1
|
Haenen A, Huis A, Teerenstra S, Liefers J, Bos N, Voss A, de Greeff S, Hulscher M. Effect and Process Evaluation of an Intervention to Improve Hand Hygiene Compliance in Long-Term Care Facilities. J Am Med Dir Assoc 2024; 25:591-598. [PMID: 37549888 DOI: 10.1016/j.jamda.2023.06.020] [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: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES This study evaluated the effect of a tailored, multifaceted improvement strategy on hand hygiene compliance in long-term care facilities (LTCFs). We also performed a process evaluation to explore the mechanisms through which our strategy brought about change. DESIGN We conducted a stepped-wedge cluster-randomized controlled trial with a sequential rollout of the improvement strategy to all participating LTCFs. The strategy consisted of education, training, reminders, observation sessions (including feedback), and team meetings (including feedback). SETTING AND PARTICIPANTS The study included nursing professionals from 14 LTCFs (23 wards) in the Netherlands. METHODS Hand hygiene compliance was observed during 5 measurement periods using WHO's "Five Moments for Hand Hygiene." Multilevel analyses and corresponding tests were completed on an intention-to-treat basis. RESULTS The absolute intervention effect of overall hand hygiene compliance (primary outcome measure) was 13% (95% CI 9.3-16.7, P < .001), adjusted for time and clustering. The adjusted absolute effect was 23% (95% CI 7-39, P < .002) before a clean and aseptic procedure, 18% (95% CI 10-26, P < .001) after touching a resident, 14% (95% CI 7-22, P < .003) before touching a resident, 10% (95% CI 5-15, P < .001) after contact with body fluid, and 1% (95% CI -11 to 13, P = .8) after touching a resident's surroundings. With the exception of leadership, participants at LTCFs with more exposure to the intervention components showed statistically significantly more improvement than those at facilities with lower exposure scores. CONCLUSIONS AND IMPLICATIONS Our strategy was successful in improving hand hygiene compliance. LTCFs with more team members exposed to the different intervention components, demonstrated a greater effect from the intervention. To strengthen the impact of our intervention, we recommend that future improvement strategies provide more support to managers to ensure they are better equipped to take on their leadership roles and enable their teams to improve and maintain hand hygiene compliance.
Collapse
Affiliation(s)
- Anja Haenen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, Bilthoven, the Netherlands.
| | - Anita Huis
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health, Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janine Liefers
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nynke Bos
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sabine de Greeff
- Department of Antimicrobial Resistance and Healthcare Associated Infections, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
2
|
Rance J, Lafferty L, Treloar C. Expert stakeholder perspectives on the acceptability of treatment-as-prevention in prison: a qualitative substudy of the 'Surveillance and Treatment of Prisoners with Hepatitis C' project (SToP-C). Addiction 2021; 116:2761-2769. [PMID: 33751739 DOI: 10.1111/add.15477] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/21/2020] [Accepted: 02/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Mathematical modelling has demonstrated the theoretical feasibility of HCV treatment-as-prevention strategies in custodial settings, yet limited empirical data exists. The Australian 'Surveillance and Treatment of Prisoners with Hepatitis C' study is the world's first trial of hepatitis C virus (HCV) treatment-as-prevention in prison. This study aimed to analyse how expert stakeholders involved in the Australian HCV response assessed the acceptability of HCV treatment-as-prevention in prison using interview data from the SToP-C qualitative substudy. DESIGN AND SETTING Qualitative analysis using semi-structured interviews in Australia. PARTICIPANTS Nineteen key HCV experts. MEASUREMENTS Drawing upon Sekhon's theoretical framework of acceptability, data were organized thematically under four component constructs of acceptability: affective attitude; ethicality; opportunity costs; and perceived effectiveness. FINDINGS Most differences in participant assessments of acceptability were a matter of relative emphasis and prioritization rather than absolute polarity. Nonetheless, a small minority of participants was overtly critical of the approach. Arguing against the focus on treatment, they instead advocated for prevention-as-prevention, including the improvement and expansion of existing harm reduction measures. CONCLUSIONS Qualitative analysis of expert stakeholder assessments of the acceptability of hepatitis C virus treatment-as-prevention in Australian prisons found no opposition to the universal rollout of direct-acting anti-virals, but most voiced concern regarding the lack of effective primary prevention in Australian prisons.
