Implementation science communications最新文献

Background: Few economic evaluations distinguish between the cost and impact of evidence-based interventions and the strategies used to improve their implementation. This distinction is essential for understanding whether a strategy is cost-effective, why it works, and the resources required to replicate its success. The Systems Analysis and Improvement Approach Hypertension (SAIA-HTN) trial evaluated an implementation strategy ("SAIA") designed to improve hypertension care among people living with HIV (PLHIV) in Mozambique. We developed a mathematical model to estimate the cost-effectiveness of both the evidence-based intervention (including hypertension screening, pharmacological treatment and follow up, and lifestyle modifications such as diet and exercise) and the SAIA implementation strategy.

Methods: We constructed a decision-analytic, state-transition model that simulated cardiovascular risk, outcomes, and associated costs for PLHIV receiving hypertension care in Mozambique using a health systems perspective. Model inputs came from published epidemiological studies and primary data from the SAIA-HTN trial on intervention and implementation strategy effectiveness and costs. We estimated the incremental cost-effectiveness (willingness to pay $647/DALY averted, GDP per capita in Mozambique) of rolling out both components, compared to a "status quo" scenario where screening and treatment of hypertension remained at their current (very low) levels. Costs were reported in 2023 US dollars, and costs and outcomes were discounted at 3% over a ten-year time horizon.

Results: Scaling up screening and pharmacological treatment of hypertension in Mozambique would have an incremental cost-effectiveness ratio (ICER) of around $212 per disability-adjusted life year (DALY) averted and cost an additional $4.61 per person per year. Incremental to the intervention, the SAIA implementation strategy would have an ICER of $44 per DALY averted and cost an additional $0.79 per person per year. The average reduction in ten-year cardiovascular risk would be 29.3% for the intervention and 40.3% if the SAIA implementation strategy were co-introduced.

Conclusions: Our model is a tool for implementation scientists, policymakers, and researchers aiming to assess cardiovascular interventions and associated implementation strategies among PLHIV. Its application to SAIA-HTN suggests that this is a cost-effective strategy for improving hypertension care, but only in the presence of adequate blood pressure equipment, training, and medications. Our study shows how implementation strategies require a minimum threshold of health system readiness to generate meaningful health impact.

Trial registration: ClinicalTrials.gov (NCT04088656).

Background: Healthcare-associated infections (HAIs) are a threat to public health, however, infection prevention and control (IPC) interventions have been shown to prevent a substantial portion of HAIs. Due to the interrelatedness of IPC intervention components, multifaceted implementation strategies, and contextual factors, IPC implementation is intricate. Organizational readiness for change (ORC) has been labelled as critical to ensure successful implementation, yet it is unclear under which conditions this is the case. We aim to examine if ORC is a necessary and/or sufficient condition for IPC implementation in REVERSE, a study aimed at decreasing multidrug-resistant HAIs in Europe.

Methods: We conducted a crisp-set Coincidence Analysis on data from the 24 hospitals enrolled in REVERSE to examine necessary and sufficient conditions for IPC implementation. We collected quantitative data on change complexity, implementation leadership, ORC, and sustainability. Implementation strategies used, as well as both theory-based outcomes of initiation and cooperative behavior, were assessed qualitatively. Models were selected based on theoretical grounds, fit indices, and case knowledge.

Results: Twelve hospitals (50%) had high IPC implementation initiation. We found two alternative pathways explaining this outcome. When hospitals implemented highly complex IPC practices, they needed high ORC levels to initiate change. When complexity was low, ORC did not shape initiation, but sites rather had to show clearly matched implementation barriers and strategies to initiate IPC. Results for cooperative behavior were inconclusive.

Conclusions: Using a novel cross-case configurational approach, we uncovered the role of ORC for IPC implementation. We found that ORC is of importance under the condition of highly complex change. When change complexity is low, solidifying ORC is dispensable, and efforts should instead be directed towards a thoughtful and targeted selection of implementation strategies based on identified barriers. These findings have implications for implementers and decision-makers, who may allocate resources based on whether IPC implementation is anticipated to be of high complexity or not, to ensure proper IPC implementation to address HAIs.

Trial registration: REVERSE was registered with the "International Standard Randomised Controlled Trial Number" (ISRCTN) register under Nr. 12956554 on 11.11.2021, https://www.isrctn.com/ISRCTN12956554.

