Implementation science communications最新文献

Background: Exercise therapy and education are recommended first-line treatments for knee osteoarthritis (KOA), yet uptake in routine care remains limited globally, including in China, which bears the largest disease burden. Barriers include limited access to allied health services, low awareness of guideline-based care, and poor integration across care sectors. To address these challenges, we developed PEAK-CHN (Physiotherapy Exercise and Physical Activity for Knee Osteoarthritis in China), a multidisciplinary implementation model covering care content, care delivery, and care providers. This study aimed to implement PEAK-CHN in real-world settings and evaluate its feasibility and early implementation outcomes using the RE-AIM framework.

Methods: We conducted a parallel-group, two-arm randomized feasibility trial (n = 73; mean age 66.4 years; 65.8% female). Participants were randomized to receive either PEAK-CHN or usual care. The intervention targeted three components: (1) care providers, a multidisciplinary team trained through workshops and online modules; (2) care content, including five structured telehealth consultations, personalized home-based strengthening exercise, tailored education, daily behavior-change messaging, and comorbidity management; and (3) care delivery within a policy-supported primary care setting using a hybrid model. Usual care was documented via the local health insurance system. Primary outcomes assessed feasibility (recruitment, adherence, engagement, staff workload, and preliminary costing). Secondary outcomes assessed clinical, psychological, and behavioral changes at baseline, 3, and 6 months. Semi-structured interviews (n = 11) explored participant experiences.

Results: Recruitment was completed within four weeks with a 63% enrollment rate. Retention at 6 months was 97%. All intervention participants completed all five telehealth consultations, and 90% achieved the prescribed exercise dose of at least three sessions per week. Delivery was feasible within routine workflows, with consultations averaging 30 min and no intervention-related adverse events. Participant satisfaction was high (mean 8.8/10), and most rated key components as helpful. Exploratory analyses suggested potential improvements in pain, function, and self-efficacy compared with usual care.

Conclusions: PEAK-CHN was feasible and acceptable in a policy-supported primary care setting in China and can be delivered using existing workforce and digital infrastructure. Findings inform the design of a future full-scale trial and broader implementation evaluation.

Trial registration: Chinese Clinical Trial Registry, https://www.chictr.org.cn/, ChiCTR2400091007, registered on 18/1/2024.

Background: Integrated behavioral health (IBH) is an evidence-based approach to addressing mental health in primary care settings. It typically involves augmenting a primary care team with a behavioral health professional (e.g., psychologist, licensed clinical social worker) who sees patients for brief, focused concerns; can function as a bridge to specialty care; and provides medical providers with support and education about patient behavioral health concerns. IBH has slowly begun to disseminate across the United States, but practices encounter significant implementation barriers. How IBH is implemented has not been systematically studied outside of trials, yet this study could provide a rich foundation for selecting and optimizing implementation strategies that can increase the speed of IBH scale-up.

Methods: Using rapid ethnographic assessment (REA), we conducted site visits, interviews, and surveys at a stratified sample of five primary care clinics in three different healthcare systems in two Midwestern states. We coded the data in a primarily deductive analysis approach using Stephens' IBH Cross-Model Framework (CMF) to characterize the IBH intervention; the Practical, Robust Implementation and Sustainability Model (PRISM) to characterize implementation barriers and facilitators; and the Expert Recommendations for Implementing Change (ERIC) taxonomy of implementation strategies. Using a matrixed multiple case study design, we identified implementation strategies that clinics found effective in implementing and sustaining IBH.

Results: Despite geographic variability, the clinics primarily served low-income and-resource populations. A strong pattern emerged regarding common IBH aspects targeted for internal implementation support, associated barriers, and strategies used for them. Successful implementation strategies included accessing additional funding for start-up, creating new clinical teams, revising professional roles, promoting adaptability, facilitating relay of data to clinical providers, and purposely reexamining the implementation process. The Normalization Process Theory (NPT) mechanisms of coherence, cognitive participation, collective action, and reflexive monitoring were all clearly identified in successful implementations.

Discussion: Implementation of IBH is an ongoing process of implementing, maintaining, and improving many specific processes. People with knowledge of the IBH practice model and desire to implement and sustain it are critical, as are policies and programs that support initial and ongoing implementation, and an organizational culture that embraces IBH as its standard of practice.