Collapse
Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | -
- Centre for Social Research in Health, UNSW Sydney, Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
3
|
Jagiello T, Wuthrich VM, Ellis LA. Implementation trial of a cognitive behavioural therapy programme for reducing student stress in the final year of secondary school. Br J Educ Psychol 2021; 92:e12460. [PMID: 34569055 DOI: 10.1111/bjep.12460] [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: 06/11/2021] [Revised: 09/03/2021] [Indexed: 11/30/2022]
Abstract
The final year of secondary school has been shown to be associated with heightened student stress. Psychological interventions have been shown to be effective in reducing and preventing distress in students during this school period, although the widespread adoption of these interventions into school settings is limited. There have been recent calls for research to examine the implementation success of evidence-based programmes when used by schools in school settings. The present study aimed to evaluate the implementation success of an evidence-based cognitive-behavioural therapy programme (Study without Stress) using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. At one Australian high school, all tutor group teachers were trained by the school counsellor to deliver the programme in standard school classes to students in the lead up to their final year of secondary school. Students (n = 80) and teachers (n = 11) reported on programme success against the RE-AIM framework at pre-intervention, post-intervention, and three-month follow-up. The findings indicated that SWOS was implemented successfully by the school. SWOS was associated with maintaining student stress levels at normal levels over time, as well as reducing the severity of stress for initially highly distressed students. The findings provide evidence from implementation science that SWOS can be adapted and delivered effectively by school staff to manage stress in final year secondary school students.
Collapse
Affiliation(s)
- Tess Jagiello
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Viviana M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
4
|
Healy GN, Goode AD, Abbott A, Burzic J, Clark BK, Dunstan DW, Eakin EG, Frith M, Gilson ND, Gao L, Gunning L, Jetann J, LaMontagne AD, Lawler SP, Moodie M, Nguyen P, Owen N, Straker L, Timmins P, Ulyate L, Winkler EAH. Supporting Workers to Sit Less and Move More Through the Web-Based BeUpstanding Program: Protocol for a Single-Arm, Repeated Measures Implementation Study. JMIR Res Protoc 2020; 9:e15756. [PMID: 32364513 PMCID: PMC7235812 DOI: 10.2196/15756] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 08/05/2019] [Revised: 12/22/2019] [Accepted: 02/06/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The web-based BeUpstanding Champion Toolkit was developed to support work teams in addressing the emergent work health and safety issue of excessive sitting. It provides a step-by-step guide and associated resources that equip a workplace representative-the champion-to adopt and deliver the 8-week intervention program (BeUpstanding) to their work team. The evidence-informed program is designed to raise awareness of the benefits of sitting less and moving more, build a supportive culture for change, and encourage staff to take action to achieve this change. Work teams collectively choose the strategies they want to implement and promote to stand up, sit less, and move more, with this bespoke and participative approach ensuring the strategies are aligned with the team's needs and existing culture. BeUpstanding has been iteratively developed and optimized through a multiphase process to ensure that it is fit for purpose for wide-scale implementation. OBJECTIVE The study aimed to describe the current version of BeUpstanding, and the methods and protocol for a national implementation trial. METHODS The trial will be conducted in collaboration with five Australian workplace health and safety policy and practice partners. Desk-based work teams from a variety of industries will be recruited from across Australia via partner-led referral pathways. Recruitment will target sectors (small business, rural or regional, call center, blue collar, and government) that are of priority to the policy and practice partners. A minimum of 50 work teams will be recruited per priority sector with a minimum of 10,000 employees exposed to the program. A single-arm, repeated-measures design will assess the short-term (end of program) and long-term (9 months postprogram) impacts. Data will be collected on the web via surveys and toolkit analytics and by the research team via telephone calls with champions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework will guide the evaluation, with assessment of the adoption/reach of the program (the number and characteristics of work teams and participating staff), program implementation (completion by the champion of core program components), effectiveness (on workplace sitting, standing, and moving), and maintenance (sustainability of changes). There will be an economic evaluation of the costs and outcomes of scaling up to national implementation, including intervention affordability and sustainability. RESULTS The study received funding in June 2018 and the original protocol was approved by institutional review board on January 9, 2017, with national implementation trial consent and protocol amendment approved March 12, 2019. The trial started on June 12, 2019, with 48 teams recruited as of December 2019. CONCLUSIONS The implementation and multimethod evaluation of BeUpstanding will provide the practice-based evidence needed for informing the potential broader dissemination of the program. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000682347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372843&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15756.
