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Hodson N, Powell BJ, Nilsen P, Beidas RS. How can a behavioral economics lens contribute to implementation science? Implement Sci 2024; 19:33. [PMID: 38671508 PMCID: PMC11046816 DOI: 10.1186/s13012-024-01362-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Implementation science in health is an interdisciplinary field with an emphasis on supporting behavior change required when clinicians and other actors implement evidence-based practices within organizational constraints. Behavioral economics has emerged in parallel and works towards developing realistic models of how humans behave and categorizes a wide range of features of choices that can influence behavior. We argue that implementation science can be enhanced by the incorporation of approaches from behavioral economics. Main body First, we provide a general overview of implementation science and ways in which implementation science has been limited to date. Second, we review principles of behavioral economics and describe how concepts from BE have been successfully applied to healthcare including nudges deployed in the electronic health record. For example, de-implementation of low-value prescribing has been supported by changing the default in the electronic health record. We then describe what a behavioral economics lens offers to existing implementation science theories, models and frameworks, including rich and realistic models of human behavior, additional research methods such as pre-mortems and behavioral design, and low-cost and scalable implementation strategies. We argue that insights from behavioral economics can guide the design of implementation strategies and the interpretation of implementation studies. Key objections to incorporating behavioral economics are addressed, including concerns about sustainment and at what level the strategies work. CONCLUSION Scholars should consider augmenting implementation science theories, models, and frameworks with relevant insights from behavioral economics. By drawing on these additional insights, implementation scientists have the potential to boost efforts to expand the provision and availability of high quality care.
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Affiliation(s)
- Nathan Hodson
- Price School of Public Policy, University of Southern California, Los Angeles, USA.
- Warwick Medical School, Unit of Mental Health and Wellbeing, Division of Health Sciences, University of Warwick, Coventry, UK.
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA.
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Per Nilsen
- Department of Health, Medicine, and Caring Sciences (HMV), Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Rinad S Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, USA
- Center for Dissemination and Implementation Science, Institute for Public Health and Medicine, Chicago, USA
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Bunger AC, Chuang E, Girth AM, Lancaster KE, Smith R, Phillips RJ, Martin J, Gadel F, Willauer T, Himmeger MJ, Millisor J, McClellan J, Powell BJ, Saldana L, Aarons GA. Specifying cross-system collaboration strategies for implementation: a multi-site qualitative study with child welfare and behavioral health organizations. Implement Sci 2024; 19:13. [PMID: 38347639 PMCID: PMC10863233 DOI: 10.1186/s13012-024-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Cross-system interventions that integrate health, behavioral health, and social services can improve client outcomes and expand community impact. Successful implementation of these interventions depends on the extent to which service partners can align frontline services and organizational operations. However, collaboration strategies linking multiple implementation contexts have received limited empirical attention. This study identifies, describes, and specifies multi-level collaboration strategies used during the implementation of Ohio Sobriety Treatment and Reducing Trauma (Ohio START), a cross-system intervention that integrates services across two systems (child welfare and evidence-based behavioral health services) for families that are affected by co-occurring child maltreatment and parental substance use disorders. METHODS In phase 1, we used a multi-site qualitative design with 17 counties that implemented Ohio START. Qualitative data were gathered from 104 staff from child welfare agencies, behavioral health treatment organizations, and regional behavioral health boards involved in implementation via 48 small group interviews about collaborative approaches to implementation. To examine cross-system collaboration strategies, qualitative data were analyzed using an iterative template approach and content analysis. In phase 2, a 16-member expert panel met to validate and specify the cross-system collaboration strategies identified in the interviews. The panel was comprised of key child welfare and behavioral health partners and scholars. RESULTS In phase 1, we identified seven cross-system collaboration strategies used for implementation. Three strategies were used to staff the program: (1) contract for expertise, (2) provide joint supervision, and (3) co-locate staff. Two strategies were used to promote service access: (4) referral protocols and (5) expedited access agreements. Two strategies were used to align case plans: (6) shared decision-making meetings, and (7) sharing data. In phase 2, expert panelists specified operational details of the cross-system collaboration strategies, and explained the processes by which strategies were perceived to improve implementation and service system outcomes. CONCLUSIONS We identified a range of cross-system collaboration strategies that show promise for improving staffing, service access, and case planning. Leaders, supervisors, and frontline staff used these strategies during all phases of implementation. These findings lay the foundation for future experimental and quasi-experimental studies that test the effectiveness of cross-system collaboration strategies.
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Affiliation(s)
- Alicia C Bunger
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Emmeline Chuang
- School of Social Welfare, University of California Berkeley, Berkeley, CA, USA
| | - Amanda M Girth
- John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, USA
| | | | - Rebecca Smith
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Jared Martin
- Center for Vulnerable Populations, Department of Medicine, University of California, San Francisco, CA, USA
| | - Fawn Gadel
- Public Children Services Association of Ohio, Columbus, OH, USA
| | | | | | | | - Jen McClellan
- Public Children Services Association of Ohio, Columbus, OH, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Lisa Saldana
- Lighthouse Institute, Chestnut Health Systems, Eugene, OR, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
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Kirk JW, Lindstroem MB, Stefánsdóttir NT, Andersen O, Powell BJ, Nilsen P, Tjørnhøj-Thomsen T. Influences of specialty identity when implementing a new emergency department in Denmark: a qualitative study. BMC Health Serv Res 2024; 24:162. [PMID: 38302985 PMCID: PMC10836004 DOI: 10.1186/s12913-024-10604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The Danish Health Authority recommended the implementation of new types of emergency departments. Organizational changes in the hospital sector challenged the role, identity, and autonomy of medical specialists. They tend to identify with their specialty, which can challenge successful implementation of change. However, investigations on specialty identity are rare in implementation science, and how the co-existence of different specialty identities influences the implementation of new emergency departments needs to be explored for the development of tailored implementation strategies. The aim of this study was to examine how medical specialty identity influences collaboration between physicians when implementing a new emergency department in Denmark. METHODS Qualitative methods in the form of participants' observations at 13 oilcloth sessions (a micro-simulation method) were conducted followed up by 53 individual semi-structured interviews with participants from the oilcloth sessions. Out of the 53 interviews, 26 were conducted with specialists. Data from their interviews are included in this study. Data were analysed deductively inspired by Social Identity Theory. RESULTS The analysis yielded three overarching themes: [1] ongoing creation and re-creation of specialty identity through boundary drawing; [2] social categorization and power relations; and [3] the patient as a boundary object. CONCLUSIONS Specialty identity is an important determinant of collaboration among physicians when implementing a new emergency department. Specialty identity involves social categorization, which entails ongoing creation and re-creation of boundary drawing and exercising of power among the physicians. In some situations, the patient became a positive boundary object, increasing the possibility for a successful collaboration and supporting successful implementation, but direct expressions of boundaries and mistrust were evident. Both were manifested through a dominating power expressed through social categorization in the form of in- and out-groups and in an "us and them" discourse, which created distance and separation among physicians from different specialties. This distancing and separation became a barrier to the implementation of the new emergency department.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | | | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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Mody A, Filiatreau LM, Goss CW, Powell BJ, Geng EH. Instrumental variables for implementation science: exploring context-dependent causal pathways between implementation strategies and evidence-based interventions. Implement Sci Commun 2023; 4:157. [PMID: 38124203 PMCID: PMC10731809 DOI: 10.1186/s43058-023-00536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The impact of both implementation strategies (IS) and evidence-based interventions (EBI) can vary across contexts, and a better understanding of how and why this occurs presents fundamental but challenging questions that implementation science as a field will need to grapple with. We use causal epidemiologic methods to explore the mechanisms of why sharp distinctions between implementation strategies (IS) and efficacy of an evidence-based intervention (EBI) may fail to recognize that the effect of an EBI can be deeply intertwined and dependent on the context of the IS leading to its uptake. METHODS We explore the use of instrumental variable (IV) analyses as a critical tool for implementation science methods to isolate three relevant quantities within the same intervention context when exposure to an implementation strategy is random: (1) the effect of an IS on implementation outcomes (e.g., uptake), (2) effect of EBI uptake on patient outcomes, and (3) overall effectiveness of the IS (i.e., ~ implementation*efficacy). We discuss the mechanisms by which an implementation strategy can alter the context, and therefore effect, of an EBI using the underlying IV assumptions. We illustrate these concepts using examples of the implementation of new ART initiation guidelines in Zambia and community-based masking programs in Bangladesh. RESULTS Causal questions relevant to implementation science are answered at each stage of an IV analysis. The first stage assesses the effect of the IS (e.g., new guidelines) on EBI uptake (e.g., same-day treatment initiation). The second stage leverages the IS as an IV to estimate the complier average causal effect (CACE) of the EBI on patient outcomes (e.g., effect of same-day treatment initiation on viral suppression). The underlying assumptions of CACE formalize that the causal effect of EBI may differ in the context of a different IS because (1) the mechanisms by which individuals uptake an intervention may differ and (2) the subgroup of individuals who take up an EBI may differ. IV methods thus provide a conceptual framework for how IS and EBIs are linked and that the IS itself needs to be considered a critical contextual determinant. Moreover, it also provides rigorous methodologic tools to isolate the effect of an IS, EBI, and combined effect of the IS and EBI. DISCUSSION Leveraging IV methods when exposure to an implementation strategy is random helps to conceptualize the context-dependent nature of implementation strategies, EBIs, and patient outcomes. IV methods formalize that the causal effect of an EBI may be specific to the context of the implementation strategy used to promote uptake. This integration of implementation science concepts and theory with rigorous causal epidemiologic methods yields novel insights and provides important tools for exploring the next generation of questions related to mechanisms and context in implementation science.
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Affiliation(s)
- Aaloke Mody
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA.
| | - Lindsey M Filiatreau
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
| | - Charles W Goss
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Byron J Powell
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 4523 Clayton Avenue, St. Louis, MO, 63110, USA
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Tuda D, Bochicchio L, Stefancic A, Hawes M, Chen JH, Powell BJ, Cabassa LJ. Using the matrixed multiple case study methodology to understand site differences in the outcomes of a Hybrid Type 1 trial of a peer-led healthy lifestyle intervention for people with serious mental illness. Transl Behav Med 2023; 13:919-927. [PMID: 37844273 PMCID: PMC10724107 DOI: 10.1093/tbm/ibad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023] Open
Abstract
Site differences in implementation trial outcomes are common but often not examined. In a Hybrid Type 1 trial examining the effectiveness-implementation of a peer-led group life-style balance (PGLB) intervention for people with serious mental illness (SMI) in three supportive housing agencies, we found that PGLB recipients' physical health outcomes differed by study sites. The matrixed multiple case study methodology was used to explore how implementation outcomes and changes in context of usual care (UC) services contributed to these site differences. Two implementation outcomes (i.e. PGLB fidelity ratings and intervention recipients' acceptability of PGLB and UC) and changes in healthcare services integration at the study sites were examined. ANOVAs were used to examine site differences in fidelity ratings and client satisfaction. Directed content analysis was used to analyze leadership interviews to identify changes in the context of UC services. Site 3 showed a trend approaching significance (P = .05) towards higher fidelity ratings. High levels of satisfaction with PGLB were reported at all sites. Significant differences in PGLB recipients' satisfaction with UC were found, with Site 3 reporting the lowest levels of satisfaction. Agency leaders reported an increase in prioritizing client's health throughout the trial with sites differing in how these priorities were put into action. Differences in PGLB recipients' satisfaction with UC, and changes in healthcare service integration seemed to have contributed to the site differences in our trial. The matrixed multiple case study methodology is a useful approach to identify implementation outcomes contributing to the heterogeneity of multisite implementation trial results.
