Implementation science communications最新文献

Background: Schools have the potential to promote equitable health from early life onwards yet require sufficient organizational capacity to achieve sustained action. Structured improvement approaches, such as PDSA cycles, may help strengthen this capacity by guiding systematic implementation processes. However, their potential in school health promotion remains insufficiently understood, particularly regarding the heterogeneous contextual factors shaping their application. This study examined which contextual determinants shape schools' perceived implementability of the PDSA cycle for health promotion and how these conditions differ across schools.

Methods: Nine German primary schools participating in a holistic health promotion program were purposively sampled to capture heterogeneity across federal states, socioeconomic contexts, and urban-rural settings. Semi-structured qualitative group interviews in a workshop format were conducted with school principals, teachers, and parents and analyzed using the framework method guided by the CFIR. To facilitate cross-case comparison, color-coded valence ratings (facilitator/barrier/mixed) were visualized in a Matrix Heat Map, enabling identification of contextual tendencies.

Results: Fifteen contextual factors emerged across the CFIR domains of Outer Setting, Inner Setting, and Individual. Schools with prior experience using structured processes similar to PDSA cycles reported more facilitators, such as established communication structures, while schools without such experience perceived more barriers, notably financial constraints. Common barriers across schools included limited parental engagement and staff shortages, whereas leadership support and compatibility of program components were consistent facilitators. Some factors interacted dynamically, with resource constraints reinforcing other barriers or with strong mission alignment amplifying engagement.

Conclusion: Schools' prior structured experience seemed to be associated with how they perceived the implementability of PDSA cycles for health promotion implementation, with more experienced schools anticipating more facilitators and fewer barriers. While causality cannot be inferred, these exploratory findings are hypothesis-generating and suggest that prior structured experience may be an important factor to consider for tailoring implementation support and building organizational capacity. Beyond these insights, extending the framework method with a color-coded Matrix Heat Map proved valuable for visualizing contextual heterogeneity and revealing tendencies across cases. This combined approach may inspire further research on how contextual configurations shape the use of structured processes in complex, multi-site implementation settings.

Background: Nearly 300 US municipalities have enacted policies regulating cigar pack size and price to reduce youth access to and use of inexpensive cigars. This study characterizes the policy implementation processes of these local policies and identifies associated barriers and facilitators.

Methods: Between June and November 2023, we conducted 36 semi-structured qualitative interviews with professionals involved in adopting and implementing local cigar regulations. Interview transcripts were coded and thematically analyzed using a template organizing style and iterative immersion-crystallization analysis of coded segments. Themes were categorized using the Inventory of Factors Assessing Successful Implementation and Sustainment determinant framework, encompassing domains such as external factors, internal organizational factors, retailer-specific factors, and policy-specific factors.

Results: Participants described distinct education and enforcement activities post-policy adoption, often managed by separate, autonomous organizations and individuals. Key facilitators identified included state funding (external), interagency collaborations and unofficial capacity-building efforts (internal), and clear, enforceable ordinances with less retailer pushback (policy-specific). Conversely, significant barriers included state-level influences (external), lack of standardized protocols, resource disparities, and varied implementer perspectives (internal). Retailer-specific barriers included limited English proficiency and a willingness to risk violations. Policy-specific challenges involved confusing cigar definitions and insufficient deterrent penalties.

Conclusions: Local cigar policy implementation often involves multiple autonomous organizations and individual implementers. The salience of identified barriers across various contexts may have important implications for policy impact. Understanding the facilitators and barriers to policy implementation may enable other localities to proactively develop strategies to increase success.

Background: Current standards advise starting HIV antiretroviral therapy (ART) as soon as possible with the goal of achieving viral suppression. Applying the domains of a sustainability framework as a roadmap, we examine factors and strategies impacting readiness to sustain Rapid Start ART (RS-ART) across 14 sites participating in a national initiative that successfully implemented this intervention to link people with HIV to initiate ART treatment within seven days after linkage or re-engagement in care. While sustainability entails the ongoing delivery of a previously implemented intervention, factors and strategies for sustaining RS-ART have not been well-defined or studied.