Background: Implementation strategies are dynamic and multi-faceted, and may require adaptations to fit implementation contexts, especially in lower-and-middle income countries. We report the adaptations for an ongoing late-stage implementation science trial (R01HL147811) that integrates hypertension management into HIV care in Lagos, Nigeria - a country with a high dual-disease burden - through the Task Strengthening Strategy for Hypertension (TASSH) intervention and Practice Facilitation implementation strategy.

Methods: FRAME (Framework for Reporting Adaptations and Modifications-Enhanced) modules were used to record adaptations to the intervention (i.e., TASSH) respectively, enhance participant recruitment and retention rates, and increase frequency of trainings. Data collection sources included (not limited to) patient records, nurses' logs, and minutes of implementation review meetings. Data across these sources was coded retrospectively by trained research staff and triangulated during virtual meeting discussions. Once consensus was reached, data was mapped onto the relevant framework modules using Microsoft Excel.

Results: We modified FRAME to include an additional component on 'what was originally planned' for the context of the adaptations. There were twelve adaptations identified during the implementation of the study. The adaptations characterized by using the frameworks included reordering recruitment start dates of study cohorts, providing patients incentives to attend follow-up visits, adding feeder sites to the study sites, and increasing the frequency of training to account for the high nurse turnover in the primary healthcare centers. Overall, 25% of the adaptations involved expanding the structure of the intervention and implementation strategies, and 33% involved adding new elements to the strategies. All adaptations occurred in the implementation phase of the trial.

Conclusion: Based on our experiences, the characterization of the adaptations using FRAME demonstrates their combined applicability to an ongoing trial that can be tailored to fit the local context.

Trial registration: ClinicalTrials.gov ( NCT04704336). Registered on 11 January 2021.

Background: The Evidence-Based Practice Attitude Scale (EBPAS) is a widely used measurement tool to assess mental health providers' attitudes toward adopting research-based interventions. To date, this scale has not been used or validated in an interdisciplinary sample of mental health professionals in Latin America. This study investigated the factor structure, psychometric properties, cross-cultural validity, and model fit of the EBPAS in a sample of Spanish-speaking and Latino social workers, counselors, and psychologists.

Methods: A culturally and linguistically tailored version of the 15-item EBPAS scale was administered to a sample of Puerto Rican mental health professionals (N = 222) working across various settings, including schools, healthcare clinics, and community organizations. The EBPAS's scores were derived from four distinct constructs involving willingness to adopt EBPs (i.e., requirements, openness to innovation, appeal, and divergence from research). A Confirmatory Factor Analysis (CFA) examined the psychometric properties of the EBPAS scale. Several first and second-order factor models were specified. A global and approximate fit examination of the measurement model and composite reliability estimation for each subscale was conducted. RStudio version 4.3.1 software was used for the CFA.

Results: The CFA supported a first-order factor model. Most subscales showed strong reliability coefficients ranging from 0.83 to 0.91, except for the divergence subscale, which showed a coefficient of 0.77. After allowing for covariance between two items in the appeal dimension, the correlated factor model demonstrated a satisfactory fit to the data, although some misspecification was observed.

Conclusions: The tailored EBPAS-15 demonstrated adequate psychometric properties in this Latinx sample of mental health professionals, suggesting that its factor structure and reliability may be useful in a Spanish-speaking and Caribbean sample of mental health professionals working across a variety of settings and contexts. Findings contribute to the scant literature on culturally and linguistically validated measures examining attitudes toward EBPs in Latin America.

Background: To promote high-quality behavioral health service delivery, federal agencies often invest in evidence-informed and evidence-based practice (EBP) implementation through discretionary (i.e., competitive) grants. However, gaps remain in understanding how federal grant mechanisms can lead to large-scale reach (i.e., the extent of EBP integration into service systems). To understand EBP reach through federal grant mechanisms and provide actionable data, we conducted a series of focus groups with relevant federal and state policy actors to gather their perspectives on how to improve federal grants to support EBP implementation.

Methods: This study was informed by ongoing research examining implementation outcomes (i.e., provider-level reach) from federal grants supporting the delivery of the Adolescent Community Reinforcement Approach (A-CRA), an EBP to address youth substance use. We conducted four focus groups, two with staff from state agencies who received federal A-CRA grants (n = 12) and two with U.S. federal agency officials responsible for behavioral health grant making (n = 12). We used the policy-adapted EPIS (Exploration, Preparation, Implementation, Sustainment) framework, conceptualizing grants as bridging factors between the outer policy context and inner service provision context. We used directed content analysis to characterize participant perspectives on contextual influences of EBP reach, and thematic analyses to identify how to improve federal grants for EBP implementation success (e.g., high levels of reach). We codified themes by EPIS domains and phases, and by policy actors.