Background: Formal compilations of implementation strategies like the Expert Recommendations for Implementing Change (ERIC; 1) are relevant for planning and evaluating implementation initiatives. The relationship between these strategies and the particulars of a specific initiative is not always clear, particularly when implementation occurs outside of organized healthcare settings. The present study reports on the process used to develop an adapted glossary of ERIC strategies for implementing evidence-based health promotion programs in African American churches.

Methods: A glossary adaptation team composed of academics and community representatives met twice a month for six months to adapt implementation strategy definitions to fit the context of the present project. Collaborative discussions were held until consensus was reached for each strategy. This project-adapted glossary was then subjected to coding to document the types of changes that occurred during the adaptation process.

Results: The glossary adaptation team collectively dedicated 99.5 person-hours to the meetings to obtain consensus for the strategies. The final strategy glossary retained 64 strategies relevant to the project, with 84.4% of strategies involving some level of adaptation. Most of the adaptation involved specifying project-specific actors, specifying that the innovation involved evidence-based health promotion programs, and noting the role the project's technical assistance team serves in supporting congregations during implementation.

Conclusions: Adapting implementation strategy definitions to a specific project is a time-intensive process that challenges a team to carefully and creatively consider how strategies may be enacted in a specific context (e.g., faith-based communities). The consensus-based process also served as a type of cultural exchange between the project's academic partners, community partners, and consultants. The development of a project-specific glossary leverages the ability of project team members to employ implementation strategies as part of project planning and evaluation.

Background: Implementation strategies that are contextually refined are essential for optimizing the delivery of evidence-based interventions (EBI) to prevent cervical cancer in low-resource settings. This paper reports the application of the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture and disseminate strategy adaptations made to a single-visit, screen-and-treat approach with thermal ablation (SV-SAT + TA) strategy aimed at establishing sustainable cervical cancer prevention services in Kenya.

Methods: A FRAME-IS-based tracking spreadsheet was developed to document bundled site-specific implementation strategy adaptations and across 10 facilities. Data was collected during technical assistants' (TAs) site visits, phone calls, and monthly meetings with health providers between March 2023 and September 2024. Sources of adaptation included tracking spreadsheets, TAs narrative reports, and field notes from direct observations during the implementation phase. Descriptive statistics summarized site characteristics and adaptation trends. The exact Poisson test compared adaptation rates by facility level (medium vs large) and period (early vs late).

Results: A total of 28 adaptations were identified. Most adaptations (70%, n = 20) occurred in the early phase. Over half were planned (57%, n = 16). We made modifications to module two (What was modified). Educational adaptations were most common (57%, n = 16), primarily targeting providers delivering screening and treatment services. Resources-related adaptations accounted for 21% (n = 6). Additionally, 43% (n = 12) of the adaptations aimed to increase adoption by expanding the number of clinicians offering the SV-SAT + TA. Nearly half (46%, n = 13) targeted the organization level. Over six months, larger facilities had 2.67 adaptations per facility, compared to 2.85 in medium level facilities (rate ratio = 0.93 (95% CI = 0.39-2.08, p = 0.89), indicating no statistically significant difference in adaptation rates by facility levels. However, adaptation rates significantly declined, from 2.0 per facility in the early phase to 0.80 in the late phase (rate ratio = 2.50, 95% CI: 1.12-6.02, p = 0.02), suggesting a reduction in adaptations over time.

Conclusion: Education and resource-related adaptations were critical to improving SV-SAT + TA implementation. Future research should focus on evaluating the impact of these adaptations on implementation and clinical outcomes, refining the FRAME-IS framework, and supporting the establishment of an adaptome to guide scalable strategies in similar settings.

Trial registration: NCT05472311.

Background: In recent years, implementation research has gained a renewed attention in the Netherlands. However, limited national funding for implementation research has mainly resulted in case- and context-specific descriptive data. To help prioritize research that holds high scientific value and practical relevance, this study aimed to identify gaps in both implementation science and implementation practice.

Methods: A two-stage study was conducted combining multiple methods to collect data from implementation researchers working in the healthcare sector in the Netherlands. A two-round e-Delphi study was employed to identify research priorities amongst implementation researchers. In addition, a survey was conducted with practitioners to identify implementation knowledge gaps and needs in implementation practice.

