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Watts GF, Jones LK, Sarkies MN, Pang J, Gidding SS, Libby P, Santos RD. International Atherosclerosis Society Roadmap for Familial Hypercholesterolaemia. Glob Heart 2024; 19:12. [PMID: 38273993 PMCID: PMC10809854 DOI: 10.5334/gh.1291] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Familial hypercholesterolaemia (FH), a common monogenic disorder, is a preventable cause of premature coronary artery disease and death. Up to 35 million people worldwide have FH, but most remain undetected and undertreated. Several clinical guidelines have addressed the gaps in care of FH, but little focus has been given to implementation science and practice. The International Atherosclerosis Society (IAS) has developed an evidence-informed guidance for the detection and management of patients with FH, supplemented with implementation strategies to optimize contextual models of care. The guidance is partitioned into detection, management and implementation sections. Detection deals with screening, diagnosis, genetic testing and counselling. Management includes risk stratification, treatment of adults and children with heterozygous and homozygous FH, management of FH during pregnancy, and use of lipoprotein apheresis. Specific and general implementation strategies, guided by processes specified by the Expert Recommendations for Implementing Change taxonomy, are provided. Core generic implementation strategies are given for improving care. Nation-specific cholesterol awareness campaigns should be utilized to promote better detection of FH. Integrated models of care should be underpinned by health policy and adapted to meet local, regional and national needs. Clinical centres of excellence are important for taking referrals from the community. General practitioners should work seamlessly with multidisciplinary teams. All health-care providers must receive training in essential skills for caring for patients and families with FH. Management should be supported by shared decision-making and service improvement driven by patient-reported outcomes. Improvements in services require sharing of existing resources that can support care. Advocacy should be utilized to ensure sustainable funding. Digital health technologies and clinical quality registries have special value. Finally, academic-service partnerships need to be developed to identify gaps in care and set priorities for research. This new IAS guidance on FH complements the recent World Heart Federation Cholesterol Roadmap.
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Affiliation(s)
- Gerald F. Watts
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Departments of Cardiology and Internal Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Laney K. Jones
- Department of Genomic Health, Geisinger, Danville PA, USA
| | - Mitchell N. Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jing Pang
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | | | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA, USA
| | - Raul D. Santos
- Lipid Clinic, Heart Institute (InCor), University of São Paulo, São Paulo, Brazil and Hospital Israelita Albert Einstein, São Paulo, Brazil
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Harvey G, Rycroft-Malone J, Seers K, Wilson P, Cassidy C, Embrett M, Hu J, Pearson M, Semenic S, Zhao J, Graham ID. Connecting the science and practice of implementation - applying the lens of context to inform study design in implementation research. Front Health Serv 2023; 3:1162762. [PMID: 37484830 PMCID: PMC10361069 DOI: 10.3389/frhs.2023.1162762] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
The saying "horses for courses" refers to the idea that different people and things possess different skills or qualities that are appropriate in different situations. In this paper, we apply the analogy of "horses for courses" to stimulate a debate about how and why we need to get better at selecting appropriate implementation research methods that take account of the context in which implementation occurs. To ensure that implementation research achieves its intended purpose of enhancing the uptake of research-informed evidence in policy and practice, we start from a position that implementation research should be explicitly connected to implementation practice. Building on our collective experience as implementation researchers, implementation practitioners (users of implementation research), implementation facilitators and implementation educators and subsequent deliberations with an international, inter-disciplinary group involved in practising and studying implementation, we present a discussion paper with practical suggestions that aim to inform more practice-relevant implementation research.
