Translational Behavioral Medicine最新文献

Background: Implementation strategies are essential for translating evidence into routine clinical practice. Their effectiveness depends on specifying and deploying behavior change techniques (BCTs): observable, irreducible components that target determinants of clinician behavior. The Behavior Change Technique Ontology (BCTO) standardizes the identification and labeling of BCTs, yet it has been applied only sparingly in implementation research to date.

Purpose: To characterize the nature and extent of BCTs explicitly reported or retrospectively identified in implementation trials that targeted evidence-based nursing practice.

Methods: In this secondary analysis of a prior systematic review, we coded BCTs across 151 implementation trials with a manual derived from the 281-item BCTO. One to two coders per study applied coding rules in NVivo; disagreements were resolved by consensus. Feasibility indicators included coder certainty ("Definitely" vs "Probably" present) and the need for extra coding rules.

Results: Trials contained 907 BCT instances: 857 in intervention arms, 50 in controls. We identified 100 of the BCTO's 281 techniques (35.6%), spanning 17 of its 20 parent groups. Intervention arms featured a median of four BCT instances (IQR 3-7) and four unique BCTs (IQR 3-5). The five most common BCTs were Instruct how to perform behavior (n = 273), Arrange informational support (n = 127), Deliver informational support (n = 83), Demonstrate behavior (n = 62), and Practice behavior (n = 43). Only 37% of BCT instances were coded with high certainty, and 17 supplementary decision rules were required for consistent coding.

Conclusions: Implementation strategies targeting nursing practice rely on instructional and informational BCTs, with limited use of goal-directed, feedback-intensive or context-altering techniques that could enhance impact.

Clinical trial information: The Clinical Trials Registration PROSPERO CRD42019130446.

Background: Lifestyle medicine (LM) is an evidence-based field of medicine that is effective in treating and preventing leading causes of morbidity and mortality. Despite demonstrated impact, few physicians and other healthcare professionals regularly implement LM. Continuing education may be an effective avenue for improving practitioner knowledge, confidence, and practice of LM, but there is a gap in the understanding of how educational content and strategies can be utilized to effectively increase LM adoption. The purpose of this study is to identify educational strategies that facilitate the implementation of LM in health systems (HS).

Methods: Eight US HSs participated in this multiple case study. We conducted in-depth, semi-structured interviews (n = 68 total; 6-8 within each HS) with HS employees leading and delivering LM programs. Interviews included questions about LM implementation and educational strategies. Transcripts were analyzed following the framework analysis approach. Strength of endorsement was assessed through quantitative and qualitative analysis.

Results: Four topic areas were identified as critical content for effective continuing education in LM. The need for further education in behavior change counseling received the strongest endorsement. Other topics included LM definition and evidence, referral opportunities, and business development skills. Ten types of continuing educational strategies were identified that facilitate LM. There was the strongest endorsement for pilot programs, employee wellness, and interpersonal educational activities, including peer-learning, communities-of-practice, and supervisor-learning/mentorship.

Conclusion: Continuing education can facilitate LM implementation in HSs. Educational strategies should emphasize training that builds skills in behavior change counseling, leverages employee wellness pilot programs, and nurtures interpersonal learning.

Tobacco use prevalence is disproportionately high among individuals with mental health conditions, including substance use disorders. Clinical practice guidelines recommend tobacco treatment for those receiving treatment for substance use given the health and psychosocial benefits from tobacco cessation. Despite this, there are several barriers to the provision of tobacco treatment in substance use treatment settings, and many patients in these settings do not receive treatment. This case study describes the acquisition of an inpatient substance use treatment facility by a major hospital system and the subsequent integration of a tobacco treatment service within this setting. In this case, we describe barriers, such as initial staff and patient hesitance toward the service, logistical challenges in service provision, and policy issues that needed to be addressed within the setting. Data derived from medical chart reviews of admitted patients show that following the introduction of the program, engagement with tobacco cessation pharmacotherapy and counseling substantially increased, which suggests acceptability and integration of the services. This case serves as a model of the adoption process of a comprehensive tobacco treatment program in substance use treatment settings as a way to reduce tobacco-related disparities in this priority population.

Background: Behavioral and implementation science frameworks should be employed in the design of interventions to change behavior, including those delivered in organizational settings, to enhance their effectiveness, replicability, and transparency. However, this is often not done well in health services research. This deficiency also impacts interventions to address unprofessional behaviors (UBs) among healthcare staff. UBs include rudeness and bullying, which harm patient safety and staff wellbeing. This study builds on an earlier realist review of these UB interventions to retroactively identify their active components.

