Implementation science communications最新文献

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.

Background: Health equity intervention implementation (which promotes positive health outcomes for populations experiencing disproportionately worse health) is often impeded by health-equity-specific barriers like provider bias; few studies demonstrate how to overcome these barriers through implementation strategies. An urgent health equity problem in the U.S. is the mental health of transgender youth. To address this, we developed Gender-Affirming Psychotherapy (GAP), a health equity intervention comprising best-practice mental health care for transgender youth. This paper details the identification of implementation determinants and the development of targeted strategies to promote provider adoption of GAP.

Methods: This study represents part of a larger study of mental health provider adoption of GAP. Here we describe the first 2 stages of the 3-stage community-engaged and human-centered design process - Discover, Design/Build, and Test - to identify implementation determinants of adoption and develop implementation strategies with transgender youth, their parents, and mental health providers. This process involved collecting data via focus groups, design meetings, usability testing, and champion meetings. Data were analyzed using rapid and conventional content analysis. Qualitative coding of implementation determinants was guided by the Health Equity Implementation Framework, and implementation strategy coding was facilitated by the ERIC Implementation Strategy Compilation.

Results: We identified 15 determinants of GAP adoption, and all were specific to the transgender population (e.g., inclusive record system, anti-transgender attitudes). Seventeen implementation strategies were recommended and 12 were developed, collectively addressing all identified determinants. Most strategies were packaged into an online self-paced mental health provider training (implementation intervention) with 6 training tools. Additional inner-setting strategies were designed to support training uptake (e.g., mandate training) and GAP adoption (e.g., change record system).

Conclusions: Community-engaged and human-centered design methods can identify health equity intervention implementation determinants and develop targeted strategies. We highlight five generalizable takeaways for health equity implementation scientists: (1) implementer bias may be a key barrier, (2) experience with the health equity population may be an important facilitator, (3) stakeholder stories may be an effective training tool, (4) inner-setting-level implementation strategies may be necessary, and (5) teaching implementers how to build implementation strategies can overcome resource-constraints.

Trial registration: November 11, 2022; NCT05626231.

Background: Interprofessional collaboration (IPC) among health and social care providers is crucial to effectively implement community-based fall prevention. Several factors hinder successful and sustainable IPC, highlighting the need to both design and evaluate context-specific implementation strategies. However, there remains a fundamental gap in the detailed description and evaluation of such strategies. Therefore, this study aims to (1) monitor the implementation process over time and (2) evaluate the impact of a multifaceted implementation strategy aimed at improving interprofessional collaboration among health and social care professionals in community-based fall prevention.

Methods: This study was conducted in two districts and one municipality in the Netherlands. We conducted a longitudinal mixed-methods study with a convergent design, emphasizing qualitative methodology. Over 24 months, qualitative (focus groups and regular meetings) and quantitative (questionnaires) data were collected semi-annually from three working groups of health and social care professionals (HSCPs). Qualitative and quantitative data were initially analyzed separately, followed by an integrated analysis for comprehensive insights on themes influencing the implementation process and the impact of the strategy on IPC and implementation outcomes.

Results: In total, 32 HSCPs originating from three communities participated in this study. Monitoring and evaluation of the multifaceted implementation strategy revealed four overarching themes: (1) "Network building", including aspects and activities that contribute to network building; (2) "Team dynamics", referring to interactions within the working groups; (3) "Coordination", addressing the coordination of implementation and establishment of protocols and work flows; and (4) "Implementation dynamics" highlighting aspects that influence the implementation process and outcomes.

Conclusions: This study identified four key themes influencing the implementation process and impact of a multifaceted implementation strategy aimed at improving IPC among HSCPs in community-based fall prevention: network building, team dynamics, coordination and implementation dynamics. Monitoring and evaluation are crucial for identifying the specific activities needed to effectively implement interventions in real-world settings. Given the complexity of implementation processes and ongoing contextual changes, continuous adjustments are necessary. An iterative monitoring and evaluation approach, as used in this study, enables these adaptations and maximizes real-world impact.

Background: Although the management of psychosocial risks in the work environment represents an evidence-based approach to the prevention of mental health problems, its implementation is limited, including in schools, and knowledge on how to support better implementation is scarce. This study compares the effectiveness of a multifaceted vs. a discrete implementation strategy on fidelity to an occupational guideline for the prevention of mental health problems. Dual perspectives were used to assess fidelity, an important aspect of the measurement agenda.