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Affiliation(s)
- Gillian Harvey
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jo Rycroft-Malone
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Kate Seers
- Warwick Medical School, Faculty of Science, University of Warwick, Coventry, United Kingdom
| | - Paul Wilson
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Mark Embrett
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jiale Hu
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, United Kingdom
| | - Sonia Semenic
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Junqiang Zhao
- Centre for Research on Health and Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Ian D. Graham
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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3
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Younas A. Uptake of Innovations in Nursing: The Necessity for Implementation Science. Creat Nurs 2023; 29:177-181. [PMID: 37800735 DOI: 10.1177/10784535231195426] [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] [Indexed: 10/07/2023]
Abstract
Innovations are critical for improving clinical practice and nursing education, and for enhancing learning and practice change for frontline nurses and nursing students. Continuous innovation for delivering safe care and improving patient outcomes is needed. Merely demonstrating the effectiveness of research innovations is not enough to promote their uptake and use in practice. A 2021 study in cancer research reported that moving research into practice takes about 15 years. Implementation science, a systemic process of identifying the most relevant approaches to move research into practice, has emerged as an effective way to bridge the research-practice gap. The purpose of this article is to discuss why and how Implementation Science is necessary to promote the uptake of innovations in clinical and educational practice.
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Aldridge WA, Roppolo RH, Brown J, Bumbarger BK, Boothroyd RI. Mechanisms of change in external implementation support: A conceptual model and case examples to guide research and practice. Implement Res Pract 2023; 4:26334895231179761. [PMID: 37790181 PMCID: PMC10291867 DOI: 10.1177/26334895231179761] [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] [Indexed: 10/05/2023] Open
Abstract
Background External implementation support (EIS) is a well-recognized feature of implementation science and practice, often under related terms such as technical assistance and implementation facilitation. Existing models of EIS have gaps related to addressing practice outcomes at both individual and organizational levels, connecting practice activities to intended outcomes, or grounding in well-established theories of behavior and organization change. Moreover, there have been calls to clarify the mechanisms of change through which EIS influences related outcomes. Method In this article, we theorize about mechanisms of change within EIS. Our theorizing process aligns with the approach advocated by Kislov et al. We aim to consolidate prior EIS literature, combining related constructs from previous empirical and conceptual work while drawing on our extensive EIS experience to develop a higher-order, midrange theory of change. Results Our theory of change is empirically and practically informed, conceptually situated within an established grand theory of change, and guided by eight practice principles and social cognitive theory. The theory of change proposes 10 core practice components as mechanisms of change within EIS. When used according to underlying theory and principles, they are believed to contribute to favorable practice outcomes at individual, team, organizational, and system levels. The model offers flexibility by recognizing the need for sequential support processes and the demand to practice in dynamic and responsive ways. Case examples are presented to illustrate major themes and patterns of the model in action. Conclusions The proposed model is intended to support prospective EIS studies by conceptualizing discernable practice components with hypothesized relationships to proximal and distal practice outcomes. The model can be behaviorally operationalized to compliment and extend competency-based approaches to implementation support practitioner (ISP) training and coaching. Over time, the model should be refined based on new empirical findings and contributions from ISPs across the field.
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Affiliation(s)
- William A. Aldridge
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca H. Roppolo
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Brian K. Bumbarger
- Griffith Criminology Institute, Griffith University, Mount Gravatt, Queensland, Australia
| | - Renée I. Boothroyd
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Finley EP, Closser S, Sarker M, Hamilton AB. Editorial: The theory and pragmatics of power and relationships in implementation. Front Health Serv 2023; 3:1168559. [PMID: 37033898 PMCID: PMC10076820 DOI: 10.3389/frhs.2023.1168559] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Erin P. Finley
- VA Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- Center for Research to Advance Community Health, Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
- Correspondence: Erin P. Finley
| | - Svea Closser
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Malabika Sarker
- Center of Excellence for the Science of Implementation and Scale-Up, BRAC University, Dhaka, Bangladesh
- Heidelberg Institute of Global Health, University of Heidelberg, Germany
| | - Alison B. Hamilton
- VA Greater Los Angeles Healthcare System, Veterans Health Administration, United States Department of Veterans Affairs, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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Aldridge WA, Roppolo RH, Chaplo SD, Everett AB, Lawrence SN, DiSalvo CI, Minch DR, Reed JJ, Boothroyd RI. Trajectory of external implementation support activities across two states in the United States: A descriptive study. Implement Res Pract 2023; 4:26334895231154285. [PMID: 37790177 PMCID: PMC10293536 DOI: 10.1177/26334895231154285] [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] [Indexed: 10/05/2023] Open
Abstract
