Implementation science communications最新文献

Background: Implementation science has made significant advances in our understanding of organizational factors that impact the implementation process. Critical to those advances has been the development of measures of key implementation-focused organizational constructs, such as implementation leadership. The Implementation Leadership Scale (ILS) was developed to capture leadership behavior identified as critical to implementation effectiveness. Recent research in education has identified additional dimensions of implementation leadership that extend our understanding of how leaders contribute to the successful implementation and sustainment of new practices. The goal of this paper is to validate the extended version of the Implementation Leadership Scale, or the ILS-X, in behavioral health settings.

Method: This paper utilized baseline data from two large implementation trials conducted in behavioral health settings that collected survey data on the ILS-X measure from 389 providers across 68 behavioral health clinics. The ILS-X is a pragmatic measure with 21 items assessing seven dimensions of implementation leadership (proactive, knowledgeable, supportive, perseverant, communication, vision/mission, and available). Analyses assessed internal consistency reliability, interrater reliability and agreement, factor structure, and construct validity evidence for scores on the measure.

Results: The ILS-X performed well across all criteria. A second-order confirmatory factor model fit the data well and had high factor loadings across all dimensions. Correlations with other clinic-level measures (e.g., transformational leadership, organizational climate, aggregate job satisfaction, clinic characteristics) were consistent with theory-guided expectations. Internal consistency reliability and aggregation indices supported future use of the measure.

Conclusion: The ILS-X allows implementation researchers and practitioners to reliably assess a more comprehensive array of implementation leadership behaviors that builds on the original ILS measure. The ILS-X will be valuable for targeting an expanded range of behaviors for identifying areas of leadership strength and improvement during implementation efforts.

Background: Pregnancy is a crucial period to improve cardiovascular health (CVH) for mothers and their families. The current study emphasizes framework-guided factors that influence the adaptation of an evidence-based intervention (Parents as Teachers and Healthy Eating Active Living Taught at Home [PAT + HEALTH]) to support healthy gestational weight gain and postpartum weight management among pregnant women with obesity and their infants in Nigeria.

Methods: From May to June 2023, 43 in-depth interviews were conducted with 11 parents, 15 community health extension workers (CHEWs)/health educators, and 17 policymakers/ healthcare supervisors in the Federal Capital Territory, Nigeria. Additionally, nine focus groups were conducted with 75 participants. Interviews were recorded, de-identified, and transcribed. The updated Consolidated Framework for Implementation Research (CFIR 2.0) informed the development of the interview guides and the thematic analysis. Transcripts were double-coded using Dedoose.

Results: We identified assessing context, tailoring strategies, local attitudes, and sustainability as constructs to consider when adapting and implementing the PAT + HEALTH intervention successfully within the Nigerian primary care context. For example, policymakers and healthcare supervisors emphasized the feasibility of the intervention, including raising community awareness, planning for hard-to-reach areas, and ensuring supportive supervision of CHEWs delivering the intervention. Additional factors included customizing educational content and delivery methods to fit the cultural, socioeconomic, and environmental contexts of Nigerian families. CHEWs highlighted the importance of public education on locally available foods for better nutrition. Potential barriers to the PAT + HEALTH intervention included local attitudes influenced by sociocultural factors, such as food taboos, and structural factors, including limited financial support for the long-term sustainability of some components of the home visiting program.

Conclusions: Building on these formative activities, the ENHANCE CVH trial will advance dissemination and implementation science by adapting, testing, and evaluating the effectiveness and implementation of the PAT + HEALTH intervention among pregnant women with obesity and their infants in Nigeria in a cluster randomized trial.

Trial registration: ClinicalTrials.gov/NCT06773299, Registration Date: January 14, 2025.

Background: There are many approaches in implementation science research and practice to prospectively and pragmatically measure the amount of effort required to implement a particular evidence-based practice (EBP). We sought to 1) demonstrate how to prospectively and pragmatically document implementation activities in a real-world implementation trial; 2) quantify implementation dose (frequency and time spent) across the implementation of four EBPs; and 3) explore potential drivers of variation in implementation dose across EBP, sites, implementation progress, and wave.

Methods: We built on the existing literature to develop a prospective and pragmatic way to track implementation activities during a type III hybrid effectiveness-implementation stepped wedge trial. We then quantified both total implementation dose (defined as total time spent by the implementer team) and how much of this dose was synchronous (defined as time spent working directly with local implementers at the sites receiving the intervention). We used multiple linear regression to understand what factors may influence differences in total implementation dose delivered (such as which evidence-based practice was being implemented, in which wave of the stepped wedge, at which medical centers), as well as how dose was related to implementation progress, categorized by 1) decision to participate, 2) training, 3) implementation with support, and 4) independent implementation.