Collapse
Affiliation(s)
- Genevieve Nissa Healy
- School of Public Health, The University of Queensland, Brisbane, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia.,Curtin University, Perth, Australia
| | - Ana D Goode
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Alison Abbott
- Workplace Health and Safety Queensland, Office of Industrial Relations, Queensland, Australia
| | - Jennifer Burzic
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Bronwyn K Clark
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Elizabeth G Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia.,Baker Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Lan Gao
- School of Health & Soc. Dev, Deakin University, Melbourne, Australia.,The University of Newcastle, Callaghan, Australia
| | | | - Jodie Jetann
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Sheleigh P Lawler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Marjory Moodie
- School of Health & Soc. Dev, Deakin University, Melbourne, Australia
| | - Phuong Nguyen
- School of Health & Soc. Dev, Deakin University, Melbourne, Australia
| | - Neville Owen
- Baker Heart and Diabetes Institute, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia
| | | | | | - Lisa Ulyate
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
5
|
Thomas M, Rusten K. Trial implementation of CIRCuiTS cognitive remediation therapy for people with schizophrenia in Orange, New South Wales. Aust J Rural Health 2020; 27:463-468. [PMID: 31663213 DOI: 10.1111/ajr.12578] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many people with schizophrenia experience cognitive impairments and current practice guidelines recommend cognitive remediation therapy. This implementation trial examined aspects of feasibility, acceptability and outcomes of the computerised interactive remediation of cognition-interactive training for schizophrenia cognitive remediation therapy program in our local context. DESIGN A longitudinal design was utilised with participants providing outcome data at commencement of the computerised interactive remediation of cognition-interactive training for schizophrenia program, completion and at follow-up 3 months later. SETTING Our trial was conducted in the inpatient and community mental health contexts within the New South Wales regional city of Orange, between January 2017 and December 2018. PARTICIPANTS Fifty-three adult volunteers commenced the computerised interactive remediation of cognition-interactive training for schizophrenia program and participated in this trial. Forty-five participants were currently admitted to psychiatric rehabilitation inpatient units at Bloomfield hospital, and eight were referred by Orange Community Mental Health Service. MAIN OUTCOME MEASURE(S) Participants completed measures of cognitive functioning (repeatable battery for the assessment of neuropsychological status), functional independence (Adaptive Behaviour Assessment Scales 3) and Goal attainment scaling. RESULTS Most participants reported they liked computerised interactive remediation of cognition-interactive training for schizophrenia therapy and made excellent progress towards their goals. Those who completed the program made significant gains in the domains of attention, memory and independence in key aspects of daily living. Gains in functional independence were sustained for a small sample following program completion. CONCLUSION This implementation trial showed the computerised interactive remediation of cognition-interactive training for schizophrenia cognitive remediation therapy program was feasible, acceptable and contributed to strong outcomes in both the inpatient and community contexts. Efforts are in progress to translate the computerised interactive remediation of cognition-interactive training for schizophrenia program, and future research will focus on longer term outcomes, cost-benefit analyses and the experiences of participants and therapists.
