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Larsson R. Come together: collaborative actions to bridge the gap between implementation research and public health practice. Front Public Health 2024; 12:1424900. [PMID: 38939561 PMCID: PMC11208301 DOI: 10.3389/fpubh.2024.1424900] [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: 04/28/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024] Open
Affiliation(s)
- Robert Larsson
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Winters M, Fuller D, Cloutier MS, Harris MA, Howard A, Kestens Y, Kirk S, Macpherson A, Moore S, Rothman L, Shareck M, Tomasone JR, Laberee K, Stephens ZP, Sones M, Ayton D, Batomen B, Bell S, Collins P, Diab E, Giles AR, Hagel BE, Harris MS, Harris P, Lachapelle U, Manaugh K, Mitra R, Muhajarine N, Myrdahl TM, Pettit CJ, Pike I, Skouteris H, Wachsmuth D, Whitehurst D, Beck B. Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities. BMJ Open 2024; 14:e085850. [PMID: 38631827 PMCID: PMC11029507 DOI: 10.1136/bmjopen-2024-085850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.
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Affiliation(s)
- Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel Fuller
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Montreal, Québec, Canada
| | - M Anne Harris
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Andrew Howard
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yan Kestens
- École de santé publique, Université de Montréal, Montreal, Québec, Canada
| | - Sara Kirk
- Healthy Populations Institute and Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Sarah Moore
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Rothman
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Martine Shareck
- Faculté de médecine et des sciences de la santé, Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Karen Laberee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Meridith Sones
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brice Batomen
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Scott Bell
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Collins
- Department of Geography and Planning, Queen's University, Kingston, Ontario, Canada
| | - Ehab Diab
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Audrey R Giles
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Brent E Hagel
- Departments of Pediatrics and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mike S Harris
- City Futures Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Harris
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Ugo Lachapelle
- Département d'études urbaines et touristiques, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Kevin Manaugh
- Department of Geography and Bieler School of Environment, McGill University, Montreal, Québec, Canada
| | - Raktim Mitra
- School of Urban and Regional Planning, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tiffany Muller Myrdahl
- Department of Gender, Sexuality, and Women's Studies and Urban Studies Program, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Christopher J Pettit
- City Futures Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian Pike
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Monash University, Melbourne, Victoria, Australia
| | - David Wachsmuth
- School of Urban Planning, McGill University, Montreal, Québec, Canada
| | - David Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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3
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Quiroz-Saavedra R, Alfaro J, Rodríguez-Rivas ME. Perceptions of professionals about factors affecting the implementation of early childhood support systems: A case study evaluation from an ecological perspective. EVALUATION AND PROGRAM PLANNING 2023; 97:102210. [PMID: 36571969 DOI: 10.1016/j.evalprogplan.2022.102210] [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: 08/12/2020] [Revised: 04/30/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
This evaluation research looked at factors affecting collaboration across the various levels of implementation of early childhood support systems. An ecological conceptual framework was used to examine barriers and facilitators to implementing social and health care services from the perspective of the professionals involved at the national, state, and local level of government. A single case study following a qualitative research strategy was conducted with a total of 29 professionals from social development and health ministries, one municipality and a family health center responsible for implementing the Chile Grows with You system. The results show that at the national level, the main factors include socio-political aspects, funding, and the empathy that professional employees hold for peers who are at lower rungs in the hierarchy. At the state level workplace conditions play a key role. For the local level those factors include information system management and the political support of the local government. The discussion section emphasizes the relevance of considering the interdependence of such factors that influence implementation outcomes and the need to move away from a single program evaluation to a multilevel implementation analysis of public policy.
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Affiliation(s)
- Rodrigo Quiroz-Saavedra
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile.