Background Reporting on strategies to advance implementation outcomes is imperative. The current study reports descriptive information about external implementation support (EIS) provided over 5 years to 13 regions in North Carolina and South Carolina scaling an evidence-based system of parenting and family supports. Regional support teams operating through the Implementation Capacity for Triple P (ICTP) projects employed core practice components (CPCs) for EIS as proposed by Aldridge et al. and further operationalized by members of The Impact Center at FPG Child Development Institute, UNC-Chapel Hill. Method Practice activities associated with CPCs were developed and iteratively refined across the study period. ICTP regional support teams systematically tracked their use of CPCs and related activities following each substantive support interaction. Tracking included the duration of time a CPC was employed and the use of specific practice activities associated with that CPC. Data were aggregated by month of the relationship to account for differential start dates across regions. Results From November 2016 through December 2021, ICTP support teams tracked 749 support interactions with Triple P regions in North Carolina and South Carolina. Monthly support decreased year over year, though dose varied considerably. Patterns of CPC use indicated a high dose of "foundational" and "co-design" CPCs early, followed by a blended and more diverse use thereafter, with some notable trends. Practice activities considered essential to influencing intended practice outcomes were characterized by higher rates of use. Like CPCs, practice activities were used dynamically across the study period. Conclusions This descriptive study offers a case study for how EIS might be operationalized, tracked, and employed. Findings suggest several interpretations that might refine our understanding and use of EIS. Although the nature of this practical report precludes generalizability of findings, directions for future research and practice are discussed.
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Affiliation(s)
- William A. Aldridge
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca H. Roppolo
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Shannon D. Chaplo
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Ariel B. Everett
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Sherra N. Lawrence
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Christina I. DiSalvo
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Devon R. Minch
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica J. Reed
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Renée I. Boothroyd
- The Impact Center at Frank Porter Graham Child Development Institute, University of North Carolina, Chapel Hill, NC, USA
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Sevdalis N, Davis R, Rabin BA, Stadnick NA. Editorial: Supporting the pandemic response? Implementation science in the time of COVID-19. Front Health Serv 2023; 3:1154164. [PMID: 36926498 PMCID: PMC10012811 DOI: 10.3389/frhs.2023.1154164] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Nick Sevdalis
- Centre for Implementation Science, King's College London, London, United Kingdom
| | - Rachel Davis
- Centre for Implementation Science, King's College London, London, United Kingdom
| | - Borsika Adrienn Rabin
- Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States.,Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Nicole A Stadnick
- Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States.,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
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8
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Jensen TM, Metz AJ, Disbennett ME, Farley AB. Developing a practice-driven research agenda in implementation science: Perspectives from experienced implementation support practitioners. Implement Res Pract 2023; 4:26334895231199063. [PMID: 37790169 PMCID: PMC10478532 DOI: 10.1177/26334895231199063] [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] [Indexed: 10/05/2023] Open
Abstract
Background Attention is being placed on the "ironic gap" or "secondary" research-to-practice gap in the field of implementation science. Among several challenges posited to exacerbate this research-to-practice gap, we call attention to one challenge in particular-the relative dearth of implementation research that is tethered intimately to the lived experiences of implementation support practitioners (ISPs). The purpose of this study is to feature a qualitative approach to engaging with highly experienced ISPs to inform the development of a practice-driven research agenda in implementation science. In general, we aim to encourage ongoing empirical inquiry that foregrounds practice-driven implementation research questions. Method Our analytic sample was comprised of 17 professionals in different child and family service systems, each with long-term experience using implementation science frameworks to support change efforts. Data were collected via in-depth, semi-structured interviews. Our analysis followed a qualitative content analysis approach. Our focal conceptual category centered on the desired areas of future research highlighted by respondents, with subcategories reflecting subsets of related research question ideas. Results Interviews yielded varying responses that could help shape a practice-driven research agenda for the field of implementation science. The following subcategories regarding desired areas for future research were identified in respondents' answers: (a) stakeholder engagement and developing trusting relationships, (b) evidence use, (c) workforce development, and (d) cost-effective implementation. Conclusions There is significant promise in bringing implementation research and implementation practice together more closely and building a practice-informed research agenda to shape implementation science. Our findings point not only to valuable practice-informed gaps in the literature that could be filled by implementation researchers, but also topics for which dissemination and translation efforts may not have yielded optimal reach. We also highlight the value in ISPs bolstering their own capacity for engaging with the implementation science literature to the fullest extent possible.
