Readiness to Change Over Time: Change Commitment and Change Efficacy in a Workplace Health-Promotion Trial

Preventive health measures in small and medium-sized enterprises: A scoping review on implementation strategies

OBJECTIVE

To describe implementation strategies for preventive health measures in SMEs and the effectiveness of the strategies on implementation outcomes.

METHODS

A literature search was performed in multiple electronic databases. Studies published between 2000 and 2021 that evaluated the implementation of preventive health measures in SMEs were included. Classification of implementation strategies was based on two complementary classification systems.

RESULTS

Nineteen studies, of which 5 RCTs were included. Eighteen distinct implementation strategies were reported. All studies applied a combination of implementation strategies, and nearly all reported a positive effect on one or more implementation outcomes: sustainability, acceptability, feasibility, penetration, fidelity, adoption, and appropriateness.

CONCLUSIONS

Overall, a positive effect of combined implementation strategies on the implementation outcome(s) was found. The 'distribution of educational materials' and 'provide ongoing consultation' combined show positive effects on sustainability.

Work from home: Facilitators for an effective ergonomic work system

Previous studies on Human Factors and Ergonomics (HFE) have primarily examined the impact of Work-From-Home (WFH) on worker health and well-being, yet little research has examined the optimal implementation process of WFH programs. Work systems perspective suggests that organizational policies, leadership, and psychological factors collectively influence the success of organizational change efforts. Our study explored the roles of managerial/supervisory, psychological, and organizational policy factors in facilitating the relationship between employees' HFE awareness and their acceptance and satisfaction with the WFH arrangement. Using data from 3195 knowledge workers in the US who use computers as their primary work tool and have worked from home at least one day in the past 30 days, we employed structural equation modeling to test our hypotheses. Transformational HFE leadership and employees' general self-efficacy are pivotal in implementing ergonomic WFH arrangements. The combination of employees' HFE awareness, transformational HFE leadership, and adequate levels of self-efficacy may foster positive process outcomes (e.g., readiness for WFH arrangement, workspace design satisfaction) in WFH arrangements. Efforts that are coordinated across organizational levels determine the effectiveness of organizational change.

Determinants of factors affecting readiness of academic institutions to conduct knowledge translation in low- and middle-income countries

Introduction

Capacity building strategies have been used to improve uptake of knowledge translation (KT) activities among academic institutions, but little is known about their effectiveness, contextual responsiveness, and adaptability. Many of these strategies target individuals while few address institutional gaps. This research describes the determinants for conducting KT (or readiness to conduct such activities) at the institutional level across diverse LMIC contexts to inform the development of capacity building strategies.

Methods

We conducted a survey to assess organizational readiness to conduct KT to public health researchers and practitioners from six academic institutions in Bangladesh, Ethiopia, DRC, India, Indonesia and Nigeria and members of a global knowledge-to-action working group. We assessed the frequency of barriers and facilitators to KT and their relationship to age, gender, country, and KT experience. We then performed logistic regression to identify determinants of five underlying factors demonstrated to influence KT readiness in LMICs (Institutional Climate, Organization Change Efficacy, Prioritization and Cosmopolitanism, Self-Efficacy and Financial Resource) along with their composite score, which represented an overall readiness score to conduct KT.

Results

A total of 111 responses were included in the final analysis. Participants represented 10 LMICs; a majority were 30-49 years old (57%) and most were male (53%). Most participants had professional foci in research (84%), teaching (62%), and project coordination (36%) and 59% indicated they had experience with KT. Common facilitators included motivated faculty (57%) and dedicated personnel (40%). Funding (60%), training (37%), and time (37%) were the most frequently reported barriers. In the adjusted model, age, gender, country, and professional focus were significantly associated with at least one factor. Prior experience with KT was significantly and positively (OR = 9.07; CI: 1.60-51.58; p < 0.05) associated with the overall KT readiness to conduct KT.

Discussion

Different KT readiness factors are relevant for younger (institutional climate) vs. older (self-efficacy) academic professionals, suggesting value in cross-generational collaborations. Leadership and gender were both relevant for organizational change efficacy indicating a need to engage leaders and promote women to influence organizational change. Institutions in different countries may be at different stages of change; readiness assessments can be used to systematically identify needs and develop targeted strategies.

Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming

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.

Considerations for Implementing the Post-Concussion Collegiate Return-to-Learn Protocol in the National Collegiate Athletic Association Power 5 Conferences

OBJECTIVE

Although concussions affect millions of young adults annually, researchers have yet to assess factors that may affect future implementation of post-concussion academic supports within higher education. Therefore, we sought to evaluate preimplementation outcomes of the acceptability, feasibility, appropriateness, and readiness for change of the Post-Concussion Collegiate Return-to-Learn (RTL) Protocol among university stakeholders.

SETTING

An online survey.

PARTICIPANTS

A convenience sample ( N = 49; 63.3% female) of athletic trainers (ATs; n = 25, age = 30.1 ± 7.6 years) and university faculty/staff ( n = 24, age = 38.3 ± 9.9 years) across the National Collegiate Athletic Association (NCAA) Power 5 Conferences from January to February 2022.

DESIGN

A cross-sectional study.

MAIN MEASURES

To compare preimplementation outcome measures using the Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), Intervention Appropriateness Measure (IAM), and Organizational Readiness for Implementing Change (ORIC) regarding the RTL protocol between ATs and university faculty/staff. Additional outcomes included internal and external barriers to implementing at their respective institutions. Statistical analyses were conducted using Mann-Whitney U tests, with effect sizes estimated using eta-squared coefficient (η 2 ).

RESULTS

Quantitative analyses yielded no statistically significant group differences ( P s > .05) across the AIM, FIM, and IAM outcomes, indicating both groups perceived the protocol to be acceptable, feasible, and appropriate. Moreover, ATs reported higher agreement regarding motivation, desire, willingness to do "whatever it takes," commitment, and determination to implement the novel protocol than faculty/staff. Further, ATs reported higher agreement regarding their institution's confidence to keep track of its progress, support adjustment, maintain momentum, manage institutional politics, coordinate tasks, encourage investment, and handle the challenges of future implementation of the RTL protocol.

CONCLUSIONS

Preliminary findings suggest ATs and university faculty/staff across the NCAA Power 5 Conferences may perceive the RTL protocol to be acceptable, feasible, and appropriate for future use; however, noteworthy internal and external barriers may influence its uptake. Future research should utilize implementation frameworks to support the protocol's adoption and reach.

Ready, set, go! The role of organizational readiness to predict adoption of a family caregiver training program using the Rogers' diffusion of innovation theory

BACKGROUND

Caregivers FIRST is an evidence-based program addressing gaps in caregivers' skills. In 2020, the Veterans Health Administration Caregiver Support Program (CSP) nationally endorsed Caregivers FIRST, offering credit in leadership performance plans to encourage all VA medical centers (VAMCs) to implement locally. This study examines the association of organizational readiness with VAMC adoption of Caregivers FIRST.

METHODS

In a cohort observational study, we surveyed CSP managers about their facilities' readiness to implement using the Organizational Readiness for Implementing Change (ORIC) instrument and compared change commitment and change efficacy domains among VAMCs "adopters" defined as delivering Caregivers FIRST within 1 year of the national announcement to those that did not ("non-adopters"). Within "adopters," we categorized time to adoption based on Rogers' diffusion of innovation theory including "innovators," "early adopters," "early majority," "late adopters," and "laggards." Organizational readiness and site characteristics (facility complexity, staffing levels, volume of applications for caregiver assistance services) were compared between "adopters," "non-adopters," and between time to adoption subcategories. Separate logistic regression models were used to assess whether ORIC and site characteristics were associated with early adoption among "adopters."

RESULTS

Fifty-one of 63 (81%) VAMCs with CSP manager survey respondents adopted Caregivers FIRST during the first year. ORIC change commitment and efficacy were similar for "adopters" and "non-adopters." However, sites that adopted earlier (innovators and early adopters) had higher ORIC change commitment and efficacy scores than the rest of the "adopters." Logistic regression results indicated that higher ORIC change commitment (odds ratio [OR] = 2.57; 95% confidence interval [CI], 1.11-5.95) and ORIC change efficacy (OR = 2.60; 95% CI, 1.12-6.03) scores were associated with increased odds that a VAMC was an early adopter (categorized as an "innovator," "early adopter", or "early majority"). Site-level characteristics were not associated with Caregivers FIRST early adoption.

