Danielle R Adams, Heidi Allen, Ginger E Nicol, Leopoldo J Cabassa
Psychedelics (e.g., 3,4-Methylenedioxymethamphetamine [MDMA], lysergic acid diethylamide [LSD], psilocybin) are molecules that have the potential to produce rapid therapeutic effects when paired with psychotherapy. Randomized clinical trials of psychedelic-assisted psychotherapy (PAT) have shown promising results for post-traumatic stress disorder (PTSD), depression, and substance use disorders. The U.S. Food and Drug Administration has acknowledged the promise of PAT, signaling potential approval of psilocybin-assisted therapy for depression by 2026. Given this timeline, implementation scientists must engage with PAT researchers, policymakers, and practitioners to think critically about bringing these promising new treatments into routine practice settings while maintaining quality and safety. This commentary aims to initiate a dialogue between implementation scientists and PAT researchers and practitioners on addressing these questions with a lens toward equity. Specifically, we discuss how the field of implementation science can support PAT stakeholders to accelerate the translational process from research into practice, focusing specifically on safety-net settings (i.e., Federally Qualified Health Centers and Veterans Affairs health systems) that serve historically marginalized populations. We use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to illustrate five critical areas where implementation science can help move PAT from research into real-world practice. For each RE-AIM dimension, we highlight ways the field of implementation science can contribute tools (e.g., implementation strategies), methodologies (e.g., pragmatic hybrid implementation-effectiveness trials), and approaches (community-based participatory research) for establishing the safety, effectiveness, and accessibility of PAT for historically underserved communities.
迷幻剂(如 3,4-亚甲二氧基甲基苯丙胺 [MDMA]、麦角酰二乙胺 [LSD]、迷幻药)是一种分子,与心理疗法搭配可产生快速治疗效果。迷幻药辅助心理疗法(PAT)的随机临床试验显示,对创伤后应激障碍(PTSD)、抑郁症和药物使用障碍的治疗效果很好。美国食品和药物管理局已经承认了 PAT 的前景,表示可能在 2026 年之前批准使用迷幻药辅助疗法治疗抑郁症。考虑到这一时间表,实施科学家必须与 PAT 研究人员、政策制定者和从业人员合作,批判性地思考如何在保证质量和安全的前提下将这些前景广阔的新疗法引入常规实践环境。本评论旨在启动实施科学家与 PAT 研究人员和从业人员之间的对话,以公平的视角解决这些问题。具体来说,我们讨论了实施科学领域如何支持 PAT 的利益相关者加快从研究到实践的转化过程,特别关注服务于历史上被边缘化人群的安全网环境(即联邦合格卫生中心和退伍军人事务卫生系统)。我们使用 "覆盖、效果、采用、实施和维护"(RE-AIM)框架来说明实施科学可以帮助将 PAT 从研究转化为现实世界实践的五个关键领域。对于 RE-AIM 的每一个维度,我们都强调了实施科学领域可以提供工具(如实施策略)、方法(如务实的混合实施效果试验)和途径(基于社区的参与式研究)的方式,以便为历史上服务不足的社区建立起 PAT 的安全性、有效性和可及性。
{"title":"Moving psychedelic-assisted therapies from promising research into routine clinical practice: Lessons from the field of implementation science.","authors":"Danielle R Adams, Heidi Allen, Ginger E Nicol, Leopoldo J Cabassa","doi":"10.1093/tbm/ibae053","DOIUrl":"10.1093/tbm/ibae053","url":null,"abstract":"<p><p>Psychedelics (e.g., 3,4-Methylenedioxymethamphetamine [MDMA], lysergic acid diethylamide [LSD], psilocybin) are molecules that have the potential to produce rapid therapeutic effects when paired with psychotherapy. Randomized clinical trials of psychedelic-assisted psychotherapy (PAT) have shown promising results for post-traumatic stress disorder (PTSD), depression, and substance use disorders. The U.S. Food and Drug Administration has acknowledged the promise of PAT, signaling potential approval of psilocybin-assisted therapy for depression by 2026. Given this timeline, implementation scientists must engage with PAT researchers, policymakers, and practitioners to think critically about bringing these promising new treatments into routine practice settings while maintaining quality and safety. This commentary aims to initiate a dialogue between implementation scientists and PAT researchers and practitioners on addressing these questions with a lens toward equity. Specifically, we discuss how the field of implementation science can support PAT stakeholders to accelerate the translational process from research into practice, focusing specifically on safety-net settings (i.e., Federally Qualified Health Centers and Veterans Affairs health systems) that serve historically marginalized populations. We use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to illustrate five critical areas where implementation science can help move PAT from research into real-world practice. For each RE-AIM dimension, we highlight ways the field of implementation science can contribute tools (e.g., implementation strategies), methodologies (e.g., pragmatic hybrid implementation-effectiveness trials), and approaches (community-based participatory research) for establishing the safety, effectiveness, and accessibility of PAT for historically underserved communities.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"744-752"},"PeriodicalIF":3.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11587814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wei Yi Kong, Jennifer Heisler-MacKinnon, Nul Loren Oh, Mary Catharine McKeithen, Samantha R Stalford, Meghan B Brennan, Christopher M Shea, Amy Liu, Nisha Gottfredson O'Shea, Sachiko Ozawa, Noel T Brewer, Melissa B Gilkey
