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Balis LE, Porter G, Grocke-Dewey M. Demonstration Projects to Test Built Environment Changes: A Systematic Review. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:490-500. [PMID: 37713643 DOI: 10.1097/phh.0000000000001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
CONTEXT Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes. OBJECTIVE To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment. DESIGN Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources. MAIN OUTCOME MEASURES Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility). RESULTS Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment. CONCLUSIONS Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools.
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Affiliation(s)
- Laura E Balis
- Gretchen Swanson Center for Nutrition, Omaha, Nebraska (Dr Balis); University of Nebraska Medical Center, Omaha, Nebraska (Dr Porter); and Montana State University, Bozeman, Montana (Dr Grocke-Dewey)
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Wolfenden L, Hall A, Bauman A, Milat A, Hodder R, Webb E, Mooney K, Yoong S, Sutherland R, McCrabb S. Research outcomes informing the selection of public health interventions and strategies to implement them: A cross-sectional survey of Australian policy-maker and practitioner preferences. Health Res Policy Syst 2024; 22:58. [PMID: 38745326 PMCID: PMC11095011 DOI: 10.1186/s12961-024-01144-4] [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: 07/12/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND A key role of public health policy-makers and practitioners is to ensure beneficial interventions are implemented effectively enough to yield improvements in public health. The use of evidence to guide public health decision-making to achieve this is recommended. However, few studies have examined the relative value, as reported by policy-makers and practitioners, of different broad research outcomes (that is, measures of cost, acceptability, and effectiveness). To guide the conduct of research and better inform public health policy and practice, this study aimed at describing the research outcomes that Australian policy-makers and practitioners consider important for their decision-making when selecting: (a) public health interventions; (b) strategies to support their implementation; and (c) to assess the differences in research outcome preferences between policy-makers and practitioners. METHOD An online value-weighting survey was conducted with Australian public health policy-makers and practitioners working in the field of non-communicable disease prevention. Participants were presented with a list of research outcomes and were asked to select up to five they considered most critical to their decision-making. They then allocated 100 points across these - allocating more points to outcomes perceived as more important. Outcome lists were derived from a review and consolidation of evaluation and outcome frameworks in the fields of public health knowledge translation and implementation. We used descriptive statistics to report relative preferences overall and for policy-makers and practitioners separately. RESULTS Of the 186 participants; 90 primarily identified as policy-makers and 96 as public health prevention practitioners. Overall, research outcomes of effectiveness, equity, feasibility, and sustainability were identified as the four most important outcomes when considering either interventions or strategies to implement them. Scores were similar for most outcomes between policy-makers and practitioners. CONCLUSION For Australian policy-makers and practitioners working in the field of non-communicable disease prevention, outcomes related to effectiveness, equity, feasibility, and sustainability appear particularly important to their decisions about the interventions they select and the strategies they employ to implement them. The findings suggest researchers should seek to meet these information needs and prioritize the inclusion of such outcomes in their research and dissemination activities. The extent to which these outcomes are critical to informing the decision of policy-makers and practitioners working in other jurisdictions or contexts warrants further investigation.
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Affiliation(s)
- Luke Wolfenden
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.
| | - Alix Hall
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Adrian Bauman
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Prevention Research Collaboration, Charles Perkins Centre, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Australian Prevention Partnership Centre, Sydney, NSW, Australia
| | - Andrew Milat
- School of Public Health, University of Sydney, Sydney, NSW, Australia
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
| | - Rebecca Hodder
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Emily Webb
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
| | - Kaitlin Mooney
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
| | - Serene Yoong
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
- School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, 3122, Australia
- Global Nutrition and Preventive Health, Institute of Health Transformation, School of Health and Social Development, Deakin University, Burwood, VIC, Australia
| | - Rachel Sutherland
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Sam McCrabb
- Faculty of Health and Medicine, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, 2318, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
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Young KWD, Kwok CYT, Ng YNP, Ng SM, Chen QRJ. Multicomponent Intervention on Improving the Cognitive Ability of Older Adults with Mild Cognitive Impairment: A Pilot Randomized Controlled Trial. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:492-514. [PMID: 38590208 DOI: 10.1080/01634372.2024.2338066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
This pilot randomized controlled trial aimed to evaluate the feasibility and potential outcomes of an innovative 16-session multicomponent intervention model to improve cognitive abilities in older adults with mild cognitive impairment (MCI) by promoting healthy lifestyle, cognitive skills, tai chi and mindfulness practices. This study was a multicentre, randomized controlled, two-arm, parallel-group, unblinded trial in Hong Kong. 57 Chinese older adults with MCI recruited from three local elderly centers were randomly assigned to either the control or intervention group. The study results support the feasibility and efficacy of the multicomponent intervention, and recommend future larger-scale randomized control trials.
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Affiliation(s)
- Kim-Wan Daniel Young
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, China
| | - Chi-Yui Timothy Kwok
- Department of Medicine/Geriatric Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Yat-Nam Petrus Ng
- Department of Social Work, Hong Kong Baptist University, Hong Kong, China
| | - Siu-Man Ng
- Department of Social Work & Social Administration, University of Hong Kong, Hong Kong, China
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Bartholomew TS, Plesons M, Serota DP, Alonso E, Metsch LR, Feaster DJ, Ucha J, Suarez E, Forrest DW, Chueng TA, Ciraldo K, Brooks J, Smith JD, Barocas JA, Tookes HE. Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services. Addict Sci Clin Pract 2024; 19:21. [PMID: 38528570 PMCID: PMC10964520 DOI: 10.1186/s13722-024-00447-9] [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: 09/26/2023] [Accepted: 02/13/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND People who inject drugs (PWID) remain a high priority population under the federal Ending the HIV Epidemic initiative with 11% of new HIV infections attributable to injection drug use. There is a critical need for innovative, efficacious, scalable, and community-driven models of healthcare in non-stigmatizing settings for PWID. We seek to test a Comprehensive-TeleHarm Reduction (C-THR) intervention for HIV prevention services delivered via a syringe services program (SSP). METHODS The CHARIOT trial is a hybrid type I effectiveness-implementation study using a parallel two-arm randomized controlled trial design. Participants (i.e., PWID; n = 350) will be recruited from a syringe services program (SSP) in Miami, Florida. Participants will be randomized to receive either C-THR or non-SSP clinic referral and patient navigation. The objectives are: (1) to determine if the C-THR intervention increases engagement in HIV prevention (i.e., HIV pre-exposure prophylaxis; PrEP or medications for opioid use disorder; MOUD) compared to non-SSP clinic referral and patient navigation, (2) to examine the long-term effectiveness and cost-effectiveness of the C-THR intervention, and (3) to assess the barriers and facilitators to implementation and sustainment of the C-THR intervention. The co-primary outcomes are PrEP or MOUD engagement across follow-up at 3, 6, 9 and 12 months. For PrEP, engagement is confirmed by tenofovir on dried blood spot or cabotegravir injection within the previous 8 weeks. For MOUD, engagement is defined as screening positive for norbuprenorphine or methadone on urine drug screen; or naltrexone or buprenorphine injection within the previous 4 weeks. Secondary outcomes include PrEP adherence, engagement in HCV treatment and sustained virologic response, and treatment of sexually transmitted infections. The short and long term cost-effectiveness analyses and mixed-methods implementation evaluation will provide compelling data on the sustainability and possible impact of C-THR on comprehensive HIV prevention delivered via SSPs. DISCUSSION The CHARIOT trial will be the first to our knowledge to test the efficacy of an innovative, peer-led telehealth intervention with PWID at risk for HIV delivered via an SSP. This innovative healthcare model seeks to transform the way PWID access care by bypassing the traditional healthcare system, reducing multi-level barriers to care, and meeting PWID where they are. TRIAL REGISTRATION ClinicalTrials.gov NCT05897099. Trial registry name: Comprehensive HIV and Harm Prevention Via Telehealth (CHARIOT). Registration date: 06/12/2023.