Methods:  A cluster-randomized controlled trial was conducted among 55 schools in Sweden. A multifaceted strategy (educational meeting, implementation teams, ongoing training, Plan-Do-Study-Act cycles, and facilitation) was compared with a discrete strategy (teams participating in the educational meeting). Fidelity to the guideline's recommendations from the recipients' perspective was measured by questionnaire (Baseline n = 2276; 12 months n = 1891). Fidelity from the implementers' perspective (n = 54) was assessed via a checklist at 12 months. Linear mixed modeling was used. A qualitative approach was applied to analyze the open-ended responses to the checklist.

Results:  Absolute changes in recipient fidelity were observed in all three indicators of the guideline's recommendation 1 (Multifaceted: 13.2 to 19.5%, Discrete: 10.4 to 13.2%). A statistically significant effect was found favoring the multifaceted strategy (d = 0.16). The indicator of recommendation 2 also supported the effect of the multifaceted strategy (Multifaceted: 9.2%, Discrete: 5.0%; d = 0.16). The largest difference between the strategies was observed for recommendation 3, for six indicators (Multifaceted: 0.7 to 13.9%, Discrete:-3.2 to 0.0%; d = 0.19 to 0.41). Convergence was observed between the two perspectives in support of the multifaceted strategy's favorable effect on guideline fidelity compared to the discrete strategy. The findings complemented each other, with implementers describing the activities that were enacted and recipients quantifying the change in fidelity over time.

Conclusions: The multifaceted strategy was more effective than the discrete strategy in fidelity attainment after 12 months. Assessing fidelity from the implementer and recipient perspectives provided an understanding of the contextual functioning of the strategies, highlighting the variation in fidelity and the importance of examining the need for adaptations of strategies during the implementation process.

Trial registration: The trial was registered the 9th of August 2021 at Clinicaltrials.gov with Trial registration number: NCT05019937 .

Background: Native American communities possess a wide range of assets that can contribute to reducing persistent inequities in food insecurity, obesity, cancer, chronic disease, and other related outcomes. Community engaged dissemination and implementation (CEDI) strategies that emphasize available, relevant, and generalizable evidence as well as community strengths and assets are well aligned to improve health outcomes with these communities.

Methods: "Delivery of Turtle Island Tales to Promote Family Wellness" applies a culturally grounded, evidence-based intervention for obesity prevention through partnership with local organizations (e.g., Cooperative Extension/Supplemental Nutrition Assistance Program Education [SNAP-Ed]) to understand and enhance community capacity for sustained health promotion. A descriptive case study design applies bundled CEDI strategies (e.g., participatory Project Steering Committee; site-specific Community Implementation Teams) guided by the Consolidated Framework for Implementation Research and the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework to examine implementation across multiple communities. CEDI strategies will be tracked longitudinally, by community, to document iterative identification of locally specific and project general CEDI strategies as they relate to program reach, adoption, adaptation, implementation, and maintenance using mixed methods approaches (e.g., validated surveys, focus groups, interviews). An economic assessment of Turtle Island Tales also will be conducted.

Discussion: This study applies innovative CEDI science to the equitable implementation of Turtle Island Tales, one of the only family-centered, home-based, evidence-based obesity prevention intervention developed for and with Native American communities. Key innovations include a mailed intervention model and culturally specific strategies that honor local community assets to support the program's relevance, scalability, and long-term sustainability.

Background: People undergoing lower extremity amputations are often overlooked in healthcare. Limited clinician knowledge and skills challenge implementation of evidence-based clinical practice guidelines. Multidisciplinary lower extremity amputation protocols (LEAP) piloted in community and regional settings have improved outcomes and reduced hospital length-of-stay-but remain untested in larger settings. The purpose of this study was to identify barriers, facilitators, and strategies for implementing a multidisciplinary evidence-based LEAP for postoperative rehabilitation in a large urban quaternary medical center.

Methods: The planning phase study used the Theoretical Domain Framework (TDF) to develop and administer an anonymous survey. A purposive sample of 238 multidisciplinary professionals from a large urban medical center responded. The TDF and Capability-Opportunity-Motivation for Behavior Change (COM-B) framework-with its 3 components aligned with 6 behavior sources in 8 domains with further construct-level detail-were used for data analysis. Analysis was descriptive with barriers rank-ordered, facilitators identified by theme analysis, and strategies derived from written comments.