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Affiliation(s)
- Todd M. Jensen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Allison J. Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Amanda B. Farley
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bartley L, Metz A, Fleming WO. What implementation strategies are relational? Using Relational Theory to explore the ERIC implementation strategies. Front Health Serv 2022; 2:913585. [PMID: 36925772 PMCID: PMC10012668 DOI: 10.3389/frhs.2022.913585] [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] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/20/2022] [Indexed: 03/18/2023]
Abstract
The identification and use of implementation strategies in implementation research and practice have strengthened our understanding of the implementation process as well as the causal pathways between mechanisms, strategies, and implementation outcomes. Although these contributions have advanced the application of strategies, there is still a need to learn more about how strategies might integrate relational exchanges and interactions. The inclusion of critical perspectives has been limited in implementation science, and theories such as Relational Theory can expand our understanding of the relational nature of implementation and enhance rigor through alternative theoretical applications. This study applied Relational Theory through a qualitative directed content analysis of the 73 Expert Recommendations for Implementation Change (ERIC) implementation strategies and examine relational components in strategy descriptions. Three reviewers used the structured approach to review and categorize the implementation strategies based on the Relational and Transactional Strategy Continuum measure, which operationalizes types of interactions, exchanges and alliances. Relational alliance strategies are those in which there is mutual growth and accountability, frequent interaction, shared power, and potential vulnerability. Operational alliances include forms of working exchanges between parties with balanced transactional and relational features. Operational alliances can be somewhat interactive in nature, with minor exchanges and limited accountability. Transactional alliance strategies are mostly uni-directional, influenced by power differentials, and do not require mutual growth, commitment, or exchange; thus, the power of growth is inherently one-sided. Results from the review suggest more implementation strategies with relational alliance features (highly relational, n = 17, semi-relational, n = 19) compared to transactional (highly transactional, n = 9, semi-transactional, n = 10) and 18 strategies coded as operational alliances. The qualitative review revealed opportunities to further expand how relational exchanges are considered within the implementation strategies descriptions, as well as the role of actors and power dynamics within strategy exchanges. The Relational and Transactional Strategy Continuum measure can help practitioners and researchers consider the sequencing, pairing, and impact on outcomes of different types and combinations of strategies in implementation practice and research. Additionally, the measure can support reflection on strategies that promote positive alliances, frequent connections, bi-directional communication, and power sharing.
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Affiliation(s)
- Leah Bartley
- Kaye Implementation and Evaluation, Tacoma, WA, United States
| | - Allison Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - W. Oscar Fleming
- School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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10
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Metz A, Jensen T, Farley A, Boaz A, Bartley L, Villodas M. Building trusting relationships to support implementation: A proposed theoretical model. Front Health Serv 2022; 2:894599. [PMID: 36925800 PMCID: PMC10012819 DOI: 10.3389/frhs.2022.894599] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022]
Abstract
This paper presents a theory of change that articulates (a) proposed strategies for building trust among implementation stakeholders and (b) the theoretical linkages between trusting relationships and implementation outcomes. The theory of change describes how trusting relationships cultivate increases in motivation, capability, and opportunity for supporting implementation among implementation stakeholders, with implications for commitment and resilience for sustained implementation, and ultimately, positive implementation outcomes. Recommendations related to the measurement of key constructs in the theory of change are provided. The paper highlights how the development of a testable causal model on trusting relationships and implementation outcomes can provide a bridge between implementation research and implementation practice.