Collapse
Affiliation(s)
- Matt Thomas
- Bloomfield Hospital, Orange, NSW, Australia.,School of Psychology, Charles Sturt University, Bathurst, NSW, Australia
| | - Kim Rusten
- Bloomfield Hospital, Orange, NSW, Australia
| |
Collapse
|
6
|
Brown CH, Curran G, Palinkas LA, Aarons GA, Wells KB, Jones L, Collins LM, Duan N, Mittman BS, Wallace A, Tabak RG, Ducharme L, Chambers DA, Neta G, Wiley T, Landsverk J, Cheung K, Cruden G. An Overview of Research and Evaluation Designs for Dissemination and Implementation. Annu Rev Public Health 2017; 38:1-22. [PMID: 28384085 PMCID: PMC5384265 DOI: 10.1146/annurev-publhealth-031816-044215] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [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: 12/14/2022]
Abstract
The wide variety of dissemination and implementation designs now being used to evaluate and improve health systems and outcomes warrants review of the scope, features, and limitations of these designs. This article is one product of a design workgroup that was formed in 2013 by the National Institutes of Health to address dissemination and implementation research, and whose members represented diverse methodologic backgrounds, content focus areas, and health sectors. These experts integrated their collective knowledge on dissemination and implementation designs with searches of published evaluations strategies. This article emphasizes randomized and nonrandomized designs for the traditional translational research continuum or pipeline, which builds on existing efficacy and effectiveness trials to examine how one or more evidence-based clinical/prevention interventions are adopted, scaled up, and sustained in community or service delivery systems. We also mention other designs, including hybrid designs that combine effectiveness and implementation research, quality improvement designs for local knowledge, and designs that use simulation modeling.
Collapse
Affiliation(s)
- C Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611;
| | - Geoffrey Curran
- Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205;
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, School of Social Work, University of Southern California, Los Angeles, California 90089;
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California 92093;
| | - Kenneth B Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California 90024;
| | - Loretta Jones
- Healthy African American Families, Los Angeles, California 90008;
| | - Linda M Collins
- The Methodology Center and Department of Human Development & Family Studies, Pennsylvania State University, University Park, Pennsylvania 16802;
| | - Naihua Duan
- Department of Psychiatry, Columbia University Medical Center, Columbia University, New York, NY 10027;
| | - Brian S Mittman
- VA Center for Implementation Practice and Research Support, Virginia Greater Los Angeles Healthcare System, North Hills, California 91343;
| | - Andrea Wallace
- College of Nursing, The University of Iowa, Iowa City, Iowa 52242;
| | - Rachel G Tabak
- Prevention Research Center, George Warren Brown School, Washington University, St. Louis, Missouri 63105;
| | - Lori Ducharme
- National Institute of Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland 20814;
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland 20850; ,
| | - Gila Neta
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland 20850; ,
| | - Tisha Wiley
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland 20814;
| | | | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York, NY 10032;
| | - Gracelyn Cruden
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611;
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, North Carolina 27514;
| |
Collapse
|
7
|
van Beljouw IMJ, van Exel E, van de Ven PM, Joling KJ, Dhondt TDF, Stek ML, van Marwijk HWJ. Does an outreaching stepped care program reduce depressive symptoms in community-dwelling older adults? A randomized implementation trial. Am J Geriatr Psychiatry 2015; 23:807-17. [PMID: 25499673 DOI: 10.1016/j.jagp.2014.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 03/25/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community. DESIGN Randomized clinical implementation trial. SETTING 18 general practices and a home care organization in the Netherlands. PARTICIPANTS 263 community-dwelling 65+-year-olds with depressive symptoms according to the Patient Health Questionnaire-9 (PHQ-9). INTERVENTION After three months of watchful waiting, participants could sequentially choose between the following evidence-based interventions: 1) guided self-help or an exercise program, 2) problem solving treatment or life review, and 3) a referral to their general practitioner. MEASUREMENTS The outcome measure was depression severity (PHQ-9), measured every three months over 2 years. RESULTS After the provision of the stepped care program, a significant short-term positive effect on depressive symptoms was found in the first three months after implementation, in which average PHQ-9 scores dropped from 9.34 (SE: 0.61, 95% CI: 8.14-10.5) to 7.83 (SE: 0.51, 95% CI: 6.84-8.81). CONCLUSIONS The Lust for Life program has a promising potential to relieve depressive symptoms of older adults in primary care in the short term. Providing one single clinical intervention in accordance with participants' choices instead of stepped care could be sufficient.
Collapse
Affiliation(s)
- Ilse M J van Beljouw
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Eric van Exel
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | | | - Max L Stek
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Harm W J van Marwijk
- Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| |
Collapse
|