Methods: We conducted one-on-one semi-structured interviews with a purposeful sample of key informants from each of the 14 sites. Data were organized using Dedoose and analyzed using thematic analysis.

Results: We conducted a total of 27 interviews with decision-makers and key staff implementing RS-ART. We identified a continuum across the sites, reflecting three different stages of readiness to sustain RS-ART. "Well-oiled machine" sites had comprehensive sustainability plans in place with RS-ART established as their current standard practice, supported by secured funding and organizational capacity. "On track" sites demonstrated a clear vision toward sustaining RS-ART, with progress contingent on securing funding and finalizing staffing plans. "To be determined" sites faced challenges, expressing uncertainty about obtaining necessary funding and determining sufficient human resources to sustain RS-ART. While feasibility and acceptability of RS-ART, driven by improved service and patient outcomes, were high across all sites, available funding and the necessary human resources were the two critical, interrelated factors impacting readiness to sustain RS-ART.

Conclusions: Sites positioned to sustain RS-ART were able to secure funding for the necessary staff positions to effectively integrate it as standard of care. Future funding of HIV care programs must provide sufficient resources for all individuals to be offered RS-ART services to improve life expectancy, manage HIV as a chronic disease and prevent transmission to others. Given the dynamic nature of sustainability, future longitudinal studies are needed to evaluate RS-ART sustainability outcomes and its long-term effectiveness after it has been sustained.

Background: Evidence-based quality improvement (QI) interventions and strategies often require adaptation before implementation in new settings. The goal of this study was to describe the adaptation process of QI strategies from an evidence-based cardiovascular initiative, previously tested in community-based primary care clinics, for use in worksite health centers (WHC). Participating WHCs were located at large manufacturing plants. The adapted QI strategies were offered as part of the Healthy Hearts in Manufacturing initiative.

Methods: Our team followed the ADAPT-ITT framework to adapt the QI strategies for twelve randomly selected WHCs. Meetings were held with WHC leaders, and semi-structured interviews were conducted with WHC clinicians and staff to understand current workflows and identify contextual factors that could help or hinder the implementation of the QI strategies. Data were analyzed using qualitative content analysis. Adaptations were then identified and developed by clinical experts and a practice facilitator, with input from an Advisory Panel. Proposed adaptations were shared with WHC leaders and clinicians for feedback before implementation protocols were finalized.

Results: Phase 1 (Assessment) showed that manufacturing communities had high rates of heart disease and its risk factors. Four QI interventions from the Million Hearts campaign were selected for implementation using evidence-based QI strategies during Phase 2 (Decision). Phase 3 (Administration) revealed helpful implementation factors, including strong patient-clinician relationships and leadership support, as well as hindering factors, including deficiencies of electronic health records systems, high staff turnover, and poor patient adherence to treatment. These factors informed the Phase 4 (Production) development of implementation materials, for example, tailored blood pressure measurement protocols and patient educational tools. During Phase 5 (Topical experts), clinicians and WHC leaders provided feedback on the adaptations, which were then integrated in Phase 6 (Integration) into a flexible implementation protocol for the practice facilitator. The final phase (Testing) is ongoing.

Conclusion: This study describes the adaptation process of a primary care cardiovascular QI initiative to meet the unique clinical settings of WHCs. The findings suggest that with contextual adaptation of QI strategies, WHCs have the potential to implement evidence-based interventions to improve cardiovascular care, providing insights for future initiatives in non-traditional clinical care settings.

Background: Despite growing global efforts to evaluate the impact of research, there remains a lack of practical, standardised tools to assess implementation in the real-world.

Aim: This study introduces a comprehensive implementation taxonomy for use in impact evaluations based on onto-terminology principles.