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Affiliation(s)
- Daniela Tuda
- George Warren Brown School of Social Work, Washington University in St. Louis Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Lauren Bochicchio
- School of Nursing, Columbia University, 560 West 168th Street, New York, NY 10032, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 98, New York, NY 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Dr, New York, NY 10032, USA
| | - Mark Hawes
- George Warren Brown School of Social Work, Washington University in St. Louis Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
| | - Jun-Hong Chen
- George Warren Brown School of Social Work, Washington University in St. Louis Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA
| | - Byron J Powell
- George Warren Brown School of Social Work, Washington University in St. Louis Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, 600 S Taylor Ave, St. Louis, MO 63110, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130, USA
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Luke DA, Powell BJ, Paniagua-Avila A. Bridges and Mechanisms: Integrating Systems Science Thinking into Implementation Research. Annu Rev Public Health 2023; 45. [PMID: 38100647 DOI: 10.1146/annurev-publhealth-060922-040205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
We present a detailed argument for how to integrate, or bridge, systems science thinking and methods with implementation science. We start by showing how fundamental systems science principles of structure, dynamics, information, and utility are relevant for implementation science. Then we examine the need for implementation science to develop and apply richer theories of complex systems. This can be accomplished by emphasizing a causal mechanisms approach. Identifying causal mechanisms focuses on the "cogs and gears" of public health, clinical, and organizational interventions. A mechanisms approach focuses on how a specific strategy will produce the implementation outcome. We show how connecting systems science to implementation science opens new opportunities for examining and addressing social determinants of health and conducting equitable and ethical implementation research. Finally, we present case studies illustrating successful applications of systems science within implementation science in community health policy, tobacco control, health care access, and breast cancer screening. Expected final online publication date for the Annual Review of Public Health, Volume 45 is April 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Douglas A Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School; Center for Dissemination & Implementation, Institute for Public Health; and Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Akiba CF, Go VF, Powell BJ, Muessig K, Golin C, Dussault JM, Zimba CC, Matewere M, Mbota M, Thom A, Masa C, Malava JK, Gaynes BN, Masiye J, Udedi M, Hosseinipour M, Pence BW. Champion and audit and feedback strategy fidelity and their relationship to depression intervention fidelity: A mixed method study. SSM Ment Health 2023; 3:100194. [PMID: 37485235 PMCID: PMC10358176 DOI: 10.1016/j.ssmmh.2023.100194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Background Globally, mental health disorders rank as the greatest cause of disability. Low and middle-income countries (LMICs) hold a disproportionate share of the mental health burden, especially as it pertains to depression. Depression is highly prevalent among those with non-communicable diseases (NCDs), creating a barrier to successful treatment. While some treatments have proven efficacy in LMIC settings, wide dissemination is challenged by multiple factors, leading researchers to call for implementation strategies to overcome barriers to care provision. However, implementation strategies are often not well defined or documented, challenging the interpretation of study results and the uptake and replication of strategies in practice settings. Assessing implementation strategy fidelity (ISF), or the extent to which a strategy was implemented as designed, overcomes these challenges. This study assessed fidelity of two implementation strategies (a 'basic' champion strategy and an 'enhanced' champion + audit and feedback strategy) to improve the integration of a depression intervention, measurement based care (MBC), at 10 NCD clinics in Malawi. The primary goal of this study was to assess the relationship between the implementation strategies and MBC fidelity using a mixed methods approach. Methods We developed a theory-informed mixed methods fidelity assessment that first combined an implementation strategy specification technique with a fidelity framework. We then created corresponding fidelity indicators to strategy components. Clinical process data and one-on-one in-depth interviews with 45 staff members at 6 clinics were utilized as data sources. Our final analysis used descriptive statistics, reflexive-thematic analysis (RTA), data merging, and triangulation to examine the relationship between ISF and MBC intervention fidelity. Results Our mixed methods analysis revealed how ISF may moderate the relationship between the strategies and MBC fidelity. Leadership engagement and implementation climate were critical for clinics to overcome implementation barriers and preserve implementation strategy and MBC fidelity. Descriptive statistics determined champion strategy fidelity to range from 61 to 93% across the 10 clinics. Fidelity to the audit and feedback strategy ranged from 82 to 91% across the 5 clinics assigned to that condition. MBC fidelity ranged from 54 to 95% across all clinics. Although correlations between ISF and MBC fidelity were not statistically significant due to the sample of 10 clinics, associations were in the expected direction and of moderate effect size. A coefficient for shared depression screening among clinicians had greater face validity compared to depression screening coverage and functioned as a proximal indicator of implementation strategy success. Conclusion Fidelity to the basic and enhanced strategies varied by site and were influenced by leadership engagement and implementation climate. Champion strategies may benefit from the addition of leadership strategies to help address implementation barriers outside the purview of champions. ISF may moderate the relationship between strategies and implementation outcomes.
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Affiliation(s)
- Christopher F. Akiba
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Vivian F. Go
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Byron J. Powell
- Brown School at Washington University in St. Louis, MSC 1196-251-46, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Kate Muessig
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill 135 Dauer Drive, 302 Rosenau Hall, CB #7440, Chapel Hill, NC, 27599-7440, USA
| | - Josée M. Dussault
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall CB #7435, Chapel Hill, NC, 27599-7435, USA
| | - Chifundo C. Zimba
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Maureen Matewere
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - MacDonald Mbota
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Annie Thom
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Cecilia Masa
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Jullita K. Malava
- Malawi Epidemiology and Intervention Research Unit (MEIRU), P.O. Box 46, Chilumba, Karonga District, Malawi
| | - Bradley N. Gaynes
- Division of Global Mental Health, Department of Psychiatry, UNC School of Medicine, 101 Manning Dr # 1, Chapel Hill, NC, 27514, USA
| | - Jones Masiye
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
| | - Michael Udedi
- Malawi Ministry of Health and Population, Non-communicable Diseases and Mental Health Clinical Services, P.O Box 30377, Lilongwe, 3, Malawi
| | - Mina Hosseinipour
- UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Brian W. Pence
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall CB #7435, Chapel Hill, NC, 27599-7435, USA
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Lovero KL, Kemp CG, Wagenaar BH, Giusto A, Greene MC, Powell BJ, Proctor EK. Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review. Implement Sci 2023; 18:56. [PMID: 37904218 PMCID: PMC10617067 DOI: 10.1186/s13012-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. METHODS We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. RESULTS The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings (n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1-46 strategies) included in each study. Most studies (n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. CONCLUSIONS While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. TRIAL REGISTRATION PROSPERO, CRD42021268374.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Greene
- Program On Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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Fernandez ME, Powell BJ, Ten Hoor GA. Editorial: Implementation Mapping for selecting, adapting and developing implementation strategies. Front Public Health 2023; 11:1288726. [PMID: 37915826 PMCID: PMC10616895 DOI: 10.3389/fpubh.2023.1288726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Affiliation(s)
- Maria E. Fernandez
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
- UTHealth Institute for Implementation Science, The University of Texas Health Science Center, Houston, TX, United States
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gill A. Ten Hoor
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
- Department of Work and Social Psychology, Faculty of Psychology and Neurosciences, Maastricht University, Maastricht, Netherlands
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10
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Brownson RC, Adams DR, Anyane-Yeboa A, Powell BJ. Learning to Prioritize Our Collaborative Opportunities: Overcoming the Bright Shiny Object Syndrome. J Contin Educ Health Prof 2023:00005141-990000000-00096. [PMID: 37706672 PMCID: PMC10937331 DOI: 10.1097/ceh.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
ABSTRACT There are multiple opportunities to participate in team science, leading to long-term benefits (eg, research impact, novelty, productivity). Scholars are not well-trained in how to choose among these opportunities, often learning via trial and error. The ability to navigate collaborations is framed by several principles and considerations: (1) locus of control (what control we have over our own behavior) and how it affects academic job satisfaction; (2) the scarcity mindset that may manifest as a result of the fear of missing future opportunities; and (3) power dynamics and inequities (eg, among women and racial/ethnic minority individuals). To provide a more systematic approach to weighing academic opportunities, the authors offer 30 questions across six overlapping domains. The domains include: the big picture (eg, Is the opportunity a building block for your career?), context (eg, How much do you have on your plate?), person (eg, Who is asking?), team (eg, Is the team productive?), role (eg, Will you lead or assist?), and outcomes (eg, Might the opportunity lead to publications and/or grants?). We offer advice for decision-making. For example, when presented with an opportunity involving a significant time commitment, it is useful to allow at least 24 hours before deciding. The authors offer advice and sample language for communicating your decision. Although every situation is different, there are several fundamental issues and questions to consider when one is presented with a new opportunity-these questions are suggested for mentors and mentees.
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Affiliation(s)
- Ross C Brownson
- Dr. Brownson: Steven H. and Susan U. Lipstein Distinguished Professor of Public Health and Director, Prevention Research Center, Brown School, and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri. Dr. Adams: NIMH Post-doctoral Fellow, Center for Mental Health Services Research, Brown School at Washington University in St. Louis, St. Louis, Missouri. Dr. Anyane-Yeboa: Assistant Professor in the Division of Gastroenterology and Instructor of Investigation in the Clinical Translational Epidemiology Unit of the Mongan Institute, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA. Dr. Powell: Associate Professor and Co-Director, Center for Mental Health Services Research, Brown School; Co-Director, Center for Dissemination and Implementation, Institute for Public Health; and Assistant Professor of Medicine, Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
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11
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Snider MDH, Boyd MR, Walker MR, Powell BJ, Lewis CC. Using audit and feedback to guide tailored implementations of measurement-based care in community mental health: a multiple case study. Implement Sci Commun 2023; 4:94. [PMID: 37580815 PMCID: PMC10424451 DOI: 10.1186/s43058-023-00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is an implementation strategy that can facilitate implementation tailoring by identifying gaps between desired and actual clinical care. While there are several theory-based propositions on which A&F components lead to better implementation outcomes, many have not been empirically investigated, and there is limited guidance for stakeholders when applying A&F in practice. The current study aims to illustrate A&F procedures in six community mental health clinics, with an emphasis on reporting A&F components that are relevant to theories of how feedback elicits behavior change. METHODS Six clinics from a larger trial using a tailored approach to implement measurement-based care (MBC) were analyzed for feedback content, delivery mechanisms, barriers to feedback, and outcomes of feedback using archival data. Pattern analysis was conducted to examine relations between A&F components and changes in MBC use. RESULTS Several sites utilized both aggregate and individualized data summaries, and data accuracy concerns were common. Feedback cycles featuring individual-level clinician data, data relevant to MBC barriers, and information requested by data recipients were related to patterns of increased MBC use. CONCLUSIONS These findings support extant theory, such as Feedback Intervention Theory. Mental health professionals wishing to apply A&F should consider establishing reciprocal feedback mechanisms on the quality and amount of data being received and adopting specific roles communicating and addressing data quality concerns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02266134.
