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Flynn R, Cassidy C, Dobson L, Al-Rassi J, Langley J, Swindle J, Graham ID, Scott SD. Knowledge translation strategies to support the sustainability of evidence-based interventions in healthcare: a scoping review. Implement Sci 2023; 18:69. [PMID: 38049900 PMCID: PMC10694920 DOI: 10.1186/s13012-023-01320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/20/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Knowledge translation (KT) strategies are widely used to facilitate the implementation of EBIs into healthcare practices. However, it is unknown what and how KT strategies are used to facilitate the sustainability of EBIs in institutional healthcare settings. OBJECTIVES This scoping review aimed to consolidate the current evidence on (i) what and how KT strategies are being used for the sustainability of EBIs in institutional healthcare settings; (ii) the reported KT strategy outcomes (e.g., acceptability) for EBI sustainability, and (iii) the reported EBI sustainability outcomes (e.g., EBI activities or component of the intervention continue). METHODS We conducted a scoping review of five electronic databases. We included studies describing the use of specific KT strategies to facilitate the sustainability of EBIs (more than 1-year post-implementation). We coded KT strategies using the clustered ERIC taxonomy and AIMD framework, we coded KT strategy outcomes using Tierney et al.'s measures, and EBI sustainability outcomes using Scheirer and Dearing's and Lennox's taxonomy. We conducted descriptive numerical summaries and a narrative synthesis to analyze the results. RESULTS The search identified 3776 studies for review. Following the screening, 25 studies (reported in 27 papers due to two companion reports) met the final inclusion criteria. Most studies used multi-component KT strategies for EBI sustainability (n = 24). The most common ERIC KT strategy clusters were to train and educate stakeholders (n = 38) and develop stakeholder interrelationships (n = 34). Education was the most widely used KT strategy (n = 17). Many studies (n = 11) did not clearly report whether they used different or the same KT strategies between EBI implementation and sustainability. Seven studies adapted KT strategies from implementation to sustainability efforts. Only two studies reported using a new KT strategy for EBI sustainability. The most reported KT strategy outcomes were acceptability (n = 10), sustainability (n = 5); and adoption (n = 4). The most commonly measured EBI sustainability outcome was the continuation of EBI activities or components (n = 23), followed by continued benefits for patients, staff, and stakeholders (n = 22). CONCLUSIONS Our review provides insight into a conceptual problem where initial EBI implementation and sustainability are considered as two discrete time periods. Our findings show we need to consider EBI implementation and sustainability as a continuum and design and select KT strategies with this in mind. Our review has emphasized areas that require further research (e.g., KT strategy adaptation for EBI sustainability). To advance understanding of how to employ KT strategies for EBI sustainability, we recommend clearly reporting the dose, frequency, adaptations, fidelity, and cost of KT strategies. Advancing our understanding in this area would facilitate better design, selection, tailored, and adapted use of KT strategies for EBI sustainability, thereby contributing to improved patient, provider, and health system outcomes.
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Affiliation(s)
- Rachel Flynn
- School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College of Cork, College Road Cork, Cork, T12 AK54, Ireland.
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Christine Cassidy
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lauren Dobson
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Joyce Al-Rassi
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jodi Langley
- School of Nursing, Faculty of Health, Dalhousie University, Room N21, Forrest Bldg., PO Box 15000 5869 University Avenue Halifax, Nova Scotia, B3H 4R2, Canada
| | - Jennifer Swindle
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
- The Centre for Implementation Research, Ottawa Hospital Research Institute, 501 Smyth Road, Box 241, Ottawa, Ontario, K1H 8L6, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Regauer V, Seckler E, Campbell C, Phillips A, Rotter T, Bauer P, Müller M. German translation and pre-testing of Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC). Implement Sci Commun 2021; 2:120. [PMID: 34666832 PMCID: PMC8527650 DOI: 10.1186/s43058-021-00222-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/08/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Implementation frameworks may support local implementation strategies with a sound theoretical foundation. The Consolidated Framework for Implementation Research (CFIR) facilitates identification of contextual barriers and facilitators, and the Expert Recommendations for Implementing Change (ERIC) allows identifying adequate implementation strategies. Both instruments are already used in German-speaking countries; however, no standardised and validated translation is available thus far. The aim of this study was to translate the CFIR and ERIC framework into German, in order to increase the use of these frameworks and the adherence to evidence-based implementation efforts in German-speaking countries. Methods The translation of the original versions of the CFIR and ERIC framework was guided by the World Health Organisation’s recommendations for the process of translating and adapting both conceptual frameworks. Accordingly, a four-step process was employed: first, forward translation from English into German was conducted by a research team of German native speakers with fluent knowledge of the English language. Second, a bilingual expert panel comprising one researcher with German as his mother tongue and expert command of the English language and one English language expert and university teacher reviewed the translation and discussed inconsistencies with the initial translators. Third, back-translation into English was conducted by an English native speaking researcher. The final version was pre-tested with 12 German researchers and clinicians who were involved in implementation projects using cognitive interviews. Results The translation and review process revealed some inconsistencies between the original version and the German translations. All issues could be solved by discussion. Central aspects of the items were confirmed in 60 to 70% of the items, and modifications were proposed in 30% of the items. Finally, we revised one CFIR-item heading after pre-testing. The final version was given consent by all involved parties. Conclusions Now, two validated and tested implementation frameworks to guide implementation efforts are available in the German language and can be used to increase the application of agreed-on implementation strategies into practice. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00222-w.
