Evaluating the effectiveness and implementation of evidence-based treatment: A multisite hybrid design

The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session "dose" (59%), core content coverage (60-70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients' scores on the Profile of Mood States total mood disturbance, significantly improved (R² = 0.06, β = -0.24, p < .01) as did a secondary outcome, physical activity (R² = 0.02, β = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Hib vaccine coverage in children attending day care/nursery school in East York

This survey assessed Haemophilus influenzae b vaccine coverage and factors affecting compliance in children at increased risk. A telephone survey was conducted of a random sample of 75 children, aged 24-60 months, attending licensed day care/nursery schools in East York. 96% of the sample was surveyed; only 51% were vaccinated. Older children were less likely to be immunized and there were more single-parent families among the non-vaccinated. The age, educational level and country of birth of the parents and the number of siblings were not associated with vaccination status. In 20% of the non-vaccinated group, concern about side effects was the main reason for non-compliance. For 91%, a factor of "moderate/very much concern" was the perceived unimportance of preventing Haemophilus influenzae b illness. Education for parents and physicians, special programs aimed at risk groups, and consideration of mandatory immunization against Haemophilus influenzae b in children attending day care/nursery schools are needed.