Implementation science communications最新文献

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.

Background: Despite many older individuals in Norway experiencing fulfilling lives, the effectiveness of local solutions for quality aging in place is inconsistent across different municipalities. To address this, White Paper No. 15, A Quality Reform for Older Adults, was introduced in Norway in 2019, targeting the challenges associated with aging in place and maintaining quality of life, irrespective of health status or location. The reform was based on recommendations from stakeholders: staff, older adults, relatives, volunteers, researchers, and leaders. This study explored how barriers, facilitators, and context interact in implementing a national aging-in-place reform and how these dynamics can inform actionable strategies for successful and context-sensitive implementation as experienced by municipal employees.

Methods: This qualitative study, utilizing a process evaluation design and the Consolidated Framework of Implementation Research (CFIR), forms part of a larger reform evaluation. This study focuses on six Norwegian municipalities of varying sizes, from three counties in central, south, and north Norway, selected due to their focus on institutional or home care and their demographics. Data was collected through focus group discussions with municipal employees (N = 36), who represent a wide range of professional backgrounds and experiences.

Results: The final analysis resulted in five main themes, structured in line with the CFIR framework: i) Policy Translation: Making Sense of the Reform in Local Context, ii) National Framing: Navigating Through Pandemic and Diversity, iii) Local Governance: The Need for a Common Implementation Platform, iv) Stakeholder Dynamics: The Importance of Interplay of Different Actors, and v) Sustainability Uncertainty: Lack of Clear Reform Responsibility. The themes provide an overview of facilitators and barriers during the reform implementation.

Conclusions: The study found that despite municipalities' diverse engagement with the reform's focus areas, there is potential for more effective implementation. Municipal employees agreed with the reform's ideas but struggled with its innovative aspects, indicating a need for clearer guidelines through top-down strategies. Facilitators were identified, but barriers such as the COVID-19 pandemic, municipal diversity, and funding issues created challenges. Insufficient leadership and inter-sector collaboration were primary obstacles. These findings are crucial for future reform implementation and service quality improvement.

Background: Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to identify and initiate treatment for alcohol and substance use in primary care settings. Among 22 public hospitals incentivized to implement SBIRT as part of a value-based Medicaid waiver program over five years, this study examined trajectories, strategies, and challenges in standardizing SBIRT within primary care.

Methods: This study utilized data from narrative reports completed by hospital leadership, obtained from the evaluation of the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program in California. Following the Multi-Level Health Outcomes Framework, template analysis was used to characterize SBIRT implementation. Content analysis was used to catalogue implementation strategies using the Expert Recommendations for Implementing Change Framework. To assess trajectories (i.e., longitudinal implementation outcomes) of SBIRT implementation, we categorized standardized adoption of sequential SBIRT processes (screening only; screening and brief intervention; screening, brief intervention, and referral to treatment) and reach (limited vs. full primary care population).

Results: Hospitals used a wide variety of measures, personnel, platforms, and workflows in screening for substance use within primary care settings. Brief intervention was conducted by primary care or behavioral health care team members who had received targeted training. Hospitals implemented a wide range of treatment options to address substance use, including referral to co-located or contracted/partnered behavioral health providers. By the end of the first implementation year, only one hospital had standardized screening processes, and none had standardized brief intervention or referral. At the end of the fifth year, 20 of 22 hospitals had standardized screening, 15 had standardized brief intervention, and 12 had standardized referral among their full primary care populations. Strategies and challenges in planning, education, and restructuring processes (e.g., integration of screening processes within electronic health records and clinical workflows) were particularly influential in facilitating implementation.

Conclusions: This study highlighted significant progress made by public hospitals in implementing standardized SBIRT processes among their primary care populations within a value-based program. However, hospitals experienced delays and challenges, highlighting key areas in which additional support or investment may be needed to sustain and promote long-term progress in SBIRT implementation.

Background: Many technologies have been developed to aid in surgical instrument counting, but wide adoption is rare. A technology that has been widely adopted around 20 years ago is the weighing scale. Lessons can be extracted from its sustainment and fidelity, and applied to the development and implementation of new laboursaving technologies in healthcare.