| | - Jaime Alfaro
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
| | - Matías E Rodríguez-Rivas
- Universidad del Desarrollo, Faculty of Psychology, Av. Plaza 680, San Carlos de Apoquindo, Las Condes, Santiago 7610658, Chile
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Chamberlain SA, Warner G, Andrew MK, Hande MJ, Hubley E, Weeks LE, Keefe JM. With COVID Comes Complexity: Assessing the Implementation of Family Visitation Programs in Long-Term Care. THE GERONTOLOGIST 2023; 63:490-500. [PMID: 36462193 PMCID: PMC10028227 DOI: 10.1093/geront/gnac175] [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: 03/31/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Coronavirus disease 2019 (COVID-19) pandemic visitor restrictions to long-term care facilities have demonstrated that eliminating opportunities for family-resident contact has devastating consequences for residents' quality of life. Our study aimed to understand how public health directives to support family visitations during the pandemic were navigated, managed, and implemented by staff. RESEARCH DESIGN AND METHODS Guided by the Consolidated Framework for Implementation Research, we conducted video/telephone interviews with 54 direct care and implementation staff in six long-term care homes in two Canadian provinces to assess implementation barriers and facilitators of visitation programs. Equity and inclusion issues were examined in the program's implementation. RESULTS Despite similar public health directives, implementation varied by facility, largely influenced by the existing culture and processes of the facility and the staff understanding of the program; differences resulted in how designated family members were chosen and restrictions around visitations (e.g., scheduling and location). Facilitators of implementation were good communication networks, leadership, and intentional planning to develop the visitor designation processes. However, the lack of consultation with direct care staff led to logistical challenges around visitation and ignited conflict around visitation rules and procedures. DISCUSSION AND IMPLICATIONS Insights into the complexities of implementing family visitation programs during a pandemic are discussed, and opportunities for improvement are identified. Our results reveal the importance of proactively including direct care staff and family in planning for future outbreaks.
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Affiliation(s)
- Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Grace Warner
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary Jean Hande
- Department of Sociology, Trent University, Peterborough, Ontario, Canada
| | - Emily Hubley
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice M Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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5
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Rapport F, Smith J, Hutchinson K, Clay-Williams R, Churruca K, Bierbaum M, Braithwaite J. Too much theory and not enough practice? The challenge of implementation science application in healthcare practice. J Eval Clin Pract 2022; 28:991-1002. [PMID: 34268832 DOI: 10.1111/jep.13600] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Implementation science (IS) should contribute to maintaining high standards of care across healthcare systems and enhancing care practices. However, despite the evident need for greater and more rapid uptake and integration of evidence in practice, IS design and methodology fall short of the needs of effective translation. AIM In this paper we examine what it is about IS that makes it so appealing for effective uptake of interventions in routine practice, and yet so difficult to achieve. We propose a number of ways that implementation scientists could build mutual relationships with healthcare practitioners and other stakeholders including public members to ensure greater shared care practices, and highlight the value of IS training, collaborative educational events, and co-designed research. DISCUSSION More consideration should be given to IS applications in healthcare contexts. Implementation scientists can make a valuable contribution by mobilizing theory and improving practice. However, goals for an evidence-based system may be more appropriately achieved through greater outreach and collaboration, with methods that are flexible to support rapid implementation in complex adaptive systems. Collective learning and mutual trust can be cultivated by embedding researchers into healthcare services while offering greater opportunities for practitioners to learn about, and engage in, implementation research. CONCLUSION To bridge the worlds of healthcare practice and IS, researchers could be more consistent in the relationships they build with professionals and the public, communicating through a shared language and co-joining practical approaches to effective implementation. This will build capacity for improved collaboration and foster respectful, interdisciplinary relationships.
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Affiliation(s)
- Frances Rapport
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Smith
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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VanDevanter N, Zhong L, Dannefer R, Manyindo N, Walker S, Otero V, Smith K, Keita R, Thorpe L, Drackett E, Seidl L, Brown-Dudley L, Earle K, Islam N. Implementation Facilitators and Challenges of a Place-Based Intervention to Reduce Health Disparities in Harlem Through Community Activation and Mobilization. Front Public Health 2022; 10:689942. [PMID: 35558526 PMCID: PMC9090448 DOI: 10.3389/fpubh.2022.689942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background To address significant health inequities experienced by residents of public housing in East and Central Harlem compared to other New Yorkers, NYC Department of Health and Mental Health (DOHMH) collaborated with community and academic organizations and the New York City Housing Authority to develop a place-based initiative to address chronic diseases in five housing developments, including a community activation and mobilization component led by community health organizers (CHOs). Purpose Guided by the Consolidated Framework for Implementation Research (CFIR), we evaluated the initial implementation of the community activation and mobilization component to systematically investigate factors that could influence the successful implementation of the intervention. Methods Nineteen in-depth qualitative interviews were conducted with a purposive sample of CHOs, community members and leaders, collaborating agencies and DOHMH staff. Interviews were transcribed verbatim, and themes and codes were developed to identify theoretically important concepts of the CFIR and emergent analytic patterns. Results Findings identified important facilitators to implementation: positive community perception of the program, CHO engagement and responsiveness to community needs, CHO norms and values and adaptability of DOHMH and CHOs to community needs. Challenges included the instability of the program in the first year, limited ability to address housing related issues, concerns about long term funding, competing community priorities, low expectations by the community for the program, time and labor intensity to build trust within the community, and the dual roles of CHOs as community advocates and DOHMH employees. Conclusions Findings will guide future community activation and mobilization activities. The study demonstrates the value of integrating implementation science and health equity frameworks.