Results: We identified three contextual influences in Bridging Factors, six in the Inner Contexts, nine in the Outer Contexts, and three in Innovation characteristics. We found seven themes about grant improvements spanning all EPIS phases; examples include strengthening collaboration between multilevel actors in the implementation process (specifically federal and state agencies and treatment organizations), and integrating EBPs into insurance billing practices (which also included insurance leadership as a key actor group).

Conclusions: To support large-scale EBP reach, federal funders may consider using implementation strategies that foster greater collaboration between policy actors from multiple sectors and organization levels. This work also demonstrates how implementation science frameworks can be used to study the influence of federal financing initiatives for EBPs in the area of youth behavioral health.

Introduction: Despite high coverage of facility-based maternal and child health (MCH) services in Mozambique, preventable maternal and neonatal deaths remain among the highest globally. To address this, the Integrated District Evidence-to-Action (IDEAs) program was implemented from 2016 to 2020 in central Mozambique as a facility-level Audit and Feedback (A&F) strategy. IDEAs adapted traditional A&F into three components: 1) biannual facility readiness assessments, 2) A&F meetings to develop action plans, and 3) supportive supervision with funding for implementation. This study estimates total and component-specific implementation costs of IDEAs and compares them to average district health budgets.

Methods: Costs were estimated from a payer perspective following CHEERS guidelines, using both Gross and Microcosting methods. Costs were annualized over five years (2016-2020) with a 3% discount rate and are reported in 2020 USD. Staff time estimates were based on program staff consultations and national salary data. Outcomes include average cost per district and total annual cost by intervention component. We conducted a deterministic sensitivity analysis to identify cost drivers with the most significant impact on the overall cost.

Results: The IDEAs programs total (2016-2020) incurred total costs were $2,224,341 (2020 USD), with $1,702,648 (76.5%) for recurrent expenses and $495,323 (22.3%) for Capital expenses. Average annual district-level costs were $41,967, including A&F meetings ($10,893; 26.0%), Capital expenditures ($8,255; 19.7%), targeted support ($9,323; 22.2%) which includes $5,700 (13.6%) for district-level cash transfers and $3,623 (8.6%) for facility supervision, and readiness assessments ($6,351; 15.1%).Per diems accounted for 52.0% of A&F meeting costs. IDEAs represented approximately 6.6% of the average district health budget. Implementation involved 33 participants with 2,560 h yearly per district. Capital expenses were highly sensitive to when applying a standard 25% increase or decrease compared to other cost categories.

Conclusion: Our findings offer practical guidance for district-level planners to adapt and scale IDEAs. Policymakers and donors should integrate recurring costs into budgets and explore cost-saving strategies like virtual tools or streamlined meetings to improve sustainability. Future research must assess long-term integration into government programs and test alternative approaches across diverse low-resource settings to guide scaling.

Background: The implementation of digital health technologies (DHTs) is a strategic priority for many health systems, yet integrating them into routine clinical use remains challenging. While numerous studies explore DHT adoption, few provide a comprehensive perspective across technologies and stakeholder groups. This review synthesises the most prevalent barriers and facilitators to DHT implementation in high-income healthcare settings.

Methods: A scoping review was conducted following Joanna Briggs Institute and PRISMA-ScR guidelines. Publications from 2019 to 2024 reporting barriers or facilitators to DHT implementation in upper-middle and high-income countries were identified through systematic searches in PubMed and Scopus. An inductive approach guided iterative coding and thematic categorisation. Findings were synthesised based on frequency, overlap, and variation across technologies and stakeholder groups.

Results: From 15,327 unique records screened, 238 publications were included. In total, 2538 barriers and 1433 facilitators were identified, grouped into three overarching dimensions: human and social dynamics, organisational structure and management, and infrastructure and data security. Human and social factors such as resistance to change, scepticism, and limited digital literacy were the most frequently reported across the majority of technologies and stakeholder groups. Organisational barriers, including funding constraints, workflow misalignment, and limited leadership engagement, along with infrastructure-related challenges such as poor usability, data privacy concerns, and interoperability issues, were also substantial but were comparatively less frequent. Patterns varied by technology type (e.g., telehealth, mobile health apps, AI tools) and stakeholder group (e.g., healthcare professionals, health system managers, users of health services), highlighting the complex, context-dependent nature of DHT implementation.