Results: From 2022 to 2023, we prospectively captured implementation dose across 25 implementation instances related to four EBPs that were implemented at seven VA medical centers. We implemented Surgical Pause seven times, TAP six times, CAPABLE six times, and EMPOWER six times. We captured and categorized 1,271 h of implementation activities. Asynchronous administrative activities were most common across implementation phases. Other common synchronous activities include engaging collaborators, problem solving, providing updates, and ongoing action/implementation planning. The EBP was the largest driver of variation in implementation dose overall. Site, implementation progress, and wave did not independently explain variations in implementation dose.

Conclusions: The EBP being implemented was a much stronger predictor of the implementation dose required than were other factors, such as experience implementing the EBP or characteristics of the medical center where the intervention was being implemented.

Background: Task shifting and task sharing (TSS) are widely used implementation strategies to expand HIV service delivery in low-resource settings. Informal lay health workers, such as traditional healers (THs), have been proposed as critical partners in bridging service delivery gaps. However, the mechanisms that support their successful integration into formal health systems remain underexplored. This qualitative sub-study aimed characterizes a novel proximal implementation outcome - empowerment - based on lived experiences of THs participating in a TSS intervention in rural Uganda.

Methods: Between July and August 2023, we conducted 22 in-depth interviews with THs in rural Uganda who completed a three day training to become lay HIV supporters. The curriculum included HIV transmission, ART adherence, stigma reduction, and HIV self-testing. Interviews were conducted in the local language, transcribed, translated into English, and analyzed using a thematic approach. Our analysis was guided by Lee and Koh's empowerment framework, which links role transformation to domains of empowerment.

Results: THs reported experiencing empowerment across four domains: meaningfulness, competence, self-determination, and impact. Participants described strong alignment between their traditional caregiving roles and new responsibilities in HIV support. They reported increased HIV-related knowledge, confidence in client care, autonomy in decision-making, and a sense of contributing meaningfully to improved health outcomes. Notably, we identified a fifth domain - external validation - defined as recognition and legitimacy conferred by representatives of the biomedical health system. This domain was central to participants' perceived integration, motivation, and potential sustainability of their involvement in these types of programs.

Conclusions: We propose empowerment as a novel proximal implementation outcome that reflects the internal and external transformations necessary for successful implementation with informal providers. Our findings support expanding Lee and Koh's empowerment framework to include external validation, particularly for cadres operating outside the formal system. Positioning empowerment as a proximal outcome offers a valuable lens for evaluating early success of broad implementation strategies that involve role transformation, such as training trainers, or engaging community champions.

Trial registration: ClinicalTrials.gov, NCT05943548. Registered 2023-07-13, https://clinicaltrials.gov/study/NCT05943548 .

Background: Autism has significantly increased in the United States with 1 in 31 children affected and increasingly included in general education settings as mandated by the Individuals with Disabilities Education Act. While several evidence-based practices (EBPs) effectively support autistic students, organizational-level factors hinder successful implementation in school settings. Implementation climate-implementers' collective perceptions that their organization prioritizes, rewards, and supports EBP implementation-strongly predicts EBP use. However, little is known about implementation climate within general education settings in public schools.

Methods: A sequential explanatory mixed-methods approach was applied. Participants included 361 general education teachers (n = 161), special education teachers (n = 138), and paraeducators (n = 62) across 60 elementary schools. All participants served at least one autistic student included in a general education classroom, with the total number of autistic students served ranging from 1 to 30 (M = 3.75). Participants completed the School Implementation Climate Scale (SICS) and aggregate mean scores for each subscale (i.e., focus on EBP, education support, recognition for EBPs, rewards for EBPs, use of data to support EBPs, existing support to deliver EBPs, integration of EBPs) were calculated. To better understand EBP use, participants were randomly selected (n = 82: 24 general education teachers, 49 special education teachers, 9 paraeducators) to complete 30-40 min semi-structured interviews, with equal distributions of non, low, and high EBP users. Data were collected between 2021-2024.

Results: Quantitative analysis via aggregate mean scores on the SICS (Total M = 1.8) subscales revealed that educators rated implementation constructs relatively low. Qualitative findings provide additional insights into implementation challenges such as limited educational and professional development opportunities, insufficient EBP preparation time, lack of resources for autistic children, and minimal recognition and reward for EBP implementation.

Conclusions: Findings reveal a suboptimal implementation climate within general education settings in public schools for supporting autistic students. These insights suggest the need to improve the implementation climate to facilitate successful EBP implementation. Recommendations and key areas for future research are discussed. Limitations, including the need to examine the impact of outer contextual factors are described.