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Affiliation(s)
- Nancy VanDevanter
- Meyers College of Nursing, College of Global Public Health, New York University, New York, NY, United States
| | - Lynna Zhong
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Rachel Dannefer
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Noel Manyindo
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Sterling Walker
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Victor Otero
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Kimberly Smith
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Rose Keita
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Lorna Thorpe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Elizabeth Drackett
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - Lois Seidl
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | - La'Shawn Brown-Dudley
- New York City Department of Health and Mental Hygiene, Center for Health Equity, Harlem Neighborhood Health Action Centers, New York, NY, United States
| | | | - Nadia Islam
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States.,Department of Population Health, School of Medicine, New York University, New York, NY, United States
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7
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Opportunities for nurse involvement in surgical antimicrobial stewardship strategies: a qualitative study. Int J Nurs Stud 2022; 128:104186. [DOI: 10.1016/j.ijnurstu.2022.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
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8
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Cyriac S, Webb Girard A, Ramakrishnan U, Mannar MGV, Khurana K, Rawat R, Neufeld LM, Martorell R, Mbuya MNN. Making programmes worth their salt: Assessing the context, fidelity and outcomes of implementation of the double fortified salt programme in Uttar Pradesh, India. MATERNAL AND CHILD NUTRITION 2021; 18:e13243. [PMID: 34278722 PMCID: PMC8710122 DOI: 10.1111/mcn.13243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/17/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
Double fortified salt (DFS) has proven efficacy in addressing iron deficiency and anaemia, thus improving maternal and child nutrition outcomes. However, DFS delivery in large‐scale settings is less understood, with limited documentation of its fidelity of implementation (FOI). We assessed the FOI of the DFS intervention in Uttar Pradesh, India, to improve the design and implementation of such programmes that aim to reduce the anaemia burden, especially in women of reproductive age (WRA). We conducted in‐depth interviews with DFS programme staff (n = 25) and end‐user WRAs (23), guided by a programme impact pathway. We transcribed and thematically analysed the interviews and used an adapted analytic framework to document FOI across four domains—objects of intervention, implementation staff, implementation context and target of implementation. DFS utilisation remained low due to a combination of factors including poor product quality, distribution challenges, ineffective promotion and low awareness amongst end‐user WRAs. Motivation levels were higher amongst district‐level staff compared to frontline staff, who lacked supervisory support and effective incentives to promote DFS. Three typologies of DFS users emerged—‘believers’, ‘thrifters’ and ‘naysayers’—who indicated differing reasons for DFS purchase and its use or nonuse. The implementation of the DFS programme varied significantly from its theorised programme impact pathway. The adapted analytic framework helped document FOI and assess the programme's readiness for impact assessments and subsequent scale‐up. The programme needs product quality improvements, incentivised distribution and stronger promotion to effectively deliver and improve the realisation of its potential as an anaemia prevention strategy.
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Affiliation(s)
- Shruthi Cyriac
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Global Alliance for Improved Nutrition, New Delhi, India
| | - Amy Webb Girard
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Usha Ramakrishnan
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - M G Venkatesh Mannar
- The India Nutrition Initiative, New Delhi, India.,Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario, Canada
| | - Kriti Khurana
- Global Alliance for Improved Nutrition, New Delhi, India
| | - Rahul Rawat
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Reynaldo Martorell
- Doctoral Program in Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mduduzi N N Mbuya
- Global Alliance for Improved Nutrition, Washington, District of Columbia, USA
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Zhang T, Shen N, Booth R, LaChance J, Jackson B, Strudwick G. Supporting the use of patient portals in mental health settings: a scoping review. Inform Health Soc Care 2021; 47:62-79. [PMID: 34032528 DOI: 10.1080/17538157.2021.1929998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the increased use of patient portals in acute and chronic care settings as a strategy to support patient care and improve patient-centric care, there is still little known about the impact of patient portals in mental health contexts. The purposes of this review were to: 1) identify the critical success factors for successful patient portal implementation and adoption among end-users that could be utilized in a mental health setting; 2) uncover what we know about existing mental health portals and their effectiveness for end-users; and 3) determine what indicators are being used to evaluate existing patient portals for end-users that may be applied in a mental health context. This scoping review was conducted through a search of six electronic databases including Medline, EMBASE, PsycINFO, and CINAHL for articles published between 2007 and 2021. A total of 31 articles were included in the review. Critical success factors of patient portal implementation included those related to education, usefulness, usability, culture, and resources. Only two patient portals had articles published related to their effectiveness for end-users (one in Canada and the other in the United States). More than 100 measures of process (n = 73) and outcome (n = 59) indicators were extracted from the studies and mapped to the Benefits Evaluation Framework. Patient portals carry great potential to improve patient care, but more attention needs to be given to ensure they are being evaluated through the development and implementation phases with the end-users in mind. Further understanding of process indicators relating to use are essential for long-term patient adoption of portals to obtain their potential benefits.