Methods: A systematic search was updated to July 2024 using MEDLINE, Embase, CINAHL, and Google Scholar. Intervention descriptions were extracted from study reports and independently coded using directed content analysis against the May 2024 version of the behavior change technique (BCT) Ontology, which contained 284 BCTs.

Results: The search identified 262 titles and abstracts, yielding five new reports. Combined with 42 papers from the prior review, 47 reports of 44 interventions were included. Interventions were categorized as single-session (n = 15), multisession (n = 12), combined session (n = 6), professional accountability (n = 7), and structured culture change (n = 4). Complex interventions used more BCTs: session-based interventions focused on awareness-raising and roleplay, professional accountability on consequences, and structured culture change on goal-oriented techniques. Few interventions reported negative outcomes, limiting the understanding of which BCTs drive effectiveness.

Conclusions: The BCT ontology is broadly applicable to organizational behavior change in healthcare. Complex interventions employ consequence-based and goal-oriented BCTs, but the effectiveness of specific BCTs remains unclear due to poor evaluations. Future interventions should use the BCT Ontology to improve intervention reporting and effectiveness.

Community-based organizations (CBOs) are critical for delivering evidence-based interventions (EBIs) to address cancer inequities. However, a lack of consensus on the core skills needed for this work often hinders capacity-building strategies to support EBI implementation. The disconnect is partly due to differing views of EBIs and related skills held by those typically receiving versus developing capacity-building interventions (here, practitioners and academics, respectively). Our team of implementation scientists and practice-based advisors used group concept mapping to engage 34 CBO practitioners and 30 academics with experience addressing cervical cancer inequities implementing EBIs. We created group-specific maps of skills using multidimensional scaling and hierarchical cluster analysis, then compared them using Procrustes comparison permutations. The 98 skills were sorted into six clusters by CBO practitioners and five by academics. The groups generated maps with statistically comparable underlying structures but also statistically significant divergence. Some skill clusters had high concordance across the two maps, e.g. "managing funding and external resources." Other skill clusters, e.g. "adapting EBIs" from the CBO practitioner map and "selecting and adapting EBIs" from the academic map, did not overlap as much. Across groups, key clusters of skills included connecting with community members, understanding the selected EBI and community context, adapting EBIs, building diverse and equitable partnerships, using data and evaluation, and managing funding and external resources. There is a significant opportunity to combine CBO practitioners' systems/community frames with the EBI-focused frame of academics to promote EBI utilization and address cancer and other health inequities.

Background: Food is Medicine (FIM) programs identify people experiencing food insecurity and diet-related chronic disease and connect them with nutritious foods. Food banks and healthcare partners are well positioned to deliver FIM programs; however, there is limited knowledge about factors that influence FIM program implementation in this context.

Purpose: The goal of this study was to understand barriers and facilitators to FIM program implementation within food bank-healthcare partnerships in diverse US settings.

Methods: A phenomenological study using semi-structured interviews was conducted with 21 programmatically and contextually diverse Food as Medicine 3.0 (FAM3) grantees, including food bank leads and some healthcare partners. The Consolidated Framework for Implementation Research (CFIR) 2.0 informed interview guide development, coding, and interpretation. Interviews and the analysis were completed by a team of trained researchers following best practices. Data was analyzed using Dedoose (version 9.2.12).

Results: Fifty participants across 21 FAM3 grantees engaged in an interview. Most grantees shared challenges related to initiating and maintaining the healthcare partnerships needed for FIM programs. The tracking, gathering, and/or sharing of FIM program implementation and evaluation data was another primary challenge. Furthermore, limited healthcare and food bank staff capacity to carry out FIM programs was another prominent barrier. Despite these challenges, FIM programs were considered adaptable, testable, and to meet a core need among neighbors, all of which were implementation facilitators.

Conclusions: Results of this study inform the need to design and test implementation strategies to overcome barriers to the implementation of a promising food bank-healthcare partnership model for FIM.

Equitable access to knowledge and knowledge translation that is inclusive to marginalized patients-including those whose health conditions have resulted in lifelong disability-may be supportive of health equity. In enhancing the evidence base of what constitutes disability-inclusive knowledge translation, patients may be better supported in their health literacy, self-management, or autonomy in making health-related decisions. To identify potential guiding principles from the discipline of special education that has been invested in providing equitable access to knowledge for patients living with disabilities across all age groups. Qualitative synthesis of existing theories, models, and frameworks (TMFs) in special education is performed to identify constructs which may guide disability-inclusive knowledge translation. A search methodology adapted from PRISMA-ScR was conducted in Web of Science and Scopus to identify review-type studies in special education scholarship. A total of 69 unique review-type studies were retrieved in the English language, resulting in 21 meeting the inclusion criteria of presenting a special education TMF with potential to inform knowledge translation. Ten themes emerged through data charting of theoretical constructs, as well as open coding of five studies. Findings that may promote disability-inclusive knowledge translation are presented in a synthesized framework with 25 considerations. Special education TMFs are diverse in focus; this first-steps study illustrates significant potential of special education TMFs in informing disability-inclusive knowledge translation. Future studies that engage with a more expansive set of special education TMFs will bring value to implementation science.