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Affiliation(s)
- Verena Regauer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany. .,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, 81377, Munich, Germany.
| | - Eva Seckler
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, 81377, Munich, Germany
| | - Craig Campbell
- University of Saskatchewan Language Centre, 221 Cumberland Avenue North, Saskatoon, Saskatchewan, S7N 1M3, Canada
| | - Amanda Phillips
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, 81377, Munich, Germany
| | - Thomas Rotter
- School of Nursing, Queen's University, 82-84 Barrie Street, Kingston, Ontario, K7L 3N6, Canada
| | - Petra Bauer
- Faculty for Applied Health and Social Sciences and Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
| | - Martin Müller
- Faculty for Applied Health and Social Sciences and Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024, Rosenheim, Germany
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Minian N, Ahad S, Ivanova A, Veldhuizen S, Zawertailo L, Ravindran A, de Oliveira C, Baliunas D, Mulder C, Bolbocean C, Selby P. The effectiveness of generic emails versus a remote knowledge broker to integrate mood management into a smoking cessation programme in team-based primary care: a cluster randomised trial. Implement Sci 2021; 16:30. [PMID: 33743777 PMCID: PMC7980670 DOI: 10.1186/s13012-021-01091-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/07/2020] [Accepted: 02/11/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Knowledge brokering is a knowledge translation approach that has been gaining popularity in Canada although the effectiveness is unknown. This study evaluated the effectiveness of generalised, exclusively email-based prompts versus a personalised remote knowledge broker for delivering evidence-based mood management interventions within an existing smoking cessation programme in primary care settings. METHODS The study design is a cluster randomised controlled trial of 123 Ontario Family Health Teams participating in the Smoking Treatment for Ontario Patients programme. They were randomly allocated 1:1 for healthcare providers to receive either: a remote knowledge broker offering tailored support via phone and email (group A), or a generalised monthly email focused on tobacco and depression treatment (group B), to encourage the implementation of an evidence-based mood management intervention to smokers presenting depressive symptoms. The primary outcome was participants' acceptance of a self-help mood management resource. The secondary outcome was smoking abstinence at 6-month follow-up, measured by self-report of smoking abstinence for at least 7 previous days. The tertiary outcome was the costs of delivering each intervention arm, which, together with the effectiveness outcomes, were used to undertake a cost minimisation analysis. RESULTS Between February 2018 and January 2019, 7175 smokers were screened for depression and 2765 (39%) reported current/past depression. Among those who reported current/past depression, 29% (437/1486) and 27% (345/1277) of patients accepted the mood management resource in group A and group B, respectively. The adjusted generalised estimating equations showed that there was no significant difference between the two treatment groups in patients' odds of accepting the mood management resource or in the patients' odds of smoking abstinence at follow-up. The cost minimisation analysis showed that the email strategy was the least costly option. CONCLUSIONS Most participants did not accept the resource regardless of remote knowledge broker strategy. In contexts with an existing KT infrastructure, decision-makers should consider an email strategy when making changes to a programme given its lower cost compared with other strategies. More research is required to improve remote knowledge broker strategies. TRIAL REGISTRATION ClinicalTrials.gov, NCT03130998 . Registered April 18, 2017, (Archived on WebCite at www.webcitation.org/6ylyS6RTe ).
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Affiliation(s)
- Nadia Minian
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada
- Institute of Medical Science, University of Toronto, Faculty of Medicine, 1 King's College Circle, Medical Science Building, Toronto, ON, M5S 1A8, Canada
| | - Sheleza Ahad
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Anna Ivanova
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Laurie Zawertailo
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Medical Sciences Building, Room 4207, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Arun Ravindran
- Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M5T 1P7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, ON, M5T 1R8, Canada
| | - Claire de Oliveira
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON, M5T 3M6, Canada
- Centre for Health Economics and Hull York Medical School, University of York, Alcuin A Block, Heslington, York, YO10 5DD, UK
| | - Dolly Baliunas
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada
- School of Public Health, The University of Queensland, Herston, QLD, Australia
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Carol Mulder
- Queen's University Department of Family Medicine, 220 Bagot St, Kingston, ON, K7L 3G2, Canada
| | - Corneliu Bolbocean
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline Street, Suite 633, Memphis, TN, 3816, USA
| | - Peter Selby
- Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen St W, Toronto, ON, M6J 1H4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College St., 1st floor, Toronto, ON, M5T 1R8, Canada.
- Department of Psychiatry, University of Toronto, 250 College Street 8th floor, Toronto, ON, M5T 1R8, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada.