CONCLUSIONS

To our knowledge, this study is the first to prospectively assess organizational readiness and the timing of subsequent program adoption. Early adoption was associated with higher ORIC change commitment and change efficacy and not site-level characteristics. These findings yield insights into the role of organizational readiness to accelerate program adoption.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03474380. Registered on March 22, 2018.

Hedonic and eudaimonic well-being for sustainable development in university students: personality traits or acceptance of change?

Introduction

The psychology of sustainability and sustainable development aims to contribute to the establishment of a culture of sustainability regarding the 2030 Agenda and its 17 sustainable development goals.

Methods

In this framework, this study examined the associations between acceptance of change and well-being (hedonic and eudaimonic sides), controlling for the effects of personality traits, in 284 Italian university students.

Results

Acceptance of change explained additional variance over personality traits regarding hedonic and eudaimonic well-being.

Discussion

Acceptance of change could thus represent a promising well-being resource from the perspective of strength-based prevention, opening future perspectives to face the challenges of sustainable development, particularly concerning Goal 3 of the 2030 Agenda: "Good health and well-being."

Role of adaptive leadership in learning organizations to boost organizational innovations with change self-efficacy

The present study investigates the direct impact of learning organizations on organizational innovations and investigates the mediating mechanism of change self-efficacy between learning organizations and organizational innovations. Furthermore, this study proposes adaptive leadership as a moderator between learning organizations, change self-efficacy, and organizational innovations. Three hundred seventy-three permanent employees from the pharmaceutical industry voluntarily participated. Data was collected using a simple random sampling technique through the temporal separation method (One-month interval between two temporal separations). SPSS v.25, AMOS v.22, and Smart-PLS were utilized to analyze reliability, validity, descriptive statistics, and correlations, and PROCESS-macro v3.4 was used for direct, indirect (mediation), and interaction (moderation) effects analysis. The study supports the hypothesized link between learning organizations and organizational innovations. In addition, change self-efficacy partially mediates the learning organizations - organizational innovations relationship. Moreover, adaptive leadership moderates the association between learning organization and organizational innovation, learning organizations and change self-efficacy, and change self-efficacy and organizational innovations relationship. The study's findings suggest that adaptive leadership is imperative not only for higher change self-efficacy of the individuals but also helps the organizations for organizational innovations with the utilization of learning organizations phenomenon. Additionally, this study highlights the importance of change self-efficacy, which plays a vital role in learning organizations for organizational innovations.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04669-z.

Measuring Organizational Readiness for Implementing Change in Primary Care Facilities in Rural Bushbuckridge, South Africa

Meaningful gains in health outcomes require successful implementation of evidence-based interventions. Organizations such as health facilities must be ready to implement efficacious interventions, but tools to measure organizational readiness have rarely been validated outside of high-income settings. We conducted a pilot study of the organizational readiness to implement change (ORIC) measure in public primary care facilities serving Bushbuckridge Municipality in South Africa in early 2019. We administered the 10-item ORIC to 54 nurses and lay counsellors in 9 facilities to gauge readiness to implement the national Central Chronic Medicine Dispensing and Distribution (CCMDD) programme intended to declutter busy health facilities. We used exploratory factor analysis (EFA) to identify factor structure. We used Cronbach alpha and intraclass correlation (ICC) to assess reliability at the individual and facility levels. To assess validity, we drew on existing data from routine clinic monitoring and a 2018 quality assessment to test the correlation of ORIC with facility resources, value of CCMDD programme, and better programme uptake and service quality. Six items from the ORIC loaded onto a single factor with Cronbach's alpha of 0.82 and ICC of 0.23. While facility ORIC score was not correlated with implementation of CCMDD, higher scores were correlated with facility resources, perceived value of the CCMDD program, patient satisfaction with wait time, and greater linkage to care following positive HIV testing. The study is limited by measuring ORIC after programme implementation. The findings support the relevance of ORIC, but identify a need for greater adaptation and validation of the measure.

