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Chee W, Yi JS, Im EO. Risk Groups by the Needs for Help: Asian American Breast Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:297-307. [PMID: 38421569 DOI: 10.1007/s13187-024-02411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
To supply proper and sufficient information and coaching through cancer education, it is important to decide who are risk groups among a target population. A decision tree analysis could help decide the characteristics of the risk groups. This study aimed to identify the combined characteristics of Asian American breast cancer survivors that were closely linked to high needs for help during their breast cancer survivorship process. The data on the needs for help among 185 Asian American breast cancer survivors from a parent clinical trial were included in this analysis. The instruments included the Supportive Care Needs Survey-Short Form 34 (SCNS-SF34) and multiple scales to measure the factors influencing the women's needs for help. The data were analyzed using latent profile analyses and decision tree analyses. The characteristics of the group with the highest needs for help were different depending on the types of needs. For instance, the group with the highest patient care/support needs for help score had high global symptom distress scores (cut point = 2.25) and high physical symptom distress (cut point = 1.57) and did not have regular access to health care (mean = 95.00; node 10). The findings suggest several risk groups to target in future interventions for cancer education to reduce the needs for help among this specific population. Multiple factors that could influence the needs for help among Asian American breast cancer survivors need to be considered in future intervention development for cancer education.
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Affiliation(s)
- Wonshik Chee
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Jee-Seon Yi
- Emory University, Atlanta, USA.
- Institute of Medical Sciences, College of Nursing, Gyeongsang National University, 816-15 Jinjudae-Ro, Jinju, Gyeongnam, 52727, Republic of Korea.
| | - Eun-Ok Im
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Lai J, Pilla B, Stephenson M, Brettle A, Zhou C, Li W, Li C, Fu J, Deng S, Zhang Y, Guo Z, Wu Y. Pre-treatment assessment of chemotherapy for cancer patients: a multi-site evidence implementation project of 74 hospitals in China. BMC Nurs 2024; 23:320. [PMID: 38734605 PMCID: PMC11088226 DOI: 10.1186/s12912-024-01997-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/07/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients. METHODS The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project. RESULTS Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased. CONCLUSION The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.
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Affiliation(s)
- Jie Lai
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Bianca Pilla
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Matthew Stephenson
- JBI, School of Public Health, University of Adelaide, Adelaide, Australia
| | - Alison Brettle
- School of Health & Society, University of Salford, Manchester, UK
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Chaixiu Li
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Jiaqi Fu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Shisi Deng
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yujie Zhang
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Zihan Guo
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China
- School of Nursing, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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McKee KE, Knighton AJ, Veale K, Martinez J, McCann C, Anderson JW, Wolfe D, Blackburn R, McKasson M, Bardsley T, Ofori-Atta B, Greene TH, Hoesch R, Püttgen HA, Srivastava R. Impact of Local Tailoring on Acute Stroke Care in 21 Disparate Emergency Departments: A Prospective Stepped Wedge Type III Hybrid Effectiveness-Implementation Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010477. [PMID: 38567507 PMCID: PMC11108744 DOI: 10.1161/circoutcomes.123.010477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Faster delivery of tPA (tissue-type plasminogen activator) results in better health outcomes for eligible patients with stroke. Standardization of stroke protocols in emergency departments (EDs) has been difficult, especially in nonstroke centers. We measured the effectiveness of a centrally led implementation strategy with local site tailoring to sustain adherence to an acute stroke protocol to improve door-to-needle (DTN) times across disparate EDs in a multihospital health system. METHODS Prospective, type III hybrid effectiveness-implementation cohort study measuring performance at 21 EDs in Utah and Idaho (stroke centers [4]/nonstroke centers [17]) from January 2018 to February 2020 using a nonrandomized stepped-wedge design, monthly repeated site measures and multilevel hierarchical modeling. Each site received the implementation strategies in 1 of 6 steps providing control and intervention data. Co-primary outcomes were percentage of DTN times ≤60 minutes and median DTN time. Secondary outcomes included percentage of door-to-activation of neurological consult times ≤10 minutes and clinical effectiveness outcomes. Results were stratified between stroke and nonstroke centers. RESULTS A total of 855 474 ED patient encounters occurred with 5325 code stroke activations (median age, 69 [IQR, 56-79] years; 51.8% female patients]. Percentage of door-to-activation times ≤10 minutes increased from 47.5% to 59.9% (adjusted odds ratio, 1.93 [95% CI, 1.40-2.67]). A total of 615 patients received tPA of ≤3 hours from symptom onset (median age, 71 [IQR, 58-80] years; 49.6% female patients). The percentage of DTN times ≤60 minutes increased from 72.5% to 86.1% (adjusted odds ratio, 3.38, [95% CI, 1.47-7.78]; stroke centers (77.4%-90.0%); nonstroke centers [59.3%-72.1%]). Median DTN time declined from 46 to 38 minutes (adjusted median difference, -9.68 [95% CI, -17.17 to -2.20]; stroke centers [41-35 minutes]; nonstroke centers [55-52 minutes]). No differences were observed in clinical effectiveness outcomes. CONCLUSIONS A centrally led implementation strategy with local site tailoring led to faster delivery of tPA across disparate EDs in a multihospital system with no change in clinical effectiveness outcomes including rates of complication. Disparities in performance persisted between stroke and nonstroke centers.