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Affiliation(s)
- Timothy Zhang
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nelson Shen
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jessica LaChance
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brianna Jackson
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Yale School of Nursing, Yale University, Orange, Connecticut, USA
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
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10
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Brown M, Rosenthal M, Yeh DD. Implementation Science and Nutrition: From Research to Practice. Nutr Clin Pract 2021; 36:586-597. [PMID: 34021636 DOI: 10.1002/ncp.10677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/09/2021] [Indexed: 11/11/2022] Open
Abstract
Implementation science (IS) is a young field that seeks to minimize the gap between what we know and what we practice, otherwise known as the "know-do gap." Recently, IS has focused on research that expedites the dissemination of evidence-based knowledge, accelerates the translation of interventions to improve knowledge gaps, shrinks healthcare disparities, enhances care of complex medical conditions, and narrows variation in clinical practice and policy. This article seeks to review theoretical frameworks of IS and demonstrate how IS can be utilized to improve nutrition care. Specific examples in this article include implementation of initiatives to improve documentation of malnutrition, increase provision of oral nutrition supplements, increase use of Enhanced Recovery After Surgery protocols, and increase energy and protein delivery. Clinical nutrition is a growing field with more and more research findings pointing to new therapies. In implementing these new therapies, practitioners should recognize the complex system present in healthcare and lean on IS findings to speed implementation and more rapidly improve clinical outcomes.
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Affiliation(s)
- Michelle Brown
- Clinical Nutrition, UF Health Shands Hospital, Gainesville, Florida, USA
| | - Martin Rosenthal
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - D Dante Yeh
- Surgery, General Surgery Residency, Division of Trauma and Surgical Critical Care, The DeWitt Daughtry Family Department of Surgery, Ryder Trauma Center/Jackson Memorial Hospital, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
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11
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Holcomb JL, Walton GH, Sokale IO, Ferguson GM, Schick VR, Highfield L. Developing and Evaluating a Quality Improvement Intervention to Facilitate Patient Navigation in the Accountable Health Communities Model. Front Med (Lausanne) 2021; 8:596873. [PMID: 33575264 PMCID: PMC7870472 DOI: 10.3389/fmed.2021.596873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: The Accountable Health Communities (AHC) Model was designed to address the health-related social needs of Centers for Medicare & Medicaid Services beneficiaries. Bridge organizations across the AHC Model have identified lack of technical assistance and peer planning as potential barriers to Model success, particularly around patient navigation. The technical assistance and peer planning literature lacks an organizing, conceptual framework, but implementation science frameworks could serve as useful guides. The Strengthening Peer AHC Navigation (SPAN) research protocol seeks to fill this gap and will apply three implementation science frameworks, Consolidated Framework for Implementation Research, Intervention Mapping, and the Expert Recommendations for Implementing Change compilation, to develop a multi-level quality improvement intervention and evaluate the impact of peer planning on Model outcomes. The aims of the SPAN study are to implement and evaluate a novel multi-level quality improvement intervention to improve AHC implementation and navigation milestones through structured peer planning and to provide successful technical assistance for the AHC Model. Methods and Analysis: The quality improvement intervention is outlined in four Tasks: (1) Assessment – to conduct an assessment of each bridge organization's current implementation, needs, and readiness in AHC Model navigation activities; (2) Planning – to engage in a peer planning approach to build capacity for AHC Model navigation activities; (3) Implementation with technical assistance – Co-creation of a quality improvement protocol for AHC Model navigation activities; and (4) Evaluation – measure the impact of the peer planning and technical assistance approach. Alongside the development and implementation of the quality improvement intervention, this protocol describes a mixed method, convergent parallel study design which will be used to evaluate whether the quality improvement intervention will lead to better outcomes. Tasks will be replicated with five bridge organizations participating in the AHC Model. Discussion: This research protocol provides a framework that can be used to conduct structured peer planning with technical assistance for social needs programs. This study will provide data on both implementation and outcomes which eventually may impact healthcare cost and utilization.