Human resource competency 4.0 and its impact on Bank Indonesia employees' readiness for transformational change

Purpose

The purpose of this paper is to analyze the influence of factors that affect human resource competency (HRC) 4.0, employee readiness for transformational change as well as analyzing the mediating and moderating factors that influence the relationship of factors such as soft skills training and individual characteristics on employee readiness for transformational change and HRC 4.0.

Design/methodology/approach

This research is a quantitative research with descriptive statistics. The analytical tool used is a structural equation model of partial least squares (PLS). This research was conducted at five Bank Indonesia Offices in Aceh and North Sumatra Provinces. Using a proportional random sampling technique, 200 respondents of employees were selected.

Findings

The results of this study are as follows: (1) both soft skill training and individual characteristics have a significant effect on HRC 4.0; (2) HRC 4.0, soft skill training and individual characteristic have a significant on employee readiness for transformational change; (3) soft skill training has significant effect on employee readiness for transformational change through HRC 4.0; (4) individual characteristic has a significant effect on employee readiness for transformational change through HRC 4.0; (5) the effect of HRC 4.0 on employee readiness for transformational change moderates by transformational leadership; (6) the effect of HRC 4.0 on employee readiness for transformational change moderates by employee commitment to change.

Originality/value

This research contains valuable novelty, which is a new concept of HRC 4.0 that is linked to soft skill training and individual characteristics variables, and employee readiness for transformational change. Furthermore, transformational leadership and employee commitment variables have significant effect in moderating the influence off HRC 4.0 on employee readiness for transformational change.

Examining the sustainability and effectiveness of co-created physical activity interventions in vocational education and training: a multimethod evaluation

Background

Co-creation approaches are increasingly used in physical activity promotion to develop interventions tailored to the target group and setting. The resulting complexity of such interventions raises challenges in evaluation. Accordingly, little is known about the effectiveness of co-created interventions and the underlying processes that impact their sustainable implementation. In this study, we attempt to fill this gap by evaluating co-created multi-component physical activity interventions in vocational education and training in nursing care and automotive mechatronics regarding (1) their sustainable implementation at the institutional level and (2) the effectiveness of single intervention components at the individual level.

Methods

Following a multimethod design, we conducted a questionnaire survey (n = 7) and semi-structured interviews (n = 4) to evaluate the sustainability of the interventions. Quantitative data were analyzed descriptively, and qualitative data were analyzed using qualitative content analysis. To examine the interventions’ effectiveness, we conducted two non-randomized controlled trials (n = 111). Analysis of variance was used to examine differences between groups.

Results

At the institutional level, long-term implementation of single intervention components in nursing care was observed; in contrast, long-term implementation in automotive mechatronics was not observed. In this context, various factors at the outer contextual (e.g., COVID-19 pandemic), inner contextual (e.g., health-promoting leadership), intervention (e.g., acceptance), and personal levels (e.g., champion) influenced sustainability. At the individual level, no significant intervention effects were found for changes in physical activity behavior and physical activity-related health competence.

Conclusion

The role of co-creation on the effectiveness and sustainability of physical activity promotion in vocational education and training cannot be answered conclusively. Only in the nursing care sector, a co-creation approach appeared promising for long-term intervention implementation. Sustainable implementation depends on various influencing factors that should be considered from the outset. Demonstrating effectiveness at the individual level was challenging. To conclusively clarify both the role and impact of co-creation, methodologically complex and elaborate evaluation designs will be required in future research projects.

Trial registration

This study was retrospectively registered at clinicaltrials.gov on 24/08/2021 (NCT05018559).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13133-9.

Continuous learning during crises: achieving change-efficacy, meaningful work and adaptive performance

Purpose

The study aims to examine the association between learning culture and adaptive performance of delivery employees during crises situation. The study develops and tests a model that explains how learning culture, through change-efficacy and meaningful work, influences employees' adaptive performance (including how they handle crisis situations and deal with uncertainty).

Design/methodology/approach

Data was collected from 298 delivery employees working in e-commerce companies throughout India in a time-lagged manner. Regression analysis and structural equation modeling were performed to assess the influence of learning culture, change-efficacy and meaningful work on adaptive performance using SPSS 24. Further, PROCESS macro was used to test the parallel mediation effects through bootstrapping approach.

