Implementation research and practice最新文献

Background: Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS) is an evidence-based intervention that promotes tobacco use cessation among teachers and tobacco control policies among schools in India. This study tested an implementation model to build Bihar Department of Education (DOE) capacity to support and deliver TFT-TFS within schools, leveraging DOE training infrastructure.

Method: We used a training-of-trainers (TOT) "cascade" implementation strategy to embed the TFT-TFS program into the Bihar DOE infrastructure. We trained 46 Cluster Coordinators to train and support Headmasters to implement TFT-TFS in their schools over one academic year. We selected three school districts, representing approximately 46 clusters and 219 schools. We used the RE-AIM framework to assess program adoption (Headmaster participation in at least one of six TFT-TFS trainings), implementation (of four core program components), and reach (teachers' participation in three or more group discussions). Using a non-inferiority design, we hypothesized that program adoption, implementation, and reach would not be inferior to the high standards demonstrated when TFT-TFS was originally tested in the Bihar School Teachers Study. We used self-reported checklists to measure outcomes and SPSS Version 25 to analyze data.

Results: For adoption, 94% of Headmasters attended the first training, although participation declined by the sixth training. Among the 112 schools out of 219 with complete Headmaster checklist data, all met our minimum criteria for implementing TFT-TFS. Over 99% of schools posted a school tobacco control policy and distributed quit booklets. However, only 69% of schools met our criteria for program reach.

Conclusions: This study outlines the processes for taking a tobacco control intervention to scale and implementing it through the Bihar DOE infrastructure. These findings provide a foundation for other Indian states and low- and middle-income countries to implement tobacco control and other health programs for schoolteachers.

Trial registration: NCT05346991.

Plain language summary: Each year in India, more than 1.2 million people die from tobacco-related causes, and India has the world's highest oral cancer burden. The world needs more evidence on how to bring cost-effective tobacco control interventions to scale, especially in low- and middle-income countries (LMICs). To address this gap, from 2017 to 2021, we examined the process of scaling up Tobacco-Free Teachers, Tobacco-Free Society (TFT-TFS), an evidence-based intervention promoting tobacco use cessation among teachers and tobacco control policies in schools. Our study tested an implementation model aimed at building the Bihar State Department of Education (DOE) capacity to support and deliver TFT-TFS. We used a training-of-trainers model to embed TFT-T

Background: The objective of this study was to assess potential challenges, prioritize adaptations, and develop an implementation and research approach to integrate and study a parenting intervention for mothers in recovery from substance use disorders in community-based home-visiting programs.

Method: An explanatory mixed-methods design, guided by process mapping with Failure Modes and Effects Analysis tools, and an Advisory Panel of 15 community members, identified potential implementation challenges and recommended solutions for the proposed intervention within five pre-specified domains. Thematic content analysis identified themes from detailed field notes.

Results: The Advisory Panel identified 44 potential challenges across all domains. They determined that the recruitment domain was most likely to create challenges. Regarding the potential challenges, two cross-domain themes emerged: (1) development of mistrust in the community and (2) difficulty initiating and sustaining engagement. Potential solutions and adaptations to protocols are reported.

Conclusion: Mistrust in the community was cited as a potentially important challenge for the delivery and study of an evidence-based parenting intervention for mothers in recovery through home-visiting programs. Adaptations to research protocols and intervention delivery strategies are needed to prioritize the psychological safety of families, particularly for groups that have been historically stigmatized.

Background: Parent coaching is an evidence-based practice for young autistic children, but it is underutilized in lower-resourced community settings like the Medicaid system (Straiton et al., 2021b). Clinicians often struggle to implement parent coaching with low-income and marginalized families (Tomczuk et al., 2022), but little is known about which factors influence clinician decision making processes about providing parent coaching to this population.

Methods: This qualitative analysis used the framework method and thematic analysis. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework (Aarons et al., 2011) to identify factors in the clinical decision-making process that community providers use when offering parent coaching to families of Medicaid-enrolled autistic children. Interviews with 13 providers and a focus group with 13 providers were analyzed.

Results: The following themes emerged: 1) Policies drive provider task priorities and affect competing demands; 2) Providers are more likely to use parent coaching when agency leaders monitor parent coaching benchmarks, though this is rarely done; 3) Logistical factors like scheduling and treatment location affect perceived feasibility of using parent coaching; 4) Previous experience or coursework in parent coaching and/or family systems supports the quality of parent coaching implementation; 5) Provider perceptions of "parent readiness" are initially indicated by overt expressions of parent interest.