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Affiliation(s)
- Tyler S Bartholomew
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.
| | - Marina Plesons
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - David P Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth Alonso
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Biostatistics Division, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jessica Ucha
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA
| | - Edward Suarez
- Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W Forrest
- Department of Anthropology, University of Miami, Miami, FL, USA
| | - Teresa A Chueng
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Katrina Ciraldo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jimmie Brooks
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City, Utah, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hansel E Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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Pinto R, Canário C, Leijten P, Rodrigo MJ, Cruz O. Implementation of Parenting Programs in Real-World Community Settings: A Scoping Review. Clin Child Fam Psychol Rev 2024; 27:74-90. [PMID: 38062309 PMCID: PMC10920434 DOI: 10.1007/s10567-023-00465-0] [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] [Accepted: 11/06/2023] [Indexed: 03/08/2024]
Abstract
Implementing parenting programs in real-world community settings is fundamental to making effective programs widely available and consequently improving the lives of children and their families. Despite the literature acknowledging that the high-quality implementation of parenting programs is particularly challenging in real-world community settings, little is known about how the programs are implemented in these settings. This scoping review followed the methodological framework described by the Joanna Briggs Institute to map evidence on how evidence-based parenting programs have been implemented under real-world conditions. A systematic search of 12 scientific databases, gray literature, and the reference lists of the included studies identified 1918 records, of which 145 were included in the review. Fifty-three parenting programs were identified in studies documenting implementation in real-world community settings worldwide. Most studies included families in psychosocial risk engaged with family-support agencies. The qualitative synthesis identified several implementation outcomes, adaptations, barriers, and facilitators. Most studies reported a maximum of two implementation outcomes, mainly fidelity and acceptability. Providers frequently made adaptations, mainly to bring down barriers and to tailor the program to improve its fit. Findings highlight the need for a more detailed description of the implementation of programs, with greater consistency in terminology, operationalization, and measurement of implementation outcomes across studies. This will promote a more transparent, consistent, and accurate evaluation and reporting of implementation and increase the public health impact of parenting programs. Future studies should also assess the impact of adaptations and the cost-effectiveness and sustainability of programs in real-world community settings.
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Affiliation(s)
- Rita Pinto
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.
| | - Catarina Canário
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Patty Leijten
- Research Institute for Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria José Rodrigo
- Department of Developmental Psychology and Education, Faculty of Psychology, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Orlanda Cruz
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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Mustanski B, Queiroz A, Merle JL, Zamantakis A, Zapata JP, Li DH, Benbow N, Pyra M, Smith JD. A Systematic Review of Implementation Research on Determinants and Strategies of Effective HIV Interventions for Men Who Have Sex with Men in the United States. Annu Rev Psychol 2024; 75:55-85. [PMID: 37722749 PMCID: PMC10872355 DOI: 10.1146/annurev-psych-032620-035725] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Men who have sex with men (MSM) are disproportionately affected by HIV, accounting for two-thirds of HIV cases in the United States despite representing ∼5% of the adult population. Delivery and use of existing and highly effective HIV prevention and treatment strategies remain suboptimal among MSM. To summarize the state of the science, we systematically review implementation determinants and strategies of HIV-related health interventions using implementation science frameworks. Research on implementation barriers has focused predominantly on characteristics of individual recipients (e.g., ethnicity, age, drug use) and less so on deliverers (e.g., nurses, physicians), with little focus on system-level factors. Similarly, most strategies target recipients to influence their uptake and adherence, rather than improving and supporting implementation systems. HIV implementation research is burgeoning; future research is needed to broaden the examination of barriers at the provider and system levels, as well as expand knowledge on how to match strategies to barriers-particularly to address stigma. Collaboration and coordination among federal, state, and local public health agencies; community-based organizations; health care providers; and scientists are important for successful implementation of HIV-related health innovations.
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Affiliation(s)
- Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Dennis H Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nanette Benbow
- Third Coast Center for AIDS Research, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Maria Pyra
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA;
| | - Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Li Z, Laginha KJ, Boyle F, Daly M, Dinner F, Hirsch P, Hobbs K, Kirsten L, Mazariego C, McAuley R, O'Brien M, O'Reilly A, Taylor N, Tobin L, Lewis S, Smith AL. Professionally led support groups for people living with advanced or metastatic cancer: a systematic scoping review of effectiveness and factors critical to implementation success within real-world healthcare and community settings. J Cancer Surviv 2024:10.1007/s11764-023-01515-w. [PMID: 38191752 DOI: 10.1007/s11764-023-01515-w] [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: 09/08/2023] [Accepted: 12/17/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE To examine the effectiveness of professionally led support groups for people with advanced or metastatic cancer, and identify factors critical to implementation success within real-world settings. METHODS Databases (MEDLINE; PsychINFO; CINAHL) and grey literature were searched for empirical publications and evaluations. Articles were screened for eligibility and data systematically extracted, charted and summarised using a modified scoping review methodology. Implementation factors were mapped using Proctor's implementation framework and the Consolidated Framework for Implementation Research 2.0. RESULTS A total of 1691 publications were identified; 19 were eligible for inclusion (8 randomised controlled trials, 7 qualitative studies, 2 cohort studies, 2 mixed methods studies). Most (n=18) studies focused on tumour-specific support groups. Evidence supported professionally led support groups in reducing mood disturbances (n=5), distress (i.e. traumatic stress, depression) (n=4) and pain (n=2). Other benefits included social connectedness (n=6), addressing existential distress (n=5), information and knowledge (n=6), empowerment and sense of control (n=2), relationships with families (n=2) and communication with health professionals (n=2). Thirteen studies identified factors predicting successful adoption, implementation or sustainment, including acceptability (n=12; 63%), feasibility (n=6; 32%) and appropriateness (n=1; 5%). Key determinants of successful implementation included group leaders' skills/experience, mode of operation, travelling distance, group composition and membership and resourcing. CONCLUSIONS Professionally led tumour-specific support groups demonstrate effectiveness in reducing mood disturbances, distress and pain among patients. Successful implementation hinges on factors such as leadership expertise, operational methods and resource allocation. IMPLICATIONS FOR CANCER SURVIVORS Professionally led support groups may fill an important gap in supportive care for people with advanced or metastatic cancer.