Methods: We conducted semi-structured interviews with experienced staff in four hospitals that use weighing systems in their surgical instrument cycle, which we analysed according to the Matrixed Multiple Case Study (MMCS) methodology. Hospitals were designated a low, medium, or high sustainment and fidelity score, after which influencing factors were identified. These factors were categorised according to the i-PARIHS domains of Innovation, Recipient, Context, and Facilitation. Within-site analysis and cross-site analysis was performed to identify influencing factors associated with a high or low level of sustainment or fidelity.

Results: All hospitals showed a high sustainment. Two hospitals showed low fidelity, and two showed high fidelity. Twenty-one total influencing factors were identified, divided among all i-PARIHS domains. All hospitals experienced similar limitations of the technology, and all hospitals showed signs of facilitation efforts during the implementation phase. In low-fidelity hospitals, interdepartmental coordination and trust in technology were limited, in contrast to high-fidelity hospitals. A large and/or complex surgical instrument inventory hindered fidelity of the weighing system.

Conclusions: 20 years after implementation, there is varying success concerning the fidelity of weighing systems for surgical instrument counting. All participating hospitals have adapted their workflow to the limitations of the technology in different ways. Given the relative straight-forwardness of weighing scales as a technology, our findings underline the complexity of implementation processes, regardless of the complexity of the innovation.

Background: Incarcerated individuals have high rates of chronic disease, which will likely increase as the prison population ages. Despite this, prison healthcare services primarily focus on infectious diseases, mental illness, and substance abuse, largely neglecting chronic physical health conditions. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program that supports self-management for people with chronic illnesses. Although numerous pilot studies of CDSMP have been conducted in correctional settings, there has been little research into efficient and effective strategies for scaling up the intervention within state corrections systems. The purpose of this project is to evaluate and develop an implementation approach to maximize the scalability of CDSMP among older adults in state correctional systems.

Methods: Guided by the Scaling up Management Framework, we will use a mixed-methods approach to assess scalability, utilizing both quantitative survey data and qualitative interviews. Study participants will include external agency leaders (n = 20), prison staff (n = 20), and incarcerated individuals (n = 20) who have been involved in CDSMP implementation within a U.S. state prison system. Data from this study will be used to develop a scale-up manual to be tested in a subsequent randomized trial. This study does not meet the World Health Organization (WHO) definition of a clinical trial.

Discussion: As the prison population continues to age, the burden of chronic disease within correctional systems will continue to increase, which contributes to skyrocketing correctional costs. Understanding how to expand evidence-based chronic disease programs within correctional systems is crucial for reducing disease-related morbidity and mortality among incarcerated individuals and for reducing costs. This line of research will identify and test scale-up strategies for chronic disease management in prisons.

Background: Police officers are exposed to potentially psychological traumatic events and are at high risk of developing post-traumatic stress injuries (PTSI). Development and wide implementation of best practices for managing PTSI are needed. The psychological first aid (PFA) framework encompasses trauma-informed knowledge to guide the development of best practices. Based on the framework and on a pilot performed among Canadian police officers, we propose a PFA program including: 1) PTSI awareness e-learning; 2) PFA training provided by local trainers; and, 3) peer-to-peer PFA intervention to mitigate PTSI in police officers. The study was designed to evaluate the feasibility and effectiveness of a large-scale PFA program implementation among Canadian police officers.

Methods: A multi-phase mixed-methods participatory action research study is being performed in five phases according to the PFA implementation and the dynamic sustainability frameworks. The program 1) was adapted to environmental needs; 2) is progressively deployed; and, to be evaluated for 3) feasibility; 4) effectiveness; and, 5) sustainability. Local trainers (N = 10) were trained to then train PFA providers (N = 322 police officers) who could then administer the intervention to police officers as needed (i.e., PFA recipients). The e-learning is being co-developed and will be disseminated. Program feasibility (i.e., acceptability, demand, practicality, implementation) will be assessed through interviews with trainers (n = 10), providers (n = 30), and recipients (n = 20). The program effectiveness will be assessed by tracking changes in PTSI literacy and stigma among officers who complete the e-learning (n = 5700) using pre-post e-learning questionnaires. Pre-post training questionnaires with participating providers (n = 175) will track perceived competence to provide the intervention. Pre-post intervention questionnaires with recipients (n = 64) will track changes in putative protective factors (i.e., professional quality of life, work safety, coping, sense of efficacy, sense of hope) and symptoms of PTSI (i.e., anxiety-, depressive-, and post-traumatic stress disorder symptoms).