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Affiliation(s)
- Allison Metz
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Todd Jensen
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Amanda Farley
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Annette Boaz
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Leah Bartley
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Melissa Villodas
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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11
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Sales AE, Farr SL, Spertus JA. The Influence of Health Behavior Theory on Implementation Practice and Science: Brief Review and Commentary. Pharmacy (Basel) 2022; 10:115. [PMID: 36136848 DOI: 10.3390/pharmacy10050115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/07/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
As research defines new treatments and policies to improve the health of patients, an increasing challenge has been to translate these insights into routine clinical practice to benefit patients and society. An important exploration is how theories of human behavior change fit into the science of implementation and quality improvement. In this paper, we begin with a brief review of the intellectual roots of implementation science and quality improvement, followed by a discussion of how theories and principles of behavior change can inform both goals and challenges in using behavior change theories. The insights offered through health behavior change theory have led to changes in how we plan for implementation and select, develop, design and tailor implementation interventions and strategies. While the degree to which organizational and external contexts influence the behavior of providers in these organizations varies widely, some degree of context external to the individual is important and needs adequate consideration. In short, health behavior change theory is essential but not sufficient to integrate in most implementation efforts, where priority must be given to both individual factors and contexts in which individuals operate.
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12
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Vroom EB, Massey OT, Akbari Z, Bristol SC, Cook B, Green AL, Levin BL, Tyson DM, Johnson ME. Exploring perceptions of implementation practice capacity in community-based behavioral health organizations. J Community Psychol 2022; 50:1700-1716. [PMID: 34797922 PMCID: PMC8917074 DOI: 10.1002/jcop.22749] [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] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.
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Affiliation(s)
- Enya B Vroom
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Oliver T Massey
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zahra Akbari
- Department of Economics, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Skye C Bristol
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Brandi Cook
- Department of Chemistry, Cell Biology, Microbiology, and Molecular Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Amy L Green
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Bruce L Levin
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Dinorah M Tyson
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Micah E Johnson
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
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13
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Metz A, Jensen T, Farley A, Boaz A. Is implementation research out of step with implementation practice? Pathways to effective implementation support over the last decade. Implement Res Pract 2022; 3:26334895221105585. [PMID: 37091077 PMCID: PMC9978647 DOI: 10.1177/26334895221105585] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: There is growing interest in the lived experience of professionals who provide implementation support (i.e., implementation support practitioners). However, there remains limited knowledge about their experiences and how those experiences can contribute to the knowledge base on what constitutes successful and sustainable implementation support models. This study aimed to examine pathways of implementation support practice, as described by experienced professionals actively supporting systems' uptake and sustainment of evidence to benefit children and families. Methods: Seventeen individuals with extensive experience providing implementation support in various settings participated in semi-structured interviews. Data were analyzed using qualitative content analysis and episode profile analysis approaches. Iterative diagramming was used to visualize the various pathways of implementation support practitioners' role reflection and transformation evidenced by the interview data. Results: Findings highlighted rich pathways of implementation support practitioners' role reflection and transformation. Participants described their roots in providing implementation support as it relates to implementing and expanding the use of evidence-based programs and practices in child and family services. Almost all participants reflected on the early stages of their careers providing implementation support and described a trajectory starting with the use of "push models," which evolved into "pull models" and eventually "co-creation or exchange models" of implementation support involving both technical and relational skills. Conclusions: Developing an implementation support workforce will require a deeper understanding of this lived experience to prevent repeated use of strategies observed to be unsuccessful by those most proximal to the work. The pathways for implementation practice in this study highlight impressive leaps forward in the field of implementation over the last 15 years and speaks to the importance of the professionals leading change efforts in this growth. Plain Language Summary Over the past few years, professionals in the field of implementation science have identified a growing gap between implementation research and implementation practice. While this issue has been highlighted informally, the field is lacking a shared understanding and clear way forward to reconcile this gap. In this paper, the authors describe how professionals providing implementation support have shifted their implementation practice over time through systematic observations of what works (and what does not work) for supporting and sustaining evidence use in service systems to improve population outcomes. The authors share the impressive leaps forward made in the field of implementation practice - from didactic training to responsive and tailored implementation strategies to co-created and relationship-based implementation solutions. The paper concludes with a call to action to the field for the creation of a virtuous learning cycle between professionals conducting implementation research and professionals providing implementation support to change practice as a way to produce a more robust and relevant science of implementation.