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Affiliation(s)
- Zhicheng Li
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia
| | - Kitty-Jean Laginha
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Frances Boyle
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michele Daly
- Cancer Institute NSW, Consumer Advisory Panel, Sydney, NSW, Australia
| | | | - Pia Hirsch
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | - Kim Hobbs
- Westmead Centre for Gynaecological Cancers, Westmead, NSW, Australia
| | | | - Carolyn Mazariego
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Mary O'Brien
- Advanced Breast Cancer Group, Brisbane, Qld, Australia
| | | | - Natalie Taylor
- Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Tobin
- Breast Cancer Network Australia, Camberwell, VIC, Australia
| | - Sophie Lewis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrea L Smith
- The Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Rm 111b, Edward Ford Building (A27), Camperdown, NSW, 2006, Australia.
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Toll K, Moullin JC, Andrew S, Williams A, Varhol R, Carey TA, Robinson S. Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol. Digit Health 2024; 10:20552076241242790. [PMID: 38571877 PMCID: PMC10989039 DOI: 10.1177/20552076241242790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Background Virtual healthcare solutions are proposed as a way to combat the inequity of access to healthcare in rural and remote areas, and to better support the front-line providers who work in these areas. Rural provider-to-provider telehealth (RPPT) connects rural and remote clinicians to a 'hub' of healthcare specialists who can increase access to emergency and specialised healthcare via an integrated model. Reported benefits for the place-based provider include enhanced knowledge, expanded professional development opportunities, improved scope of practice, and increased confidence in treating more complex cases. These reported benefits could have implications for supporting and futureproofing our health workforce in terms of productivity, burnout, recruitment, and retention. Methods The research uses an explanatory sequential mixed methods approach across multiple phases to evaluate the current implementation of Western Australia Country Health Service's (WACHS) Command Centre (CC) services and explore factors associated with their differential use. The primary population of interest and participants in this study are the place-based providers in country Western Australia (WA). Patient data constitutes the secondary population, informing the access and reach of CC services into country WA. Data collection will include service data, an online survey, and semi-structured interviews with the primary population. The data will be interpreted to inform evidence-based strategies and recommendations to improve the implementation and sustainment of RPPT. Discussion Innovative and sustained workforce models and solutions are needed globally. Virtual healthcare, including provider-to-provider models, demonstrate potential, especially in rural and remote areas, designed to increase access to specialised expertise for patients and to support the local workforce. This research will generate new data around behaviour, perceptions, and value from the WACHS rural and remote workforce about provider-to-provider telehealth, to explore the implementation and investigate strategies for the long-term sustainment of RPPT services.
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Affiliation(s)
- Kaylie Toll
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Stephen Andrew
- WA Country Health Service, Command Centre, Perth, Western Australia, Australia
| | - Aled Williams
- WA Country Health Service, Command Centre, Perth, Western Australia, Australia
| | - Richard Varhol
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Timothy A Carey
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Robinson
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Tan TC, Roslan NEB, Li JW, Zou X, Chen X, Santosa A. Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study. JMIR Form Res 2023; 7:e49239. [PMID: 37219234 PMCID: PMC11019963 DOI: 10.2196/49239] [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: 05/23/2023] [Revised: 08/27/2023] [Accepted: 11/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Chatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. OBJECTIVE We aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). METHODS We administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. RESULTS Between June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients' comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. CONCLUSIONS This study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts.
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Affiliation(s)
- Tze Chin Tan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
| | - Nur Emillia Binte Roslan
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - James Weiquan Li
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Xinying Zou
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Xiangmei Chen
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Anindita Santosa
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Division of Rheumatology and Immunology, Department of Medicine, Changi General Hospital, Singapore, Singapore
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10
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Studts CR, Ford B, Glasgow RE. RE-AIM implementation outcomes and service outcomes: what's the connection? results of a cross-sectional survey. BMC Health Serv Res 2023; 23:1417. [PMID: 38102634 PMCID: PMC10722784 DOI: 10.1186/s12913-023-10422-w] [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: 04/14/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Implementation science and health services outcomes research each focus on many constructs that are likely interrelated. Both fields would be informed by increased understanding of these relationships. However, there has been little to no investigation of the relationships between implementation outcomes and service outcomes, despite general acknowledgement that both types of outcomes are important in the pathway to individual and population health outcomes. Given the lack of objective data about the links between implementation and service outcomes, an initial step in elucidating these relationships is to assess perceptions of these relationships among researchers and practitioners in relevant fields. The purpose of this paper is to assess perceived relationships between Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outcomes and service outcomes, testing five a priori hypotheses about which perceived relationships may be strongest. METHODS A cross-sectional online survey was administered to a convenience sample of implementation scientists, health services researchers, and public health and medical practitioners from a variety of settings. Respondents provided information on their discipline, training, practice and research settings, and levels of experience in health service outcomes research, implementation science, and the RE-AIM framework. Next, they rated perceived relationships between RE-AIM and service outcomes. Repeated measures analysis of variance were used to test a priori hypotheses. Exploratory analyses assessed potential differences in mean ratings across groups of respondents categorized by discipline, setting, and levels of implementation science, health services, and RE-AIM experience. RESULTS Surveys were completed by 259 respondents, most of whom were employed in academic and medical settings. The majority were doctoral-level researchers and educators or physicians. Reported levels of experience with implementation research, health services research, and the RE-AIM framework varied. The strongest perceived relationships overall were between Implementation/Fidelity and Effectiveness (as a service outcome); Maintenance and Efficiency; Reach and Equity; Adoption and Equity; Implementation/Adaptation and Patient-Centeredness; Adoption and Patient-Centeredness; and Implementation/Fidelity and Safety. All but one of the a priori hypotheses were supported. No significant differences in ratings of perceived relationships were observed among subgroups of respondents. CONCLUSIONS This study is an initial step in developing conceptual understanding of the links between implementation outcomes, health services outcomes, and health outcomes. Our findings on perceived relationships between RE-AIM and services outcomes suggest some areas of focus and identify several areas for future research to advance both implementation science and health services research toward common goals of improving health outcomes.