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Affiliation(s)
- Mira D H Snider
- Department of Psychology, West Virginia University, 53 Campus Drive Morgantown, Morgantown, WV, 26505, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, Los Angeles, USA
| | - Madison R Walker
- Center for Health Equity Research, University of North Carolina, Chapel Hill, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
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Riley-Gibson E, Hall A, Shoesmith A, Wolfenden L, Shelton RC, Doherty E, Pollock E, Booth D, Salloum RG, Laur C, Powell BJ, Kingsland M, Lane C, Hailemariam M, Sutherland R, Nathan N. A systematic review to determine the effect of strategies to sustain chronic disease prevention interventions in clinical and community settings: study protocol. Res Sq 2023:rs.3.rs-2333454. [PMID: 37398340 PMCID: PMC10312971 DOI: 10.21203/rs.3.rs-2333454/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Background The primary purpose of this review is to synthesise the effect of strategies aiming to sustain the implementation of evidenced based interventions (EBIs) targeting key health behaviours associated with chronic disease (i.e., physical inactivity, poor diet, harmful alcohol use and tobacco smoking) in clinical and community settings. The field of implementation science is bereft of an evidence base of effective sustainment strategies, and as such this review will provide important evidence to advance the field of sustainability research. Methods This systematic review protocol is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol (PRISMA-P) checklist (Additional file 1). Methods will follow Cochrane gold-standard review methodology. The search will be undertaken across multiple databases, adapting filters previously developed by the research team; data screening and extraction will be performed in duplicate; strategies will be coded using an adapted sustainability-explicit taxonomy; evidence will be synthesised using appropriate methods (i.e. meta-analytic following Cochrane or non-meta-analytic following SWiM guidelines). We will include any randomised controlled study that targets any staff or volunteers delivering interventions in clinical or community settings. Studies which report on any objective or subjective measure of the sustainment of a health prevention policy, practice, or program within any of the eligible settings will be included. Article screening, data extraction, risk of bias and quality assessment will be performed independently by two review authors. Risk of bias will be assessed using Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). A random effect meta-analysis will be conducted to estimate the pooled effect of sustainment strategies separately by setting (i.e. clinical and community). Sub-group analyses will be undertaken to explore possible causes of statistical heterogeneity and may include: time period, single or multi strategy, type of setting and type of intervention. Differences between sub-groups will be statistically compared. Discussion/Conclusion This will be the first systematic review to determine the effect of strategies designed to support sustainment on sustaining the implementation of EBIs in clinical and community settings. The findings of this review will directly inform the design of future sustainability-focused implementation trials. Further, these findings will inform the development of a sustainability practice guide for public health practitioners. Registration This review was prospectively registered with PROSPERO (registration ID: CRD42022352333).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Celia Laur
- University of Toronto Institute of Health Policy Management and Evaluation
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McGuier EA, Aarons GA, Wright JD, Fortney JC, Powell BJ, Rothenberger SD, Weingart LR, Miller E, Kolko DJ. Team-focused implementation strategies to improve implementation of mental health screening and referral in rural Children's Advocacy Centers: study protocol for a pilot cluster randomized hybrid type 2 trial. Implement Sci Commun 2023; 4:58. [PMID: 37237302 PMCID: PMC10214641 DOI: 10.1186/s43058-023-00437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Children's Advocacy Centers (CACs) use multidisciplinary teams to investigate and respond to maltreatment allegations. CACs play a critical role in connecting children with mental health needs to evidence-based mental health treatment, especially in low-resourced rural areas. Standardized mental health screening and referral protocols can improve CACs' capacity to identify children with mental health needs and encourage treatment engagement. In the team-based context of CACs, teamwork quality is likely to influence implementation processes and outcomes. Implementation strategies that target teams and apply the science of team effectiveness may enhance implementation outcomes in team-based settings. METHODS We will use Implementation Mapping to develop team-focused implementation strategies to support the implementation of the Care Process Model for Pediatric Traumatic Stress (CPM-PTS), a standardized screening and referral protocol. Team-focused strategies will integrate activities from effective team development interventions. We will pilot team-focused implementation in a cluster-randomized hybrid type 2 effectiveness-implementation trial. Four rural CACs will implement the CPM-PTS after being randomized to either team-focused implementation (n = 2 CACs) or standard implementation (n = 2 CACs). We will assess the feasibility of team-focused implementation and explore between-group differences in hypothesized team-level mechanisms of change and implementation outcomes (implementation aim). We will use a within-group pre-post design to test the effectiveness of the CPM-PTS in increasing caregivers' understanding of their child's mental health needs and caregivers' intentions to initiate mental health services (effectiveness aim). CONCLUSIONS Targeting multidisciplinary teams is an innovative approach to improving implementation outcomes. This study will be one of the first to test team-focused implementation strategies that integrate effective team development interventions. Results will inform efforts to implement evidence-based practices in team-based service settings. TRIAL REGISTRATION Clinicaltrials.gov, NCT05679154 . Registered on January 10, 2023.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Jaely D Wright
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - John C Fortney
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, HSR&D Center of Innovation for Veteran-Centered and Value Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Scott D Rothenberger
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
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Yakovchenko V, Chinman MJ, Lamorte C, Powell BJ, Waltz TJ, Merante M, Gibson S, Neely B, Morgan TR, Rogal SS. Refining Expert Recommendations for Implementing Change (ERIC) strategy surveys using cognitive interviews with frontline providers. Implement Sci Commun 2023; 4:42. [PMID: 37085937 PMCID: PMC10122282 DOI: 10.1186/s43058-023-00409-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/06/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) compilation includes 73 defined implementation strategies clustered into nine content areas. This taxonomy has been used to track implementation strategies over time using surveys. This study aimed to improve the ERIC survey using cognitive interviews with non-implementation scientist clinicians. METHODS Starting in 2015, we developed and fielded annual ERIC surveys to evaluate liver care in the Veterans Health Administration (VA). We invited providers who had completed at least three surveys to participate in cognitive interviews (October 2020 to October 2021). Before the interviews, participants reviewed the complete 73-item ERIC survey and marked which strategies were unclear due to wording, conceptual confusion, or overlap with other strategies. They then engaged in semi-structured cognitive interviews to describe the experience of completing the survey and elaborate on which strategies required further clarification. RESULTS Twelve VA providers completed surveys followed by cognitive interviews. The "Engage Consumer" and "Support Clinicians" clusters were rated most highly in terms of conceptual and wording clarity. In contrast, the "Financial" cluster had the most wording and conceptual confusion. The "Adapt and Tailor to Context" cluster strategies were considered to have the most redundancy. Providers outlined ways in which the strategies could be clearer in terms of wording (32%), conceptual clarity (51%), and clarifying the distinction between strategies (51%). CONCLUSIONS Cognitive interviews with ERIC survey participants allowed us to identify and address issues with strategy wording, combine conceptually indistinct strategies, and disaggregate multi-barreled strategies. Improvements made to the ERIC survey based on these findings will ultimately assist VA and other institutions in designing, evaluating, and replicating quality improvement efforts.
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Affiliation(s)
- Vera Yakovchenko
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
| | - Matthew J. Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
- RAND Corporation, Pittsburgh, PA USA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO USA
| | - Thomas J. Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI USA
| | - Monica Merante
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA USA
| | - Brittney Neely
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA USA
- Department of Medicine, University of California, Irvine, CA USA
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Building 30, Room 2A113, University Drive C (151C), Pittsburgh, PA 15240-1001 USA
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA USA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA
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Geng EH, Mody A, Powell BJ. On-the-Go Adaptation of Implementation Approaches and Strategies in Health: Emerging Perspectives and Research Opportunities. Annu Rev Public Health 2023; 44:21-36. [PMID: 37010927 DOI: 10.1146/annurev-publhealth-051920-124515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
In many cases, implementation approaches (composed of one or more strategies) may need to change over time to work optimally. We use a literature review to inform a mechanistic analysis of such on-the-go adaptations. We suggest that such adaptations of implementation strategies consist of three necessary steps. The first component is the initial effect of the implementation approach on intended implementation, service delivery, or clinical outcomes. Second, these initial effects must in turn be used to modify, alter, intensify, or otherwise change the implementation approach. Third, the modified approach itself has effects. Conceiving of adaptation as all three steps implies that a full understanding of adaptation involves (a) a sense of initial effects, (b) conceptualizing and documenting content and rationale for changes in approach (e.g., alteration, intensification), and (c) the effects of the changed approach (including how the latter effects depend on initial effects). Conceptualizing these steps can help researchers ask questions about adaptation (e.g., thresholds for change, dosing, potentiation, sequencing) to advance our understanding of implementation strategies.
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Affiliation(s)
- Elvin H Geng
- Division of Infectious Diseases, Department of Medicine; and Center for Dissemination and Implementation, Institute for Public Health; Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Aaloke Mody
- Division of Infectious Diseases, Department of Medicine; and Center for Dissemination and Implementation, Institute for Public Health; Washington University in St. Louis, St. Louis, Missouri, USA;
| | - Byron J Powell
- Division of Infectious Diseases, Department of Medicine; and Center for Dissemination and Implementation, Institute for Public Health; Washington University in St. Louis, St. Louis, Missouri, USA;
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
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Barwick M, Brown J, Petricca K, Stevens B, Powell BJ, Jaouich A, Shakespeare J, Seto E. The Implementation Playbook: study protocol for the development and feasibility evaluation of a digital tool for effective implementation of evidence-based innovations. Implement Sci Commun 2023; 4:21. [PMID: 36882826 PMCID: PMC9990055 DOI: 10.1186/s43058-023-00402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/12/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Evidence-based innovations can improve health outcomes, but only if successfully implemented. Implementation can be complex, highly susceptible to failure, costly and resource intensive. Internationally, there is an urgent need to improve the implementation of effective innovations. Successful implementation is best guided by implementation science, but organizations lack implementation know-how and have difficulty applying it. Implementation support is typically shared in static, non-interactive, overly academic guides and is rarely evaluated. In-person implementation facilitation is often soft-funded, costly, and scarce. This study seeks to improve effective implementation by (1) developing a first-in-kind digital tool to guide pragmatic, empirically based and self-directed implementation planning in real-time; and (2) exploring the tool's feasibility in six health organizations implementing different innovations. METHODS Ideation emerged from a paper-based resource, The Implementation Game©, and a revision called The Implementation Roadmap©; both integrate core implementation components from evidence, models and frameworks to guide structured, explicit, and pragmatic planning. Prior funding also generated user personas and high-level product requirements. This study will design, develop, and evaluate the feasibility of a digital tool called The Implementation Playbook©. In Phase 1, user-centred design and usability testing will inform tool content, visual interface, and functions to produce a minimum viable product. Phase 2 will explore the Playbook's feasibility in six purposefully selected health organizations sampled for maximum variation. Organizations will use the Playbook for up to 24 months to implement an innovation of their choosing. Mixed methods will gather: (i) field notes from implementation team check-in meetings; (ii) interviews with implementation teams about their experience using the tool; (iii) user free-form content entered into the tool as teams work through implementation planning; (iv) Organizational Readiness for Implementing Change questionnaire; (v) System Usability Scale; and (vi) tool metrics on how users progressed through activities and the time required to do so. DISCUSSION Effective implementation of evidence-based innovations is essential for optimal health. We seek to develop a prototype digital tool and demonstrate its feasibility and usefulness across organizations implementing different innovations. This technology could fill a significant need globally, be highly scalable, and potentially valid for diverse organizations implementing various innovations.