Methods: This work is part of the Global Impact Analytics Framework (GIAF) program. An international expert panel of 32 members developed the taxonomy using nominal group techniques and an iterative refinement process. The design was informed by the Technology Readiness Levels for Implementation Sciences (TRL-IS) to ensure its relevance and application across the life cycle of implementation. Case studies have been conducted in ten countries and the knowledge gained from practical experiences has been incorporated into the taxonomy.

Results: The GIAF taxonomy outlines 82 subdomains organised across 15 domains and three sequential implementation phases. The Initiation phase captures early preparatory steps before real-world use, including planning, engagement, and pre-readiness. The Maturity phase focuses on early implementation and real-world demonstration studies, covering the initiative's readiness (from demonstration to release), dissemination, usability, adoption, and uptake. The Evolution phase refers to later-stage activities once the intervention or tool is fully implemented, with domains encompassing sustainability, diffusion, prolongation, expansion, diversification, exporting, and de-implementation. The taxonomy is supported by tools including a glossary and practical checklists to guide consistent application.

Conclusions: The GIAF taxonomy offers a structured, detailed, and flexible toolkit for evaluating implementation processes using mixed methods and across diverse projects and settings. It supports both quantitative scoring and qualitative insight to inform cross-context comparison and learning. By clearly defining and measuring these processes, it enhances the rigour, replicability, and comparability of implementation research and practice. The taxonomy also supports comparative effectiveness analyses of implementation strategies. This comprehensive approach addresses a critical gap in the implementation science field, contributing to stronger evidence-based practices, health and social care programs, and research globally. The GIAF toolkit provides researchers, evaluators, and other decision-makers with a practical resource for assessing implementation impact. It can also support planning processes and, through learnings from assessment results, help improve future implementation efforts.

Introduction: The Implementation of Infant Pain Practice Change (ImPaC) Resource is a 7-step, multifaceted, web-based implementation strategy to improve pain assessment and treatment in Neonatal Intensive Care Units (NICUs). We explored facilitators and barriers to implementing ImPaC and their relationship to implementation outcomes.

Method: A hybrid type 1 effectiveness-implementation study was conducted using a cluster randomized controlled trial (reported elsewhere) and a mixed-method exploratory study design. Level 2 and 3 Canadian NICUs with >15 beds were invited to participate and were randomized to intervention (INT, n=12) or usual care (UC, n=11) groups. INT NICUs recruited a change team who accessed ImPaC for 6 months; UC NICUs were waitlisted for 6 months and then offered ImPaC. Focus groups were conducted with all change teams following ImPaC completion. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and analyses. Professionally transcribed interview data were coded and analysed using directed content analysis. Valence (+/-) and strength (-2, -1, 0, +1, +2) were assigned for each CFIR construct/subconstruct. Inductive codes were identified. Relationships between CFIR constructs/subconstructs and ImPaC implementation outcomes (feasibility and fidelity) were determined.

Results: 83 NICU change team members (median 4/site) participated in focus groups; 1,105 discrete codes relating to 31 CFIR constructs/subconstructs were identified. The most frequent facilitator constructs were Design Quality and Packaging, Compatibility, Available Resources, Champions, Implementation Climate, and Engaging Key Stakeholders. Complexity and Reflecting and Evaluating were salient in 21 transcripts, and Patient Needs and Resources was identified in 20 NICUs. Available Resources and Relative Priority were barriers. A positive association existed between the feasibility of implementing ImPaC and Engaging Key Stakeholders (0.46, p=0.041), Champions (0.82, p=0.001), Relative Priority (0.75, p=0.001) and Networks and Communication (0.60, p=0.023). There was a positive relationship between Engaging Key Stakeholders (0.42, p=0.048), Relative Priority (0.85, p=0.002), Patient Needs and Resources (0.46, p=0.049) and Fidelity.