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Affiliation(s)
- Christina R Studts
- Department of Pediatrics, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, 1890 N. Revere Ct., Aurora, CO, 80045, USA.
| | - Bryan Ford
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Russell E Glasgow
- Department of Family Medicine, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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11
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Holtrop K, Casaburo G, Hickman T, Yzaguirre MM, Young D. The acceptability and preliminary effectiveness of a brief, online parenting program: Expanding access to Evidence-Based parenting intervention content. FAMILY PROCESS 2023; 62:1506-1523. [PMID: 37039325 DOI: 10.1111/famp.12883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
Parenting interventions are a promising means for preventing and treating a variety of child behavior and conduct problems; yet, many families lack access to such services. Online parenting programs offer an opportunity to mitigate many barriers to intervention access by extending service delivery options. The purpose of the present study was to evaluate the acceptability and preliminary effectiveness of a brief, online parenting program. We developed a new online parenting program based on foundational content from the evidence-based GenerationPMTO intervention and used a mixed-methods, single-arm open trial (pre-post) design to perform a preliminary evaluation. The combined results from the quantitative and qualitative data provide initial support for the acceptability and preliminary effectiveness of the online program, based on participant self-report data from program completers. Participants indicated high levels of acceptability for the program topics and videos. They also reported statistically significant improvements from baseline to 4 weeks postintervention in parental efficacy, parenting practices, and child behavior problems. The qualitative data corroborated and expanded these findings. We go on to discuss important accessibility and sustainability considerations addressed by this online parenting program as well as to suggest implications for intervention research and mental health practice.
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Affiliation(s)
| | | | | | | | - Deja Young
- Michigan State University, East Lansing, Michigan, USA
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12
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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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13
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Dopp AR, Hunter SB, Godley MD, González I, Bongard M, Han B, Cantor J, Hindmarch G, Lindquist K, Wright B, Schlang D, Passetti LL, Wright KL, Kilmer B, Aarons GA, Purtle J. Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study. Implement Sci 2023; 18:50. [PMID: 37828518 PMCID: PMC10571404 DOI: 10.1186/s13012-023-01305-z] [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: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | | | - Michelle Bongard
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kerry Lindquist
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Blanche Wright
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Danielle Schlang
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr. (0812), La Jolla, San Diego, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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14
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Glasgow RE, Brtnikova M, Dickinson LM, Carroll JK, Studts JL. Implementation strategies preferred by primary care clinicians to facilitate cancer prevention and control activities. J Behav Med 2023; 46:821-836. [PMID: 37031347 PMCID: PMC10098247 DOI: 10.1007/s10865-023-00400-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/09/2023] [Indexed: 04/10/2023]
Abstract
Key clinical and community members need to be involved in the identification of feasible and impactful implementation strategies for translation of evidence-based interventions into practice. While a wide range of implementation strategies has been developed, there is little research on their applicability for cancer prevention and control (CPC) efforts in primary care. We conducted a survey of primary care physicians to identify implementation strategies they perceive as most feasible and impactful. The survey included both primary prevention behavior change counseling and cancer screening issues. Analyses contrasted ratings of feasibility and impact of nine implementation strategies, and among clinicians in different settings with a focus on comparisons between clinicians in rural vs. non-rural settings. We recruited a convenience sample of 326 respondents from a wide range of practice types from four practice-based research networks in 49 states and including 177 clinicians in rural settings. Ratings of impact were somewhat higher than those for feasibility. Few of the nine implementation strategies were high on both impact and feasibility. Only 'adapting to my practice' was rated higher than a 4 ("moderate") on both impact and feasibility. There were relatively few differences between rural and non-rural clinicians or associated with other clinician or setting characteristics. There is considerable variability in perceived impact and feasibility of implementation strategies for CPC activities among family medicine clinicians. It is important to assess both feasibility and impact of implementation strategies as well as their generalizability across settings. Our results suggest that optimal strategies to implement evidence-based CPC activities will likely need to be adapted for primary care settings. Future research is needed to replicate these findings and identify practical, implementation partner informed implementation strategies.
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Affiliation(s)
- Russell E Glasgow
- Department of Family Medicine, University of Colorado School of Medicine, 1844 Kona St. Eugene, Aurora, CO, OR 97403-2142, USA.
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Michaela Brtnikova
- Adult and Child Center for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado School of Medicine, 1844 Kona St. Eugene, Aurora, CO, OR 97403-2142, USA
| | - Jennifer K Carroll
- Department of Family Medicine, University of Colorado School of Medicine, 1844 Kona St. Eugene, Aurora, CO, OR 97403-2142, USA
- American Academy of Family Physicians National Research Network, Leawood, KS, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Cancer Center, Aurora, CO, USA
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15
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Zeldman J, Salloum RG, Mobley AR. Implementing Successful Early Childhood Obesity Prevention Interventions: The Need for Family-Based Effectiveness-Implementation Hybrid Studies. J Acad Nutr Diet 2023; 123:1409-1416. [PMID: 37247755 DOI: 10.1016/j.jand.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Jamie Zeldman
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
| | - Amy R Mobley
- Department of Health Education and Behavior, University of Florida, Gainesville, Florida.
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16
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Smith MJ, Sherwood K, Sung C, Williams ED, Ross B, Sharma S, Sharma A, Harrington M, Brown C, Telfer D, Bond J, Toda S, Kearon D, Morrow S, Lovelace T, Dababnah S, Kattari SK, Magaña S, Watkins T, Liggett C, Riddle E, Smith JD, Hume K, Dawkins T, Baker-Ericzén M, Eack SM, Sinco B, Burke-Miller JK, Olsen D, Elkins J, Humm L, Steacy C. Enhancing pre-employment transition services: A type 1 hybrid randomized controlled trial protocol for evaluating WorkChat: A Virtual Workday among autistic transition-age youth. Contemp Clin Trials Commun 2023; 34:101153. [PMID: 37456506 PMCID: PMC10338963 DOI: 10.1016/j.conctc.2023.101153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/14/2023] [Indexed: 07/18/2023] Open
Abstract
Autistic transition-age youth experience high rates of unemployment and underemployment, in part due to the social challenges they may face when having conversations in the workplace. In an effort to help enhance conversational abilities in the workplace, our collaborative team partnered to develop WorkChat: A Virtual Workday. Specifically, our team of scientists, community partners, and diversity and inclusion experts participated in a community-engaged process to develop WorkChat using iterative feedback from autistic transition-age youth and their teachers. With initial development complete, this study reports on the protocol that our collaborative team developed, reviewed, and approved to conduct a randomized controlled trial (RCT) to evaluate the real-world effectiveness and initial implementation process outcomes of WorkChat when integrated into post-secondary pre-employment transition services (Pre-ETS). Our aims are to: 1) evaluate whether services-as-usual in combination with WorkChat, compared to services-as-usual with an attention control, enhances social cognition and work-based social ability (between pre- and post-test); reduces anxiety about work-based social encounters (between pre- and post-test), and increases sustained employment by 9-month follow-up; 2) evaluate whether social cognitive ability and work-based social ability mediate the effect of WorkChat on sustained employment; and 3) conduct a multilevel, mixed-method process evaluation of WorkChat implementation.