Results: Twenty-six (55%) of the 47 invited researchers participated in Round 1 of the e-Delphi, leading to the identification of 31 research topics categorized into 7 themes. In Round 2, 22 of the 26 researchers (85%) completed the process, reaching consensus on 12 topics. These topics were grouped into six themes and linked to four areas of research: implementation, sustainability, scale-up, and de-implementation. The themes include: (1) understanding determinants, (2) matching strategies to determinants, (3) implementation strategies, (4) measuring implementation outcomes, (5) theories, models and frameworks, and (6) research designs. The survey of 74 practitioners revealed 230 implementation knowledge gaps, which were then triangulated with the e-Delphi results, highlighting specific research topics that emphasize implementation capacity and the need for pragmatic tools to enhance evidence-based implementation in practice.

Conclusions: By integrating insights from both implementation researchers and practitioners, the research agenda addresses topics that are relevant to both fields. Recommendations were made to advance the scientific field and improve implementation practice. This research agenda can guide research coordination and policymaking, aiming to consolidate research efforts in the Netherlands.

Background: Mental health issues in children, particularly anxiety, are a major global concern, with the prevalence of these disorders in Czechia mirroring global trends. While parent-led cognitive-behavioral therapy (CBT) has shown promise in addressing anxiety with benefits like reduced therapist involvement, cost-effectiveness, and long-term sustainability, such programs are scarce in Czechia.

Methods: This study aimed to adapt a Parent-led CBT program from the University of Oxford for the Czech context using complementary frameworks and guides for the process of adaptation to ensure its feasibility, acceptability, and sustainability. Using mixed-methods methodology, we adapted and piloted a parent-led CBT intervention for children with anxiety in Czechia. Adaptations were guided by ADAPT, ToC, CFIR, and TIDieR frameworks to ensure relevant local adaptations. A formative phase included three workshops and 50 semi-structured interviews with key stakeholders to identify barriers, facilitators, and implementation context and needs. Feasibility piloting involved 12 parents, with quantitative outcomes collected via standardized measures and qualitative feedback from interviews and a focus group discussion (FGD) thematically analyzed to inform further implementation adaptations.

Results: The adapted intervention is described having been piloted with Czech parents, yielding promising results: significant reductions in child anxiety, high attendance rates, and positive feedback. This study demonstrated the feasibility and acceptability of the adapted parent-led CBT program for children with anxieties in Czechia.

Conclusions: Guided by ToC and CFIR, adaptations balanced the evidence-based original intervention with culturally and contextually important adaptations to increase future implementation success. Further research should assess effectiveness and implementation fidelity to inform sustainable uptake and integration in the Czech mental health system.

Background: Recently expanded WHO guidelines on differentiated service delivery (DSD) include expanded eligibility for adolescents and youth living with HIV (AYLHIV). We evaluated implementation of a stepped care program that included DSD for stable AYLHIV and intensified services, including mental health counseling, for AYLHIV with greater needs.

Methods: We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to guide evaluation of the Data-informed Stepped Care (DiSC) study, a cluster randomized controlled trial implemented from April 2022 to August 2023 in 24 HIV care facilities in Kenya. We used a mixed methods convergent parallel design to evaluate performance indicators across RE-AIM dimensions. Surveys were analyzed using descriptive statistics and qualitative data using directed content analysis.

Results: Of 3,945 AYLHIV ages 10-24 years old attending care at intervention facilities, 933 AYLHIV were screened and 895 were enrolled, representing an enrollment rate of 96% and 23% reach of the intervention. Distribution by age groups were 10-14 years: 29%; 15-19 years: 48%; 20-24 years: 24%. Perceived effectiveness, including improved retention and viral suppression among AYLHIV, motivated continued implementation throughout the study duration. Providers also identified opportunities to improve AYLHIV outcomes by highlighting the importance of integrating mental health into HIV care programs. Prior to implementation, 49 health providers were trained to deliver the DiSC intervention, representing adoption by 25% of the total facility workforce, including 95% of clinical officers and 56% of nurses. Implementation was facilitated by provider-identified, fidelity-consistent adaptations to optimize contextual fit of the intervention. Key determinants influencing implementation were provider collective efficacy, compatibility with clinic workflows, leadership engagement, and alignment with changing national guidelines. Post-trial, providers supported continued use of the DiSC intervention (maintenance), citing leadership support, training, and material and human resources as key influencers on future sustainment.