Background: Implementation fidelity-the degree to which an intervention is executed as intended-is critical for evaluating healthcare interventions' success. Contextual determinants such as organizational culture, communication, and leadership influence how interventions unfold at the site level. The Veterans Health Administration (VA) developed the Patient Safety Events in Community Care: Reporting, Investigation, and Improvement Guidebook to improve standardization of patient safety reporting across VA-delivered and VA-purchased care. While the Guidebook aims to enhance reporting fidelity, little is known about which local contextual factors influence its implementation success across diverse VA sites. This study examined the contextual determinants associated with site-level variation in Guidebook implementation fidelity.

Methods: We conducted a cross-sectional, mixed-methods evaluation of 18 geographically diverse VA Medical Centers. Data were collected from 32 interviews with 45 key personnel involved in Guidebook implementation. Using the 2009 Consolidated Framework for Implementation Research (CFIR), 12 constructs were rated at each site. Fidelity was assessed across three safety processes (reporting, investigation, and improvement) on a three-point scale. We used Coincidence Analysis, a configurational comparative method, to identify combinations of CFIR constructs (difference-makers) that consistently distinguished higher- from lower-fidelity sites.

Results: Guidebook fidelity varied across sites (range = 0.23 to 1.59). We identified three key CFIR constructs associated with higher fidelity: Networks & Communications, Relative Priority, and Leadership Engagement. Of these, Networks & Communications was both a necessary and sufficient condition for higher fidelity, serving as a precondition for high levels of Leadership Engagement. Sites that rated highly in Relative Priority were more likely to fully implement Guidebook processes. These constructs fostered strong collaboration, timely information exchange, and internal alignment on the importance of patient safety reporting.

Conclusions: Effective communication networks and perceived priority of the intervention were central to high-fidelity implementation of the VA's safety reporting Guidebook. These findings highlight critical levers for improving implementation fidelity in complex healthcare systems. Targeted strategies that strengthen communication and emphasize the value of safety interventions may enhance implementation success, offering valuable insights for patient safety efforts both within and beyond the VA.

Background: Given the substantial public funding of health-related research, tangible benefits of this support must be demonstrated. Implementation science provides actionable methods to enhance population health, reduce health inequities, and guide effective public health and clinical practices and policies. We must elevate the notion of impact (the "so-what gap") and the role of implementation science, particularly in university settings.

Main text: We distinguish between scientific output and impacts. Impacts in implementation science are commonly defined as improvements in health outcomes, quality of life, quality of services, or policy change. In contrast, traditional academic outputs, such as citation counts and grant awards, hold minimal, direct societal relevance. Principles of audience segmentation (partitioning the target audience for dissemination and implementation into smaller groups by meaningful distinctions), which are increasingly applied in implementation science, can enhance impact. We highlight trade-offs in enhancing the focus on impact across multiple categories (e.g., accountability, evaluation). We describe four essential domains of implementation impact: speed of research translation, sustainability, de-implementation, and equity. Multiple examples, across diverse topics, illustrate these domains (e.g., HIV treatment, use of community health workers). To boost impact via more active dissemination and implementation of research findings, we provide ideas within five categories: (1) co-production of knowledge, (2) tailored dissemination, (3) organizational support, (4) capacity building, and (5) implementation metrics.

Conclusions: Generating new research knowledge does not guarantee societal impact. For implementation science to become more relevant to societal needs, enhancing and evaluating its impacts matter; otherwise, systemic changes required in institutions will continue to evolve slowly. We argue that impactful implementation science involves developing new skill sets and uncovering meaningful work that changes the field while adopting a collaborative working approach with individual researchers, their organizations, funders, and the communities they aim to benefit. Navigating the hurdles and translating research into practice and policy can amplify societal impact, making implementation science more applicable, accessible, and equitable for all.

Background: Climate-sensitive hazards such as extreme heat are increasing in frequency and severity. Protecting population health requires hazard-specific risk assessment, selection of potential interventions, and support for intervention implementation. This process typically takes several years, constraining health adaptation to climate-sensitive hazards. The investigators have developed an online decision support platform, CHaRT, that links evidence-based, location-specific heat-health risk assessment with transparent analyses of risk drivers and evidence-based risk reduction guidance for use in local health departments (LHDs). CHaRT's effectiveness in supporting delivery of effective health interventions has not been evaluated.  METHODS: LHDs are the organizational unit being studied. In this pilot randomized controlled trial, LHDs from the conterminous US will be recruited in coordination with the National Association of City and County Health Officials (NACCHO). Thirty LHDs will be selected at random from interested participants. Fifteen will be randomized to receive the intervention, a facilitated engagement with CHaRT, and 15 will receive the control, a package with information on heat vulnerability assessment and potential interventions. Intervention and control packages will be delivered simultaneously. Facilitated engagement will include an introduction to the tool, user exploration of the tool, elective inclusion of site-specific data into the tool, follow-up sessions to address additional questions, and discussion with investigators regarding planning and implementation needs. Pre- and post-study surveys will be used to assess CHaRT's effectiveness using the RE-AIM (Reach, Effectiveness, Acceptability, Implementation, Maintenance) framework and by comparing each site's intentions to implement specific interventions. After the trial, barriers and facilitators of the CHaRT platform's implementation will be assessed through key informant interviews with the intervention group and analyzed using the Consolidated Framework for Implementation Research (CFIR).