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Affiliation(s)
- Matthew J. Smith
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Kari Sherwood
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Psychology, Ann Arbor, MI, USA
| | - Connie Sung
- Michigan State University, East Lansing, MI, USA
| | - Ed-Dee Williams
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Brittany Ross
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Sagun Sharma
- Michigan State University, East Lansing, MI, USA
| | - Apara Sharma
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | | | | | | | - Justine Bond
- Michigan Rehabilitation Services, Lansing, MI, USA
| | - Sen Toda
- Michigan Career and Technical Institute, Plainwell, MI, USA
| | | | | | - Temple Lovelace
- Advanced Education Research & Development Fund, Oakland, CA, USA
| | - Sarah Dababnah
- University of Maryland, School of Social Work, Baltimore, MD, USA
| | - Shanna K. Kattari
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
- University of Michigan, Department of Women's and Gender Studies, Ann Arbor, MI, USA
| | - Sandra Magaña
- University of Texas, School of Social Work, Austin, TX, USA
| | - Tikia Watkins
- Walled Lake Consolidated Schools, Walled Lake, MI, USA
| | | | | | - Justin D. Smith
- University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Kara Hume
- University of North Carolina, School of Education, Chapel Hill, NC, USA
| | - Tamara Dawkins
- University of North Carolina, Department of Psychiatry, Chapel Hill, NC, USA
| | - Mary Baker-Ericzén
- San Diego State University, Interwork Institute and Department of Administration, Rehabiliation, and Post-Secondary Education, San Diego, CA, USA
| | - Shaun M. Eack
- University of Pittsburgh, School of Social Work and Department of Psychiatry, Pittsburgh, PA, USA
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17
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Hübsch C, Clarenbach C, Chadwick P, Peterer M, Beckmann S, Naef R, Schmid-Mohler G. Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional's Perspective - A Mixed Method Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1487-1497. [PMID: 37489242 PMCID: PMC10363352 DOI: 10.2147/copd.s404712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/30/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it. Methods Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results. Results A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention's overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician's resources and difficulties in adaptability. Conclusion While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.
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Affiliation(s)
- Christine Hübsch
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christian Clarenbach
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Paul Chadwick
- Centre for Behaviour Change, University College London, London, UK
| | - Matthias Peterer
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Beckmann
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Gabriela Schmid-Mohler
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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18
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Turon H, Wolfenden L, Finch M, McCrabb S, Naughton S, O'Connor SR, Renda A, Webb E, Doherty E, Howse E, Harrison CL, Love P, Smith N, Sutherland R, Yoong SL. Dissemination of public health research to prevent non-communicable diseases: a scoping review. BMC Public Health 2023; 23:757. [PMID: 37095484 PMCID: PMC10123991 DOI: 10.1186/s12889-023-15622-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Dissemination is a critical element of the knowledge translation pathway, and a necessary step to ensure research evidence is adopted and implemented by key end users in order to improve health outcomes. However, evidence-based guidance to inform dissemination activities in research is limited. This scoping review aimed to identify and describe the scientific literature examining strategies to disseminate public health evidence related to the prevention of non-communicable diseases. METHODS Medline, PsycInfo and EBSCO Search Ultimate were searched in May 2021 for studies published between January 2000 and the search date that reported on the dissemination of evidence to end users of public health evidence, within the context of the prevention of non-communicable diseases. Studies were synthesised according to the four components of Brownson and colleagues' Model for Dissemination of Research (source, message, channel and audience), as well as by study design. RESULTS Of the 107 included studies, only 14% (n = 15) directly tested dissemination strategies using experimental designs. The remainder primarily reported on dissemination preferences of different populations, or outcomes such as awareness, knowledge and intentions to adopt following evidence dissemination. Evidence related to diet, physical activity and/or obesity prevention was the most disseminated topic. Researchers were the source of disseminated evidence in over half the studies, and study findings/knowledge summaries were more frequently disseminated as the message compared to guidelines or an evidence-based program/intervention. A broad range of dissemination channels were utilised, although peer-reviewed publications/conferences and presentations/workshops predominated. Practitioners were the most commonly reported target audience. CONCLUSIONS There is a significant gap in the peer reviewed literature, with few experimental studies published that analyse and evaluate the effect of different sources, messages and target audiences on the determinants of uptake of public health evidence for prevention. Such studies are important as they can help inform and improve the effectiveness of current and future dissemination practices in public health contexts.
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Affiliation(s)
- Heidi Turon
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Meghan Finch
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Shaan Naughton
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, 3220, Australia
| | - Sean R O'Connor
- School of Psychology, Queen's University Belfast, Malone Road, Belfast, BT9 5BN, Northern Ireland
| | - Ana Renda
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Sydney Local Health District, Camperdown, NSW, 2050, Australia
| | - Emily Webb
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Emma Doherty
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Glebe, NSW, 2037, Australia
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, 3168, Australia
| | - Penelope Love
- Faculty of Health, School of Exercise and Nutrition Sciences (SENS), Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, VIC, Australia
| | - Natasha Smith
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, 3220, Australia
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19
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Sperber NR, Boucher N, Hughes JM, Bruening R, Zullig LL, Decosimo K, Tucker M, Christensen LA, Allen KD, Hastings SN, Van Houtven CH. Mandated Caregiver Training in the Veterans Health Administration: Caregiver Inquiry Informs National Dissemination. THE GERONTOLOGIST 2023; 63:534-544. [PMID: 36327120 PMCID: PMC10461180 DOI: 10.1093/geront/gnac162] [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: 03/15/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported the implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination. RESEARCH DESIGN AND METHODS This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning, and interview questions elicited caregivers' reports about the value of the program for them. RESULTS Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit. DISCUSSION AND IMPLICATIONS Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.
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Affiliation(s)
- Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Nathan Boucher
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Sanford School of Public Policy, Duke University, Durham, North Carolina, USA
| | - Jaime M Hughes
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Rebecca Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kasey Decosimo
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Matthew Tucker
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
| | - Leah A Christensen
- Veteran's Health Administration Central Office, Washington, District of Columbia, USA
| | - Kelli D Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney H Van Houtven
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
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20
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Riester MR, Zullo AR. Prediction tool Development and Implementation in pharmacy praCTice (PreDICT) proposed guidance. Am J Health Syst Pharm 2023; 80:111-123. [PMID: 36242567 DOI: 10.1093/ajhp/zxac298] [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: 10/13/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Proposed guidance is presented for Prediction tool Development and Implementation in pharmacy praCTice (PreDICT). This guidance aims to assist pharmacists and their collaborators with planning, developing, and implementing custom risk prediction tools for use by pharmacists in their own health systems or practice settings. We aimed to describe general considerations that would be relevant to most prediction tools designed for use in health systems or other pharmacy practice settings. SUMMARY The PreDICT proposed guidance is organized into 3 sequential phases: (1) planning, (2) development and validation, and (3) testing and refining prediction tools for real-world use. Each phase is accompanied by a checklist of considerations designed to be used by pharmacists or their trainees (eg, residents) during the planning or conduct of a prediction tool project. Commentary and a worked example are also provided to highlight some of the most relevant and impactful considerations for each phase. CONCLUSION The proposed guidance for PreDICT is a pharmacist-focused set of checklists for planning, developing, and implementing prediction tools in pharmacy practice. The list of considerations and accompanying commentary can be used as a reference by pharmacists or their trainees before or during the completion of a prediction tool project.