Discussion: The PFA program is designed to help officers to recognize PTSI, promote self-care strategies and help-seeking, enhance organizational support, and expand psychological support. The study could provide trauma-informed guidelines for implementation and evaluation practices in high-risk and interdependent organizations and inform future directions for policy decisions.

Trial registration: The study was pre-registered on OSF ( https://osf.io/7khgs/?view_only=33260c704ffc46ffb75a704320283ccf ).

Background: The field of implementation research has recently seen much interest in equity, with a strong emphasis on recognising and responding to disparities in care. Recent studies highlight the role of macro-level processes that translate meso-level institutional behaviours to micro-level healthcare practices, and that are generative of health and care inequities. They emphasise challenges patient-centredness and underscore the need for justice-oriented intervention design to address disparities and promote equitable care.

Aim: To develop a patient-centred and justice-informed approach to the design of complex healthcare interventions and innovations in service delivery.

Method: Patient-centred Equity Design was developed in five stages. Sociological, public health, and implementation science theories explaining the generation of modifiable inequities were identified, and relevant explanatory constructs were extracted from them and organised into a determinant framework. Framework elements were then translated into (a) process models characterizing causal mechanisms of systemic inequities; (b) generative principles to guide equity- and patient-centred interventions and services; and (c) critical design questions to appraise the ways that inequities are embedded in healthcare interventions and services.

Results: Development work led to a determinant framework linking macro-level processes to meso- and micro-level healthcare inequities, and these were visualized in process models. The framework informed principles for the promotion of equitable, patient-centred interventions: fostering civility and dependability, ensuring clarity and continuity, and reducing workload and complexity. Four critical questions address relational inequalities, participation barriers, role expectations, and restitution for inequities. These were translated into proposed content for a simple appraisal tool to support the equitable design and evaluation of healthcare interventions and services.

Conclusion: Patient-centred Equity Design integrates sociology, social justice, and implementation science to create equity-focused healthcare interventions. It offers a determinant framework, process models, generative principles, and critical questions to guide design. While not a validated tool, it enhances intervention development and service delivery, with potential for future Medical Research Council Framework integration. Patient- centred Equity Design provides actionable generative design principles to centre patient and caregiver experiences within intervention development, emphasizing restitution for inequities.

Background: Integrating mental health services into primary health care (PHC) in low- and middle-income countries (LMICs) is a complex systems-change challenge that requires robust, contextually adapted frameworks. The Mental Health in Primary Care (MeHPriC) initiative in Lagos, Nigeria, aimed to scale up Mental Health Gap Action Programme (mhGAP) based task-sharing for depression, psychosis, and epilepsy. To guide this complex intervention, a participatory Theory of Change (ToC) approach was adopted as a planning, implementation, and governance tool.

Methods: Using a participatory action research design guided by the Consolidated Framework for Implementation Research (CFIR), the MeHPriC ToC was co-created over an 18-month period (2013-2014). The process involved three structured workshops, 36 stakeholder-specific consultations, and four technical working groups with over 150 participants from government, health facilities, and communities. A Community Knowledge, Attitudes, and Practices survey assessed community-level changes in mental health literacy and stigma. A mixed-methods evaluation was conducted (2014-2017) to assess implementation and clinical outcomes using the ToC as an analytical framework, with operational definitions established for key indicators.

