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/22/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States. METHODS Between February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions). RESULTS Practitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries. CONCLUSIONS This study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.
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Affiliation(s)
- Elizabeth L. Budd
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
- Prevention Science Institute, College of Education, University of Oregon, 5261 University of Oregon, Eugene, OR 97403 USA
| | - Anna J. deRuyter
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | - Zhaoxin Wang
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No .1239 Siping Road, Yangpu District, Shanghai, China
| | - Pauline Sung-Chan
- The Hong Kong Polytechnic University, GH 410 Department of Applied Social Sciences, Hung Hom Kowloon, China
| | - Xiangji Ying
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | - Karishma S. Furtado
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
| | - Tahna Pettman
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Victoria, 3010 Australia
| | - Rebecca Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Victoria, 3010 Australia
| | - Rodrigo S. Reis
- Pontifical Catholic University of Parana, Curitiba, Rua Imaculada Conceicao, 1155, Prado Velho, 80215901 Brazil
| | - Jianwei Shi
- Shanghai Tenth People’s Hospital, Tongji University School of Medicine, No .1239 Siping Road, Yangpu District, Shanghai, China
| | - Tabitha Mui
- The Hong Kong Polytechnic University, GH 410 Department of Applied Social Sciences, Hung Hom Kowloon, China
| | - Tahnee Saunders
- Melbourne School of Population and Global Health, The University of Melbourne, Level 5, 207 Bouverie Street, Victoria, 3010 Australia
| | - Leonardo Becker
- Pontifical Catholic University of Parana, Curitiba, Rua Imaculada Conceicao, 1155, Prado Velho, 80215901 Brazil
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, One Brookings Dr., Campus Box 1196, St. Louis, MO 63130 USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO 63130 USA
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Furtado KS, Budd EL, Ying X, deRuyter AJ, Armstrong RL, Pettman TL, Reis RS, Sung-Chan P, Wang Z, Saunders T, Becker LA, Shi J, Mui LST, Brownson RC. Exploring political influences on evidence-based non-communicable disease prevention across four countries. HEALTH EDUCATION RESEARCH 2018; 33:89-103. [PMID: 29547975 PMCID: PMC6279167 DOI: 10.1093/her/cyy005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 02/05/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
Implementation of evidence-based practices can improve efficiency and effectiveness of public health efforts. Few studies have explored the political contextual factors that impact implementation of evidence-based non-communicable disease prevention (EBNCDP). This study aimed to do so in Australia, Brazil, China and the United States. Investigators conducted 10-13 qualitative, semi-structured interviews of public health practitioners working in functionally similar public health organizations in each country (total N = 50). Study participants were identified through purposive sampling and interviews were structured around an interview guide covering six domains related to EBNCDP. Interviewees from all four countries identified funding as the primary politically-influenced barrier to implementing EBNCDP. Similarly widespread barriers included government funding priorities that shift based on who is in power and the difficulty of convincing policy-makers and funders that non-communicable disease prevention is a wise investment of political capital. Policymakers who are not evidence-driven was another common barrier even in the United States and Australia, where EBNCDP is more established. Findings suggest that political contextual factors influence EBNCDP and vary to an extent by country, though certain factors seem to be universal. This can aid public health practitioners, political leaders, and policymakers in advocating for conditions and policies that encourage evidence-based practice.
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Affiliation(s)
- Karishma S Furtado
- Prevention Research Center in St. Louis, Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
| | - Elizabeth L Budd
- College of Education, University of Oregon, 5261 University of Oregon, Eugene, OR 97403, USA
| | - Xiangji Ying
- T. H. Chan School of Public Health, Harvard University, Massachusetts Hall, Cambridge, MA 02138, USA
| | - Anna J deRuyter
- Prevention Research Center in St. Louis, Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
| | - Rebecca L Armstrong
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Tahna L Pettman
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Rodrigo S Reis
- Prevention Research Center in St. Louis, Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
| | | | | | - Tahnee Saunders
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Leonardo A Becker
- Federal University of Parana, Street Coração de Maria, 92, Curitiba, Brazil
| | | | | | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University, One Brookings Drive, St. Louis, MO 63130, USA
- Department of Surgery, Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, MO 63110, USA
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