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Affiliation(s)
- Melanie Barwick
- Research Institute, The Hospital for Sick Children, Toronto, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | | | - Kadia Petricca
- Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Bonnie Stevens
- Research Institute, The Hospital for Sick Children, Toronto, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St Louis, St. Louis, MO, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.,Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Alexia Jaouich
- Stepped Care Solutions, Mount Pearl, Newfoundland, Canada
| | - Jill Shakespeare
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Canada
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Schilling S, Powell BJ, Stewart PW, Wood JN. Child Adult Relationship Enhancement in Primary Care (PriCARE): study design/protocol for a randomized trial of a primary care-based group parenting intervention to prevent child maltreatment. Trials 2023; 24:138. [PMID: 36823526 PMCID: PMC9947901 DOI: 10.1186/s13063-022-07024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/15/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Problematic parent-child relationships lie at the heart of CM. Parents who maltreat their children are more likely to have punitive parenting styles characterized by high rates of negative interaction and ineffective discipline strategies with over-reliance on punishment. Thus, parenting interventions that strengthen parent-child relationships, teach positive discipline techniques, decrease harsh parenting, and decrease child behavioral problems hold promise as CM prevention strategies. Challenges in engaging parents, particularly low-income and minority parents, and a lack of knowledge regarding effective implementation strategies, however, have greatly limited the reach and impact of parenting interventions. Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO is a 6-session group parenting intervention that holds promise in addressing these challenges because PriCARE/CARIÑO was (1) developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families and (2) designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention. METHODS This study is a multicenter randomized controlled trial with two parallel arms. Children, 2-6 years old with Medicaid/CHIP/no insurance, and their English- and Spanish-speaking caregivers recruited from pediatric primary care clinics in Philadelphia and North Carolina will be enrolled. Caregivers assigned to the intervention regimen will attend PriCARE/CARIÑO and receive usual care. Caregivers assigned to the control regimen will receive usual care only. The primary outcome is occurrence of an investigation for CM by child protective services during the 48 months following completion of the intervention. In addition, scores for CM risk, child behavior problems, harsh and neglectful parenting behaviors, caregiver stress, and caregiver-child interactions will be assessed as secondary outcome measures and for investigation of possible mechanisms of intervention-induced change. We will also identify PriCARE/CARIÑO implementation factors that may be barriers and facilitators to intervention referrals, enrollment, and attendance. DISCUSSION By evaluating proximal outcomes in addition to the distal outcome of CM, this study, the largest CM prevention trial with individual randomization, will help elucidate mechanisms of change and advance the science of CM prevention. This study will also gather critical information on factors influencing successful implementation and how to optimize intervention referrals, enrollment, and attendance to inform future dissemination and practical applications. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov (NCT05233150) on February 1, 2022, prior to enrolling subjects.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - Byron J. Powell
- grid.4367.60000 0001 2355 7002Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA ,grid.4367.60000 0001 2355 7002Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA ,grid.4367.60000 0001 2355 7002Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, USA
| | - Paul W. Stewart
- grid.10698.360000000122483208Department of Biostatistics, Gilling School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joanne N. Wood
- grid.239552.a0000 0001 0680 8770Safe Place: The Center for Child Protection and Health, PolicyLab, Center for Pediatric Effectiveness and Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
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McHugh SM, Riordan F, Kerins C, Curran G, Lewis CC, Presseau J, Wolfenden L, Powell BJ. Understanding tailoring to support the implementation of evidence-based interventions in healthcare: The CUSTOMISE research programme protocol. HRB Open Res 2023; 6:7. [PMID: 37361339 PMCID: PMC10285335 DOI: 10.12688/hrbopenres.13675.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 09/22/2023] Open
Abstract
Although there are effective evidence-based interventions (EBIs) to prevent, treat and coordinate care for chronic conditions they may not be adopted widely and when adopted, implementation challenges can limit their impact. Implementation strategies are "methods or techniques used to enhance the adoption, implementation, and sustainment of a clinical program or practice". There is some evidence to suggest that to be more effective, strategies should be tailored; that is, selected and designed to address specific determinants which may influence implementation in a given context. Despite the growing popularity of tailoring the concept is ill-defined, and the way in which tailoring is applied can vary across studies or lack detail when reported. There has been less focus on the part of tailoring where stakeholders prioritise determinants and select strategies, and the way in which theory, evidence and stakeholders' perspectives should be combined to make decisions during the process. Typically, tailoring is evaluated based on the effectiveness of the tailored strategy, we do not have a clear sense of the mechanisms through which tailoring works, or how to measure the "success" of the tailoring process. We lack an understanding of how stakeholders can be involved effectively in tailoring and the influence of different approaches on the outcome of tailoring. Our research programme, CUSTOMISE (Comparing and Understanding Tailoring Methods for Implementation Strategies in healthcare) will address some of these outstanding questions and generate evidence on the feasibility, acceptability, and efficiency of different tailoring approaches, and build capacity in implementation science in Ireland, developing and delivering training and supports for, and network of, researchers and implementation practitioners. The evidence generated across the studies conducted as part of CUSTOMISE will bring greater clarity, consistency, coherence, and transparency to tailoring, a key process in implementation science.
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Affiliation(s)
- Sheena M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Claire Kerins
- School of Public Health, University College Cork, Cork, Ireland
| | - Geoff Curran
- University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, Washington, USA
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Luke Wolfenden
- College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Byron J Powell
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine,, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
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Pilar M, Purtle J, Powell BJ, Mazzucca S, Eyler AA, Brownson RC. An Examination of Factors Affecting State Legislators' Support for Parity Laws for Different Mental Illnesses. Community Ment Health J 2023; 59:122-131. [PMID: 35689717 PMCID: PMC9188272 DOI: 10.1007/s10597-022-00991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 01/09/2023]
Abstract
Mental health parity legislation can improve mental health outcomes. U.S. state legislators determine whether state parity laws are adopted, making it critical to assess factors affecting policy support. This study examines the prevalence and demographic correlates of legislators' support for state parity laws for four mental illnesses- major depression disorder, post-traumatic stress disorder (PTSD), schizophrenia, and anorexia/bulimia. Using a 2017 cross-sectional survey of 475 U.S. legislators, we conducted bivariate analyses and multivariate logistic regression. Support for parity was highest for schizophrenia (57%), PTSD (55%), and major depression (53%) and lowest for anorexia/bulimia (40%). Support for parity was generally higher among females, more liberal legislators, legislators in the Northeast region of the country, and those who had previously sought treatment for mental illness. These findings highlight the importance of better disseminating evidence about anorexia/bulimia and can inform dissemination efforts about mental health parity laws to state legislators.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA.
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA.
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Amy A Eyler
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, 63130, USA
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Maddox BB, Phan ML, Byeon YV, Wolk CB, Stewart RE, Powell BJ, Okamura KH, Pellecchia M, Becker-Haimes EM, Asch DA, Beidas RS. Metrics to evaluate implementation scientists in the USA: what matters most? Implement Sci Commun 2022; 3:75. [PMID: 35842690 PMCID: PMC9287698 DOI: 10.1186/s43058-022-00323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background Implementation science has grown rapidly as a discipline over the past two decades. An examination of how publication patterns and other scholarly activities of implementation scientists are weighted in the tenure and promotion process is needed given the unique and applied focus of the field. Methods We surveyed implementation scientists (mostly from the USA) to understand their perspectives on the following matters: (1) factors weighted in tenure and promotion for implementation scientists, (2) how important these factors are for success as an implementation scientist, (3) how impact is defined for implementation scientists, (4) top journals in implementation science, and (5) how these journals are perceived with regard to their prestige. We calculated univariate descriptive statistics for all quantitative data, and we used Wilcoxon signed-rank tests to compare the participants’ ratings of various factors. We analyzed open-ended qualitative responses using content analysis. Results One hundred thirty-two implementation scientists completed the survey (response rate = 28.9%). Four factors were rated as more important for tenure and promotion decisions: number of publications, quality of publication outlets, success in obtaining external funding, and record of excellence in teaching. Six factors were rated as more important for overall success as an implementation scientist: presentations at professional meetings, involvement in professional service, impact of the implementation scientist’s scholarship on the local community and/or state, impact of the implementation scientist’s scholarship on the research community, the number and quality of the implementation scientist’s community partnerships, and the implementation scientist’s ability to disseminate their work to non-research audiences. Participants most frequently defined and described impact as changing practice and/or policy. This expert cohort identified Implementation Science as the top journal in the field. Conclusions Overall, there was a significant mismatch between the factors experts identified as being important to academic success (e.g., tenure and promotion) and the factors needed to be a successful implementation scientist. Findings have important implications for capacity building, although they are largely reflective of the promotion and tenure process in the USA. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00323-0.
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McHugh SM, Riordan F, Curran GM, Lewis CC, Wolfenden L, Presseau J, Lengnick-Hall R, Powell BJ. Conceptual tensions and practical trade-offs in tailoring implementation interventions. Front Health Serv 2022; 2:974095. [PMID: 36925816 PMCID: PMC10012756 DOI: 10.3389/frhs.2022.974095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
Tailored interventions have been shown to be effective and tailoring is a popular process with intuitive appeal for researchers and practitioners. However, the concept and process are ill-defined in implementation science. Descriptions of how tailoring has been applied in practice are often absent or insufficient in detail. This lack of transparency makes it difficult to synthesize and replicate efforts. It also hides the trade-offs for researchers and practitioners that are inherent in the process. In this article we juxtapose the growing prominence of tailoring with four key questions surrounding the process. Specifically, we ask: (1) what constitutes tailoring and when does it begin and end?; (2) how is it expected to work?; (3) who and what does the tailoring process involve?; and (4) how should tailoring be evaluated? We discuss these questions as a call to action for better reporting and further research to bring clarity, consistency, and coherence to tailoring, a key process in implementation science.