Results: The participatory process produced a comprehensive, co-owned ToC map detailing causal pathways, assumptions, and indicators across community, facility, administrative, and state levels. Implementation outcomes included training 320 PHC workers, achieving 69.1% practice adoption and 79.6% fidelity to core protocols. This resulted in a 58.7% increase in mental health consultations and a 60.3% clinical recovery rate for depression. Community stigma remained at 20% post-intervention. A systematic analysis of implementation barriers and facilitators through CFIR domains showed distinct patterns within each domain, such as the need for cultural adaptations, involvement of religious leaders, and the use of hybrid supervision models. Key policy wins included integration of mental health indicators into the state Health Management Information System and establishment of dedicated budget lines for supervision.

Conclusion: A participatory and empirically-refined ToC approach can serve as an effective governance and implementation framework for complex health system interventions in LMIC settings. The MeHPriC experience demonstrates that this methodology guides implementation to achieve positive clinical outcomes while fostering stakeholder alignment necessary for policy integration and long-term sustainability.

Nilsen et al.'s (Implement Sci Commun 6:90, 2025) proposal to distinguish between implementation efficacy and effectiveness, and to situate implementation studies along a continuum from ideal to real-world conditions, offers a valuable conceptual advance. In this commentary, we acknowledge the contribution of their debate while highlighting potential limitations of applying a single-axis continuum to a field heavily characterized by contextual complexity. Drawing from decades of healthcare quality improvement, we argue that implementation interventions often blend efficacy-like and effectiveness-like elements, making neat classification difficult. We further suggest that oversimplification risks obscuring the realities of organizational change. Instead, we propose a double-axis model that considers both the implementation intervention and the context in which it unfolds. Economic evaluation likewise requires nuanced approaches that go beyond their proposed continuum indicator tool ("Implementation PRECIS"). To constructively extend Nilsen et al.'s contribution, we advocate for integration of the tool with existing approaches to evaluation, co-production with stakeholders, and empirical validation across diverse settings. While no implementation endeavor is ideal, advancing discourse around how efficacy and effectiveness are conceptualized can support more pragmatic, context-responsive, and sustainable improvements in healthcare.

Introduction: Out-of-hospital cardiac arrest (OHCA) poses a critical public health challenge globally, with survival rates in China being significantly lower than that in high-income countries. Delayed emergency response, low bystander Cardio Pulmonary Resuscitation (CPR) rates, and limited AED accessibility contribute to poor outcomes. Leveraging smart technology to mobilize trained volunteers via mobile applications has emerged as a promising strategy to bridge these gaps. However, in urban contexts within China, there remains a scarcity of implementation evidence encompassing aspects such as adoption, contextual barriers, and sustainability. This shortage of evidence hinders the integration of policies and systems at the policy and system levels. This study aims to improve the survival rates of OHCA patients in China, by designing, implementing and evaluating the effectiveness of an optimized "Interconnected First-Aid App" dispatching EMS volunteers through a stepped-wedge cluster randomized trial.

Methods and analysis: A stepped-wedge cluster randomized controlled trial will be conducted in 24 streets/townships across three districts in Shaoguan, China. The 24 streets/townships will be randomly assigned to four clusters, and each cluster will receive staggered interventions over 18 months, including volunteer recruitment/training, app-AED-EMS integration, and community education step by step. The trial adopts the PEDALS framework (Problem, Evidence-based Practice, Determinants, Action, Long-term, Scale) to assess both implementation processes and clinical outcomes. Primary outcomes include survival rates, bystander CPR/AED utilization, and response times. Implementation outcomes will evaluate adoption, feasibility, and sustainability through surveys, interviews, and health system data analysis. Findings will inform scalable, context-adapted implementation strategies for community-based OHCA response, particularly leveraging digital health innovations to address inequities in emergency care access in low- and middle-income settings.

Ethics and dissemination: This protocol was approved by the Biomedical Research Ethics Committee of Peking University First Hospital (2025R0017-0001). Findings will be disseminated through traditional academic pathways, including peer-reviewed publications and conference presentations, with policy briefings prepared for stakeholders and leaders at the local, provincial and national levels.

Trial registration: The study is registered with the Chinese Clinical Trial Registry under the ID ChiCTR2500101187, registered on April 21, 2025.