Conclusion: Site-specific tailoring to enhance facilitators (e.g., champions, implementation climate) and mitigate local barriers (e.g., resources, relative priority) will provide a viable influence on optimizing implementation outcomes.

Background: Despite the high incidence of cervical cancer and availability of cervical cancer screening (CCS) services in different healthcare settings in Kenya, uptake remains low. The primary aim of this mixed-methods study was to examine individual client-level and clinic-level factors associated with the uptake of CCS in family planning (FP) clinics in Mombasa County, Kenya.

Methods: This study was a convergent, mixed-methods analysis nested within a randomized controlled trial testing the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), for increasing CCS in FP clinics in Mombasa, Kenya. This analysis included the 10 FP clinics randomized to the SAIA intervention. Individual client-level data were abstracted from FP registers. Clinic-level variables were obtained from a baseline in-depth survey. Face-to-face in-depth interviews with clinic managers and staff in the intervention clinics were conducted. Log-binomial regression using a generalized linear mixed-effects model to adjust for clustering by FP clinic was used to estimate adjusted prevalence ratios (aPRs) for the association between individual client-level characteristics and CCS. A Fisher's exact test was used to examine associations between each clinic-level characteristic and CCS. Qualitative data were analyzed using content analysis to identify recurring themes and high-level concepts.

Results: At the individual client-level, use of long-acting reversible contraception was associated with an increased likelihood of CCS. Cervical cancer screening was provided at 7.9% (10/127) of visits by women on long-acting reversible contraceptives compared to 3.8% (29/756) of visits by women on short-acting contraceptives (PR 2.05, 95% CI 0.97 - 3.95; aPR 2.16, 95% CI 1.09 - 4.28). Providers indicated that they were more likely to offer CCS to women receiving intrauterine contraceptive devices (IUCDs). Qualitative interviews identified barriers, including clients' fear and negative perceptions about CCS. At the facility level, adequate staff training and availability of supplies and equipment were crucial facilitators for CCS.

Conclusion: The findings emphasize the need to address barriers at multiple levels to improve uptake of CCS. Additionally, these results highlight actionable strategies, such as healthcare provider training, that can be adopted to enhance the provision of CCS services to women attending FP clinics.

Background: Antenatal and postnatal Group Care, based on the Centering Healthcare model, relies on three core components: health assessment, interactive learning and community building. The health assessment consists of self-assessments conducted by the participants and one-to-one medical check-ups conducted by the healthcare provider. Research shows that this component can be challenging within existing health care systems. This study aimed to investigate the modifications and corresponding strategies applied to adopt the health assessment during Group Care implementation.

Methods: A qualitative descriptive study explored modifications to the health assessment and the corresponding strategies in 24 Group Care implementation sites in seven countries. A structured qualitative survey was conducted based on the Expanded Framework for Adaptations and Modifications to Evidence-Based Interventions including views of different stakeholders (site-level and project-level implementers). This provided data on the 'who', 'what', and 'where' of modifications and corresponding strategies. Reflexive thematic analysis provided both structured and in-depth insights into the adaptation process.

Results: Three cross-country strategies were identified: (1) creative solutions to find appropriate spaces for Group Care to accommodate the health assessment, (2) providing assistance with self-assessment, (3) and extending the duration of one-to-one medical check-ups. These strategies were primarily the result of joint decisions made by the implementation team, influenced by multiple context-related factors. Different perspectives emerged regarding for whom these strategies were applied, with some stating it as being for the benefit of the participants, while others aimed to align with facilitators' preferences and familiarity with providing routine care.

Conclusions: The role of differing perspectives in the adaptation process when implementing Group Care and the challenge for facilitators to align their attitudes, beliefs and skills toward the Group Care model within an individually focused healthcare system, emerged as underlying factors to fully adopt the health assessment. Furthermore, our study demonstrates that, despite the locally context-driven nature of modifications in implementation, it remains valuable to examine them within a cross-country design to identify transferable insights that inform future implementation efforts and implementation science.