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Affiliation(s)
- Kathleen E McKee
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Health, Salt Lake City, UT
| | - Kristy Veale
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - Julie Martinez
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - Cory McCann
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | | | - Doug Wolfe
- Healthcare Delivery Institute, Intermountain Health, Salt Lake City, UT
| | - Rob Blackburn
- Continuous Improvement, Intermountain Health, Salt Lake City, UT
| | - Marilyn McKasson
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - Tyler Bardsley
- Division of Biostatistics, School of Medicine, University of Utah, Salt Lake City, UT
| | - Blessing Ofori-Atta
- Division of Biostatistics, School of Medicine, University of Utah, Salt Lake City, UT
| | - Tom H Greene
- Division of Biostatistics, School of Medicine, University of Utah, Salt Lake City, UT
| | - Robert Hoesch
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - H Adrian Püttgen
- Neurosciences Clinical Program, Intermountain Health, Salt Lake City, UT
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Health, Salt Lake City, UT
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, UT
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Caltabiano P, Bailie J, Laycock A, Shea B, Dykgraaf SH, Lennox N, Ekanayake K, Bailie R. Identifying barriers and facilitators to primary care practitioners implementing health assessments for people with intellectual disability: a Theoretical Domains Framework-informed scoping review. Implement Sci Commun 2024; 5:39. [PMID: 38627849 PMCID: PMC11020327 DOI: 10.1186/s43058-024-00579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION People with intellectual disability experience poorer health outcomes compared with the general population, partly due to the difficulties of accessing preventive care in primary care settings. There is good evidence that structured annual health assessments can enhance quality of care for people with intellectual disability, and their use has become recommended policy in several high-income countries. However, uptake remains low. The Theoretical Domains Framework (TDF) offers a conceptual structure for understanding barriers to implementation and has been usefully applied to inform implementation of health assessments for other high-need groups, but not for people with intellectual disability. We conducted a scoping review of the literature, using the TDF, to identify barriers and facilitators influencing primary care practitioners' implementation of annual health assessments for people with intellectual disability as part of routine primary care practice. METHODS This study was conducted according to the JBI methodological approach for scoping reviews. Searches were conducted in Medline (OVID-SP), Embase (OVID-SP), PsycINFO (OVID-SP), CINHAL (EBSCO), Scopus (Elsevier) and Web of Science (Clarivate) for relevant peer-reviewed publications up to May 2023. Screening, full-text review and data extraction were completed by two independent reviewers. Data were extracted and mapped to the TDF to identify relevant barriers and facilitators. RESULTS The search yielded 1057 publications, with 21 meeting the inclusion criteria. Mapping data to the TDF, the most frequently identified domains were (a) environmental context and resources, (b) skills, (c) knowledge and (d) emotion. Predominant factors impacting on implementation included practitioners' lack of awareness about health assessments and their identified benefits; inadequate training and experience by practitioners in the delivery of health assessments for people with intellectual disability; insufficient time to provide health assessments; and practitioner burnout. CONCLUSION Using a theory-informed behavioural framework, our review aids understanding of the barriers and facilitators to improving the implementation of health assessments as part of routine care for people with intellectual disability. However, there is a clear need for further qualitative research to examine the perceptions of primary care practitioners regarding implementation barriers and facilitators to health assessments in general, including views from practitioners who are not currently undertaking health assessments.
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Affiliation(s)
- Paul Caltabiano
- School of Rural Health, The University of Sydney, Dubbo, Australia
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, Australia.
- Centre for Disability Research and Policy, The University of Sydney, Camperdown, Australia.
| | - Alison Laycock
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Bradley Shea
- Sydney Medical School, The University of Sydney, Camperdown, Australia
- University Centre for Rural Health, The University of Sydney, Lismore, Australia
| | - Sally Hall Dykgraaf
- Rural Clinical School, Australian National University, ACT, Canberra, Australia
| | - Nicholas Lennox
- Queensland Centre for Intellectual and Developmental Disability, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Kanchana Ekanayake
- University of Sydney Library, The University of Sydney, Camperdown, Australia
| | - Ross Bailie
- School of Public Health, The University of Sydney, Camperdown, Australia
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Meng M, Hu J, Liu X, Tian M, Lei W, Liu E, Han Z, Li Q, Chen Y. Barriers and facilitators to guideline for the management of pediatric off-label use of drugs in China: a qualitative descriptive study. BMC Health Serv Res 2024; 24:435. [PMID: 38580958 PMCID: PMC10998389 DOI: 10.1186/s12913-024-10860-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Despite being a global public health concern, there is a research gap in analyzing implementation strategies for managing off-label drug use in children. This study aims to understand professional health managers' perspectives on implementing the Guideline in hospitals and determine the Guideline's implementation facilitators and barriers. METHODS Pediatric directors, pharmacy directors, and medical department directors from secondary and tertiary hospitals across the country were recruited for online interviews. The interviews were performed between June 27 and August 25, 2022. The Consolidated Framework for Implementation Research (CFIR) was adopted for data collection, data analysis, and findings interpretation to implement interventions across healthcare settings. RESULTS Individual interviews were conducted with 28 healthcare professionals from all over the Chinese mainland. Key stakeholders in implementing the Guideline for the Management of Pediatric Off-Label Use of Drugs in China (2021) were interviewed to identify 57 influencing factors, including 27 facilitators, 29 barriers, and one neutral factor, based on the CFIR framework. The study revealed the complexity of the factors influencing managing children's off-label medication use. A lack of policy incentives was the key obstacle in external settings. The communication barrier between pharmacists and physicians was the most critical internal barrier. CONCLUSION To our knowledge, this study significantly reduces the implementation gap in managing children's off-label drug use. We provided a reference for the standardized management of children's off-label use of drugs.
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Affiliation(s)
- Min Meng
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Jiale Hu
- Department of Nurse Anesthesia, Virginia Commonwealth University, Richmond, USA
| | - Xiao Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Min Tian
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Wenjuan Lei
- Department of Pharmacy, Gansu Provincial Hospital, Lanzhou, China
| | - Enmei Liu
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhu Han
- College of Pharmacy, Gansu University of Chinese Medicine, Lanzhou, China
| | - Qiu Li
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Department of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Yaolong Chen
- Chevidence Lab of Child & Adolescent Health, Children's Hospital of Chongqing Medical University, Chongqing, China.
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, China.
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences(2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
- Lanzhou University GRADE Center, Lanzhou, China.
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Sideris K, Weir CR, Schmalfuss C, Hanson H, Pipke M, Tseng PH, Lewis N, Sallam K, Bozkurt B, Hanff T, Schofield R, Larimer K, Kyriakopoulos CP, Taleb I, Brinker L, Curry T, Knecht C, Butler JM, Stehlik J. Artificial intelligence predictive analytics in heart failure: results of the pilot phase of a pragmatic randomized clinical trial. J Am Med Inform Assoc 2024; 31:919-928. [PMID: 38341800 PMCID: PMC10990545 DOI: 10.1093/jamia/ocae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVES We conducted an implementation planning process during the pilot phase of a pragmatic trial, which tests an intervention guided by artificial intelligence (AI) analytics sourced from noninvasive monitoring data in heart failure patients (LINK-HF2). MATERIALS AND METHODS A mixed-method analysis was conducted at 2 pilot sites. Interviews were conducted with 12 of 27 enrolled patients and with 13 participating clinicians. iPARIHS constructs were used for interview construction to identify workflow, communication patterns, and clinician's beliefs. Interviews were transcribed and analyzed using inductive coding protocols to identify key themes. Behavioral response data from the AI-generated notifications were collected. RESULTS Clinicians responded to notifications within 24 hours in 95% of instances, with 26.7% resulting in clinical action. Four implementation themes emerged: (1) High anticipatory expectations for reliable patient communications, reduced patient burden, and less proactive provider monitoring. (2) The AI notifications required a differential and tailored balance of trust and action advice related to role. (3) Clinic experience with other home-based programs influenced utilization. (4) Responding to notifications involved significant effort, including electronic health record (EHR) review, patient contact, and consultation with other clinicians. DISCUSSION Clinician's use of AI data is a function of beliefs regarding the trustworthiness and usefulness of the data, the degree of autonomy in professional roles, and the cognitive effort involved. CONCLUSION The implementation planning analysis guided development of strategies that addressed communication technology, patient education, and EHR integration to reduce clinician and patient burden in the subsequent main randomized phase of the trial. Our results provide important insights into the unique implications of implementing AI analytics into clinical workflow.