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Affiliation(s)
| | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Geoff M. Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Cara C. Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Luke Wolfenden
- College of Medicine, Health and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Justin Presseau
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rebecca Lengnick-Hall
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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Nathan N, Powell BJ, Shelton RC, Laur CV, Wolfenden L, Hailemariam M, Yoong SL, Sutherland R, Kingsland M, Waltz TJ, Hall A. Do the Expert Recommendations for Implementing Change (ERIC) strategies adequately address sustainment? Front Health Serv 2022; 2:905909. [PMID: 36925827 PMCID: PMC10012683 DOI: 10.3389/frhs.2022.905909] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022]
Abstract
Background Sustainability science is an emerging area within implementation science. There is limited evidence regarding strategies to best support the continued delivery and sustained impact of evidence-based interventions (EBIs). To build such evidence, clear definitions, and ways to operationalize strategies specific and/or relevant to sustainment are required. Taxonomies and compilations such as the Expert Recommendations for Implementing Change (ERIC) were developed to describe and organize implementation strategies. This study aimed to adapt, refine, and extend the ERIC compilation to incorporate an explicit focus on sustainment. We also sought to classify the specific phase(s) of implementation when the ERIC strategies could be considered and applied. Methods We used a two-phase iterative approach to adapt the ERIC. This involved: (1) adapting through consensus (ERIC strategies were mapped against barriers to sustainment as identified via the literature to identify if existing implementation strategies were sufficient to address sustainment, needed wording changes, or if new strategies were required) and; (2) preliminary application of this sustainment-explicit ERIC glossary (strategies described in published sustainment interventions were coded against the glossary to identify if any further amendments were needed). All team members independently reviewed changes and provided feedback for subsequent iterations until consensus was reached. Following this, and utilizing the same consensus process, the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework was applied to identify when each strategy may be best employed across phases. Results Surface level changes were made to the definitions of 41 of the 73 ERIC strategies to explicitly address sustainment. Four additional strategies received deeper changes in their definitions. One new strategy was identified: Communicate with stakeholders the continued impact of the evidence-based practice. Application of the EPIS identified that at least three-quarters of strategies should be considered during preparation and implementation phases as they are likely to impact sustainment. Conclusion A sustainment-explicit ERIC glossary is provided to help researchers and practitioners develop, test, or apply strategies to improve the sustainment of EBIs in real-world settings. Whilst most ERIC strategies only needed minor changes, their impact on sustainment needs to be tested empirically which may require significant refinement or additions in the future.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Columbia University, Mailman School of Public Health, New York, NY, United States
| | - Celia V. Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Maji Hailemariam
- Department of Obstetrics, Gynaecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Sze Lin Yoong
- School of Health Science, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
| | - Thomas J. Waltz
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, United States
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, Newcastle, NSW, Australia
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Akiba CF, Powell BJ, Pence BW, Muessig K, Golin CE, Go V. "We start where we are": a qualitative study of barriers and pragmatic solutions to the assessment and reporting of implementation strategy fidelity. Implement Sci Commun 2022; 3:117. [PMID: 36309715 PMCID: PMC9617230 DOI: 10.1186/s43058-022-00365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Fidelity measurement of implementation strategies is underdeveloped and underreported, and the level of reporting is decreasing over time. Failing to properly measure the factors that affect the delivery of an implementation strategy may obscure the link between a strategy and its outcomes. Barriers to assessing and reporting implementation strategy fidelity among researchers are not well understood. The aims of this qualitative study were to identify barriers to fidelity measurement and pragmatic pathways towards improvement. METHODS We conducted in-depth interviews among researchers conducting implementation trials. We utilized a theory-informed interview approach to elicit the barriers and possible solutions to implementation strategy fidelity assessment and reporting. Reflexive-thematic analysis guided coding and memo-writing to determine key themes regarding barriers and solutions. RESULTS Twenty-two implementation researchers were interviewed. Participants agreed that implementation strategy fidelity was an essential element of implementation trials and that its assessment and reporting should improve. Key thematic barriers focused on (1) a current lack of validated fidelity tools with the need to assess fidelity in the short term, (2) the complex nature of some implementation strategies, (3) conceptual complications when assessing fidelity within mechanisms-focused implementation research, and (4) structural issues related to funding and publishing. Researchers also suggested pragmatic solutions to overcome each barrier. Respondents reported using specification and tracking data in the short term until validated tools become available. Participants suggested that researchers with strategy-specific content expertise lead the way in identifying core components and setting fidelity requirements for them. Addressing the third barrier, participants provided examples of what pragmatic prospective and retrospective fidelity assessments might look like along a mechanistic pathway. Finally, researchers described approaches to minimize costs of data collection, as well as more structural accountability like adopting and enforcing reporting guidelines or changing the structure of funding opportunities. DISCUSSION We propose short- and long-term priorities for improving the assessment and reporting of implementation strategy fidelity and the quality of implementation research. CONCLUSIONS A better understanding of the barriers to implementation strategy fidelity assessment may pave the way towards pragmatic solutions.
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Affiliation(s)
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kate Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carol E Golin
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Ingvarsson S, Hasson H, von Thiele Schwarz U, Nilsen P, Powell BJ, Lindberg C, Augustsson H. Strategies for de-implementation of low-value care-a scoping review. Implement Sci 2022; 17:73. [PMID: 36303219 PMCID: PMC9615304 DOI: 10.1186/s13012-022-01247-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background The use of low-value care (LVC) is a persistent problem that calls for knowledge about strategies for de-implementation. However, studies are dispersed across many clinical fields, and there is no overview of strategies that can be used to support the de-implementation of LVC. The extent to which strategies used for implementation are also used in de-implementing LVC is unknown. The aim of this scoping review is to (1) identify strategies for the de-implementation of LVC described in the scientific literature and (2) compare de-implementation strategies to implementation strategies as specified in the Expert Recommendation for Implementing Change (ERIC) and strategies added by Perry et al. Method A scoping review was conducted according to recommendations outlined by Arksey and O’Malley. Four scientific databases were searched, relevant articles were snowball searched, and the journal Implementation Science was searched manually for peer-reviewed journal articles in English. Articles were included if they were empirical studies of strategies designed to reduce the use of LVC. Two reviewers conducted all abstract and full-text reviews, and conflicting decisions were discussed until consensus was reached. Data were charted using a piloted data-charting form. The strategies were first coded inductively and then mapped onto the ERIC compilation of implementation strategies. Results The scoping review identified a total of 71 unique de-implementation strategies described in the literature. Of these, 62 strategies could be mapped onto ERIC strategies, and four strategies onto one added category. Half (50%) of the 73 ERIC implementation strategies were used for de-implementation purposes. Five identified de-implementation strategies could not be mapped onto any of the existing strategies in ERIC. Conclusions Similar strategies are used for de-implementation and implementation. However, only a half of the implementation strategies included in the ERIC compilation were represented in the de-implementation studies, which may imply that some strategies are being underused or that they are not applicable for de-implementation purposes. The strategies assess and redesign workflow (a strategy previously suggested to be added to ERIC), accountability tool, and communication tool (unique new strategies for de-implementation) could complement the existing ERIC compilation when used for de-implementation purposes. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01247-y.
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Affiliation(s)
- Sara Ingvarsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.
| | - Henna Hasson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Division of Public Health, Linköping University, Linköping, Sweden
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA.,Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Clara Lindberg
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Karolinska, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Stockholm, Sweden
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Okamura KH, Okamoto SK, Marshall SM, Chin SK, Garcia PM, Powell BJ, Stern KA, Becker SJ, Mandell DS. Ho'ouna Pono implementation: applying concept mapping to a culturally grounded substance use prevention curriculum in rural Hawai'i schools. Implement Sci Commun 2022; 3:111. [PMID: 36224628 PMCID: PMC9556135 DOI: 10.1186/s43058-022-00359-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite their potential to ameliorate health disparities and address youth substance use, prevention programs have been poorly disseminated and implemented across Hawai'i, which begs the question: Why are effective prevention programs not being used in communities most in need of them? Implementing and sustaining culturally grounded prevention programs is critical to address equitable healthcare and minimize health disparities in communities. The field of implementation science provides frameworks, theories, and methods to examine factors associated with community adoption of these programs. METHOD Our project applies concept mapping methods to a culturally grounded youth drug prevention program with state level educational leadership in rural Hawai'i schools. The goal is to integrate barrier and facilitator salience collected through teacher and school staff surveys and specific implementation strategies to regionally tailored implementation plans on Hawai'i island. This protocol paper describes the concept mapping steps and how they will be applied in public and public-charter schools. DISCUSSION Improving prevention program implementation in rural schools can result in sustained support for populations that need it most. The project will integrate implementation science and culturally grounded methods in rural Hawai'i, where most youth are of Native Hawaiian and Pacific Islander descent. This project addresses health disparities among Native Hawaiian and Pacific Islander youth and provides actionable plans for rural Hawai'i communities to implement effective prevention programming.
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Affiliation(s)
- Kelsie H Okamura
- The Baker Center for Children and Families/Harvard Medical School, 53 Parker Hill Ave, Boston, MA, 02120-3225, USA.
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, HI, 96826, Honolulu, USA.
| | - Scott K Okamoto
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Sarah Momilani Marshall
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Steven Keone Chin
- Population Sciences in the Pacific Program, University of Hawai'i Cancer Center, 701 Ilalo Street, Honolulu, HI, 96813, USA
| | - Pamela M Garcia
- Department of Psychology, Hawai'i Pacific University, 500 Ala Moana Blvd, Honolulu, HI, 96813, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelly A Stern
- Hawai'i State Department of Education, West Hawai'i School Based Behavioral Health Services, 74-5000 Puohulihuli St, Kailua-Kona, HI, 96740, USA
| | - Sara J Becker
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl, Philadelphia, PA, 19104, USA
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Riordan F, Kerins C, Pallin N, Albers B, Clack L, Morrissey E, Curran GM, Lewis CC, Powell BJ, Presseau J, Wolfenden L, McHugh SM. Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13507.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two or more members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies.
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Nelson KL, Powell BJ, Langellier B, Lê-Scherban F, Shattuck P, Hoagwood K, Purtle J. State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study. Adm Policy Ment Health 2022; 49:834-847. [PMID: 35737191 PMCID: PMC9219374 DOI: 10.1007/s10488-022-01201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/22/2022]
Abstract
To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.
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Affiliation(s)
- Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brent Langellier
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, USA
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Kwak L, Toropova A, Powell BJ, Lengnick-Hall R, Jensen I, Bergström G, Elinder LS, Stigmar K, Wåhlin C, Björklund C. A randomized controlled trial in schools aimed at exploring mechanisms of change of a multifaceted implementation strategy for promoting mental health at the workplace. Implement Sci 2022; 17:59. [PMID: 36050743 PMCID: PMC9438275 DOI: 10.1186/s13012-022-01230-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background This study will explore implementation mechanisms through which a single implementation strategy and a multifaceted implementation strategy operate to affect the implementation outcome, which is fidelity to the Guideline For The Prevention of Mental Ill Health within schools. The guideline gives recommendations on how workplaces can prevent mental ill health among their personnel by managing social and organizational risks factors in the work environment. Schools are chosen as the setting for the study due to the high prevalence of mental ill health among teachers and other personnel working in schools. The study builds on our previous research, in which we compared the effectiveness of the two strategies on fidelity to the guideline. Small improvements in guideline adherence were observed for the majority of the indicators in the multifaceted strategy group. This study will focus on exploring the underlying mechanisms of change through which the implementation strategies may operate to affect the implementation outcome. Methods We will conduct a cluster-randomized-controlled trial among public schools (n=55 schools) in Sweden. Schools are randomized (1:1 ratio) to receive a multifaceted strategy (implementation teams, educational meeting, ongoing training, Plan-Do-Study-Act cycles) or a single strategy (implementation teams, educational meeting). The implementation outcome is fidelity to the guideline. Hypothesized mediators originate from the COM-B model. A mixed-method design will be employed, entailing a qualitative study of implementation process embedded within the cluster-randomized controlled trail examining implementation mechanisms. The methods will be used in a complementary manner to get a full understanding of the implementation mechanisms. Discussion This implementation study will provide valuable knowledge on how implementation strategies work (or fail) to affect implementation outcomes. The knowledge gained will aid the selection of effective implementation strategies that fit specific determinants, which is a priority for the field. Despite recent initiatives to advance the understanding of implementation mechanisms, studies testing these mechanisms are still uncommon. Trial registration ClinicalTrials.org dr.nr 2020-01214. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01230-7.
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Affiliation(s)
- Lydia Kwak
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Toropova
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rebecca Lengnick-Hall
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Bergström
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Occupational and Public Health Sciences, Faculty of Health and Occupational Studies, Centre for Musculoskeletal Research, University of Gävle, Gävle, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm, Stockholm Region, Sweden
| | | | - Charlotte Wåhlin
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Occupational and Environmental Medicine Center, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine, Linköping University, Linköping, Sweden
| | - Christina Björklund
- Unit of Intervention and Implementation Research for Worker Health, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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McHugh S, Presseau J, Luecking CT, Powell BJ. Examining the complementarity between the ERIC compilation of implementation strategies and the behaviour change technique taxonomy: a qualitative analysis. Implement Sci 2022; 17:56. [PMID: 35986333 PMCID: PMC9389676 DOI: 10.1186/s13012-022-01227-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Efforts to generate evidence for implementation strategies are frustrated by insufficient description. The Expert Recommendations for Implementing Change (ERIC) compilation names and defines implementation strategies; however, further work is needed to describe the actions involved. One potentially complementary taxonomy is the behaviour change techniques (BCT) taxonomy. We aimed to examine the extent and nature of the overlap between these taxonomies. METHODS Definitions and descriptions of 73 strategies in the ERIC compilation were analysed. First, each description was deductively coded using the BCT taxonomy. Second, a typology was developed to categorise the extent of overlap between ERIC strategies and BCTs. Third, three implementation scientists independently rated their level of agreement with the categorisation and BCT coding. Finally, discrepancies were settled through online consensus discussions. Additional patterns of complementarity between ERIC strategies and BCTs were labelled thematically. Descriptive statistics summarise the frequency of coded BCTs and the number of strategies mapped to each of the categories of the typology. RESULTS Across the 73 strategies, 41/93 BCTs (44%) were coded, with 'restructuring the social environment' as the most frequently coded (n=18 strategies, 25%). There was direct overlap between one strategy (change physical structure and equipment) and one BCT ('restructuring physical environment'). Most strategy descriptions (n=64) had BCTs that were clearly indicated (n=18), and others where BCTs were probable but not explicitly described (n=31) or indicated multiple types of overlap (n=15). For some strategies, the presence of additional BCTs was dependent on the form of delivery. Some strategies served as examples of broad BCTs operationalised for implementation. For eight strategies, there were no BCTs indicated, or they did not appear to focus on changing behaviour. These strategies reflected preparatory stages and targeted collective cognition at the system level rather than behaviour change at the service delivery level. CONCLUSIONS This study demonstrates how the ERIC compilation and BCT taxonomy can be integrated to specify active ingredients, providing an opportunity to better understand mechanisms of action. Our results highlight complementarity rather than redundancy. More efforts to integrate these or other taxonomies will aid strategy developers and build links between existing silos in implementation science.