Conclusions: Successful DHT implementation demands more than technical readiness. It requires organisational leadership, robust infrastructure, and system-wide alignment. While human and social dynamics remain central, leadership, resource allocation, and robust infrastructures are equally critical. Current evidence often underemphasises structural barriers such as governance gaps, misaligned incentives, and technical limitations. Sustainable digital transformation requires a balanced approach combining top-down strategic guidance for regulatory clarity with bottom-up engagement to foster cultural change. Future research should operationalise governance strategies, leadership practices, and monitoring indicators that support long-term digital health integration.

Registration: A prospective protocol was uploaded to the Open Science Framework: https://osf.io/vr7d9/ (https://doi.org/10.17605/OSF.IO/VR7D9).

Background: Tailoring implementation of an evidence-based intervention based on context is well established in implementation science. However, questions remain about tailoring implementation support via an external practice facilitator (henceforth facilitator) and methods and mechanisms of facilitator-driven tailoring. Therefore, this study examines how facilitators supported clinics in a large pragmatic study to identify contextual factors that influenced the selection and application of implementation strategies.

Methods: We conducted a descriptive qualitative study of facilitator tailoring in a 15-month implementation study to support primary care clinics in increasing screening, brief intervention and referral to treatment (SBIRT), and medication assisted treatment (MAUD) for unhealthy alcohol use. Data included bi-annual interviews and monthly periodic reflections with study-funded facilitators. A framework analysis, informed by the ERIC taxonomy and i-PARIHS, was conducted to categorize and map strategies across diverse examples of clinic factors to identify key techniques of tailoring.

Results: Nine facilitators who provided practice support during implementation participated in 20 interviews and 16 periodic reflections. Practice facilitators tailored their implementation support to clinics through four key domains: 1) facilitation structure and process support; 2) technical support for clinical processes; 3) assessing and monitoring support needs over time; and 4) evidence-based intervention and quality improvement skill building support. Though facilitators used common and well-established ERIC implementation strategies in their work with clinics, the techniques used to apply those strategies varied based on clinic factors across multiple levels of context. Tailoring support was found to be both proactive and reactive. According to facilitators, utilizing a tailored approach to implementation benefited clinics by reducing the burden of administrative processes related to facilitation and implementation, improving clinic study enrollment and engagement amidst challenges or disruptions, and increasing engagement in SBIRT and MAUD activities.

Conclusion: Our study found that facilitators tailored their support to clinics via their deployment of implementation strategies according to clinic factors in four key domains. Facilitators described tailoring efforts as important for increasing clinic engagement in quality improvement efforts. Future studies should focus on assessing the effectiveness of specific tailoring techniques on performance outcomes.

Background: Sepsis remains a leading cause of mortality despite increased adherence to clinical guidelines. Personalized immunotherapy, tailored to individual immune profiles, holds promise as an adjunctive treatment. Understanding of barriers influencing decision-making is essential for developing appropriate implementation strategies to promote the uptake of personalized immunotherapy into routine practice. Identifying barriers early, before personalized immunotherapy is included in clinical guidelines, can help accelerate its implementation in the future. This study aims to prioritize these barriers.

Methods: A cross-sectional survey was conducted among healthcare professionals involved in the care of patients with infectious diseases. Using maximum difference scaling, 29 barriers were ranked according to their perceived relevance. The mean relative importance score of each barrier was calculated using hierarchical Bayes estimation for the total sample, as well as separately for groups with low versus high levels of experience with immunotherapy for patients with infectious diseases. These scores were used to rank barriers, with higher scores indicating higher relative importance.

Results: A total of 174 healthcare professionals completed the survey. The most relevant barriers identified were lack of protocols and insufficient scientific evidence. Regarding the remaining barriers, healthcare professionals with less immunotherapy experience prioritized individual-level barriers, such as insufficient domain knowledge, while those with more experience prioritized organizational-level barriers, such as insufficient priority from hospital management. Barriers related to team processes and patient outcome expectations were ranked low by both groups.

Conclusions: This study highlights the need for a multifaceted implementation strategy to effectively introduce personalized immunotherapy for sepsis patients. Strategies should be tailored to varying levels of immunotherapy experience of healthcare professionals.