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Affiliation(s)
- Konstantinos Sideris
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Charlene R Weir
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Carsten Schmalfuss
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Heather Hanson
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Matt Pipke
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Po-He Tseng
- PhysIQ, Inc., Chicago, IL 60563, United States
| | - Neil Lewis
- Cardiology Section, Medical Service, Hunter Holmes McGuire Veterans Medical Center, Richmond, VA 23249, United States
- Department of Internal Medicine, Division of Cardiovascular Disease, Virginia Commonwealth University, Richmond, VA 23249, United States
| | - Karim Sallam
- Cardiology Section, Medical Service, VA Palo Alto Health Care System, Palo Alto, CA 94304, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Biykem Bozkurt
- Cardiology Section, Medical Service, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Thomas Hanff
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Richard Schofield
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | | | - Christos P Kyriakopoulos
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Iosif Taleb
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Lina Brinker
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
| | - Tempa Curry
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Cheri Knecht
- Cardiology Section, Medical Service, Malcom Randall VA Medical Center, Gainesville, FL 32608, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Florida College of Medicine, Gainesville, FL 32610, United States
| | - Jorie M Butler
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT 84108, United States
| | - Josef Stehlik
- Cardiology Section, Medical Service, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, United States
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, UT 84112, United States
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Moore SA, Cooper JM, Malloy J, Lyon AR. Core Components and Implementation Determinants of Multilevel Service Delivery Frameworks Across Child Mental Health Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:172-195. [PMID: 38117431 PMCID: PMC10850020 DOI: 10.1007/s10488-023-01320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
Multilevel service delivery frameworks are approaches to structuring and organizing a spectrum of evidence-based services and supports, focused on assessment, prevention, and intervention designed for the local context. Exemplar frameworks in child mental health include positive behavioral interventions and supports in education, collaborative care in primary care, and systems of care in community mental health settings. Yet, their high-quality implementation has lagged. This work proposes a conceptual foundation for multilevel service delivery frameworks spanning diverse mental health service settings that can inform development of strategic implementation supports. We draw upon the existing literature for three exemplar multilevel service delivery frameworks in different child mental health service settings to (1) identify core components common to each framework, and (2) to highlight prominent implementation determinants that interface with each core component. Six interrelated components of multilevel service delivery frameworks were identified, including, (1) a systems-level approach, (2) data-driven problem solving and decision-making, (3) multiple levels of service intensity using evidence-based practices, (4) cross-linking service sectors, (5) multiple providers working together, including in teams, and (6) built-in implementation strategies that facilitate delivery of the overall model. Implementation determinants that interface with core components were identified at each contextual level. The conceptual foundation provided in this paper has the potential to facilitate cross-sector knowledge sharing, promote generalization across service settings, and provide direction for researchers, system leaders, and implementation intermediaries/practitioners working to strategically support the high-quality implementation of these frameworks.
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Affiliation(s)
- Stephanie A Moore
- School of Education, University of California Riverside, Riverside, CA, 92521, USA.
| | | | - JoAnne Malloy
- Institute on Disability, College of Health and Human Services, University of New Hampshire, Durham, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
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Ingram L, Pitt R, Shrubsole K. Health professionals' practices and perspectives of post-stroke coordinated discharge planning: a national survey. BRAIN IMPAIR 2024; 25:IB23092. [PMID: 38566295 DOI: 10.1071/ib23092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Background It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals' practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers. Methods A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis. Results Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family . The main perceived barriers were the socio-political context and health professionals' beliefs about capabilities . The main perceived facilitators were health professionals' social/professional role and identity, knowledge, and intentions . The organisation domain was perceived as both a barrier and facilitator to CDP. Conclusion Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.
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Affiliation(s)
- Lara Ingram
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia; and Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia; and Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia
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10
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Stewart C, Power E, McCluskey A, Kuys S, Lovarini M. Implementing ward-based practice books to increase the amount of practice completed during inpatient stroke rehabilitation: a mixed-methods process evaluation. Disabil Rehabil 2024:1-11. [PMID: 38386409 DOI: 10.1080/09638288.2024.2315502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. METHODS Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. RESULTS Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. CONCLUSIONS Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books.
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Affiliation(s)
- Claire Stewart
- Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia
| | - Emma Power
- The University of Technology Sydney, Graduate School of Health, Sydney, Australia
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Annie McCluskey
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Sydney, Australia
| | - Suzanne Kuys
- School of Allied Health, Australian Catholic University, Banyo, Australia
| | - Meryl Lovarini
- Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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11
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Lin FF, Murphy N, Martinez A, Marshall AP. Facilitators and barriers to evidence-based practice in central venous access device insertion and management in an intensive care unit: A qualitative study. Intensive Crit Care Nurs 2024; 80:103553. [PMID: 37783178 DOI: 10.1016/j.iccn.2023.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/27/2023] [Accepted: 09/16/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Research evidence and clinical practice guidelines exist on preventing central line-associated bloodstream infections. However, there is limited knowledge about the barriers and facilitators to evidence-based central venous access device care. AIM The aim of this study was to investigate the facilitators and barriers to evidence-based central venous access device care in the adult intensive care setting. METHOD This exploratory qualitative study involved focus groups and interviews with registered nurses and physicians involved in central venous access device insertion and management in a tertiary Australian intensive care unit. Purposive sampling was used to recruit staff (n = 26) with varying years of clinical experience and clinical positions. Six focus groups and three individual interviews were conducted. Interviews were audio recorded, transcribed verbatim and analysed using content analysis. RESULTS Three overarching categories emerged: work structures to support optimal performance; processes to optimise quality of care, and factors influencing staff members' behaviour. Perceived facilitators to optimal central venous access device care included explicit language use in procedure documents, work-system integrated strategies, research evidence dissemination, audit, and feedback. However, there was a lack of consistency in practices such as audit, feedback, and patient participation. CONCLUSION To bring about effective improvement in central venous access device care, future interventions should be tailored to address identified barriers, including integrating audit and feedback into clinicians' work processes. Additionally, future research is needed to explore the role of patients and their families in central venous access device care. IMPLICATIONS FOR CLINICAL PRACTICE When developing practice policies or procedure manuals, it is important to use explicit language to ensure clear communication of evidence-based recommendations to clinicians. Strategies integrated into work processes can enhance adherence to evidence-based practice. Large departments with limited educators should explore innovative methods like online education to ensure optimal central venous access device care.