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Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - Justin Presseau
- School of Epidemiology & Public Health, University of Ottawa and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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Yakovchenko V, Morgan TR, Miech EJ, Neely B, Lamorte C, Gibson S, Beste LA, McCurdy H, Scott D, Gonzalez R, Park A, Powell BJ, Bajaj JS, Dominitz JA, Chartier M, Ross D, Chinman MJ, Rogal SS. Core implementation strategies for improving cirrhosis care in the Veterans Health Administration. Hepatology 2022; 76:404-417. [PMID: 35124820 PMCID: PMC9288973 DOI: 10.1002/hep.32395] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The Veterans Health Administration (VHA) provides care for more than 80,000 veterans with cirrhosis. This longitudinal, multimethod evaluation of a cirrhosis care quality improvement program aimed to (1) identify implementation strategies associated with evidence-based, guideline-concordant cirrhosis care over time, and (2) use qualitative interviews to operationalize strategies for a manualized intervention. APPROACH AND RESULTS VHA providers were surveyed annually about the use of 73 implementation strategies to improve cirrhosis care in fiscal years 2018 (FY18) and 2019 (FY19). Implementation strategies linked to guideline-concordant cirrhosis care were identified using bivariate statistics and comparative configurational methods. Semistructured interviews were conducted with 12 facilities in the highest quartile of cirrhosis care to specify the successful implementation strategies and their mechanisms of change. A total of 106 VHA facilities (82%) responded at least once over the 2-year period (FY18, n = 63; FY19, n = 100). Facilities reported using a median of 12 (interquartile range [IQR] 20) implementation strategies in FY18 and 10 (IQR 19) in FY19. Of the 73 strategies, 35 (48%) were positively correlated with provision of evidence-based cirrhosis care. Configurational analysis identified multiple strategy pathways directly linked to more guideline-concordant cirrhosis care. Across both methods, a subset of eight strategies was determined to be core to cirrhosis care improvement and specified using qualitative interviews. CONCLUSIONS In a national cirrhosis care improvement initiative, a multimethod approach identified a core subset of successful implementation strategy combinations. This process of empirically identifying and specifying implementation strategies may be applicable to other implementation challenges in hepatology.
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA
| | - Timothy R. Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA,Division of Gastroenterology, Department of Medicine, University of California, Irvine, CA
| | - Edward J. Miech
- Department of Veterans Affairs, Roudebush VA Medical Center, HSR&D Center for Health Information & Communication, VA PRIS-M QUERI, Indianapolis, IN,Regenstrief Institute, Indianapolis, IN
| | - Brittney Neely
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Carolyn Lamorte
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Sandra Gibson
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Lauren A. Beste
- Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA,General Medicine Service, VA Puget Sound Health Care System, Seattle, WA
| | | | - Dawn Scott
- Department of Medicine, Central Texas Veterans Healthcare System, Temple, TX
| | - Rachel Gonzalez
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA
| | - Angela Park
- Office of Healthcare Transformation, Department of Veterans Affairs, Washington, DC
| | - Byron J. Powell
- Brown School, Washington University in St. Louis, St. Louis, MO
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University, Richmond, VA,Division of Gastroenterology, Central Virginia Veterans Affairs Healthcare System, Richmond, VA
| | - Jason A. Dominitz
- Gastroenterology Section, Veterans Affairs Puget Sound Health Care System, Seattle, WA,Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC
| | - David Ross
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC
| | - Matthew J. Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,RAND Corporation, Pittsburgh, PA
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA,Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA,Department of Surgery, University of Pittsburgh, Pittsburgh, PA
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Kirk JW, Stefánsdóttir NÞ, Powell BJ, Lindstroem MB, Andersen O, Tjørnhøj-Thomsen T, Nilsen P. Oilcloth sessions as an implementation strategy: a qualitative study in Denmark. BMC Med Educ 2022; 22:571. [PMID: 35870916 PMCID: PMC9308909 DOI: 10.1186/s12909-022-03635-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of this study was to explore healthcare professionals, managers, and other key employees' experiences of oilcloth sessions as a strategy when implementing new emergency departments in Denmark, based on their participations in these sessions. The study addresses the importance of securing alignment in implementation strategies. Too often, this does not get enough attention in the literature and in practice. In this study, alignment among components was achieved in an educational implementation strategy called oilcloth sessions. METHODS The study is based on participants' observations of 13 oilcloth sessions and follow-up via 53 semi-structured interviews with the board of directors, managers, and key employees from the present emergency department and different specialty departments. Data were analysed deductively using Biggs and Tang's model of didactic alignment. RESULTS The analysis showed the complexity of challenges when using oilcloth sessions as a strategy when implementing a new emergency department described in terms of three phases and nine main themes (a-i): the preparation phase: (a) preparing individually and collectively, (b) objectives, (c) involving participants, (d) selecting cases; the execution phase: (e) using materials, (f) facilitating the sessions, (g) temporal structures; evaluation: (h) following up on the sessions, (i) adapting to the context. CONCLUSIONS This study shows that it is important to ensure alignment among elements in implementation strategies. Thus, oilcloth sessions with high alignment are useful if the challenges experienced are to be overcome and the strategy will be experienced as a useful way to support the implementation of a new emergency department from the participants' point of view. Bigg and Tang's didactic model is useful as an analytical framework to ensure alignment in implementation strategies in general.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.
- Department of Public Health, Nursing, Aarhus University, 8000, Aarhus C, Denmark.
| | - Nina Þórný Stefánsdóttir
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen K, Denmark
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
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Gertner AK, Clare HM, Powell BJ, Gilbert AR, Jones HE, Silberman P, Shea CM, Domino ME. A mixed methods study of provider factors in buprenorphine treatment retention. International Journal of Drug Policy 2022; 105:103715. [DOI: 10.1016/j.drugpo.2022.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022]
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Schilling S, Bigal L, Powell BJ. Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care. Implementation Research and Practice 2022; 3:26334895221091219. [PMID: 37091079 PMCID: PMC9924241 DOI: 10.1177/26334895221091219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: This practical implementation report describes a primary care-based group parenting intervention—Child–Adult Relationship Enhancement in Primary Care (PriCARE)—and the approach taken to understand and strengthen the referral process for PriCARE within a pediatric primary care clinic through the deployment of synergistic implementation strategies to promote physician referrals. PriCARE has evidence of effectiveness for reducing child behavior problems, harsh and permissive parenting, and parent stress from three randomized controlled trials (RCTs). The integration of evidence-based parenting interventions into pediatric primary care is a promising means for widespread dissemination. Yet, even when integrated into this setting, the true reach will depend on parents knowing about and attending the intervention. A key factor in this process is the endorsement of and referral to the intervention by the child's pediatrician. Therefore, identifying strategies to improve physician referrals to parenting interventions embedded in primary care is worthy of investigation. Method: Through lessons learned from the RCTs and key informant interviews with stakeholders, we identified barriers and facilitators to physician referrals of eligible parent–child dyads to PriCARE. Based on this data, we selected and implemented five strategies to increase the PriCARE referral rate. We outline the selection process, the postulated synergistic interactions, and the results of these efforts. Conclusions: The following five discrete strategies were implemented: physician reminders, direct advertising to patients, incentives/public recognition, interpersonal patient narratives, and audit and feedback. These discrete strategies were synergistically combined to create a multifaceted approach to improve physician referrals. Following implementation, referrals increased from 13% to 55%. Continued development, application, and evaluation of implementation strategies to promote the uptake of evidence-based parenting interventions into general use in the primary care setting are discussed. Plain Language Summary There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.
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Affiliation(s)
- Samantha Schilling
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Luisa Bigal
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Stefánsdóttir NT, Nilsen P, Lindstroem MB, Andersen O, Powell BJ, Tjørnhøj-Thomsen T, Kirk JW. Implementing a new emergency department: a qualitative study of health professionals' change responses and perceptions. BMC Health Serv Res 2022; 22:447. [PMID: 35382815 PMCID: PMC8985264 DOI: 10.1186/s12913-022-07805-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study is two-fold. It explores how managers and key employees at the Emergency Department (ED) and specialist departments in a university hospital in the Capital Region of Denmark respond to the planned change to a new ED, and how they perceive the change involved in the implementation of the new ED. The study investigates what happens when health professionals are confronted with implementation of policy that changes their organization and everyday work lives. Few studies provide in-depth investigations of health professionals’ reactions to the implementation of new EDs, and particularly how they influence the implementation of a nationwide organizational change framed within a political strategy. Methods The study used semi-structured individual interviews with 51 health professionals involved in implementation activities related to an organizational change of establishing a new ED with new patient pathways for acutely ill patients. The data was deductively analyzed using Leon Coetsee’s theoretical framework of change responses, but the analysis also allowed for a more inductive reading of the material. Results Fourteen types of responses to establishing a new ED were identified and mapped onto six of the seven overall change responses in Coetsee’s framework. The participants perceived the change as particularly three changes. Firstly, they wished to create the best possible acute patient pathway in relation to their specialty. Whether the planned new ED would redeem this was disputed. Secondly, participants perceived the change as relocation to a new building, which both posed potentials and worries. Thirdly, both hopeful and frustrated statements were given about the newly established medical specialty of emergency medicine (EM), which was connected to the success of the new ED. Conclusions The study showcases how implementation processes within health care are not straightforward and that it is not only the content of the implementation that determines the success of the implementation and its outcomes but also how these are perceived by managers and employees responsible for the process and their context. In this way, managers must recognize that it cannot be pre-determined how implementation will proceed, which necessitates fluid implementation plans and demands implementation managements skills.
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Affiliation(s)
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Mette Bendtz Lindstroem
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Emergency Department, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, 2200, Copenhagen, Denmark
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, 1455, Copenhagen K, Denmark
| | - Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, 2650, Hvidovre, Denmark.,Department of Public Health, Nursing, Aarhus University, 8000, Aarhus C, Denmark
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Olawepo JO, Ezeanolue EE, Ekenna A, Ogunsola OO, Itanyi IU, Jedy-Agba E, Egbo E, Onwuchekwa C, Ezeonu A, Ajibola A, Olakunde BO, Majekodunmi O, Ogidi AG, Chukwuorji J, Lasebikan N, Dakum P, Okonkwo P, Oyeledun B, Oko J, Khamofu H, Ikpeazu A, Nwokwu UE, Aliyu G, Shittu O, Rositch AF, Powell BJ, Conserve DF, Aarons GA, Olutola A. Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance. BMJ Glob Health 2022; 7:bmjgh-2021-008241. [PMID: 35450861 PMCID: PMC9024272 DOI: 10.1136/bmjgh-2021-008241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 01/21/2023] Open
Abstract
There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa’s most populous country.