Implementation science research identifies clinical champions as instrumental in aligning healthcare professionals' (HCPs) behavior with practice guidelines for delivering health services, including vaccinations. However, we know relatively little about identifying or supporting champions. To characterize who vaccine champions are, what they do, and how to support their work in pediatric primary care. In 2022, we interviewed a purposive sample of peer-nominated or self-identified vaccine champions (n=20) and HCPs who worked with vaccine champions (n=4). We thematically analyzed qualitative data. Vaccine champions' defining characteristics were firsthand primary care experience, whether as providers or nursing staff, and a strong belief in vaccinations as uniquely effective tools for primary prevention. Participants noted these beliefs were "part of the DNA" of specialties like pediatrics and infectious disease, where they perceived champions as especially common. Being "insatiable in their quest for knowledge," champions primarily conceptualized their role as understanding and sharing complex information and performance metric data related to vaccine administration. Champions' role in leading other implementation strategies, such as communication training, was more peripheral. Champions reported that dedicated time and staff support helped them "go above and beyond" to improve vaccination rates. Our findings suggest that vaccine champions can be found among providers and nursing staff with deep clinical experience and commitment to primary prevention through vaccination, including through providing vaccine education to colleagues. Healthcare systems can allocate resources to support champions as educators, while exploring opportunities to extend their role in other implementation strategies to improve vaccination rates.
{"title":"Identifying and supporting vaccine champions in pediatric primary care: a qualitative interview study.","authors":"Wei Yi Kong, Jennifer Heisler-MacKinnon, Nul Loren Oh, Mary Catharine McKeithen, Samantha R Stalford, Meghan B Brennan, Christopher M Shea, Amy Liu, Nisha Gottfredson O'Shea, Sachiko Ozawa, Noel T Brewer, Melissa B Gilkey","doi":"10.1093/tbm/ibae054","DOIUrl":"10.1093/tbm/ibae054","url":null,"abstract":"<p><p>Implementation science research identifies clinical champions as instrumental in aligning healthcare professionals' (HCPs) behavior with practice guidelines for delivering health services, including vaccinations. However, we know relatively little about identifying or supporting champions. To characterize who vaccine champions are, what they do, and how to support their work in pediatric primary care. In 2022, we interviewed a purposive sample of peer-nominated or self-identified vaccine champions (n=20) and HCPs who worked with vaccine champions (n=4). We thematically analyzed qualitative data. Vaccine champions' defining characteristics were firsthand primary care experience, whether as providers or nursing staff, and a strong belief in vaccinations as uniquely effective tools for primary prevention. Participants noted these beliefs were \"part of the DNA\" of specialties like pediatrics and infectious disease, where they perceived champions as especially common. Being \"insatiable in their quest for knowledge,\" champions primarily conceptualized their role as understanding and sharing complex information and performance metric data related to vaccine administration. Champions' role in leading other implementation strategies, such as communication training, was more peripheral. Champions reported that dedicated time and staff support helped them \"go above and beyond\" to improve vaccination rates. Our findings suggest that vaccine champions can be found among providers and nursing staff with deep clinical experience and commitment to primary prevention through vaccination, including through providing vaccine education to colleagues. Healthcare systems can allocate resources to support champions as educators, while exploring opportunities to extend their role in other implementation strategies to improve vaccination rates.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"722-731"},"PeriodicalIF":3.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Florine Ndakuya-Fitzgerald, Amy Farkas, Alexa A Lopez, Jeff Whittle, Kristin O Haeger, Qiyan Mu