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Affiliation(s)
- Frances Fengzhi Lin
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, South Australia, Australia; School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Health, University of the Sunshine Coast, Queensland, Australia; Sunshine Coast Health Institute, Queensland, Australia.
| | - Niki Murphy
- Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Angelly Martinez
- Intensive Care Unit, Gold Coast University Hospital, Queensland Health, Queensland, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia; Gold Coast Hospital and Health Service, Queensland, Australia
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12
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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024. [PMID: 38291546 DOI: 10.1111/jocn.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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13
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Moniz A, Duarte ST, Aguiar P, Caeiro C, Pires D, Fernandes R, Moço D, Marques MM, Sousa R, Canhão H, Branco J, Rodrigues AM, Cruz EB. Physiotherapists' barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice in patients at risk of recurrence of low back pain: a qualitative study. BMC PRIMARY CARE 2024; 25:39. [PMID: 38279123 PMCID: PMC10811813 DOI: 10.1186/s12875-024-02274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/12/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists' perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. METHODS Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. RESULTS In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists' implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. CONCLUSIONS This study identified modifiable barriers and facilitators to physiotherapists' implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.
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Affiliation(s)
- Alexandre Moniz
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal.
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal.
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal.
| | - Susana T Duarte
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Pedro Aguiar
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carmen Caeiro
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pires
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rita Fernandes
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Moço
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
| | - Marta M Marques
- Comprehensive Health Research Center (CHRC), National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
- National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rute Sousa
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jaime Branco
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Reumatologia Do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Lisbon, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center (CHRC), NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade NOVA de Lisboa, Lisbon, Portugal
- EpiDoc Unit, NOVA Medical School|Faculdade de Ciências Médicas, NMS|FCM, Universidade Nova de Lisboa, Lisbon, Portugal
- Serviço de Reumatologia Do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental (CHLO), Lisbon, Portugal
- Rheumatology Unit, Hospital Dos Lusíadas, Lisbon, Portugal
| | - Eduardo B Cruz
- Departamento de Fisioterapia, Escola Superior de Saúde, Instituto Politécnico de Setúbal, Setúbal, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal
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Bjerk M, Flottorp SA, Pripp AH, Øien H, Hansen TM, Foy R, Close J, Linnerud S, Brovold T, Solli R, Olsen NR, Skelton DA, Rydwik E, Helbostad JL, Idland G, Kvæl L, Vieira E, Taraldsen K. Tailored implementation of national recommendations on fall prevention among older adults in municipalities in Norway (FALLPREVENT trial): a study protocol for a cluster-randomised trial. Implement Sci 2024; 19:5. [PMID: 38273325 PMCID: PMC10811923 DOI: 10.1186/s13012-024-01334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite substantial research evidence indicating the effectiveness of a range of interventions to prevent falls, uptake into routine clinical practice has been limited by several implementation challenges. The complexity of fall prevention in municipality health care underlines the importance of flexible implementation strategies tailored both to general determinants of fall prevention and to local contexts. This cluster-randomised trial (RCT) investigates the effectiveness of a tailored intervention to implement national recommendations on fall prevention among older home-dwelling adults compared to usual practice on adherence to the recommendations in health professionals. METHODS Twenty-five municipalities from four regions in Norway will be randomised to intervention or control arms. Each municipality cluster will recruit up to 30 health professionals to participate in the study as responders. The tailored implementation intervention comprises four components: (1) identifying local structures for implementation, (2) establishing a resource team from different professions and levels, (3) promoting knowledge on implementation and fall prevention and (4) supporting the implementation process. Each of these components includes several implementation activities. The Consolidated Framework for Implementation Research (CFIR) will be used to categorise determinants of the implementation process and the Expert Recommendations for Implementing Change (ERIC) will guide the matching of barriers to implementation strategies. The primary outcome measure for the study will be health professionals' adherence to the national recommendations on fall prevention measured by a questionnaire. Secondary outcomes include injurious falls, the feasibility of the intervention, the experiences of the implementation process and intervention costs. Measurements will be carried out at baseline in August 2023, post-intervention in May 2024 and at a follow-up in November 2024. DISCUSSION This study will provide evidence on the effectiveness, intervention costs and underlying processes of change of tailored implementation of evidence-based fall prevention recommendations. TRIAL REGISTRATION The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/JQ9T5 . Registered: March 03, 2023.
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Affiliation(s)
- Maria Bjerk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway.