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Affiliation(s)
- John Olajide Olawepo
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.,Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria .,Healthy Sunrise Foundation, Las Vegas, Nevada, USA
| | - Adanma Ekenna
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Emmanuel Egbo
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Alexandra Ezeonu
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - Abiola Ajibola
- Center for Integrated Health Programs (CIHP), Abuja, FCT, Nigeria
| | - Babayemi O Olakunde
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Prevention and Care Services, National Agency for Control of AIDS (NACA), Abuja, FCT, Nigeria
| | | | - Amaka G Ogidi
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - JohnBosco Chukwuorji
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Psychology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Patrick Dakum
- Institute of Human Virology Nigeria, Abuja, FCT, Nigeria
| | | | - Bolanle Oyeledun
- Center for Integrated Health Programs (CIHP), Abuja, FCT, Nigeria
| | - John Oko
- Caritas Nigeria, Abuja, FCT, Nigeria
| | | | - Akudo Ikpeazu
- National AIDS, Viral Hepatitis and Sexually Transmitted Infections Control Programme, Federal Ministry of Health, Abuja, FCT, Nigeria
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, FCT, Nigeria
| | - Oladapo Shittu
- Federal University of Health Sciences Otukpo, Otukpo, Benue State, Nigeria
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ayodotun Olutola
- Center for Clinical Care and Clinical Research, Abuja, FCT, Nigeria
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Knapp AA, Carroll AJ, Mohanty N, Fu E, Powell BJ, Hamilton A, Burton ND, Coldren E, Hossain T, Limaye DP, Mendoza D, Sethi M, Padilla R, Price HE, Villamar JA, Jordan N, Langman CB, Smith JD. A stakeholder-driven method for selecting implementation strategies: a case example of pediatric hypertension clinical practice guideline implementation. Implement Sci Commun 2022; 3:25. [PMID: 35256017 PMCID: PMC8900435 DOI: 10.1186/s43058-022-00276-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/19/2022] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
This article provides a generalizable method, rooted in co-design and stakeholder engagement, to identify, specify, and prioritize implementation strategies. To illustrate this method, we present a case example focused on identifying strategies to promote pediatric hypertension (pHTN) Clinical Practice Guideline (CPG) implementation in community health center-based primary care practices that involved meaningful engagement of pediatric clinicians, clinic staff, and patients/caregivers. This example was chosen based on the difficulty clinicians and organizations experience in implementing the pHTN CPG, as evidenced by low rates of guideline-adherent pHTN diagnosis and treatment.
Methods
We convened a Stakeholder Advisory Panel (SAP), comprising 6 pediatricians and 5 academic partners, for 8 meetings (~12 h total) to rigorously identify determinants of pHTN CPG adherence and to ultimately develop a testable multilevel, multicomponent implementation strategy. Our approach expanded upon the Expert Recommendations for Implementation Change (ERIC) protocol by incorporating a modified Delphi approach, user-centered design methods, and the Implementation Research Logic Model (IRLM). At the recommendation of our SAP, we gathered further input from youth with or at-risk for pHTN and their caregivers, as well as clinic staff who would be responsible for carrying out facets of the implementation strategy.
Results
First, the SAP identified 17 determinants, and 18 discrete strategies were prioritized for inclusion. The strategies primarily targeted determinants in the domains of intervention characteristics, inner setting, and characteristics of the implementers. Based on SAP ratings of strategy effectiveness, feasibility, and priority, three tiers of strategies emerged, with 7 strategies comprising the top tier implementation strategy package. Next, input from caregivers and clinic staff confirmed the feasibility and acceptability of the implementation strategies and provided further detail in the definition and specification of those strategies.
Conclusions
This method—an adaptation of the ERIC protocol—provided a pragmatic structure to work with stakeholders to efficiently identify implementation strategies, particularly when supplemented with user-centered design activities and the intuitive organizing framework of the IRLM. This generalizable method can help researchers identify and prioritize strategies that align with the implementation context with an increased likelihood of adoption and sustained use.
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Riordan F, Curran GM, Lewis CC, Powell BJ, Presseau J, Wolfenden L, McHugh SM. Characterising processes and outcomes of tailoring implementation strategies in healthcare: a protocol for a scoping review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13507.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two or more members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies.
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Kolko DJ, McGuier EA, Turchi R, Thompson E, Iyengar S, Smith SN, Hoagwood K, Liebrecht C, Bennett IM, Powell BJ, Kelleher K, Silva M, Kilbourne AM. Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial. Implement Sci 2022; 17:20. [PMID: 35193619 PMCID: PMC8862323 DOI: 10.1186/s13012-022-01195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation facilitation is an effective strategy to support the implementation of evidence-based practices (EBPs), but our understanding of multilevel strategies and the mechanisms of change within the "black box" of implementation facilitation is limited. This implementation trial seeks to disentangle and evaluate the effects of facilitation strategies that separately target the care team and leadership levels on implementation of a collaborative care model in pediatric primary care. Strategies targeting the provider care team (TEAM) should engage team-level mechanisms, and strategies targeting leaders (LEAD) should engage organizational mechanisms. METHODS We will conduct a hybrid type 3 effectiveness-implementation trial in a 2 × 2 factorial design to evaluate the main and interactive effects of TEAM and LEAD and test for mediation and moderation of effects. Twenty-four pediatric primary care practices will receive standard REP training to implement Doctor-Office Collaborative Care (DOCC) and then be randomized to (1) Standard REP only, (2) TEAM, (3) LEAD, or (4) TEAM + LEAD. Implementation outcomes are DOCC service delivery and change in practice-level care management competencies. Clinical outcomes are child symptom severity and quality of life. DISCUSSION This statewide trial is one of the first to test the unique and synergistic effects of implementation strategies targeting care teams and practice leadership. It will advance our knowledge of effective care team and practice-level implementation strategies and mechanisms of change. Findings will support efforts to improve common child behavioral health conditions by optimizing scale-up and sustainment of CCMs in a pediatric patient-centered medical home. TRIAL REGISTRATION ClinicalTrials.gov, NCT04946253 . Registered June 30, 2021.
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Affiliation(s)
- David J Kolko
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Elizabeth A McGuier
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Renee Turchi
- Department of Pediatrics, Drexel University College of Medicine and St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Eileen Thompson
- PA Medical Home Program, PA Chapter, American Academy of Pediatrics, Media, PA, USA
| | - Satish Iyengar
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawna N Smith
- Department of Health Management & Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ian M Bennett
- Departments of Family Medicine and Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Kelly Kelleher
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital Research Institute, Columbus, OH, USA
| | - Maria Silva
- Allegheny Family Network, Pittsburgh, PA, USA
| | - Amy M Kilbourne
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
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Albright K, Navarro EI, Jarad I, Boyd MR, Powell BJ, Lewis CC. Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists. Transl Behav Med 2022; 12:324-334. [PMID: 34791490 PMCID: PMC9127548 DOI: 10.1093/tbm/ibab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although communication is widely observed to be central to the implementation process, the field of implementation science has largely overlooked the details of how communication may best be utilized to facilitate implementation. This paper draws on relevant insights from Rogers' Diffusion of Innovations Theory, which laid the foundation for explicitly attending to the role of communication as a mechanism for implementation strategies to exert their effects. To offer empirically-derived and theory-informed recommendations regarding communication processes to support the effective introduction of new clinical practices. This investigation leverages data from 61 therapists poised to undergo implementation of measurement-based care (MBC) for depressed adults receiving psychotherapy in community mental health settings. Data were collected via focus groups across 12 sites. Themes emergent in the data analysis suggest five practices to facilitate effective communication in the introduction of new clinical practices like MBC: the communication of a clear rationale for the new practice; the provision of necessary procedural knowledge; communication about the change via multiple methods; sufficient lead time to prepare for the change; and the opportunity for bidirectional engagement. In addition to indicating several best practices to improve communication prior to implementation, our results suggest that the current conceptualization of implementation strategies may not yet be complete. Components and/or methods of effective communication about new practices should be included among the growing set of implementation strategies. Existing implementation strategies might also benefit from more temporal specificity, with more attention to the exploration and preparation phases. (Trial Registration: Clinicaltrials.gov NCT02266134. Registered 12 October 2014.).
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Affiliation(s)
- Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office One, Aurora, CO, USA
| | | | - Iman Jarad
- Centerstone Research Institute, Nashville, TN, USA
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Harborview Medical Center, Seattle, WA, USA
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Abstract
Implementation strategies are systematic approaches to improve the uptake and sustainability of evidence-based interventions. They frequently focus on changing provider behavior through the provision of interventions such as training, coaching, and audit-and-feedback. Implementation strategies often impact intermediate behavioral outcomes like provider guideline adherence, in turn improving patient outcomes. Fidelity of implementation strategy delivery is defined as the extent to which an implementation strategy is carried out as it was designed. Implementation strategy fidelity measurement is under-developed and under-reported, with the quality of reporting decreasing over time. Benefits of fidelity measurement include the exploration of the extent to which observed effects are moderated by fidelity, and critical information about Type-III research errors, or the likelihood that null findings result from implementation strategy fidelity failure. Reviews of implementation strategy efficacy often report wide variation across studies, commonly calling for increased implementation strategy fidelity measurement to help explain variations. Despite the methodological benefits of rigorous fidelity measurement, implementation researchers face multi-level challenges and complexities. Challenges include the measurement of a complex variable, multiple data collection modalities with varying precision and costs, and the need for fidelity measurement to change in-step with adaptations. In this position paper, we weigh these costs and benefits and ultimately contend that implementation strategy fidelity measurement and reporting should be improved in trials of implementation strategies. We offer pragmatic solutions for researchers to make immediate improvements like the use of mixed methods or innovative data collection and analysis techniques, the inclusion of implementation strategy fidelity assessment in reporting guidelines, and the staged development of fidelity tools across the evolution of an implementation strategy. We also call for additional research into the barriers and facilitators of implementation strategy fidelity measurement to further clarify the best path forward.
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Affiliation(s)
- Christopher F Akiba
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brian W Pence
- Department of Epidemiology, Gillings School of Global Public Health, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Minh X B Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
| | - Carol Golin
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, School of Medicine, UNC-Chapel Hill, NC, USA
| | - Vivian Go
- Department of Health Behavior, Gillings School of Global Public Health, UNC-Chapel Hill, NC, USA
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Abstract
Elvin Hsing Geng and colleagues discuss mechanism mapping and its utility in conceptualizing and understanding how implementation strategies produce desired effects.
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Affiliation(s)
- Elvin H. Geng
- Center for Dissemination and Implementation, Institute for Public Health and Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
| | - Ana A. Baumann
- Division of Prevention Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Byron J. Powell
- Center for Dissemination and Implementation, Institute for Public Health and Brown School, Washington University, St. Louis, Missouri, United States of America
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Dopp AR, Gilbert M, Silovsky J, Ringel JS, Schmidt S, Funderburk B, Jorgensen A, Powell BJ, Luke DA, Mandell D, Edwards D, Blythe M, Hagele D. Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process. Implement Sci Commun 2022; 3:1. [PMID: 34983689 PMCID: PMC8724666 DOI: 10.1186/s43058-021-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, "service agencies"). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. METHOD Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies' EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. DISCUSSION This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.