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Affiliation(s)
- Allison Metz
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Todd Jensen
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Amanda Farley
- School of Social Work, University of North Carolina at Chapel
Hill, Chapel Hill, NC, USA
| | - Annette Boaz
- Department of Health Services Research and Policy, London School of Hygiene and Tropical
Medicine, London, UK
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Woodward EN, Ball IA. Perspectives on learning to practice reflexivity while engaging communities in implementation science. Front Health Serv 2022; 2:1070444. [PMID: 36925788 PMCID: PMC10012695 DOI: 10.3389/frhs.2022.1070444] [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] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 01/18/2023]
Abstract
Background As implementation scientists and practitioners engage community members and service users, reflexivity rises as a critical approach for managing power imbalances and effective collaborative work to promote equity. Reflexivity is an approach for acknowledging scientists' own positions, including their understanding and limits of how they view their phenomena of inquiry. We describe our perspective practicing reflexivity as an implementation science team new to community engagement. Methods We spent over two years learning principles of Community-Based Participatory Research (CBPR) to inform implementation science and practice, then applied CPBR principles into a new community-academic partnership in August 2020 for and with veterans of the United States Military living in rural Arkansas. We used five methods to practice reflexivity for the first time: identifying positionality, writing fieldnotes, obtaining mentorship on technical aspects, comparing head notes, and consulting reference materials. Discussion We found multiple methods for practicing reflexivity to be feasible, although difficult to stay consistent with busy schedules. Fieldnotes especially required commitment and were important not to minimize. Written fieldnotes enabled us to reflect on successes and missteps, funneling into action planning. Head notes allowed emotional catharsis and to generate insights based on each other's perspectives. Referencing books or course modules reminded us of ideal CBPR principles. Discussion with mentors helped us with technical aspects and balancing real-world challenges with ideal CBPR principles. Our methods to practice reflexivity were valuable and directly impacted process and research outcomes. Future training for implementation science and practice might consider reflexivity practice as a core competency.
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Affiliation(s)
- Eva N. Woodward
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- Correspondence: Eva N. Woodward
| | - Irenia A. Ball
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
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15
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Flynn R, Brooks SP, Thomson D, Zimmermann GL, Johnson D, Wasylak T. An Implementation Science Laboratory as One Approach to Whole System Improvement: A Canadian Healthcare Perspective. Int J Environ Res Public Health 2021; 18:12681. [PMID: 34886408 DOI: 10.3390/ijerph182312681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/27/2021] [Accepted: 11/28/2021] [Indexed: 01/04/2023]
Abstract
Implementation science (IS) has emerged as an integral component for evidence-based whole system improvement. IS studies the best methods to promote the systematic uptake of evidence-based interventions into routine practice to improve the quality and effectiveness of health service delivery and patient care. IS laboratories (IS labs) are one mechanism to integrate implementation science as an evidence-based approach to whole system improvement and to support a learning health system. This paper aims to examine if IS labs are a suitable approach to whole system improvement. We retrospectively analyzed an existing IS lab (Alberta, Canada’s Implementation Science Collaborative) to assess the potential of IS labs to perform as a whole system approach to improvement and to identify key activities and considerations for designing IS labs specifically to support learning health systems. Results from our evaluation show the extent to which IS labs support learning health systems through enabling infrastructures for system-wide improvement and research.
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Leppin AL, Baumann AA, Fernandez ME, Rudd BN, Stevens KR, Warner DO, Kwan BM, Shelton RC. Teaching for implementation: A framework for building implementation research and practice capacity within the translational science workforce. J Clin Transl Sci 2021; 5:e147. [PMID: 34527287 PMCID: PMC8411269 DOI: 10.1017/cts.2021.809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/12/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 12/26/2022] Open
Abstract
Implementation science offers a compelling value proposition to translational science. As such, many translational science stakeholders are seeking to recruit, teach, and train an implementation science workforce. The type of workforce that will make implementation happen consists of both implementation researchers and practitioners, yet little guidance exists on how to train such a workforce. We-members of the Advancing Dissemination and Implementation Sciences in CTSAs Working Group-present the Teaching For Implementation Framework to address this gap. We describe the differences between implementation researchers and practitioners and demonstrate what and how to teach them individually and in co-learning opportunities. We briefly comment on educational infrastructures and resources that will be helpful in furthering this type of approach.