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Affiliation(s)
- Melissa R Riester
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Andrew R Zullo
- Departments of Health Services, Policy, and Practice and Epidemiology, Brown University School of Public Health, Providence, RI.,Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA
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21
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Damschroder LJ, Miech EJ, Freitag MB, Evans R, Burns JA, Raffa SD, Goldstein MG, Annis A, Spohr SA, Wiitala WL. Facility-level program components leading to population impact: a coincidence analysis of obesity treatment options within the Veterans Health Administration. Transl Behav Med 2022; 12:1029-1037. [PMID: 36408955 DOI: 10.1093/tbm/ibac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Obesity is a well-established risk factor for increased morbidity and mortality. Comprehensive lifestyle interventions, pharmacotherapy, and bariatric surgery are three effective treatment approaches for obesity. The Veterans Health Administration (VHA) offers all three domains but in different configurations across medical facilities. Study aim was to explore the relationship between configurations of three types of obesity treatments, context, and population impact across VHA using coincidence analysis. This was a cross-sectional analysis of survey data describing weight management treatment components linked with administrative data to compute population impact for each facility. Coincidence analysis was used to identify combinations of treatment components that led to higher population impact. Facilities with higher impact were in the top two quintiles for (1) reach to eligible patients and (2) weight outcomes. Sixty-nine facilities were included in the analyses. The final model explained 88% (29/33) of the higher-impact facilities with 91% consistency (29/32) and was comprised of five distinct pathways. Each of the five pathways depended on facility complexity-level plus factors from one or more of the three domains of weight management: comprehensive lifestyle interventions, pharmacotherapy, and/or bariatric surgery. Three pathways include components from multiple treatment domains. Combinations of conditions formed "recipes" that lead to higher population impact. Our coincidence analyses highlighted both the importance of local context and how combinations of specific conditions consistently and uniquely distinguished higher impact facilities from lower impact facilities for weight management.
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Affiliation(s)
- Laura J Damschroder
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Edward J Miech
- Veterans Affairs Center for Health Information & Communication, VA EXTEND QUERI, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Michelle B Freitag
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Richard Evans
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jennifer A Burns
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Susan D Raffa
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michael G Goldstein
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.,Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Ann Annis
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | - Stephanie A Spohr
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA
| | - Wyndy L Wiitala
- Veterans Affairs Center for Clinical Management Research, VA MIDAS QUERI Ann Arbor Healthcare System, Ann Arbor, MI, USA
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22
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Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci 2022; 17:75. [DOI: 10.1186/s13012-022-01245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many implementation efforts fail, even with highly developed plans for execution, because contextual factors can be powerful forces working against implementation in the real world. The Consolidated Framework for Implementation Research (CFIR) is one of the most commonly used determinant frameworks to assess these contextual factors; however, it has been over 10 years since publication and there is a need for updates. The purpose of this project was to elicit feedback from experienced CFIR users to inform updates to the framework.
Methods
User feedback was obtained from two sources: (1) a literature review with a systematic search; and (2) a survey of authors who used the CFIR in a published study. Data were combined across both sources and reviewed to identify themes; a consensus approach was used to finalize all CFIR updates. The VA Ann Arbor Healthcare System IRB declared this study exempt from the requirements of 38 CFR 16 based on category 2.
Results
The systematic search yielded 376 articles that contained the CFIR in the title and/or abstract and 334 unique authors with contact information; 59 articles included feedback on the CFIR. Forty percent (n = 134/334) of authors completed the survey. The CFIR received positive ratings on most framework sensibility items (e.g., applicability, usability), but respondents also provided recommendations for changes. Overall, updates to the CFIR include revisions to existing domains and constructs as well as the addition, removal, or relocation of constructs. These changes address important critiques of the CFIR, including better centering innovation recipients and adding determinants to equity in implementation.
Conclusion
The updates in the CFIR reflect feedback from a growing community of CFIR users. Although there are many updates, constructs can be mapped back to the original CFIR to ensure longitudinal consistency. We encourage users to continue critiquing the CFIR, facilitating the evolution of the framework as implementation science advances.
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23
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Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non–/quasi-experimental trials. Prev Med Rep 2022; 29:101943. [PMID: 36161121 PMCID: PMC9502049 DOI: 10.1016/j.pmedr.2022.101943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/30/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Abstract
The review evaluated internal and external validity using the rE-AIM Framework. Results indicate an overall low reporting of validity factors. Information on adoption and maintenance was particularly low. Future studies should improve the reporting across all rE-AIM dimensions. Future studies should consider adaptations during the implementation phase.
The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non–/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies. Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators. We included 39 studies of which 22 were non–/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non–/quasi-experimental trials. Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings. Trial registration: The review was registered with PROSPERO (CRD42021283688).
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24
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Kuo GM, Trinkley KE, Rabin B. Research and Scholarly Methods: Implementation Science Studies. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022; 5:995-1004. [PMID: 36212610 PMCID: PMC9534307 DOI: 10.1002/jac5.1673] [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: 03/29/2022] [Accepted: 06/14/2022] [Indexed: 11/08/2022]
Abstract
Traditional research focuses on efficacy or effectiveness of interventions but lacks evaluation of strategies needed for equitable uptake, scalable implementation, and sustainable evidence-based practice transformation. The purpose of this introductory review is to describe key implementation science (IS) concepts as they apply to medication management and pharmacy practice, and to provide guidance on literature review with an IS lens. There are five key ingredients of IS, including: (1) evidence-based intervention; (2) implementation strategies; (3) IS theory, model, or framework; (4) IS outcomes and measures; and (5) stakeholder engagement, which is key to a successful implementation. These key ingredients apply across the three stages of IS research: (1) pre-implementation; (2) implementation; and (3) sustainment. A case example using a combination of IS models, PRISM (Practical, Robust Implementation and Sustainability model) and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), is included to describe how an IS study is designed and conducted. This case is a cluster randomized trial comparing two clinical decision support tools to improve guideline-concordant prescribing for patients with heart failure and reduced ejection fraction. The review also includes information on the Standards for Reporting Implementation Studies (StaRI), which is used for literature review and reporting of IS studies,as well as IS-related learning resources.