Conclusions: Applying RE-AIM to evaluate performance indicators of a stepped care program for AYLHIV identified high adoption and perceived effectiveness, and key influences on implementation and maintenance. Providers were motivated to adopt and sustain use of the DiSC intervention because of perceived positive impact on health system efficiencies and AYLHIV outcomes.

Trial registration: ClinicalTrials.gov, NCT05007717. Registered 13 July 2021.

Background: Previous systematic reviews have examined the use of the 2009 version of the Consolidated Framework for Implementation Research (CFIR) in healthcare settings. However, these reviews primarily focused on studies conducted in secondary and tertiary care, with limited attention to its application in primary care. The use of the CFIR in primary care remains underexplored. Given the unique attributes of primary care-guiding principles such as first-contact care, continuity, comprehensiveness, coordination, and people-centeredness-findings from studies in other healthcare settings may not fully translate to the primary care context. This systematic review aimed to investigate how the CFIR has been applied in primary care, evaluate how it aligns with the guiding principles of primary care, and propose refinements to enhance its future application.

Methods: We searched Scopus and PubMed for publications including the terms CFIR and primary care from 2009 to February 15, 2024. We included studies that addressed clinical, organizational, or service delivery interventions implemented in primary care settings interventions within primary care settings. Data abstraction focused on several variables, including study design and location, participants, health topic, CFIR domains and constructs used, rationale for use, and additional implementation frameworks. We also evaluated how the applied constructs related to the WHO guiding principles of primary care.

Results: Out of 394 studies, 105 met the inclusion criteria. The use of the CFIR in primary care steadily increased between 2015 and 2024. Most studies were qualitative (80.9%), focused on non-communicable diseases (19%), conducted during the post-implementation phase (43.8%), centered on healthcare workers' perceptions (40%), and conducted in high-income country (83%). Most studies (61%) applied the five domains of the CFIR. However, 53.3% of the studies did not reported the rationale for selecting the domains. Some CFIR constructs investigated aligned with the guiding principles of primary care, particularly people-centeredness and comprehensiveness.

Conclusions: Refinements for applying the CFIR in primary care include enhancing community participation throughout the research process, from study design to interpretation and development of practice recommendations; reporting the rationale for selecting CFIR constructs, including their alignment with the guiding principles of primary care; increasing pre-implementation evaluation to support longitudinal, formative implementation research; and strengthening the role of implementation research in healthcare policies.

Systematic review registration: osf.io/4yq2f.

Background: Latino men who have sex with men (MSM) in the United States experience significant HIV disparities, exacerbated by mental health and substance use (MH/SU) concerns. Although evidence-based clinical interventions, such as pre-exposure prophylaxis (PrEP) and MH/SU treatment, can prevent HIV and mitigate MH/SU adverse outcomes, their reach to Latino MSM remain suboptimal. This gap underscores the need for adjunctive interventions and implementation strategies that improve PrEP and MH/SU treatment reach. SOMOS Alianza (San Juan, Orlando, Miami Organizational Strategic Alliance) is a research-practice network spanning three Ending the HIV Epidemic (EHE) jurisdictions. HIV organizations in SOMOS Alianza leverage their expertise in serving Latino MSM to develop and use adjunctive interventions and implementation strategies to improve PrEP and MH/SU treatment reach within their communities. These locally developed interventions and strategies could be scaled across other HIV organizations to meet U.S. EHE goals.

Methods: In Aim 1, we will characterize and assess the degree to which existing adjunctive interventions and strategies used by local organizations align with the existing evidence base. We will combine Rapid Assessment Procedure-Informed Clinical Ethnography and "reverse" implementation mapping to evaluate these interventions and strategies. In Aim 2, we will apply user-centered design principles to develop an online Dashboard featuring interventions and strategies identified in Aim 1. Finally, in Aim 3 we will assess the Dashboard's usability and impact at the organizational level across EHE jurisdictions. Using baseline and 12-month follow-up assessments, we will evaluate outcomes quantitatively and qualitatively, and results will be used to refine the Dashboard for public use.

Discussion: This study will go beyond traditional research-to-practice models by identifying and scaling up existing adjunctive interventions and implementation strategies, addressing gaps in implementation science and ultimately improving health outcomes for Latino MSM. Expected outcomes include identifying contextually appropriate and feasible approaches to improve PrEP and MH/SU treatment reach to Latino MSM, developing a scalable Dashboard for dissemination, and creating a generalizable model for implementation, and advancing public health goals aligned with EHE priorities.