The Veterans Health Administration (VHA) provides maternity care by paying for Veterans to receive pregnancy-related care in community settings and by utilizing maternity care coordinators (MCCs) at each medical facility. The purpose of this qualitative descriptive study was to understand the MCC's experiences performing their role across VA facilities. Thirty MCCs were recruited and interviewed virtually using Microsoft Teams. Interviews were recorded and transcribed verbatim. Using thematic analysis, transcripts were coded, and themes were derived. MCC's roles include being a liaison, care coordinator, and supporter. MCCs improve Veterans' care during pregnancy and postpartum by education, monitoring health status, and connecting Veterans to providers within VA and the community. Across VA facilities, there was variation in how MCCs engaged with Veterans and in the services provided. A challenge shared was the lack of dedicated time to the role. In the VA, MCCs are valuable in ensuring high-quality care coordination of pregnant/postpartum Veterans despite the fragmentation of care between VA and community providers. To improve inconsistencies in how the MCC program is implemented, systematic strategies such as ensuring dedicated time are needed.
退伍军人健康管理局(VHA)通过支付退伍军人在社区环境中接受孕期相关护理的费用,以及在各医疗机构使用孕产妇护理协调员(MCC)来提供孕产妇护理。这项定性描述性研究的目的是了解产科护理协调员在退伍军人医疗机构中履行职责的经验。我们招募了 30 名 MCC,并使用 Microsoft Teams 进行了虚拟访谈。对访谈进行了录音和逐字记录。采用主题分析法对记录誊本进行编码,并得出主题。MCC 的角色包括联络员、护理协调员和支持者。产妇协调中心通过教育、监测健康状况以及将退伍军人与退伍军人事务部和社区内的医疗服务提供者联系起来,改善退伍军人在孕期和产后的护理。在退伍军人事务部的各个机构中,产妇陪护中心与退伍军人接触的方式和提供的服务各不相同。共同面临的一个挑战是缺乏专门的时间来履行这一职责。在退伍军人事务部,尽管退伍军人事务部和社区医疗服务提供者之间的医疗服务是分散的,但母婴传播中心在确保对怀孕/产后退伍军人进行高质量的医疗协调方面是非常有价值的。为了改善 MCC 计划实施过程中的不一致性,需要采取系统性策略,如确保专职时间。
{"title":"Maternity care coordinator's experiences at the department of Veteran Affairs.","authors":"Florine Ndakuya-Fitzgerald, Amy Farkas, Alexa A Lopez, Jeff Whittle, Kristin O Haeger, Qiyan Mu","doi":"10.1093/tbm/ibae052","DOIUrl":"10.1093/tbm/ibae052","url":null,"abstract":"<p><p>The Veterans Health Administration (VHA) provides maternity care by paying for Veterans to receive pregnancy-related care in community settings and by utilizing maternity care coordinators (MCCs) at each medical facility. The purpose of this qualitative descriptive study was to understand the MCC's experiences performing their role across VA facilities. Thirty MCCs were recruited and interviewed virtually using Microsoft Teams. Interviews were recorded and transcribed verbatim. Using thematic analysis, transcripts were coded, and themes were derived. MCC's roles include being a liaison, care coordinator, and supporter. MCCs improve Veterans' care during pregnancy and postpartum by education, monitoring health status, and connecting Veterans to providers within VA and the community. Across VA facilities, there was variation in how MCCs engaged with Veterans and in the services provided. A challenge shared was the lack of dedicated time to the role. In the VA, MCCs are valuable in ensuring high-quality care coordination of pregnant/postpartum Veterans despite the fragmentation of care between VA and community providers. To improve inconsistencies in how the MCC program is implemented, systematic strategies such as ensuring dedicated time are needed.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"684-691"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Borsika A Rabin, Justin D Smith, Emily V Dressler, Deborah J Cohen, Rebekka M Lee, Melody S Goodman, Heather D'Angelo, Wynne E Norton, April Y Oh