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | - Signe A Flottorp
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Henning Øien
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Tonya Moen Hansen
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Jacqueline Close
- Neuroscience Research Australia, Randwick, NSW, Australia
- Prince of Wales Hospital, SESLHD, Randwick, NSW, Australia
| | - Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Rune Solli
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Nina Rydland Olsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Elisabeth Rydwik
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Solna, Sweden
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health, NTNU, Trondheim, Norway
| | - Gro Idland
- Agency for Health, Municipality of Oslo, Oslo, Norway
| | - Linda Kvæl
- Department of Housing and Ageing Research, Norwegian Social Research - NOVA, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Edgar Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
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Saha A, Mandal B, Muhammad T, Ali W. Decomposing the rural-urban differences in depression among multimorbid older patients in India: evidence from a cross-sectional study. BMC Psychiatry 2024; 24:60. [PMID: 38254089 PMCID: PMC10804604 DOI: 10.1186/s12888-023-05480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND In India, the prevalence of depression among older adults dealing with multiple health conditions varies between rural and urban areas due to disparities in healthcare access and cultural factors. The distinct patterns observed underscore the necessity for tailored research and interventions to address mental health inequalities among multimorbid older patients in diverse geographic contexts. METHODS This study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total of 7,608 adults aged ≥ 60 years who were diagnosed with two or more chronic conditions (such as hypertension, diabetes, cancer, chronic lung disease, chronic heart diseases, stroke, bone/joint disease, any neurological or psychiatric diseases, and high cholesterol) were included in this study. Descriptive statistics, bivariate analysis, logistic regression estimates, and Fairlie decomposition method were used to accomplish the study's objectives. RESULTS The prevalence of depression among older adults with multimorbidity was 9.48% higher in rural areas (38.33%) than in urban areas (28.85%).. Older adults with multimorbidity belonging to the scheduled caste group were 40% more likely to experience depression. Moreover, those with multimorbidity and any form of disability in activities of daily living (ADL) were 93% more likely to experience depression than those without disability, whereas those with multimorbidity and perceived good general health were 65% less likely to suffer from depression than those with poor self-perceived health. Additionally, decomposition analysis revealed that education (35.99%), caste status (10.30%), IADL disability (19.30%), and perceived discrimination (24.25%) were the primary factors contributing to the differences in depression prevalence among older adults with multimorbidity between rural and urban areas. CONCLUSIONS We found significant rural-urban differences in depression among older Indians with multimorbidity. The findings underscore the need for targeted interventions that address the unique challenges faced by older patients in rural areas, including lack of social capital, discrimination, and limited resources that enable access to healthcare services. Policymakers and healthcare professionals must collaboratively design and implement effective strategies to improve the mental health and overall well-being of rural older adults, particularly those with multiple comorbidities.
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Affiliation(s)
- Amiya Saha
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Bittu Mandal
- School of Humanities and Social Sciences, Indian Institute of Technology, Indore, 453552, India
| | - T Muhammad
- Center for Healthy Aging, The Pennsylvania State University, University park, 16802, USA
| | - Waad Ali
- Department of Geography, Sultan Qaboos University, Muscat, 123, Oman
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16
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Woodward EN, Castillo AIM, True G, Willging C, Kirchner JE. Challenges and promising solutions to engaging patients in healthcare implementation in the United States: an environmental scan. BMC Health Serv Res 2024; 24:29. [PMID: 38178131 PMCID: PMC10768202 DOI: 10.1186/s12913-023-10315-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND One practice in healthcare implementation is patient engagement in quality improvement and systems redesign. Implementers in healthcare systems include clinical leadership, middle managers, quality improvement personnel, and others facilitating changes or adoption of new interventions. Patients provide input into different aspects of health research. However, there is little attention to involve patients in implementing interventions, especially in the United States (U.S.), and this might be essential to reduce inequities. Implementers need clear strategies to overcome challenges, and might be able to learn from countries outside the U.S. METHODS We wanted to understand existing work about how patients are being included in implementation activities in real world U.S. healthcare settings. We conducted an environmental scan of three data sources: webinars, published articles, and interviews with implementers who engaged patients in implementation activities in U.S. healthcare settings. We extracted, categorized, and triangulated from data sources the key activities, recurring challenges, and promising solutions using a coding template. RESULTS We found 27 examples of patient engagement in U.S. healthcare implementation across four webinars, 11 published articles, and seven interviews, mostly arranging patient engagement through groups and arranging processes for patients that changed how engaged they were able to be. Participants rarely specified if they were engaging a population experiencing healthcare inequities. Participants described eight recurring challenges; the two most frequently identified were: (1) recruiting patients representative of those served in the healthcare system; and (2) ensuring processes for equitable communication among all. We matched recurring challenges to promising solutions, such as logistic solutions on how to arrange meetings to enhance engagement or training in inclusivity and power-sharing. CONCLUSION We clarified how some U.S. implementers are engaging patients in healthcare implementation activities using less and more intensive engagement. It was unclear whether reducing inequities was a goal. Patient engagement in redesigning U.S. healthcare service delivery appears similar to or less intense than in countries with more robust infrastructure for this, such as Canada and the United Kingdom. Challenges were common across jurisdictions, including retaining patients in the design/delivery of implementation activities. Implementers in any region can learn from those in other places.
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Affiliation(s)
- Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA.
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
| | - Andrea Isabel Melgar Castillo
- VA Center for Mental Healthcare and Outcomes Research, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
- Graduate School, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
| | - Gala True
- South Central Mental Illness Research Education and Clinical Center, Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA
- Section on Community and Population Medicine, School of Medicine, Louisiana State University, 2400 Canal St (11F), New Orleans, LA, USA
| | - Cathleen Willging
- Pacific Institute for Research and Evaluation, 851 University Boulevard, Suite 101, Albuquerque, NM, 87106, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA
- Behavioral Health Quality Enhancement Research Initiative (QUERI), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, Building 11, North Little Rock, AR, 72114, USA
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Lopez CJ, Jones JM, Campbell KL, Bender JL, Strudwick G, Langelier DM, Reiman T, Greenland J, Neil-Sztramko SE. A pre-implementation examination of barriers and facilitators of an electronic prospective surveillance model for cancer rehabilitation: a qualitative study. BMC Health Serv Res 2024; 24:17. [PMID: 38178095 PMCID: PMC10768357 DOI: 10.1186/s12913-023-10445-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND An electronic Prospective Surveillance Model (ePSM) uses patient-reported outcomes to monitor symptoms along the cancer pathway for timely identification and treatment. Randomized controlled trials show that ePSMs can effectively manage treatment-related adverse effects. However, an understanding of optimal approaches for implementing these systems into routine cancer care is limited. This study aimed to identify barriers and facilitators prior to the implementation of an ePSM to inform the selection of implementation strategies. METHODS A qualitative study using virtual focus groups and individual interviews was conducted with cancer survivors, oncology healthcare providers, and clinic leadership across four cancer centres in Canada. The Consolidated Framework for Implementation Research (CFIR) guided the interviews and analysis of barriers and facilitators based on five domains (intervention characteristics, individual characteristics, inner setting, outer setting, and process). RESULTS We conducted 13 focus groups and nine individual interviews with 13 patient participants and 56 clinic staff. Of the 39 CFIR constructs, 18 were identified as relevant determinants to the implementation. The adaptability, relative advantage, and complexity of an ePSM emerged as key intervention-level factors that could influence implementation. Knowledge of the system was important at the individual level. Within the inner setting, major determinants were the potential fit of an ePSM with clinical workflows (compatibility) and the resources that could be dedicated to the implementation effort (readiness for implementation). In the outer setting, meeting the needs of patients and the availability of rehabilitation supports were key determinants. Engaging various stakeholders was critical at the process level. CONCLUSIONS Improving the implementation of ePSMs in routine cancer care has the potential to facilitate early identification and management of treatment-related adverse effects, thereby improving quality of life. This study provides insight into important factors that may influence the implementation of an ePSM, which can be used to select appropriate implementation strategies to address these factors.