Results: Clinicians responded from medicine (17.3%), nursing (16.0%), prosthetics (5.8%), physical therapy (36.0%), occupational therapy (24.0%), and recreational therapy (0.9%). Primary barriers fell within the knowledge, skill, and belief-in-capability capability-domains; and the professional role and environmental context opportunity-domains. Four capability and opportunity component facilitators emerged with corresponding strategies: education via short multimedia resources, hands-on clinical training, clinical support via champion mentors, and interdisciplinary coordination via automated multidisciplinary order set.

Conclusions: Identifying barriers and facilitators led to provider- and organization-level strategies that address capability and opportunity TDF components. Capability strategies included didactic education and clinical training supported by mentors. An automated multidisciplinary order set referral system emerged as the principal opportunity strategy. The order set aimed to improve communication regarding professional roles, enhance clinical training opportunities, and coordinate interdisciplinary care in the teaching hospital context of rotating multidisciplinary clinicians of a large urban quaternary medical center.

Background: Critically ill children tend to receive fluid volumes exceeding physiologic requirements despite evidence demonstrating harm with increasing net positive fluid balance. However, interventions aimed at optimizing fluid balance have yet to demonstrate significant clinical benefit, likely because there are multiple drivers of this complex problem. In this study, we used qualitative inquiry to describe the current practice at a community pediatric intensive care unit and discover potential barriers and facilitators to clinical practice change.

Methods: We designed a semi-structured interview guide informed by the consolidated framework in implementation research (CFIR) and conducted interviews with attending physicians, dietitians, nurses, nurse practitioners, pharmacists, and physician assistants. We coded interview transcripts according to a deductive coding framework based on the CFIR with additional inductive codes as pertinent to the clinical problems described. Referencing Braun and Clarke's six steps to thematic analysis, we analyzed the coded data and developed themes to synthesize findings and draw meaningful insights for clinical practice.

Results: We interviewed 20 participants who practiced in 5 distinct healthcare roles. Clinical priorities and suggestions for improvement differed among healthcare roles, but four key themes guiding fluid optimization emerged: "Positive Self-Perceptions of Fluid Optimization," "Delegation and Autonomy in Fluid Prescribing," "The Influence of EHR Design on Clinical Practice," and "Clinical Uncertainty and Predictive Support." We mapped each of the themes with key CFIR domains and constructs as well as potential barriers and facilitators to development and implementation of a clinical innovation to fluid optimization.

Conclusions: Interview participants recognized the problem of fluid overload but offered mixed perspectives on how to change clinical practice. Recognizing the multidisciplinary nature of caring for critically ill children with potential variations in viewpoints, we used the CFIR as a solution rooted in complexity to improve understanding of the problem, identify existing barriers, and leverage facilitators before designing a contextualized and practical strategy to optimize fluid balance.

Background: Healthcare team communication is essential to high-quality childhood cancer care, especially during high-acuity events such as clinical deterioration and in resource-variable settings, where supportive interventions to resolve deterioration are less available. Communication quality has traditionally been understudied in these settings, and there is a notable lack of communication interventions that are appropriate and feasible in settings across resource levels. We propose addressing this challenge in this study protocol, which will co-develop and pilot a multi-level intervention to improve communication and outcomes for children receiving cancer treatment.

Methods/design: This study leverages systems and implementation science methodologies to evaluate and improve communication quality in the care of hospitalized children with cancer. We will use a newly developed reliable and multilingual measure of communication quality during clinical deterioration (CritCom). In this study, we will: 1) evaluate the relationship between healthcare team communication structures (using social network analysis) and quality (using CritCom) in the care of children with cancer, with a specific focus on the impact of hierarchy and modifiable communication determinants. We will then: 2) co-develop a multilevel intervention to address challenges in communication quality across variably resourced settings, using semi-structured interviews among clinicians working in these settings and intervention mapping with a global expert panel. Finally, we will 3) test the feasibility, acceptability, appropriateness, and preliminary efficacy of this novel intervention using a cluster-randomized wait list control pilot trial in eight resource-variable hospitals providing childhood cancer care with poor team communication quality.