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Affiliation(s)
- Grace M Kuo
- Texas Tech University Health Sciences Center and Professor Emerita at University of California San Diego; Address: 1300 S. Coulter Street, Suite 104, Amarillo, TX 79106
| | - Katy E Trinkley
- University of Colorado Skaggs Schools of Medicine and Pharmacy and Pharmaceutical Sciences at the Anschutz Medical Campus; Aurora, Colorado
| | - Borsika Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science and Co-Director of the UC San Diego ACTRI Dissemination and Implementation Science Center at University of California San Diego; La Jolla, California
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25
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Jones LK, Strande NT, Calvo EM, Chen J, Rodriguez G, McCormick CZ, Hallquist MLG, Savatt JM, Rocha H, Williams MS, Sturm AC, Buchanan AH, Glasgow RE, Martin CL, Rahm AK. A RE-AIM Framework Analysis of DNA-Based Population Screening: Using Implementation Science to Translate Research Into Practice in a Healthcare System. Front Genet 2022; 13:883073. [PMID: 35692820 PMCID: PMC9174580 DOI: 10.3389/fgene.2022.883073] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: DNA-based population screening has been proposed as a public health solution to identify individuals at risk for serious health conditions who otherwise may not present for medical care. The clinical utility and public health impact of DNA-based population screening is a subject of active investigation. Geisinger, an integrated healthcare delivery system, was one of the first healthcare systems to implement DNA screening programs (MyCode Community Health Initiative (MyCode) and clinical DNA screening pilot) that leverage exome data to identify individuals at risk for developing conditions with potential clinical actionability. Here, we demonstrate the use of an implementation science framework, RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance), to conduct a post-hoc evaluation and report outcomes from these two programs to inform the potential impact of DNA-based population screening. Methods: Reach and Effectiveness outcomes were determined from the MyCode research program, while Adoption and Implementation outcomes were measured using the clinical DNA screening pilot. Reach was defined as the number of patients who were offered and consented to participate in MyCode. Effectiveness of DNA screening was measured by reviewing MyCode program publications and synthesizing findings from themes. Adoption was measured by the total number of DNA screening tests ordered by clinicians at the clinical pilot sites. Implementation was assessed by interviewing a subset of clinical pilot clinicians about the deployment of and recommended adaptations to the pilot that could inform future program dissemination. Results:Reach: As of August 2020, 68% (215,078/316,612) of individuals approached to participate in the MyCode program consented. Effectiveness: Published evidence reported from MyCode demonstrates that DNA screening identifies at-risk individuals more comprehensively than clinical ascertainment based on phenotypes or personal/family history. Adoption: From July 2018 to June 2021, a total of 1,026 clinical DNA screening tests were ordered by 60 clinicians across the three pilot clinic sites. Implementation: Interviews with 14 clinicians practicing at the pilot clinic sites revealed motivation to provide patients with DNA screening results and yielded future implementation strategies. Conclusion: The RE-AIM framework offers a pragmatic solution to organize, analyze, and report outcomes across differently resourced and designed precision health programs that include genomic sequencing and return of clinically actionable genomic information.
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Affiliation(s)
- Laney K. Jones
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Heart and Vascular Institute, Geisinger, Danville, PA, United States
| | - Natasha T. Strande
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Evan M. Calvo
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Jingheng Chen
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | | | - Juliann M. Savatt
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Heather Rocha
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Marc S. Williams
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Amy C. Sturm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Heart and Vascular Institute, Geisinger, Danville, PA, United States
| | - Adam H. Buchanan
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
| | - Russell E. Glasgow
- University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christa L. Martin
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, United States
| | - Alanna Kulchak Rahm
- Genomic Medicine Institute, Geisinger, Danville, PA, United States
- *Correspondence: Alanna Kulchak Rahm,
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26
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Geagea D, Griffin B, Kimble R, Polito V, Terhune DB, Tyack Z. Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol. Pilot Feasibility Stud 2022; 8:58. [PMID: 35264248 PMCID: PMC8905723 DOI: 10.1186/s40814-022-01017-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Burns and related procedures are painful and distressing for children, exposing them to acute and chronic sequelae that can negatively affect their physiological, psychological, and social functions. Non-pharmacological interventions such as distraction techniques are beneficial adjuncts to pharmacological agents for procedural pain, state anxiety, and itch in children with burns but have limitations (e.g. lack of research on burn-related itch, tailoring, and consensus on optimal treatment). Hypnotherapy is a non-pharmacological intervention that can be tailored for varied settings and populations with evidence of benefit for itch and superior effectiveness in comparison to other non-pharmacological interventions for children’s procedural pain and state anxiety. Thus, children with burns can benefit from hypnotherapy as an adjunct to pharmacological agents. Yet, in paediatric burns, rigorous studies of effectiveness are limited and no studies have been identified that screen for hypnotic suggestibility, an important predictor of hypnotherapy outcomes. Considering potential barriers to the delivery of hypnotherapy in paediatric burns, the proposed study will examine the feasibility and acceptability of hypnotic suggestibility screening followed by hypnotherapy for procedural pain, state anxiety, and itch in children with acute burns. Methods An observational mixed-methods feasibility and acceptability study will be conducted over 15 weeks. Eligible children (N = 30) aged 4 to 16 years presenting to a paediatric burns outpatient centre in a metropolitan children’s hospital in Australia with acute burns requiring dressing changes will be included. Eligible parents of children (N = up to 30) and clinicians who perform dressing changes (N = up to 20) will also be included. Child participants screened as having medium to high suggestibility as assessed by behavioural measures will receive hypnotherapy during dressing changes. A process evaluation will target feasibility and acceptability as primary outcomes and implementation (i.e. fidelity in delivery), reach, potential effectiveness, and adoption of evaluation procedures and intervention as secondary outcomes. Discussion Ethical approval was obtained from the Queensland Children’s Hospital and Health Service ethics committee. Results will be published in peer-reviewed publications and conference proceedings. The findings will guide the design of future trials on the effectiveness of hypnotherapy and inform the development of child-centred hypnotic interventions in children with burns. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12620000988954 Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01017-z.
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Affiliation(s)
- Dali Geagea
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia. .,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.
| | - Bronwyn Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, 4058, Australia.,Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, South Brisbane, QLD, 4101, Australia
| | - Vince Polito
- School of Psychological Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Devin B Terhune
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, Level 7, 62 Graham Street, South Brisbane, QLD, 4101, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4067, Australia.,Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
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27
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Damschroder LJ, Reardon CM, Opra Widerquist MA, Lowery J. Conceptualizing outcomes for use with the Consolidated Framework for Implementation Research (CFIR): the CFIR Outcomes Addendum. Implement Sci 2022; 17:7. [PMID: 35065675 PMCID: PMC8783408 DOI: 10.1186/s13012-021-01181-5] [Citation(s) in RCA: 160] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The challenges of implementing evidence-based innovations (EBIs) are widely recognized among practitioners and researchers. Context, broadly defined as everything outside the EBI, includes the dynamic and diverse array of forces working for or against implementation efforts. The Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks to guide assessment of contextual determinants of implementation. The original 2009 article invited critique in recognition for the need for the framework to evolve. As implementation science has matured, gaps in the CFIR have been identified and updates are needed. Our team is developing the CFIR 2.0 based on a literature review and follow-up survey with authors. We propose an Outcomes Addendum to the CFIR to address recommendations from these sources to include outcomes in the framework. MAIN TEXT We conducted a literature review and surveyed corresponding authors of included articles to identify recommendations for the CFIR. There were recommendations to add both implementation and innovation outcomes from these sources. Based on these recommendations, we make conceptual distinctions between (1) anticipated implementation outcomes and actual implementation outcomes, (2) implementation outcomes and innovation outcomes, and (3) CFIR-based implementation determinants and innovation determinants. CONCLUSION An Outcomes Addendum to the CFIR is proposed. Our goal is to offer clear conceptual distinctions between types of outcomes for use with the CFIR, and perhaps other determinant implementation frameworks as well. These distinctions can help bring clarity as researchers consider which outcomes are most appropriate to evaluate in their research. We hope that sharing this in advance will generate feedback and debate about the merits of our proposed addendum.