Data sharing, the act of making scientific research data available to others, can accelerate innovation and discoveries, and ultimately enhance public health. The National Cancer Institute Implementation Science Centers in Cancer Control convened a diverse group of research scientists, practitioners, and community partners in three interactive workshops (May-June 2022) to identify and discuss factors that must be considered when designing research for equitable data sharing with a specific emphasis on implementation science and social, behavioral, and population health research. This group identified and operationalized a set of seven key considerations for equitable data sharing-conceptualized as an inclusive process that fairly includes the perspectives and priorities of all partners involved in and impacted by data sharing, with consideration of ethics, history, and benefits-that were integrated into a framework. Key data-sharing components particularly important for health equity included: elevating data sharing into a core research activity, incorporating diverse perspectives, and meaningfully engaging partners in data-sharing decisions throughout the project lifecycle. As the process of data sharing grows in research, it is critical to continue considering the potential positive and adverse impact of data sharing on diverse beneficiaries of health data and research.
{"title":"Designing for data sharing: Considerations for advancing health equity in data management and dissemination.","authors":"Borsika A Rabin, Justin D Smith, Emily V Dressler, Deborah J Cohen, Rebekka M Lee, Melody S Goodman, Heather D'Angelo, Wynne E Norton, April Y Oh","doi":"10.1093/tbm/ibae049","DOIUrl":"10.1093/tbm/ibae049","url":null,"abstract":"<p><p>Data sharing, the act of making scientific research data available to others, can accelerate innovation and discoveries, and ultimately enhance public health. The National Cancer Institute Implementation Science Centers in Cancer Control convened a diverse group of research scientists, practitioners, and community partners in three interactive workshops (May-June 2022) to identify and discuss factors that must be considered when designing research for equitable data sharing with a specific emphasis on implementation science and social, behavioral, and population health research. This group identified and operationalized a set of seven key considerations for equitable data sharing-conceptualized as an inclusive process that fairly includes the perspectives and priorities of all partners involved in and impacted by data sharing, with consideration of ethics, history, and benefits-that were integrated into a framework. Key data-sharing components particularly important for health equity included: elevating data sharing into a core research activity, incorporating diverse perspectives, and meaningfully engaging partners in data-sharing decisions throughout the project lifecycle. As the process of data sharing grows in research, it is critical to continue considering the potential positive and adverse impact of data sharing on diverse beneficiaries of health data and research.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"637-642"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ariella R Korn, April Y Oh, Nanmathi Manian, Sophia Tsakraklides, Lori Carter-Edwards
Longstanding inequities in cancer prevention and control require novel approaches to improve evidence-based intervention implementation. Exploring and elevating the perspectives of cancer prevention and control practitioners working to advance health equity and equitably implement evidence-based interventions is an important yet underutilized step among researchers working in this space. The purpose of this study was to explore practitioners' perspectives of how health equity is defined and integrated into their work, challenges of advancing health equity for implementation in local settings, and associated strategies. We conducted virtual key informant interviews and focus groups with 16 US practitioners (e.g. clinicians, health administrators, public health professionals) in 2021-2022. Interviews and focus groups were audio recorded and transcribed. Data were coded using inductive content analysis and summarized into themes. Four major themes emerged: (i) how health equity is conceptualized as a process and outcome; (ii) need to shift equity mindsets; (iii) importance of community partnerships; (iv) organizational policies and strategies for fostering equity in implementation. Respondents noted the need for research and medical communities to learn about the importance and benefits of allowing communities to shape implementation to advance equity in the delivery of evidence-based interventions and outcomes. Additionally, respondents emphasized that institutional leaders should initiate changes regarding equitable implementation at the organizational- and system-levels. Respondents endorsed the need to address equity issues related to the implementation of cancer prevention and control programs, practices, and policies. Many findings can be applied beyond cancer prevention and control to support equitable implementation and outcomes more generally.