Churches hold promise for reaching populations with high rates of chronic disease, yet few faith-based large-scale implementation studies exist. The study purpose was to examine 12-month implementation outcomes and associated Consolidated Framework for Implementation Research (CFIR) constructs after converting in-person training to online for an evidence-based intervention designed to improve church organizational practices related to physical activity (PA) and healthy eating (HE). US churches recruited from 2020 to 2022 participated in eight online lessons prior to implementation. Each church's coordinator completed an online baseline and 12-month survey assessing church practices for PA/HE components targeted in the Faith, Activity, and Nutrition (FAN) intervention (opportunities, messages, policies, and pastor support) and constructs from four CFIR domains. Mixed-effects regression models examined changes in practices over time and the impact of in-person versus online church operation at baseline. Linear regression tested associations between CFIR constructs and PA/HE implementation, adjusting for baseline practices. Churches (N = 107, 75% predominantly African American) from 23 states enrolled. At 12 months, 84% completed the survey. Implementation of all PA/HE practices increased, with larger effects for churches operating in-person for PA composite, messages, and policies and HE messages and policies. Constructs from all four CFIR domains were associated with implementation outcomes. In conclusion, online training was associated with significantly improved PA/HE church practices at 12 months. For churches operating in-person at baseline, effect sizes and CFIR associations with implementation outcomes were comparable to results of three prior studies using in-person training. Training for FAN is scalable with the potential to advance racial health equity.

Background: Physical activity (PA) has proven health benefits for cancer survivors, yet PA programmes are not routinely available in general practice.

Purpose: This mixed-methods study used the RE-AIM framework to evaluate the Adoption, Implementation, and Maintenance of a PA programme at an organisational level for cancer survivors in Dutch general practice.

Methods: Primary care practitioners (practice nurses, dieticians, and doctor's assistants) delivering a PA programme aimed at increasing PA in daily activities, and general practitioners (GPs) in whose practices it was performed, completed questionnaires and interviews. Quantitative and qualitative data were analysed descriptively or by thematic analysis, respectively.

Results: Concerning Adoption, 9% of general practices (n = 14) took part and showed high representativeness. Primary care practitioners coached a median of seven patients over 18.5 months, with barriers and facilitators emerging mainly related to organizational support, programme alignment, and patient health benefits. Concerning Implementation, adherence to the protocol was 77%, and the training was evaluated as 8 out of 10. Concerning Maintenance, 11 primary care practitioners (69%) used programme elements outside the study context.

Conclusions: We conclude that our PA programme seems feasible in general practice provided there is sufficient organizational capacity. Designating a lead-motivated practitioner, providing sufficient training, and aligning and integrating PA counselling in routine care are key to providing appropriate and targeted support for cancer survivors in general practice.

Background: Peer support (PS) programs offer care to women at-risk for and surviving breast cancer to improve their quality of life (QoL).

Purpose: This study evaluated a cancer-focused community-based organization's (CBO) one-on-one and no-cost PS program to identify its uptake and outcomes.

Methods: A secondary analysis was conducted among N = 1054 breast cancer previvors and survivors who contacted the CBO for information and support: outcomes were assessed 30 days later. Associations among demographic/clinical factors and the offer, uptake, and outcomes of PS were analyzed.

Results: In this sample, N = 930 women (88.2%) were breast cancer survivors. PS was offered to N = 807 women (76.6%). Logistic regression demonstrated increased odds of being offered PS among those who were younger (odds ratio [OR] = 1.24), with lower household incomes (OR = 1.37), and who found the CBO more beneficial for themselves and their families (e.g. OR = 1.19). Of those offered PS, N = 304 (37.7%) utilized it. PS utilization was more likely among mothers (OR = 1.57), breast cancer previvors (OR = 1.59), and those with lower QoL (OR = 1.18). Women who utilized PS generally reported positive experiences (Mean = 44.4/50): younger age and positive experience were associated with better PS outcome (P's ≤ 0.03). Among women who did not utilize PS, commonly reported challenges included time (17.5%) and discomfort sharing personal information (9.8%). Other barriers (63.9%) analyzed qualitatively referenced lack of need or interest, time constraints, and existing support networks.

Conclusions: PS programming was well-received among the one-third of women who participated, especially younger women and with those lower QoL. Barriers to utilizing PS could be addressed to enhance its reach and impact.