Discussion: This study will allow investigators to evaluate the public health impact of a decision support platform and to identify barriers and facilitators of its implementation. The results will guide future research into strategies for increasing public health adaptation to climate change at the speed and breadth required.

Trial registration: NCT06971978, https://clinicaltrials.gov/study/NCT06971978 , 5/14/25.

Background: Mental health services play a key role in caring for autistic youth given the common and often unmet mental health needs in this population. There is a pressing need to enhance the uptake and use of evidence-based interventions (EBIs) that improve mental health services for autism and optimize outcomes. EBIs targeting transdiagnostic or key factors relevant across autism and mental health conditions exist and have the potential to enhance mental health services for autism. Yet, these interventions have not been widely tested. Similarly, autism EBI training is an implementation strategy with the potential to enhance mental health service quality broadly given specific components and strategies incorporated into the EBI to enhance its impact and fit. This protocol paper describes a multisite study that examines the clinical and implementation effectiveness of a transdiagnostic EBI developed for autistic children compared to a non-autism transdiagnostic EBI in children's mental health settings (Aim 1), confirms engaged clinical and implementation mechanisms (Aim 2), and examines the generalized and expanded effects of EBI training beyond autism (Aim 3).

Methods: This study will employ a hybrid type 2 effectiveness-implementation design to test Unstuck and On Target, an executive functioning EBI adapted for mental health services (autism EBI) and Unified Protocol for Children (non-autism EBI). Twenty-eight mental health programs will be randomized to an EBI condition and 224 therapists across these programs will be recruited and receive EBI training. Additionally, 224 autistic children and 224 non-autistic children, yoked to participating therapists, will be recruited as EBI recipients. This study will measure clinical (mental health symptom change) and implementation outcomes (EBI fidelity, training engagement, psychotherapy quality, reach) and clinical (executive functioning skills, emotion regulation skills) and implementation (autism self-efficacy and knowledge, perception of fit) mechanisms.

Discussion: This study will confirm the effectiveness of a promising executive functioning EBI in mental health settings as well as generate clinical knowledge about the potential of transdiagnostic interventions improve mental health outcomes for autistic children. Findings also have immense potential to demonstrate the ability of autism EBIs to enhance mental health services for autistic and non-autistic children more broadly.

Trial registration: This study is registered with Clinicaltrials.gov (NCT06651086). Registered on October 18, 2024.

Background: Modifications and adaptations to evidence-based interventions are common, and of special relevance to complex interventions in healthcare. Although they play an important role in scale-up and sustainment, the potential exists for negatively affecting the core functions of an intervention. This study explores modifications to rapid response systems (RRSs), using the established Framework for Reporting Adaptations and Modifications - Expanded (FRAME). RRSs are patient safety interventions developed to identify and respond to hospital patients in clinical deterioration. Despite widespread use, little evidence-based guidance exists for necessary adaptations to local context. Applying adaptation frameworks is a novel perspective to improve RRS intervention design and implementation guidance. We aimed to explore which modifications and adaptations to RRSs that have taken place in Norwegian hospital units, how they occurred, and what the underlying reasons were by using FRAME.

Methods: Nine hospital units across six hospitals, which had initiated the implementation of RRSs 4 to 12 years previously, were included. Data was collected through focus group and individual interviews with clinicians and leaders. Analysis involved two steps: a conventional, inductive content analysis to identify and categorize modifications, followed by further characterization of these modifications through deductive analysis employing FRAME.

Results: Inductive analysis identified 5 categories and 24 subcategories of modifications to the RRS intervention. Application of FRAME revealed modifications to be mainly reactive and occurring in the maintenance/sustainment phase, decided at the unit level and with varying fidelity consistency. Both structured and informal processes were identified. The goals of modifications were improvement of feasibility, effectiveness and fit, and reasons were related to available resources, service structure, clinical judgment and patient factors. Minor adaptations to FRAME were necessary to fit the RRS intervention and the methods of data collection.

Conclusions: Studying real-life implementations of RRSs provides insight in modification processes, highlights which intervention elements are modified for better fit and feasibility, and which modifications are prone to fidelity inconsistency. Our findings underline the ubiquity of modifications to RRSs, and the need to systematically anticipate them throughout all implementation stages. Further exploration of RRS core functions and application of FRAME within collectively implemented patient safety interventions could advance the field.