{"title":"Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control.","authors":"Ariella R Korn, April Y Oh, Nanmathi Manian, Sophia Tsakraklides, Lori Carter-Edwards","doi":"10.1093/tbm/ibae048","DOIUrl":"10.1093/tbm/ibae048","url":null,"abstract":"<p><p>Longstanding inequities in cancer prevention and control require novel approaches to improve evidence-based intervention implementation. Exploring and elevating the perspectives of cancer prevention and control practitioners working to advance health equity and equitably implement evidence-based interventions is an important yet underutilized step among researchers working in this space. The purpose of this study was to explore practitioners' perspectives of how health equity is defined and integrated into their work, challenges of advancing health equity for implementation in local settings, and associated strategies. We conducted virtual key informant interviews and focus groups with 16 US practitioners (e.g. clinicians, health administrators, public health professionals) in 2021-2022. Interviews and focus groups were audio recorded and transcribed. Data were coded using inductive content analysis and summarized into themes. Four major themes emerged: (i) how health equity is conceptualized as a process and outcome; (ii) need to shift equity mindsets; (iii) importance of community partnerships; (iv) organizational policies and strategies for fostering equity in implementation. Respondents noted the need for research and medical communities to learn about the importance and benefits of allowing communities to shape implementation to advance equity in the delivery of evidence-based interventions and outcomes. Additionally, respondents emphasized that institutional leaders should initiate changes regarding equitable implementation at the organizational- and system-levels. Respondents endorsed the need to address equity issues related to the implementation of cancer prevention and control programs, practices, and policies. Many findings can be applied beyond cancer prevention and control to support equitable implementation and outcomes more generally.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"643-652"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michaela S McCarthy, Marina McCreight, Deisy Hernandez Lujan, Heidi Sjoberg, Catherine Battaglia
There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&I) Learning Hub that offered foundational D&I knowledge and opportunities for skill building. We developed the D4D&I Learning Hub curricula to train novice participants in the multicomponent D4D&I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants' growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&I Learning Hub. Thirty-one participants completed the D4D&I Learning Hub across four cohorts. Participants found the D4D&I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&I Learning Hub provides foundational education for novice participants of D&I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model.
{"title":"The development and evaluation of the Designing for Dissemination and Implementation Learning Hub.","authors":"Michaela S McCarthy, Marina McCreight, Deisy Hernandez Lujan, Heidi Sjoberg, Catherine Battaglia","doi":"10.1093/tbm/ibae036","DOIUrl":"10.1093/tbm/ibae036","url":null,"abstract":"<p><p>There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&I) Learning Hub that offered foundational D&I knowledge and opportunities for skill building. We developed the D4D&I Learning Hub curricula to train novice participants in the multicomponent D4D&I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants' growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&I Learning Hub. Thirty-one participants completed the D4D&I Learning Hub across four cohorts. Participants found the D4D&I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&I Learning Hub provides foundational education for novice participants of D&I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"653-660"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarra Nazem, Shengnan Sun, Sean M Barnes, Lindsey L Monteith, Trisha A Hostetter, Jeri E Forster, Lisa A Brenner, Hanga Galfalvy, Fatemeh Haghighi
Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t-tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P < .001; d = -1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P = .17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk.