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Affiliation(s)
- Christian J Lopez
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
| | - Jennifer M Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Jackie L Bender
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - David M Langelier
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Tony Reiman
- Department of Oncology, Saint John Regional Hospital, Saint John, Canada
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Jonathan Greenland
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Canada
- Dr. H. Bliss Murphy Cancer Centre, Eastern Health, St. John's, Canada
| | - Sarah E Neil-Sztramko
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, McMaster University, Hamilton, Canada
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Hubeishy MH, Rolving N, Poulsen AG, Jensen TS, Rossen CB. Barriers to the use of clinical practice guidelines: a qualitative study of Danish physiotherapists and chiropractors. Disabil Rehabil 2024; 46:105-114. [PMID: 36537245 DOI: 10.1080/09638288.2022.2157501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Low back pain (LBP) is the leading cause of disability worldwide. Providing evidence-based practice (EBP) for patients with LBP is more cost-effective compared with non-EBP. To help health care professionals provide EBP, several clinical practice guidelines have been published. However, a relatively poor uptake of the guidelines has been identified across various countries. To enhance future implementation of EBP, the aim of this study was to explore barriers to using LBP guidelines in clinical practice. MATERIALS AND METHODS A qualitative constructivist grounded theory design was employed in order to gain an in-depth understanding of the barriers. Semi-structured interviews (+/- observations) of nine physiotherapists and nine chiropractors from primary care in the Central Denmark Region were conducted. RESULTS Two key barriers were found to using guidelines in practice: (1) a scepticism due to doubts about validity and applicability of the guidelines, which emerged particularly among physiotherapists; and (2) a deep biomechanical professional identity, due to perceived role, interest, lack of skills, and patient preferences, which emerged particularly among chiropractors. CONCLUSIONS For guidelines to be better implemented in practice, these key barriers must be addressed in a tailored strategy. Furthermore, this study showed a difference in barriers between the two professions.
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Affiliation(s)
- Maja Husted Hubeishy
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Nanna Rolving
- Department of Physiotherapy and Occupational Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anne Grøndahl Poulsen
- DEFACTUM, Public Health and Rehabilitation Research, Central Region Denmark, Aarhus, Denmark
| | - Tue Secher Jensen
- Diagnostic Center - Imaging Section, Silkeborg Regional Hospital, Silkeborg, Denmark
- Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Camilla Blach Rossen
- Interdisciplinary Research Unit, Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Batterham P, Allenhof C, Cerga Pashoja A, Etzelmueller A, Fanaj N, Finch T, Freund J, Hanssen D, Mathiasen K, Piera Jiminez J, Qirjako G, Rapley T, Sacco Y, Samalin L, Schuurmans J, van Genugten C, Vis C. Psychometric properties of two implementation measures: Normalization MeAsure Development questionnaire (NoMAD) and organizational readiness for implementing change (ORIC). IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241245448. [PMID: 38686322 PMCID: PMC11057218 DOI: 10.1177/26334895241245448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background Effective interventions need to be implemented successfully to achieve impact. Two theory-based measures exist for measuring the effectiveness of implementation strategies and monitor implementation progress. The Normalization MeAsure Development questionnaire (NoMAD) explores the four core concepts (Coherence, Cognitive Participation, Collective Action, Reflexive Monitoring) of the Normalization Process Theory. The Organizational Readiness for Implementing Change (ORIC) is based on the theory of Organizational Readiness for Change, measuring organization members' psychological and behavioral preparedness for implementing a change. We examined the measurement properties of the NoMAD and ORIC in a multi-national implementation effectiveness study. Method Twelve mental health organizations in nine countries implemented Internet-based cognitive behavioral therapy (iCBT) for common mental disorders. Staff involved in iCBT service delivery (n = 318) participated in the study. Both measures were translated into eight languages using a standardized forward-backward translation procedure. Correlations between measures and subscales were estimated to examine convergent validity. The theoretical factor structures of the scales were tested using confirmatory factor analysis (CFA). Test-retest reliability was based on the correlation between scores at two time points 3 months apart. Internal consistency was assessed using Cronbach's alpha. Floor and ceiling effects were quantified using the proportion of zero and maximum scores. Results NoMAD and ORIC measure related but distinct latent constructs. The CFA showed that the use of a total score for each measure is appropriate. The theoretical subscales of the NoMAD had adequate internal consistency. The total scale had high internal consistency. The total ORIC scale and subscales demonstrated high internal consistency. Test-retest reliability was suboptimal for both measures and floor and ceiling effects were absent. Conclusions This study confirmed the psychometric properties of the NoMAD and ORIC in multi-national mental health care settings. While measuring on different but related aspects of implementation processes, the NoMAD and ORIC prove to be valid and reliable across different language settings.