Findings

The study establishes a significant direct and indirect relationship between learning culture and adaptive performance for employees. Further, underpinning the transformative learning theory (Mezirow, 1997), and job characteristics theory (1976), this study came across two pathways for organizations to transform their learning efforts into improved adaptive performance for employees.

Practical implications

Organizations, particularly in crisis situations, can leverage employees' change-efficacy and meaningful work to connect learning efforts with employees' adaptive performance.

Originality/value

The study contributes significantly to existing theory on transformative learning and job characteristics theory while strengthening the literature on antecedents of employees' adaptive performance, particularly in crises situation.

Assessing Firm Readiness to Adopt Cluster-Based Innovative Projects: A Segmentation Analysis

As innovation has garnered substantial attention on corporate success and sustainability, organizations must evaluate internal contexts to determine potential innovative practices and benefits. Firms need to investigate the determining factors of innovation preparedness as organizational innovation practices are catalyzed through internal elements. This study evaluates small and medium firms’ readiness to adopt and execute collaborative innovative projects within a future cluster and its impacts on organizational advantages, intentions, and attributes. Thereby, three dimensions were considered in examining organizational preparedness, namely, climate, culture, and motivation. A total of 70 firms operating in the labeled agri-food sector in Morocco were interviewed and homogenously classified using integrated hierarchical and non-hierarchical algorithms, following a segmentation approach. Three segments were identified, stressing the degree of organizational readiness to undertake innovative projects within future service clusters. The segments varied according to the firm’s sub-sector, experience, and resources. Considering the association of readiness with benefits and practical aims, the results broaden firm preparedness understanding to adopt innovative projects. The results also illustrate the relevance of adapting both innovative and beneficial project arrangements for firms with minor to moderate experience while addressing current issues across different segments.

PyFF: A Fog-Based Flexible Architecture for Enabling Privacy-by-Design IoT-Based Communal Smart Environments

The advent of the Internet of Things (IoT) and the massive growth of devices connected to the Internet are reshaping modern societies. However, human lifestyles are not evolving at the same pace as technology, which often derives into users' reluctance and aversion. Although it is essential to consider user involvement/privacy while deploying IoT devices in a human-centric environment, current IoT architecture standards tend to neglect the degree of trust that humans require to adopt these technologies on a daily basis. In this regard, this paper proposes an architecture to enable privacy-by-design with human-in-the-loop IoT environments. In this regard, it first distills two IoT use-cases with high human interaction to analyze the interactions between human beings and IoT devices in an environment which had not previously been subject to the Internet of People principles.. Leveraging the lessons learned in these use-cases, the Privacy-enabling Fog-based and Flexible (PyFF) human-centric and human-aware architecture is proposed which brings together distributed and intelligent systems are brought together. PyFF aims to maintain end-users' privacy by involving them in the whole data lifecycle, allowing them to decide which information can be monitored, where it can be computed and the appropriate feedback channels in accordance with human-in-the-loop principles.

Can a participatory organizational intervention improve social capital and organizational readiness to change? Cluster randomized controlled trial at five Danish hospitals

AIM

This study investigates the effect of a participatory organizational intervention on social capital and organizational readiness for change.

DESIGN

Cluster randomized controlled trial.

METHODS

In 2016, 27 departments from five hospitals in Denmark were randomly allocated at the department level to 1 year of participatory intervention (14 clusters, 316 healthcare workers) or a control group (13 clusters, 309 healthcare workers). The participatory intervention consisted of 2 × 2 hr workshops, where managers, 2-5 healthcare workers from each department, and the hospital's health and safety staff, developed action plans for implementing solutions for improving the use of assistive devices at the department throughout the 1-year intervention period. Workplace social capital: (a) within teams (bonding); (b) between teams and nearest leaders (linking A); and (c) between teams and distant leaders (linking B) and organizational readiness for change were measured using questionnaires at baseline, 6, and 12 months.

RESULTS

No group-by-time interaction occurred for any of the outcome measures. However, explorative post hoc analysis showed within-group improvements in bonding and linking B social capital and organizational readiness for change following the participatory intervention.

CONCLUSION

Participatory organizational interventions may improve social capital within teams and between teams and distant leaders and organizational readiness for change.