{"title":"Impact of an internet-based insomnia intervention on suicidal ideation and associated correlates in veterans at elevated suicide risk.","authors":"Sarra Nazem, Shengnan Sun, Sean M Barnes, Lindsey L Monteith, Trisha A Hostetter, Jeri E Forster, Lisa A Brenner, Hanga Galfalvy, Fatemeh Haghighi","doi":"10.1093/tbm/ibae032","DOIUrl":"10.1093/tbm/ibae032","url":null,"abstract":"<p><p>Improving public health approaches to suicide prevention requires scalable evidence-based interventions that can be easily disseminated. Given empirical data supporting the association between insomnia and suicide risk, internet-delivered insomnia interventions are promising candidates to meet this need. The purpose of this study was to examine whether an unguided internet-delivered cognitive-behavioral therapy for insomnia (iCBT-I) improved insomnia severity, suicidal ideation (SI), and suicide risk correlates (depression, post-traumatic stress disorder, anxiety, hostility, belongingness, hopelessness, agitation, irritability, concentration) in a sample of veterans. Secondary data analysis of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans (n = 50) with clinically significant insomnia and elevated SI drawn from a larger randomized controlled trial (RCT) of an iCBT-I, Sleep Healthy Using the Internet (SHUTi). Two-sample t-tests or Wilcoxon rank sum tests were used to evaluate between-group differences (SHUTi vs. Insomnia Education Website control) in symptom improvement from baseline to post-intervention. SHUTi participants experienced a significant improvement in insomnia severity (P < .001; d = -1.08) and a non-significant with small (subthreshold medium) effect size reduction of SI (P = .17, d = 0.40), compared to control participants. Significant improvement in hopelessness was observed (medium effect size), with non-significant small to medium effect size reductions in most remaining suicide risk correlates. Self-administered iCBT-I was associated with improvements in insomnia severity in veterans at elevated risk for suicide. These preliminary findings suggest that SI and suicide risk correlates may improve following an iCBT-I intervention, demonstrating the need for future well-powered iCBT-I RCTs targeted for populations at elevated suicide risk.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"673-683"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maribel Cedillo, Jesell Zepeda, Bernadette Kiraly, Michael Flynn, Paulina Larios Elizalde, Emily Zheutlin, Elizabeth A Rudd, Polina V Kukhareva, Jorie M Butler, Rachel Hess, Kensaku Kawamoto, Paul Estabrooks, Molly B Conroy
Maintaining a healthy weight postintentional weight loss is crucial for preventing chronic health conditions, yet many regain weight postintervention. Electronic health record (EHR) portals offer a promising avenue for weight management interventions, leveraging patient-primary care relationships. Our previous research demonstrated that coaching alongside self-monitoring improves weight maintenance compared to monitoring alone. Integrating weight management into routine clinical practice by training existing staff could enhance scalability and sustainability. However, challenges such as inconsistent staff qualifications and high coach turnover rates could affect intervention effectiveness. Standardizing services, training, and coaching continuity seem crucial for success. To report on developing, testing, and evaluating an EHR-based coaching training program for clinical staff, guided by an implementation tool for the MAINTAIN PRIME study. Conducted across 14 University of Utah primary care sites, we developed, tested, and evaluated a coaching training for clinical staff. Guided by a planning model and the Predisposing, Enabling, and Reinforcing (PER) tool, stakeholders actively participated in planning, ensuring alignment with clinic priorities. All clinical staff were invited to participate voluntarily. Evaluation measures included staff interest, training effectiveness, confidence, and readiness. Data collection utilized REDCap, with survey results analyzed using descriptive statistics. Despite increased clinical workload and reassignments posed by coronavirus disease 2019, we were able to train 39 clinical staff, with 34 successfully coaching patients. Feedback indicated high readiness and positive perceptions of coaching feasibility. Coaches reported satisfaction with training, support, and enjoyed establishing connections with patients. The PER strategies allowed us to implement a well-received training program found effective by primary care coaches.