Discussion: This project identifies modifiable determinants of communication before co-developing and testing interventions with clinicians. When completed, this study will produce an evidence-informed, multilevel intervention to improve healthcare team communication during clinical deterioration, advancing the science of team communication during cancer care, and ultimately improving survival for children with cancer.

Trial registration: ClinicalTrials.gov Record NCT07083674.

Background: Depression is highly prevalent in people living with HIV (PWH), affecting their daily life and HIV outcomes. Following a successful pilot study to treat depression in PWH with Group Interpersonal Therapy, we examined its implementation potential. Despite a strong willingness for its adoption routine practice, formal integration of mental health services into HIV care remained challenging. Using Implementation Mapping, we aimed to select and specify a set of implementation strategies to integrate depression services into Senegalese HIV care.

Methods: For each step of depression services (i.e. screening, diagnostic confirmation/referral, and treatment), we selected potential implementation strategies using the Expert Recommendations for Implementing Change (ERIC). During a 3-day workshop, 14 different stakeholders, including doctors, social workers, community health workers, a psychiatrist, a socio-anthropologist and local health officials, reviewed and discussed strategies selected for each implementation step. Each participant also voted on the importance and feasibility of each strategy, using a Likert scale from 1 to 5 (5 = very high importance or feasibility). Scores were then plotted on a 'go-zone' graph. Details of strategies ranked as important and feasible were then specified by stakeholders.

Results: Forty-eight strategies were identified. Among them, 62,5% were considered as highly important and feasible, 31,3% as important but with concerns about feasibility, 6,2% as not very important or feasible. A total of 46 distinct implementation strategies, derived from 21 ERIC strategies and corresponding to 8 ERIC thematic clusters, were selected for the final implementation plan. Materials needed to implement and monitor implementation (i.e. registers, decision tree, patient's record) were validated during the workshop. Finally, a summary of the implementation plan for integrating depression management into HIV care services in Senegal was elaborated.

Conclusions: A systematic approach was used to collaboratively develop an implementation plan to integrate depression management into HIV care in Senegal. Informed by various stakeholders, this work can facilitate a national dissemination of the integration program and may offer a useful reference for developing similar programs for PWH in other settings.

Introduction: While the importance of a more holistic approach to implementation science, recognizing the interconnection among implementation determinants and the heterogeneity of context and care professionals (CPs), has long been acknowledged, recent research has increasingly focused on these issues. Despite this growing attention, the practical application of these insights within implementation research remains limited. In this study, we aimed to identify distinctive subgroups of CPs based on their profiles of implementation determinants concerning the Childcheck, a guideline facilitating early identification of child abuse based on parental characteristics. We also explored the influence of organization type on subgroups of CPs with specific implementation characteristics (subgroup membership) and assessed their relationship to CPs implementation level.

Methods: A total of 562 Dutch CPs in Mental Health Care (aMHC) and Forensic Care settings completed a self-reported questionnaire on Childcheck implementation determinants. We conducted Latent Profile Analysis to identify subgroups of CPs. The influence of organization type on subgroup membership was examined using Chi-Squared test and we explored the impact of subgroup membership on implementation levels using a one-way ANOVA.

Results: We identified five distinct subgroups. Subgroup A (Reporting Center for Child Abuse and Neglect (RCCAN) collaboration issues, 11.7%) faced issues related to the external organization, such as feedback and collaboration issues. Subgroup B (RCCAN collaboration and organizational issues, 5.0%) encountered challenges with both the external and internal organization, including issues with financial resources and formal agreements, resulting in the lowest implementation level. Subgroup C (Limited implementation issues, 9.4%) demonstrated relatively high ratings across determinants, achieving the highest implementation level. CPs in subgroup D (CP-client interaction issues, 37.7%) encountered challenges in CP-client interaction. CPs in subgroup E (Indifferent attitudes towards implementation, 36.1%) expressed low to average retings, were mainly from aMHC settings, and reported a low to average implementation level.

Conclusions: This study highlights the importance of tailored implementation plans to address each subgroup's specific needs and challenges, instead of employing a one-size-fits-all approach. Latent Profile Analysis successfully revealed the variations in implementation determinants among CPs in aMHC and Forensic Care settings. Tailoring implementation strategies for these subgroups is key to successful guideline implementation and enhancing the well-being of vulnerable children and families.