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Affiliation(s)
- P. Batterham
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Caroline Allenhof
- German Foundation for Research and Education on Depression, Leipzig, Germany
| | - Arlinda Cerga Pashoja
- London School of Hygiene & Tropical Medicine, London, UK
- St. Marys University Twickenham, UK
| | - A. Etzelmueller
- HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Hamburg, Germany
- Department Health and Sport Sciences, Technical University of Munich, School of Medicine and Health, Professorship Psychology & Digital Mental Health Care, München, Germany
| | - N. Fanaj
- Alma Mater Europaea Campus College Rezonanca, Pristina, Kosovo
| | - T. Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - J. Freund
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Professorship Psychology and Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - D. Hanssen
- Interdisciplinary Centre Psychopathology and Emotion Regulation, University Medical Centre Groningen, Groningen, Netherlands
| | - K. Mathiasen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Digital Psychiatry, Lillebaelt Hospital – University Hospital of Southern Denmark, Vejle, Denmark
| | - Jordi Piera Jiminez
- Government of Catalonia Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
| | - G. Qirjako
- Department of Public Health, University of Medicine of Tirana, Tirane, Albania
- Community Centre for Health and Wellbeing, Tirane, Albania
| | - T. Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Y. Sacco
- Fondazione Don Carlo Gnocchi, Presidio Ausiliatrice S. Maria ai Colli, Torino, Italy
| | - L. Samalin
- Department of Psychiatry, CHU Clermont-Ferrand, University of Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | | | - Claire van Genugten
- Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - C. Vis
- Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Public and Occupational Health, Amsterdam University Medical Center, Amsterdam, Netherlands
- Forhelse Research Centre for Digital Mental Health Services Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Horgan S, Drennan J, Andrews E, Saab MM, Hegarty J. Healthcare professionals' knowledge and attitudes towards surgical site infection and surveillance: A quasi-experimental study. Nurs Open 2024; 11:e2048. [PMID: 38268293 PMCID: PMC10697123 DOI: 10.1002/nop2.2048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/23/2023] [Accepted: 10/23/2023] [Indexed: 01/26/2024] Open
Abstract
AIM SSI is one of the most prevalent healthcare-associated infections and is associated with extended hospital stays, increased need for reoperation and higher hospital readmission rates. Implementing systematic SSI surveillance can reduce these adverse outcomes. Implementing a surveillance system into a hospital is a complex intervention requiring that staff involved in a patient's perioperative journey have the knowledge of SSI prevention, the data required for surveillance, an understanding of how data informs quality improvement initiatives and their role in surveillance. The aim of this study was to evaluate the impact of a complex intervention on the knowledge and attitudes of healthcare professionals towards surgical site infection (SSI), SSI prevention and surveillance in a university hospital setting. DESIGN The study used a quasi-experimental pre-test-post-test design. METHOD The impact of a complex intervention was evaluated by measuring healthcare professionals' (n = 74) knowledge of and attitudes towards SSI and surveillance. Normalisation process theory (NPT) guided the study and the development of the intervention. RESULTS There was a statistically significant increase in scores on the knowledge of SSI and prevention from pre-intervention to post-test. The knowledge of risk factors scores at post-test was significantly higher than that at pre-intervention. Overall attitudes to SSI prevention and surveillance were good both pre-intervention and post-test but there was a significant change in the attitude of participants. The findings reveal an overall positive impact of the complex intervention on the knowledge and attitude of healthcare professionals relating to SSI, SSI prevention and surveillance; however, the extent of the change varied across items measured.
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Affiliation(s)
- Sinéad Horgan
- Department of Nursing and MidwiferySouth/South West Hospitals Group, ErinvilleCorkIreland
| | - Jonathan Drennan
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
| | - Emmet Andrews
- Department of SurgeryCork University HospitalCorkIreland
| | - Mohamad M. Saab
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
| | - Josephine Hegarty
- School of Nursing and Midwifery, College of Medicine and HealthUniversity College CorkCorkIreland
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21
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Christie LJ, Rendell R, McCluskey A, Fearn N, Hunter A, Lovarini M. Development of a behaviour change intervention to increase the delivery of upper limb constraint-induced movement therapy programs to people with stroke and traumatic brain injury. Disabil Rehabil 2023:1-12. [PMID: 38131636 DOI: 10.1080/09638288.2023.2290686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Purpose: Constraint-induced movement therapy (CIMT) is a recommended intervention for arm recovery after acquired brain injury but is underutilised in practice. The purpose of this study is to describe the development of a behaviour change intervention targeted at therapists, to increase delivery of CIMT.Methods: A theoretically-informed approach for designing behaviour change interventions was used including identification of which behaviours needed to change (Step 1), barriers and enablers that needed to be addressed (Step 2), and intervention components to target those barriers and enablers (Step 3). Data collection methods included file audits and therapist interviews. Quantitative data (file audits) were analysed using descriptive statistics. Qualitative data analysis (interviews) was informed by the Theoretical Domains Framework (TDF) and Behaviour Change Wheel.Results: Fifty two occupational therapists, physiotherapists and allied health assistants participated in focus groups (n = 7) or individual interviews (n = 6). Key barriers (n = 20) and enablers (n = 10) were identified across 11 domains of the TDF and perceived to influence CIMT implementation. The subsequent behaviour change intervention included training workshops, nominated team champions, community of practice meetings, three-monthly file audit feedback cycles, poster reminders and drop-in support during CIMT.Conclusion: This study describes the development of a behaviour change intervention to increase CIMT delivery by clinicians.Trial registration: Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617001147370.
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Affiliation(s)
- Lauren J Christie
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Reem Rendell
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, Australia
- School of Health Sciences, Western Sydney University - Campbelltown Campus, Campbelltown, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The StrokeEd Collaboration, Ashfield, Australia
| | - Nicola Fearn
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Allied Health Research Unit, St Vincent's Health Network Sydney, Darlinghurst, Australia
| | - Abigail Hunter
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Sydney, Australia
- Physiotherapy Department, The Wellington Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Meryl Lovarini
- Discipline of Occupational Therapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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22
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IJzerman RVH, van der Vaart R, Breeman LD, Arkenbout K, Keesman M, Kraaijenhagen RA, Evers AWM, Scholte Op Reimer WJM, Janssen VR. An iterative approach to developing a multifaceted implementation strategy for a complex eHealth intervention within clinical practice. BMC Health Serv Res 2023; 23:1455. [PMID: 38129824 PMCID: PMC10740292 DOI: 10.1186/s12913-023-10439-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The number of complex eHealth interventions has increased considerably. Despite available implementation theory outlining well-designed strategies, implementing complex interventions within practice proves challenging and often does not lead to sustainable use. To improve sustainability, theory and practice should be addressed during the development of an implementation strategy. By subsequently transparently reporting the executed theory-based steps and their corresponding practice findings, others can learn from these valuable lessons learned. This study outlines the iterative approach by which a multifaceted implementation strategy for a complex eHealth intervention in clinical practice was developed, tested and refined. METHODS We implemented the BENEFIT program, an advanced eHealth platform with Personal Health Portal facilitating healthy living in cardiac patients. In six iterative phases alternating between theory and practice, the implementation strategy was developed, tested and refined. The initial implementation strategy (phase 1) was drawn up using the Implementation model and RE-AIM. Subsequently, this strategy was further updated in brainstorming sessions and group discussions with twenty key stakeholders from three cardiac care centres and then evaluated in a pilot (phases 2 and 3). RESULTS The pilot of the program led to the identification of (context-specific) key challenges in practice (phase 4), which were subsequently connected back to broader theory (phase 5) using the Consolidated Framework of Implementation Research (CFIR). In the final phase, practice recommendations tackling the key challenges were formulated (phase 6) based on CFIR theory, the CFIR-ERIC Matching Tool, and stakeholders' input and feedback. These recommendations were then added to the refined strategy. Thus, executing this approach led to the realisation and use of a multifaceted theory-informed practice-based implementation strategy. CONCLUSION This case study gives an in-depth description of an iterative approach to developing an evidence-based, practice-tailored strategy for implementing a complex eHealth intervention in cardiac care. As such, this study may serve as a blueprint for other researchers aspiring to implement complex eHealth interventions within clinical practice sustainably.