{"title":"Scalable and successful patient portal lifestyle coaching training for primary care clinical staff.","authors":"Maribel Cedillo, Jesell Zepeda, Bernadette Kiraly, Michael Flynn, Paulina Larios Elizalde, Emily Zheutlin, Elizabeth A Rudd, Polina V Kukhareva, Jorie M Butler, Rachel Hess, Kensaku Kawamoto, Paul Estabrooks, Molly B Conroy","doi":"10.1093/tbm/ibae047","DOIUrl":"10.1093/tbm/ibae047","url":null,"abstract":"<p><p>Maintaining a healthy weight postintentional weight loss is crucial for preventing chronic health conditions, yet many regain weight postintervention. Electronic health record (EHR) portals offer a promising avenue for weight management interventions, leveraging patient-primary care relationships. Our previous research demonstrated that coaching alongside self-monitoring improves weight maintenance compared to monitoring alone. Integrating weight management into routine clinical practice by training existing staff could enhance scalability and sustainability. However, challenges such as inconsistent staff qualifications and high coach turnover rates could affect intervention effectiveness. Standardizing services, training, and coaching continuity seem crucial for success. To report on developing, testing, and evaluating an EHR-based coaching training program for clinical staff, guided by an implementation tool for the MAINTAIN PRIME study. Conducted across 14 University of Utah primary care sites, we developed, tested, and evaluated a coaching training for clinical staff. Guided by a planning model and the Predisposing, Enabling, and Reinforcing (PER) tool, stakeholders actively participated in planning, ensuring alignment with clinic priorities. All clinical staff were invited to participate voluntarily. Evaluation measures included staff interest, training effectiveness, confidence, and readiness. Data collection utilized REDCap, with survey results analyzed using descriptive statistics. Despite increased clinical workload and reassignments posed by coronavirus disease 2019, we were able to train 39 clinical staff, with 34 successfully coaching patients. Feedback indicated high readiness and positive perceptions of coaching feasibility. Coaches reported satisfaction with training, support, and enjoyed establishing connections with patients. The PER strategies allowed us to implement a well-received training program found effective by primary care coaches.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"661-672"},"PeriodicalIF":3.6,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sophia A Hussen, Rosalind N Byrd, Kamini Doraivelu, Shamia J Moore, Daniel M Camp, Drew Wood-Palmer, Ameeta S Kalokhe, Eugene W Farber, Mohammed K Ali
Behavioral health conditions are disproportionately experienced by people living with Human immunodeficiency virus (HIV), including young Black gay, bisexual, and other men who have sex with men (GBMSM). Left unaddressed, these symptoms can adversely impact HIV care outcomes. Improving the integration of behavioral health and HIV care services has been proposed as a strategy to address this challenge. To conduct a pre-implementation study exploring barriers and facilitators to improving HIV and behavioral health care integration at two HIV clinics in Atlanta, Georgia. We conducted a mixed-methods study guided by the Consolidated Framework for Implementation Research (CFIR). Sixty (60) HIV care providers, behavioral health care providers, and social service providers participated in cross-sectional surveys, and a subset of survey participants (15) also participated in a qualitative in-depth interview to explore CFIR constructs in greater depth. We focused on Intervention Characteristics, Outer Setting, and Inner Setting as the most relevant CFIR domains. Within each of these domains, we identified both facilitators and barriers to improving HIV and behavioral care integration in the two clinics. Participants agreed that enhancing integration would provide a relative advantage over current practice, would address young Black GBMSM and other patient needs, and would be compatible with the organizational mission. However, they also expressed concerns about complexity, resource availability, and priority relative to other clinic initiatives. Participants were enthusiastic about improving care integration but also invoked practical challenges to translating this idea into practice. Future research should test specific implementation strategies and their potential effectiveness for improving the integration of behavioral health and HIV care, as a strategy for improving well-being among young Black GBMSM and other people living with HIV.