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Affiliation(s)
- Jennifer L Holcomb
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gretchen H Walton
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Itunu O Sokale
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gayla M Ferguson
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Vanessa R Schick
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Highfield
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.,Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
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12
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Warner G, Kervin E, Pesut B, Urquhart R, Duggleby W, Hill T. How do inner and outer settings affect implementation of a community-based innovation for older adults with a serious illness: a qualitative study. BMC Health Serv Res 2021; 21:42. [PMID: 33413394 PMCID: PMC7792161 DOI: 10.1186/s12913-020-06031-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Implementing community-based innovations for older adults with serious illness, who are appropriate for a palliative approach to care, requires developing partnerships between health and community. Nav-CARE is an evidence-based innovation wherein trained volunteer navigators advocate, facilitate community connections, coordinate access to resources, and promote active engagement of older adults within their communities. Acknowledging the importance of partnerships between organizations, the aim of our study was to use the Consolidated Framework for Implementation Research (CFIR) to explore organizational (Inner Setting) and community or health system level (Outer Setting) barriers and facilitators to Nav-CARE implementation. Methods Guided by CFIR, qualitative individual and group interviews were conducted to examine the implementation of Nav-CARE in a Canadian community. Participants were individuals who delivered or managed Nav-CARE research, and stakeholders who provided services in the community. The Framework Method was used to analyse the data. Particular attention was paid to the host organization’s external network and community context. Results Implementation was affected by several inter-related CFIR domains, making it difficult to meaningfully separate key findings by only inner and outer settings. Thus, findings were organized into themes informed by CFIR, that cut across other domains and incorporated inductive findings: intraorganizational perceptions of Nav-CARE; public and healthcare professionals’ perceptions of palliative care; interorganizational partnerships and relationships; community and national-level factors that should have facilitated Nav-CARE implementation; and suggested changes to Nav-CARE. Themes demonstrated barriers to implementing Nav-CARE, such as poor organizational readiness for implementation, and public and health provider perceptions palliative care was synonymous with fast-approaching death. Conclusions Implementation science frameworks and theories commonly focus on assessing implementation of innovations within facilities and changing behaviours of individuals within that organizational structure. Implementation frameworks need to be adapted to better assess Outer Setting factors that affect implementation of community-based programs. Although applying the CFIR helped uncover critical elements in the Inner and Outer Settings that affected implementation of Nav-CARE. Our study suggests that the CFIR could expand the Outer Setting to acknowledge and assess organizational structures and beliefs of individuals within organizations external to the host organization who impact successful implementation of community-based innovations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06031-6.
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Affiliation(s)
- Grace Warner
- Associate Professor School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Emily Kervin
- Mount Saint Vincent University, 166 Bedford Highway, Halifax, NS, B3M 2J6, Canada
| | - Barb Pesut
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Robin Urquhart
- Department of Surgery, Dalhousie University, Rm 8-032, 8th floor, Centennial Building, 1678 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th Ave., Edmonton, AB, Canada
| | - Taylor Hill
- Department of Psychology and Neuroscience, Dalhousie University, 6299 South St, Halifax, NS, B3H 4J1, Canada
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13
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Maltinsky W, Swanson V. Behavior change in diabetes practitioners: An intervention using motivation, action planning and prompts. PATIENT EDUCATION AND COUNSELING 2020; 103:2312-2319. [PMID: 32402490 DOI: 10.1016/j.pec.2020.04.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES It is important for health professionals to have behavior change skills to empower people to manage long-term-conditions. Theoretically derived, competency-based training can be particularly effective where it considers reflective and automatic routes to behavior change. The aim of this study was to develop, deliver and evaluate a motivational, action and prompting behavior change skills intervention for diabetes health practitioners in Scotland, UK. METHODS This was a longitudinal intervention study. A 2-day intervention was delivered to 99 health professionals. Participants set behavioral goals to change practice, completing action and coping plans post-training. Motivation and plan quality were evaluated in relation to goal achievement at 6-week follow-up. RESULTS Post-training, practitioners could develop high quality work-related action and coping plans, which they were motivated to enact. Although under half responded at follow-up, most reported successful goal achievement. There was no difference in plan quality for goal achievers, non-achievers and non-responders. Barriers and facilitators of behavior change included institutional, service-user and individual factors. CONCLUSIONS The intervention successfully used planning to implement participants' behaviour change goals. PRACTICE IMPLICATIONS Planning interventions are helpful to support clinicians to change their practice to help people self-manage diabetes care but may not fit demands of day-to-day clinical practice.