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Haskell L, Tavender EJ, Wilson C, O’Brien S, Babl FE, Borland ML, Cotterell L, Schuster T, Orsini F, Sheridan N, Johnson D, Oakley E, Dalziel SR. Implementing evidence-based practices in the care of infants with bronchiolitis in Australasian acute care settings: study protocol for a cluster randomised controlled study. BMC Pediatr 2018; 18:218. [PMID: 29980177 PMCID: PMC6035428 DOI: 10.1186/s12887-018-1187-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchiolitis is the most common reason for admission to hospital for infants less than one year of age. Although management is well defined, there is substantial variation in practice, with infants receiving ineffective therapies or management. This study will test the effectiveness of tailored, theory informed knowledge translation (KT) interventions to decrease the use of five clinical therapies or management processes known to be of no benefit, compared to usual dissemination practices in infants with bronchiolitis. The primary objective is to establish whether the KT interventions are effective in increasing compliance to five evidence based recommendations in the first 24 h following presentation to hospital. The five recommendations are that infants do not receive; salbutamol, antibiotics, glucocorticoids, adrenaline, or a chest x-ray. METHODS/DESIGN This study is designed as a cluster randomised controlled trial. We will recruit 24 hospitals in Australia and New Zealand, stratified by country and provision of tertiary or secondary paediatric care. Hospitals will be randomised to either control or intervention groups. Control hospitals will receive a copy of the recent Australasian Bronchiolitis Guideline. Intervention hospitals will receive KT interventions informed by a qualitative analysis of factors influencing clinician care of infants with bronchiolitis. Key interventions include, local stakeholder meetings, identifying medical and nursing clinical leads in both emergency departments and paediatric inpatient areas who will attend a single education train-the-trainer day to then deliver standardised staff education with the training materials provided and coordinate audit and feedback reports locally over the study period. Data will be extracted retrospectively for three years prior to the study intervention year, and for seven months of the study intervention year bronchiolitis season following intervention delivery to determine compliance with the five evidence-based recommendations. Data will be collected to assess fidelity to the implementation strategies and to facilitate an economic evaluation. DISCUSSION This study will contribute to the body of knowledge to determine the effectiveness of tailored, theory informed interventions in acute care paediatric settings, with the aim of reducing the evidence to practice gaps in the care of infants with bronchiolitis. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616001567415 (retrospectively registered on 14 November 2016).
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Affiliation(s)
- Libby Haskell
- Children’s Emergency Department, Starship Children’s Hospital, Private Bag 92024, Auckland, 1142 New Zealand
- University of Auckland, Auckland, New Zealand
| | - Emma J. Tavender
- Murdoch Childrens Research Institute, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | - Sharon O’Brien
- Princess Margaret Hospital for Children, Perth, Australia
| | - Franz E. Babl
- Murdoch Childrens Research Institute, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Meredith L. Borland
- Princess Margaret Hospital for Children, Perth, Australia
- Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Australia
| | - Liz Cotterell
- Armidale Rural Referral Hospital, Armidale, NSW Australia
- University of New England, Armidale, NSW Australia
| | - Tibor Schuster
- Murdoch Childrens Research Institute, Melbourne, Australia
- Melbourne Children’s Trials Centre, Melbourne, Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Melbourne, Australia
- Melbourne Children’s Trials Centre, Melbourne, Australia
| | | | - David Johnson
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ed Oakley
- Murdoch Childrens Research Institute, Melbourne, Australia
- The Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Private Bag 92024, Auckland, 1142 New Zealand
- University of Auckland, Auckland, New Zealand
| | - on behalf of PREDICT
- Paediatric Research in Emergency Departments International Collaborative, Melbourne, Australia
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Brown CE, Nicholson Perry K. Cognitive behavioural therapy for eating disorders: how do clinician characteristics impact on treatment fidelity? J Eat Disord 2018; 6:19. [PMID: 30186605 PMCID: PMC6119328 DOI: 10.1186/s40337-018-0208-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinicians routinely report not practising evidence-based treatments with eating disorders. There has been limited research investigating the impact of adaptable clinician characteristics such as self-efficacy and therapeutic optimism in this area. This study evaluated if there is a relationship between clinician therapeutic optimism, self-efficacy and the provision of evidence-based practice in the treatment of bulimia nervosa and binge eating disorder. METHOD A survey developed for this study was administered to 100 psychologists who were recruited online via a range of organisations affiliated with psychology and/or eating disorders. The survey measured demographic factors, eating disorder treatment knowledge, treatment fidelity, the use of individual treatment components and a range of clinician characteristics including self-efficacy and therapeutic optimism. RESULTS Results demonstrated that clinician self-efficacy was positively associated with and predicted treatment fidelity. Therapeutic optimism had significant low correlations with treatment fidelity but did not predict treatment fidelity. CONCLUSION These findings would suggest that strengthening clinician self-efficacy is useful in improving evidence-based practice in the treatment of binge eating disorder and bulimia nervosa and may also have implications in the training of clinicians. The study also demonstrated that the use of a range of knowledge translation strategies are valuable in enhancing clinician adherence to evidence-based practice. Further research with direct measures of treatment fidelity is needed to clarify these findings.
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Affiliation(s)
- C E Brown
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
| | - K Nicholson Perry
- Australian College of Applied Psychology, Discipline of Psychological Science, 255 Elizabeth St, Sydney, NSW 2000 Australia
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