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Affiliation(s)
- Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Marilla A Opra Widerquist
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Julie Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Scheuer H, Kuklinski MR, Sterling SA, Catalano RF, Beck A, Braciszewski J, Boggs J, Hawkins JD, Loree AM, Weisner C, Carey S, Elsiss F, Morse E, Negusse R, Jessen A, Kline-Simon A, Oesterle S, Quesenberry C, Sofrygin O, Yoon T. Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care. Contemp Clin Trials 2022; 112:106621. [PMID: 34785305 PMCID: PMC8802622 DOI: 10.1016/j.cct.2021.106621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/01/2021] [Accepted: 11/09/2021] [Indexed: 01/03/2023]
Abstract
Evidence-based parenting interventions play a crucial role in the sustained reduction of adolescent behavioral health concerns. Guiding Good Choices (GGC) is a 5-session universal anticipatory guidance curriculum for parents of early adolescents that has been shown to reduce substance use, depression symptoms, and delinquent behavior. Although prior research has demonstrated the effectiveness of evidence-based parenting interventions at achieving sustained reductions in adolescent behavioral health concerns, public health impact has been limited by low rates of uptake in community and agency settings. Pediatric primary care is an ideal setting for implementing and scaling parent-focused prevention programs as these settings have a broad reach, and prevention programs implemented within them have the potential to achieve population-level impact. The current investigation, Guiding Good Choices for Health (GGC4H), tests the feasibility and effectiveness of implementing GGC in 3 geographically and socioeconomically diverse large integrated healthcare systems. This pragmatic, cluster randomized clinical trial will compare GGC parenting intervention to usual pediatric primary care practice, and will include approximately 3750 adolescents; n = 1875 GGC intervention and n = 1875 usual care. The study team hypothesizes that adolescents whose parents are randomized into the GGC intervention arm will show reductions in substance use initiation, the study's primary outcomes, and other secondary (e.g., depression symptoms, substance use prevalence) and exploratory outcomes (e.g., health services utilization, anxiety symptoms). The investigative team anticipates that the implementation of GGC within pediatric primary care clinics will successfully fill an unmet need for effective preventive parenting interventions. Trial registration: Clinicaltrials.govNCT04040153.
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Affiliation(s)
- Hannah Scheuer
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Margaret R Kuklinski
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Stacy A Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Richard F Catalano
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Jordan Braciszewski
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Jennifer Boggs
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - J David Hawkins
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Amy M Loree
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Susan Carey
- Social Development Research Group, School of Social Work, University of Washington, 9725 Third Ave. NE, Suite 401, Seattle, WA 98115, USA.
| | - Farah Elsiss
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
| | - Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Rahel Negusse
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Andrew Jessen
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd, Suite 200, Aurora, CO 80014, USA.
| | - Andrea Kline-Simon
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Sabrina Oesterle
- Southwest Interdisciplinary Research Center, 201 N. Central Ave., 33rd Floor, Phoenix, AZ 85004, USA.
| | - Charles Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Oleg Sofrygin
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612, USA.
| | - Tae Yoon
- Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48202, USA.
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Shin HD, Cassidy C, Weeks LE, Campbell LA, Drake EK, Wong H, Donnelly L, Dorey R, Kang H, Curran JA. Interventions to change clinicians' behavior related to suicide-prevention care in the emergency department: a scoping review. JBI Evid Synth 2021; 20:788-846. [PMID: 34907133 DOI: 10.11124/jbies-21-00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework. INTRODUCTION An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments and/or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine interventions' functional characteristics and how they can influence emergency department clinicians' behaviors related to suicide-prevention care. INCLUSION CRITERIA This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude. METHODS This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behavior Change Wheel's intervention functions. Reported outcome measures were categorized. Findings are tabulated and synthesized narratively. RESULTS Forty-one studies were included from the database searches, representing a mixture of experimental (n = 2), quasi-experimental (n = 24), non-experimental (n = 12), qualitative (n = 1), and mixed methods (n = 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. In summary, this review included a total of 70 citations, describing 66 different interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n = 48), training (n = 40), enablement (n = 36), persuasion (n = 21), environmental restructuring (n = 18), modeling (n = 7), and incentivisation (n = 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n = 38), patient (n = 4), and/or organization levels (n = 6). Few studies reported implementation outcomes, such as measures of reach (n = 4), adoption (n = 5), or fidelity (n = 1). There were no evaluation data reported on the interventions identified through Google searches. CONCLUSIONS Interventions included in this review were diverse and leveraged a range of mechanisms to change emergency department clinicians' behavior. However, most interventions relied solely on education and/or training to improve clinicians' knowledge and/or skills. Future research should consider diverse intervention functions to target both individual- and/or organization-level barriers for a given context. Secondly, the ultimate goal for changing emergency department clinicians' behavior is to improve patient health outcomes related to suicide-related thoughts and behaviors, but current research has most commonly evaluated clinicians' behavior in isolation of patient outcomes. Future studies should consider reporting patient-level outcomes alongside clinician-level outcomes.
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Affiliation(s)
- Hwayeon Danielle Shin
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada Faculty of Health, Dalhousie University, Halifax, NS, Canada Nova Scotia Health Authority, Halifax, NS, Canada
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Dissemination and Implementation Science Approaches for Occupational Safety and Health Research: Implications for Advancing Total Worker Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111050. [PMID: 34769573 PMCID: PMC8583149 DOI: 10.3390/ijerph182111050] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
Total Worker Health® (TWH), an initiative of the U.S. National Institute for Occupational Safety and Health, is defined as policies, programs, and practices that integrate protection from work-related health and safety hazards by promoting efforts that advance worker well-being. Interventions that apply the TWH paradigm improve workplace health more rapidly than wellness programs alone. Evidence of the barriers and facilitators to the adoption, implementation, and long-term maintenance of TWH programs is limited. Dissemination and implementation (D&I) science, the study of methods and strategies for bridging the gap between public health research and practice, can help address these system-, setting-, and worker-level factors to increase the uptake, impact, and sustainment of TWH activities. The purpose of this paper is to draw upon a synthesis of existing D&I science literature to provide TWH researchers and practitioners with: (1) an overview of D&I science; (2) a plain language explanation of key concepts in D&I science; (3) a case study example of moving a TWH intervention down the research-to-practice pipeline; and (4) a discussion of future opportunities for conducting D&I science in complex and dynamic workplace settings to increase worker safety, health, and well-being.
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