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Affiliation(s)
- Wendy Maltinsky
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | - Vivien Swanson
- Centre for Health and Behaviour Change, Psychology Division, University of Stirling, Stirling FK9 4LA, United Kingdom
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14
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Sibbald SL, Ziegler BR, Maskell R, Schouten K. Implementation of interprofessional team-based care: A cross-case analysis. J Interprof Care 2020; 35:654-661. [PMID: 32835539 DOI: 10.1080/13561820.2020.1803228] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Two out of five Canadians have at least one chronic disease and four out of five are at risk of developing a chronic disease. Successful disease management relies on interprofessional team-based approaches, yet lack of purposeful cultivation and patient engagement has led to systematic inefficiencies. Two primary care teams in Southwestern Ontario implementing interprofessional chronic care programs for patients with chronic obstructive pulmonary disease were compared. A mixed-methods cross-case analysis was conducted including interviews, focus groups, observations and document analysis. Cases (n = 2) were chosen based on intrinsic and unique value. Participants (n = 46) were sampled using a combination of purposive and multi-level sampling. Data was analyzed using an iterative process; inductive coding was used to gain a sense of context followed by a deductive cross-case analysis to compare and contrast themes across sites. Kompier's five-step framework was used to assess factors contributing to successful implementation and to provide insight into interactions between teams, providers and patients. Both cases satisfied all five factors (systemic and gradual approach, identification of risk factors, theory-driven, participatory approach and sustained committed support). However, one case was more successful at fully implementing their model, attributed to a flexible implementation, plans to mitigate risks, theory use, a supportive team and continued buy-in from leadership. By better understanding key facilitators and barriers, we can support the implementation of chronic disease management programs, foster sustainability of high-performing interprofessional teams, and engage patients in the development and maintenance of team-based chronic disease management.
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Affiliation(s)
- Shannon L Sibbald
- School of Health Studies, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - Bianca R Ziegler
- Environment Health and Hazards Laboratory, Department of Geography, Western University, London, ON, Canada
| | - Rachelle Maskell
- School of Health Studies, Western University, London, ON, Canada
| | - Karen Schouten
- School of Health Studies, Western University, London, ON, Canada
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15
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Ha BTT, Pham Van T, Mirzoev T. <p>Implementation of Health Policy on Establishment of Provincial Center of Diseases Control (CDC) in Vietnam</p>. Healthc Policy 2020; 13:915-926. [PMID: 32801966 PMCID: PMC7406358 DOI: 10.2147/rmhp.s250748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/14/2020] [Indexed: 01/17/2023] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Bui Thi Thu Ha
- Hanoi University of Public Health, Hanoi, Vietnam
- Correspondence: Bui Thi Thu Ha Hanoi University of Public Health, No. 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, VietnamTel +84-0913363603 Email
| | - Tac Pham Van
- Department of Manpower, Ministry of Health, Hanoi, Vietnam
| | - Tolib Mirzoev
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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16
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Integrating Economic Evaluation and Implementation Science to Advance the Global HIV Response. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S314-S321. [PMID: 31764269 DOI: 10.1097/qai.0000000000002219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous cost-effectiveness analyses have indicated good value for money from a wide array of interventions for treatment and prevention of HIV/AIDS. There is limited evidence, however, regarding how cost-effectiveness information contributes to better decision-making around investment and action in the global HIV response. METHODS We review challenges for economic evaluation relevant to the global HIV response and consider how the practice of cost-effectiveness analysis could integrate approaches and insights from implementation science to enhance the impact and efficiency of HIV investments. RESULTS In light of signals that cost-effectiveness analyses may be vulnerable to systematic bias toward overly optimistic conclusions, we emphasize two priorities for advancing the field of economic evaluation in HIV/AIDS and more broadly in global health: (1) systematic reevaluation of the cost-effectiveness literature with reference to ex-post empirical evidence on costs and effects in real-world programs and (2) development and adoption of good-practice guidelines for incorporating implementation and delivery aspects into economic evaluations. Toward the latter aim, we propose an integrative approach that focuses on comparative evaluation of strategies, which specify both technologies/interventions as well as the delivery platforms, complementary interventions, and actions needed to increase coverage, quality, and uptake of those technologies/interventions. Specific recommendations draw on several existing implementation science models that provide systematic frameworks for understanding implementation barriers and enablers, designing and choosing specific implementation and policy actions, and evaluating outcomes. DISCUSSION These preliminary steps aimed at bridging the divide between economic evaluation and implementation science can help to advance the practice of economic evaluation toward a science of comparative strategy evaluation.