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Affiliation(s)
- Aaron L. Leppin
- Robert E. and Patricia D. Kern Center for the Science of Healthcare Delivery and Mayo Clinic Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, USA
| | - Ana A. Baumann
- Brown School of Social Work, Washington University of St. Louis, St. Louis, MO, USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Brittany N. Rudd
- Department of Psychiatry and Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathleen R. Stevens
- Institute for Integration of Medicine & Science, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bethany M. Kwan
- Department of Family Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Gallo CG, Berkel C, Mauricio A, Sandler I, Wolchik S, Villamar JA, Mehrotra S, Brown CH. Implementation methodology from a social systems informatics and engineering perspective applied to a parenting training program. Fam Syst Health 2021; 39:7-18. [PMID: 34014726 PMCID: PMC8962635 DOI: 10.1037/fsh0000590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE For implementation of an evidence-based program to be effective, efficient, and equitable across diverse populations, we propose that researchers adopt a systems approach that is often absent in efficacy studies. To this end, we describe how a computer-based monitoring system can support the delivery of the New Beginnings Program (NBP), a parent-focused evidence-based prevention program for divorcing parents. METHOD We present NBP from a novel systems approach that incorporates social system informatics and engineering, both necessary when utilizing feedback loops, ubiquitous in implementation research and practice. Examples of two methodological challenges are presented: how to monitor implementation, and how to provide feedback by evaluating system-level changes due to implementation. RESULTS We introduce and relate systems concepts to these two methodologic issues that are at the center of implementation methods. We explore how these system-level feedback loops address effectiveness, efficiency, and equity principles. These key principles are provided for designing an automated, low-burden, low-intrusive measurement system to aid fidelity monitoring and feedback that can be used in practice. DISCUSSION As the COVID-19 pandemic now demands fewer face-to-face delivery systems, their replacement with more virtual systems for parent training interventions requires constructing new implementation measurement systems based on social system informatics approaches. These approaches include the automatic monitoring of quality and fidelity in parent training interventions. Finally, we present parallels of producing generalizable and local knowledge bridging systems science and engineering method. This comparison improves our understanding of system-level changes, facilitates a program's implementation, and produces knowledge for the field. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Carlos G Gallo
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Cady Berkel
- Integrated Behavior Health, College of Health Solutions, AZ State University
| | - Anne Mauricio
- REACH Institute, Department of Psychology, AZ State University
| | - Irwin Sandler
- REACH Institute, Department of Psychology, AZ State University
| | | | - Juan A Villamar
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Sanjay Mehrotra
- Department of Industrial Engineering and Management Sciences, Northwestern University
| | - C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
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18
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Bice MR, Brown SL, Parry T. Retrospective evaluation of factors that influence the implementation of CATCH in southern Illinois schools. Health Promot Pract 2014; 15:706-13. [PMID: 24648287 DOI: 10.1177/1524839914526206] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
BACKGROUND Coordinated Approach to Child Health (CATCH) is a school health program implemented in southern Illinois that focuses on physical activity and nutrition and consists of a classroom curriculum, physical education framework, and cafeteria guidelines. Though many schools agreed to implement CATCH, some schools implemented it better than others. This study examined implementation practices of classroom and physical education teachers and cafeteria supervisors. METHOD We surveyed 284 school employees at 36 elementary schools located in southern Illinois. Attention focused on organizational readiness, commitment to change, school leadership, implementation barriers, and innovation perceptions concerning degree of implementation of CATCH. RESULTS Organizational readiness and implementation barriers were significant predictors of degree of implementation for school employees. Additionally, organizational readiness was reported a significant predictor of classroom teacher degree of implementation whereas leadership was a significant predictor of degree of implementation by physical education teachers. CONCLUSION Data from this study can be used to enhance implementation of CATCH as well as other school health programs. This study provides educators evidence of why school employees have different implementation practices, evidence of what constructs influence degree of implementation most, and some explanation of school employee degree of implementation.
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Affiliation(s)
| | | | - Thomas Parry
- Northeastern Illinois University, Chicago, IL, USA
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