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Affiliation(s)
- Alex R Dopp
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Marylou Gilbert
- Department of Behavioral and Policy Sciences, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jane Silovsky
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Jeanne S Ringel
- Department of Economics, Sociology, and Statistics, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Susan Schmidt
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Beverly Funderburk
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Ashley Jorgensen
- Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th Street Suite 4900, Oklahoma City, OK, 73104, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School and School of Medicine, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Douglas A Luke
- Brown School, Washington University, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - David Mandell
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, USA
| | - Daniel Edwards
- Evidence-Based Associates, 1311 Delaware Ave, Suite 637, Washington, DC, 20024, USA
| | - Mellicent Blythe
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
| | - Dana Hagele
- NC Child Treatment Program c/o Center for Child and Family Health, 1121 W, Chapel Hill St. Ste. 100, Durham, NC, 27701, USA
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Kirk JW, Nilsen P, Andersen O, Powell BJ, Tjørnhøj-Thomsen T, Bandholm T, Pedersen MM. Co-designing implementation strategies for the WALK-Cph intervention in Denmark aimed at increasing mobility in acutely hospitalized older patients: a qualitative analysis of selected strategies and their justifications. BMC Health Serv Res 2022; 22:8. [PMID: 34974829 PMCID: PMC8722331 DOI: 10.1186/s12913-021-07395-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Selecting appropriate strategies to target barriers to implementing interventions represents a considerable challenge in implementation research and practice. The aim was to investigate what categories of implementation strategies were selected by health care practitioners and their managers in a co-design process and how they justified these strategies aimed at facilitating the implementation of the WALK-Cph intervention. METHODS The study used a qualitative research design to explore what implementation strategies were selected and the justifications for selecting these strategies. Workshops were used because this qualitative method is particularly well suited for studying co-design processes that involve substantial attention to social interaction and the context. Data were 1) analyzed deductively based on the Proctor et al. taxonomy of implementation strategies, 2) categorized in accordance with the ERIC compilation of implementation strategies by Powell et al., and 3) analyzed to examine the justification for the selected strategies by the Proctor et al. framework for justifications of implementation strategies. RESULTS Thirteen different types of implementation strategies were chosen across two hospitals. The deductive analysis showed that selection of implementation strategies was based on pragmatic and theoretical justifications. The contents of the two types of justifications were thematized into nine subthemes. CONCLUSION This study contributes with knowledge about categories and justification of implementation strategies selected in a co-design process. In this study, implementation strategies were selected through pragmatic and theoretical justifications. This points to a challenge in balancing strategies based on practice-based and research-based knowledge and thereby selection of strategies with or without proven effectiveness.
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Affiliation(s)
- Jeanette Wassar Kirk
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark.
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark.
| | - Per Nilsen
- Department of Health, Medical and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Tine Tjørnhøj-Thomsen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Orthopedic Surgery, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Mette Merete Pedersen
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
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Pullmann MD, Dorsey S, Duong MT, Lyon AR, Muse I, Corbin CM, Davis CJ, Thorp K, Sweeney M, Lewis CC, Powell BJ. Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children's Mental Health Services Implementation Efforts. Implement Res Pract 2022; 3:10.1177/26334895221120797. [PMID: 36504561 PMCID: PMC9731268 DOI: 10.1177/26334895221120797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Strategies to implement evidence-based interventions (EBIs) in children's mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children's mental health services, to be used for implementation planning, research, and quality improvement. Methods Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects. Results Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one's own life. Conclusions This research advances the field by providing children's mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children's mental health implementation strategies for each participant role.
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Affiliation(s)
- Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
- Michael Pullmann, University of Washington
School of Medicine, Department of Psychiatry and Behavioral Sciences, School
Mental Health Assessment, Research, and Training Center, 6200 NE 74th Street,
Suite 110, Seattle, WA 98115-6560, USA.
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Mylien T. Duong
- Education, Research, and Impact Committee for Children, Seattle, WA,
USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Ian Muse
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Cathy M. Corbin
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | - Chayna J. Davis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of
Medicine, School Mental Health Assessment, Research, and Training Center,
Seattle, WA, USA
| | | | - Millie Sweeney
- Family-Run Executive Director Leadership Association (FREDLA),
Columbia, MD, USA
| | - Cara C. Lewis
- Kaiser Permanente Washington Health
Research Institute, Seattle, WA, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington
University, St. Louis, MO, USA
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. Implement Res Pract 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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Yakovchenko V, Morgan TR, Chinman MJ, Powell BJ, Gonzalez R, Park A, Malone PS, Chartier M, Ross D, Rogal SS. Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the veterans health administration. BMC Health Serv Res 2021; 21:1348. [PMID: 34922538 PMCID: PMC8684191 DOI: 10.1186/s12913-021-07312-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND While few countries and healthcare systems are on track to meet the World Health Organization's hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. We aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA. METHODS We conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019. Participants from 130 VHA medical centers treating HCV were sent annual electronic surveys about their use of 73 implementation strategies, organized into nine clusters as described by the Expert Recommendations for Implementing Change taxonomy. Descriptive and nonparametric analyses assessed strategy use over time, strategy attribution to the HIT, and strategy associations with site HCV treatment volume and rate of adoption, following the Theory of Diffusion of Innovations. RESULTS Between 58 and 109 medical centers provided responses in each year, including 127 (98%) responding at least once, and 54 (42%) responding in all four implementation years. A median of 13-27 strategies were endorsed per year, and 8-36 individual strategies were significantly associated with treatment volume per year. Data warehousing, tailoring, and patient-facing strategies were most commonly endorsed. One strategy-"identify early adopters to learn from their experiences"-was significantly associated with HCV treatment volume in each year. Peak implementation year was associated with revising professional roles, providing local technical assistance, using data warehousing (i.e., dashboard population management), and identifying and preparing champions. Many of the strategies were driven by a national learning collaborative, which was instrumental in successful HCV elimination. CONCLUSIONS VHA's tremendous success in rapidly treating nearly all Veterans with HCV can provide a roadmap for other HCV elimination initiatives.
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Affiliation(s)
- Vera Yakovchenko
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Timothy R Morgan
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
| | - Matthew J Chinman
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA
- RAND Corporation, Pittsburgh, PA, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Gonzalez
- Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA
- Department of Veterans Affairs, Sierra Pacific Veterans Integrated Service Network, Pharmacy Benefits Management, Mather, CA, USA
| | - Angela Park
- Department of Veterans Affairs, Office of Healthcare Transformation, Washington, DC, USA
| | - Patrick S Malone
- Sanford School of Public Policy, Duke University, Durham, NC, USA
| | - Maggie Chartier
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - David Ross
- HIV, Hepatitis, and Related Conditions Programs, Office of Specialty Care Services, Veterans Health Administration, Washington, DC, USA
| | - Shari S Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Building 30, Pittsburgh, PA, 15240, USA.
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA.
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Lewis CC, Powell BJ, Brewer SK, Nguyen AM, Schriger SH, Vejnoska SF, Walsh-Bailey C, Aarons GA, Beidas RS, Lyon AR, Weiner B, Williams N, Mittman B. Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda. BMJ Open 2021; 11:e053474. [PMID: 34663668 PMCID: PMC8524292 DOI: 10.1136/bmjopen-2021-053474] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences. METHODS AND ANALYSIS A network of scientific experts will convene in 'Deep Dive' meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members' approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration's (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda. ETHICS AND DISSEMINATION This initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.
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Affiliation(s)
- Cara C Lewis
- MacColl Center, Kaiser Permanente, Seattle, Washington, USA
| | - Byron J Powell
- Brown School, Washington University in St Louis, St. Louis, Missouri, USA
| | - Stephanie K Brewer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ann M Nguyen
- Center for State Health Policy, Rutgers, New Brunswick, New Jersey, USA
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah F Vejnoska
- Department of Psychiatry and Behavioral Sciences, UC Davis MIND Institute, Sacramento, California, USA
| | | | - Gregory A Aarons
- Department of Psychiatry and Dissemination and Implementation Science Center, University of California San Diego, La Jolla, California, USA
| | - Rinad S Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Brian Mittman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Stanick CF, Halko HM, Nolen EA, Powell BJ, Dorsey CN, Mettert KD, Weiner BJ, Barwick M, Wolfenden L, Damschroder LJ, Lewis CC. Pragmatic measures for implementation research: development of the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). Transl Behav Med 2021; 11:11-20. [PMID: 31747021 DOI: 10.1093/tbm/ibz164] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The use of reliable, valid measures in implementation practice will remain limited without pragmatic measures. Previous research identified the need for pragmatic measures, though the characteristic identification used only expert opinion and literature review. Our team completed four studies to develop a stakeholder-driven pragmatic rating criteria for implementation measures. We published Studies 1 (identifying dimensions of the pragmatic construct) and 2 (clarifying the internal structure) that engaged stakeholders-participants in mental health provider and implementation settings-to identify 17 terms/phrases across four categories: Useful, Compatible, Acceptable, and Easy. This paper presents Studies 3 and 4: a Delphi to ascertain stakeholder-prioritized dimensions within a mental health context, and a pilot study applying the rating criteria. Stakeholders (N = 26) participated in a Delphi and rated the relevance of 17 terms/phrases to the pragmatic construct. The investigator team further defined and shortened the list, which were piloted with 60 implementation measures. The Delphi confirmed the importance of all pragmatic criteria, but provided little guidance on relative importance. The investigators removed or combined terms/phrases to obtain 11 criteria. The 6-point rating system assigned to each criterion demonstrated sufficient variability across items. The grey literature did not add critical information. This work produced the first stakeholder-driven rating criteria to assess whether measures are pragmatic. The Psychometric and Pragmatic Evidence Rating Scale (PAPERS) combines the pragmatic criteria with psychometric rating criteria, from previous work. Use of PAPERS can inform development of implementation measures and to assess the quality of existing measures.
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Affiliation(s)
- Cameo F Stanick
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
| | | | - Elspeth A Nolen
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, MO, USA
| | - Caitlin N Dorsey
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA, USA
| | - Melanie Barwick
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Laura J Damschroder
- VA Ann Arbor Healthcare System, Center for Clinical Management Research (CCMR), Ann Arbor, MI, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Abstract
We investigate the cause of spatial superexchange anisotropy in a family of copper-based, quasi-two-dimensional materials with very similar geometries. The compounds in this family differ mainly in their inter-layer separation but they have very different magnetic interactions, even within the basal plane. We use density functional theory and Wannier functions to parameterize two complimentary tight-binding models and show that the superexchange between the Cu2+ ions is dominated by a σ-mediated interaction between hybrid Cu-pyrazine orbitals centered on the copper atoms. We find no correlations between the strength of this exchange interaction and homologous geometric features across the compounds, such as Cu and pyrazine bond lengths and orientations of nearby counterions. We find that the pyrazine tilt angles do not affect the Cu-pyrazine-Cu exchange because the lowest unoccupied molecular orbital on pyrazine is at a very high energy (relative to the frontier orbitals, which are Cu-based). We conclude that careful control of the entire crystal structure, including non-homologous geometric features such as the inter-layer organic ligands, is vital for engineering magnetic properties.
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Affiliation(s)
- E P Kenny
- School of Mathematics and Physics, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - A C Jacko
- School of Mathematics and Physics, The University of Queensland, St Lucia, Queensland 4072, Australia
| | - B J Powell
- School of Mathematics and Physics, The University of Queensland, St Lucia, Queensland 4072, Australia
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