Conclusions: In the absence of outer-context and inner-context policies, providers have more decision-making power to offer parent coaching based on their own judgements and preferences, which may result in fewer families being offered parent coaching and increased bias related to which families are offered this service. State-, agency-, and clinician-level recommendations are provided for increasing equitable provision of this evidence-based practice for autism.

Background: The field of Implementation science (IS) continues to evolve, and the number and type of IS capacity building Programs (ISCBPs) are in flux. These changes push the field to revisit the accepted IS competencies and to guide sustainment of ISCBPs. Our objectives were: (1) compare characteristics of current ISCBPs; (2) identify recommendations to support ISCBP sustainment; (3) measure how often ISCBPs address IS competencies; (4) identify novel and important IS competencies for the field.

Method: This multi-method study included ISCBPs delivering structured, longitudinal IS training, excluding single courses and brief workshops. We used three complementary methods to meet our objectives. First, we identified ISCBPs via an internet search and snowball sampling methods. Second, we surveyed these ISCBPs to identify areas of program focus, types of trainees, IS competencies addressed, and recommendations to sustain ISCBPs. Third, we conducted a modified Delphi process with IS researchers/leaders to reach consensus on the IS competencies that were both important and novel as compared to the IS competencies published to date.

Results: Among 74 eligible ISCBPs identified, 46 responded (62% response rate). Respondent ISCBPs represented diverse areas of focus (e.g., global health, cardiopulmonary disease) and trainee stages (e.g., graduate students, mid-career faculty). While most respondent ISCBPs addressed core IS methods, targeting IS competencies was less consistent (33% for nongraduate/non-fellowship ISCBPs; >90% for graduate/national ISCBPs). Our modified Delphi process identified eight novel and important IS competencies related to increasing health equity or the speed of translation. Recommendations to sustain ISCBPs included securing financial administrative support.

Conclusions: Current ISCBPs train learners across varying career stages in diverse focus areas. To promote rigor, we recommend ISCBPs address specific IS competencies, with consideration of these eight novel/emerging competencies. We also recommend ISCBPs report on their IS competencies, focus area(s), and trainee characteristics. ISCBP programs need administrative financial support.

Plain language summary: There is a limited workforce capacity to conduct implementation science (IS) research. To address this gap, the number and type of IS capacity building Programs (ISCBPs) focusing on training researchers and practitioners in IS methods continue to increase. Our efforts to comprehensively identify and describe ISCBPs for researchers and practitioners highlighted four implications for leaders of ISCBPs related to program sustainment and rigor. First, we identified a range of contextual characteristics of ISCBPs, including the research topics, methods, and IS competencies addressed, and the types of trainees accepted. Second, given the variability of trainee types a

Background: The public health impact of behavioral and biobehavioral interventions to prevent and treat mental health and substance use problems hinges on developing methods to strategically maximize their effectiveness, affordability, scalability, and efficiency.

Methods: The multiphase optimization strategy (MOST) is an innovative, principled framework that guides the development of multicomponent interventions. Each phase of MOST (Preparation, Optimization, Evaluation) has explicit goals and a range of appropriate research methods to achieve them. Methods for attaining Optimization and Evaluation phase goals are well-developed. However, methods used in the Preparation phase are often highly researcher-specific, and concrete ways to achieve Preparation phase goals are a priority area for further development.

Results: We propose that the discover, design, build, and test (DDBT) framework provides a theory-driven and methods-rich roadmap for achieving the goals of the Preparation phase of MOST, including specifying the conceptual model, identifying and testing candidate intervention components, and defining the optimization objective. The DDBT framework capitalizes on strategies from the field of human-centered design and implementation science to drive its data collection methods.

Conclusions: MOST and DDBT share many conceptual features, including an explicit focus on implementation determinants, being iterative and flexible, and designing interventions for the greatest public health impact. The proposed synthesized DDBT/MOST approach integrates DDBT into the Preparation phase of MOST thereby providing a framework for rigorous and efficient intervention development research to bolster the success of intervention optimization.

Plain language summary: 1. What is already known about the topic? Optimizing behavioral interventions to balance effectiveness with affordability, scalability, and efficiency requires a significant investment in intervention development.2. What does this paper add? This paper provides a structured approach to integrating human-centered design principles into the Preparation phase of the multiphase optimization strategy (MOST).3. What are the implications for practice, research, or policy? The proposed synthesized model provides a framework for rigorous and efficient intervention development research in the Preparation phase of MOST that will ensure the success of intervention optimization and contribute to improving public health impact of mental health and substance use interventions.