IMPACT

Implementing participatory interventions at the workplace may be a cost-effective strategy as they provide additional benefits, e.g., increased social capital and improved organizational readiness for change, that exceed the primary outcome of the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02708550) March 2016.

Influence of an Implementation Support Intervention on Barriers and Facilitators to Delivery of a Substance Use Prevention Program

Implementation support interventions have helped organizations implement programs with quality and obtain intended outcomes. For example, a recent randomized controlled trial called Preparing to Run Effective Programs (PREP) showed that an implementation support intervention called Getting To Outcomes (GTO) improved implementation of an evidence-based substance use prevention program (CHOICE) run in community-based settings. However, more information is needed on how these interventions affect organizational barriers and facilitators of implementation. This paper aims to identify differences in implementation facilitators and barriers in sites conducting a substance use prevention program with and without GTO. PREP is a cluster-randomized controlled trial testing GTO, a two-year implementation support intervention, in Boys & Girls Clubs. The trial compares 15 Boys & Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 Boys & Girls Club sites implementing CHOICE supported by GTO (intervention group). All sites received CHOICE training. Intervention sites also received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE, and then evaluate and make quality improvements to CHOICE implementation using feedback reports summarizing their data. Following the second year of CHOICE and GTO implementation, all sites participated in semi-structured interviews to identify barriers and facilitators to CHOICE implementation using the Consolidated Framework for Implementation Research (CFIR). This paper assesses the extent to which these facilitators and barriers differed between intervention and control group. Intervention sites had significantly higher average ratings than control sites for two constructs from the CFIR process domain: planning and reflecting and evaluating. At the same time, intervention sites had significantly lower ratings on the culture and available resources constructs. Findings suggest that strong planning, evaluation, and reflection-likely improved with GTO support-can facilitate implementation even in the face of perceptions of a less desirable implementation climate. These findings highlight that implementation support, such as GTO, is likely to help low-resourced community-based organizations improve program delivery through a focus on implementation processes. TRIAL REGISTRATION: This project is registered at ClinicalTrials.gov with number NCT02135991 (URL: https://clinicaltrials.gov/show/NCT02135991). The trial was first registered May 12, 2014.

Organizational Readiness to Implement System Changes in an Alaskan Tribal Dental Care Organization

INTRODUCTION

Tribal health care systems are striving to implement internal changes to improve dental care access and delivery and reduce health inequities for American Indian and Alaska Native children. Within similar systems, organizational readiness to implement change has been associated with adoption of system-level changes and affected by organizational factors, including culture, resources, and structure.

OBJECTIVES

The objectives of this study were to assess organizational readiness to implement changes related to delivery of evidence-based dental care within a tribal health care organization and determine workforce- and perceived work environment-related factors associated with readiness.

METHODS

A 92-item questionnaire was completed online by 78 employees, including dental providers, dental assistants, and support staff (88% response rate). The questionnaire queried readiness for implementation (Organizational Readiness for Implementing Change), organizational context and resources, workforce issues, organizational functioning, and demographics.

RESULTS

Average scores for the change commitment and change efficacy domains (readiness for implementation) were 3.93 (SD = .75) and 3.85 (SD = .80), respectively, where the maximum best score was 5. Perceived quality of management, a facet of organizational functioning, was the only significant predictor of readiness to implement change (B = .727, SE = .181, P < .0002) when all other variables were accounted for.

CONCLUSION

Results suggest that when staff members (including dentists, dental therapists, hygienists, assistants, and support staff) from a tribal health care organization perceive management to be high quality, they are more supportive of organizational changes that promote evidence-based practices. Readiness-for-change scores indicate an organization capable of institutional adoption of new policies and procedures. In this case, use of more effective management strategies may be one of the changes most critical for enhancing institutional behaviors to improve population health and reduce health inequities.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians and other leaders implementing changes within dental care organizations. To promote organizational readiness for change and, ultimately, more expedient and efficient adoption of system-level changes by stakeholders, consideration should be given to organizational functioning generally and quality of management practices specifically.

The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention

BACKGROUND

Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector.

METHODS

As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS (n = 12) or an attention control placebo (n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked.

RESULTS

A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls.

CONCLUSION

Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018-Retrospectively registered.