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Westerlund A, Sundberg L, Nilsen P. Implementation of Implementation Science Knowledge: The Research-Practice Gap Paradox. Worldviews Evid Based Nurs 2020; 16:332-334. [PMID: 31603625 PMCID: PMC6899530 DOI: 10.1111/wvn.12403] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Anna Westerlund
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Linda Sundberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per Nilsen
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Linköping, Sweden
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18
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Jahn B, Todorovic J, Bundo M, Sroczynski G, Conrads-Frank A, Rochau U, Endel G, Wilbacher I, Malbaski N, Popper N, Chhatwal J, Greenberg D, Mauskopf J, Siebert U. Budget Impact Analysis of Cancer Screening: A Methodological Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:493-511. [PMID: 31016686 DOI: 10.1007/s40258-019-00475-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Budget impact analyses (BIAs) describe changes in intervention- and disease-related costs of new technologies. Evidence on the quality of BIAs for cancer screening is lacking. OBJECTIVES We systematically reviewed the literature and methods to assess how closely BIA guidelines are followed when BIAs are performed for cancer-screening programs. DATA SOURCES Systematic searches were conducted in MEDLINE, EMBASE, EconLit, CRD (Centre for Reviews and Dissemination, University of York), and CEA registry of the Tufts Medical Center. STUDY ELIGIBILITY CRITERIA Eligible studies were BIAs evaluating cancer-screening programs published in English, 2010-2018. SYNTHESIS METHODS Standardized evidence tables were generated to extract and compare study characteristics outlined by the ISPOR BIA Task Force. RESULTS Nineteen studies were identified evaluating screening for breast (5), colorectal (6), cervical (3), lung (1), prostate (3), and skin (1) cancers. Model designs included decision-analytic models (13) and simple cost calculators (6). From all studies, only 53% reported costs for a minimum of 3 years, 58% compared to a mix of screening options, 42% reported model validation, and 37% reported uncertainty analysis for participation rates. The quality of studies appeared to be independent of cancer site. LIMITATIONS "Gray" literature was not searched, misinterpretation is possible due to limited information in publications, and focus was on international methodological guidelines rather than regional guidelines. CONCLUSIONS Our review highlights considerable variability in the extent to which BIAs evaluating cancer-screening programs followed recommended guidelines. The annual budget impact at least over the next 3-5 years should be estimated. Validation and uncertainty analysis should always be conducted. Continued dissemination efforts of existing best-practice guidelines are necessary to ensure high-quality analyses.
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Affiliation(s)
- Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Jovan Todorovic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Marvin Bundo
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Annette Conrads-Frank
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Ursula Rochau
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria
| | - Gottfried Endel
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Ingrid Wilbacher
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Nikoletta Malbaski
- Evidence-based Health Care, Main Association of Austrian Social Insurance Institutions, Haidingergasse 1, 1030, Vienna, Austria
| | - Niki Popper
- DWH Simulation Services, DEXHELPP, Neustiftgasse 57-59, 1070, Vienna, Austria
- TU Wien, Information and Software Engineering Group (ifs - E194-01), Favoritenstraße 9-11/194-01, 1040, Vienna, Austria
| | - Jagpreet Chhatwal
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er-Sheva, Israel
| | - Josephine Mauskopf
- RTI Health Solutions, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tyrol, Austria.
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 101 Merrimac St, Boston, MA, 02114, USA.
- Division of Health Technology Assessment, ONCOTYROL-Center for Personalized Cancer Medicine, Karl-Kapferer-Straße 5, 6020, Innsbruck, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA.
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