人类免疫缺陷病毒(HIV)感染者,包括年轻的黑人男同性恋、双性恋和其他男男性行为者(GBMSM)的行为健康状况尤为严重。这些症状如果得不到解决,会对艾滋病护理结果产生不利影响。改善行为健康与 HIV 护理服务的整合已被提出作为应对这一挑战的策略。我们在佐治亚州亚特兰大市的两家艾滋病诊所开展了一项实施前研究,以探索改善艾滋病和行为健康护理整合的障碍和促进因素。我们在实施研究综合框架 (CFIR) 的指导下开展了一项混合方法研究。六十(60)名艾滋病医疗服务提供者、行为医疗服务提供者和社会服务提供者参与了横断面调查,调查参与者的一部分(15 人)还参与了定性深入访谈,以更深入地探讨 CFIR 构建。我们将重点放在干预特征、外部环境和内部环境上,将其作为最相关的 CFIR 领域。在每个领域中,我们都确定了在两家诊所中加强艾滋病和行为治疗整合的促进因素和障碍。与会人员一致认为,与目前的做法相比,加强整合将提供相对优势,可以满足年轻黑人 GBMSM 和其他患者的需求,并且符合组织使命。然而,他们也表达了对复杂性、资源可用性以及相对于其他诊所计划的优先性的担忧。与会者对改善护理整合充满热情,但也提出了将这一想法付诸实践所面临的实际挑战。未来的研究应该检验具体的实施策略及其在改善行为健康与 HIV 护理整合方面的潜在有效性,以此作为改善年轻黑人 GBMSM 及其他 HIV 感染者福祉的策略。
{"title":"Pre-implementation planning to enhance integration of HIV and behavioral health care services at two Ryan White-funded HIV care centers.","authors":"Sophia A Hussen, Rosalind N Byrd, Kamini Doraivelu, Shamia J Moore, Daniel M Camp, Drew Wood-Palmer, Ameeta S Kalokhe, Eugene W Farber, Mohammed K Ali","doi":"10.1093/tbm/ibae046","DOIUrl":"10.1093/tbm/ibae046","url":null,"abstract":"<p><p>Behavioral health conditions are disproportionately experienced by people living with Human immunodeficiency virus (HIV), including young Black gay, bisexual, and other men who have sex with men (GBMSM). Left unaddressed, these symptoms can adversely impact HIV care outcomes. Improving the integration of behavioral health and HIV care services has been proposed as a strategy to address this challenge. To conduct a pre-implementation study exploring barriers and facilitators to improving HIV and behavioral health care integration at two HIV clinics in Atlanta, Georgia. We conducted a mixed-methods study guided by the Consolidated Framework for Implementation Research (CFIR). Sixty (60) HIV care providers, behavioral health care providers, and social service providers participated in cross-sectional surveys, and a subset of survey participants (15) also participated in a qualitative in-depth interview to explore CFIR constructs in greater depth. We focused on Intervention Characteristics, Outer Setting, and Inner Setting as the most relevant CFIR domains. Within each of these domains, we identified both facilitators and barriers to improving HIV and behavioral care integration in the two clinics. Participants agreed that enhancing integration would provide a relative advantage over current practice, would address young Black GBMSM and other patient needs, and would be compatible with the organizational mission. However, they also expressed concerns about complexity, resource availability, and priority relative to other clinic initiatives. Participants were enthusiastic about improving care integration but also invoked practical challenges to translating this idea into practice. Future research should test specific implementation strategies and their potential effectiveness for improving the integration of behavioral health and HIV care, as a strategy for improving well-being among young Black GBMSM and other people living with HIV.</p>","PeriodicalId":48679,"journal":{"name":"Translational Behavioral Medicine","volume":" ","pages":"598-610"},"PeriodicalIF":3.6,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}