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Affiliation(s)
- Renée V H IJzerman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands.
| | - Rosalie van der Vaart
- Centre of expertise Health Innovation, The Hague University of Applied Sciences, Den Haag, the Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | - Karin Arkenbout
- Department of Cardiology, Tergooi MC, Blaricum and Hilversum, the Netherlands
| | - Mike Keesman
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | | | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden, 2333, the Netherlands
| | | | - Veronica R Janssen
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
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Archibald MM. Co-implementation: collaborative and concurrent approaches to advance embedded implementation in the health sciences. FRONTIERS IN HEALTH SERVICES 2023; 3:1068297. [PMID: 38174215 PMCID: PMC10761409 DOI: 10.3389/frhs.2023.1068297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/20/2023] [Indexed: 01/05/2024]
Abstract
There is a global movement towards stakeholder engagement in healthcare research. This movement has been catalyzed by a need to create context relevant evidence of maximal utility to health service provision and policy. The concept of "co-implementation" has potential to inform and extend these discussions of partnership and to complement the growing literature on collaborative implementation. Attending to this concept may preempt conceptual confusion and provide opportunities for sustainable and context-responsive embedded research necessary for the strengthening of health systems. In this perspective article, I seek to advance the discussion of co-implementation through an examination of the concept and through consideration of it merits to the health sciences.
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Affiliation(s)
- Mandy M. Archibald
- Helen Glass Centre for Nursing, University of Manitoba, Winnipeg, MB, Canada
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24
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Tierney-Hendricks C, Schliep ME, Vallila-Rohter S. Barriers and facilitators to outcome measurement and treatment practices in aphasia rehabilitation in the USA: a mixed methods approach using the Theoretical Domains Framework. Disabil Rehabil 2023:1-16. [PMID: 38053357 DOI: 10.1080/09638288.2023.2288221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. MATERIALS AND METHODS Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. RESULTS Factors related to the TDF domain of "environmental context and resources" (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of "memory, attention, decision-making" (decision-making processes), "knowledge" (awareness of evidence) and "social influences" (client and caregiver preferences). CONCLUSIONS Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators.
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Affiliation(s)
| | - Megan E Schliep
- Spaulding Rehabilitation Hospital, Boston, MA, USA
- MGH Institute of Health Professions, Boston, MA, USA
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25
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Verweij L, Oesch S, Naef R. Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis. BMC Health Serv Res 2023; 23:1339. [PMID: 38041092 PMCID: PMC10693161 DOI: 10.1186/s12913-023-10285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The Family in Intensive Care UnitS (FICUS) trial investigates the clinical effectiveness of a multicomponent, nurse-led interprofessional family support intervention (FSI) and explores its implementation in intensive care units (ICUs). The local context of each ICU strongly influences intervention performance in practice. To promote FSI uptake and to reduce variation in intervention delivery, we aimed to develop tailored implementation strategies. METHODS A mixed method contextual analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed from March to June 2022 on eight ICUs assigned to the intervention group. ICU key clinical partners were asked to complete a questionnaire on CFIR inner setting measures (i.e., organizational culture, resources, learning climate and leadership engagement) and the Organizational Readiness for Implementing Change (ORIC) scale prior to group interviews, which were held to discuss barriers and facilitators to FSI implementation. Descriptive analysis and pragmatic rapid thematic analysis were used. Then, tailored implementation strategies were developed for each ICU. RESULTS In total, 33 key clinical partners returned the questionnaire and 40 attended eight group interviews. Results showed a supportive environment, with CFIR inner setting and ORIC measures each rated above 3 (scale: 1 low-5 high value), with leadership engagement scoring highest (median 4.00, IQR 0.38). Interview data showed that the ICU teams were highly motivated and committed to implementing the FSI. They reported limited resources, new interprofessional information exchange, and role adoption of nurses as challenging. CONCLUSION We found that important pre-conditions for FSI implementation, such as leadership support, a supportive team culture, and a good learning climate were present. Some aspects, such as available resources, interprofessional collaboration and family nurses' role adoption were of concern and needed attention. An initial set of implementation strategies were relevant to all ICUs, but some additions and adaptation to local needs were required. Multi-component interventions are challenging to implement within complex systems, such as ICUs. This pragmatic, theory-guided, mixed methods contextual analysis demonstrated high readiness and commitment to FSI implementation in the context of a clinical trial and enabled the specification of a tailored, multifaceted implementation strategy.
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Affiliation(s)
- Lotte Verweij
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Saskia Oesch
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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26
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Im EO, Yi JS, Chee W. A Decision Tree Analysis on Symptom Experience of Asian American Breast Cancer Survivors. West J Nurs Res 2023; 45:1076-1084. [PMID: 37882470 DOI: 10.1177/01939459231204294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Mainly due to their cultural attitudes toward symptoms and breast cancer, Asian American breast cancer survivors tend to suffer from symptoms and often delay in getting treatments, information, and support. To improve their symptom management, it would be important to determine risk groups among them. Decision tree analyses reportedly help determine risk groups by identifying the characteristics that are directly associated with target health outcomes. OBJECTIVE Using a decision tree analysis, this study aimed at identifying the characteristics that were closely linked to the symptom experience of Asian American breast cancer survivors. METHODS This was a part of a parent randomized controlled trial among Asian American breast cancer survivors. Only the data from 135 women at the pre-test were included. Multiple instruments were used to collect the data: the Memorial Symptom Assessment Scale-Short Form, the Cancer Behavior Inventory, the PRQ-2000, the Perceived Isolation Scale, and the Supportive Care Needs Survey-Short Form 34. The data were analyzed using latent profile analysis and decision tree analyses. RESULTS Two most frequently found profiles included the low symptom experience profile (72.6%) and the high symptom experience profile (27.4%). The high symptom experience profile was predicted by 2 combined characteristics; (a) high psychological needs for help (over 60.00 points), and (b) low psychological needs for help (cut point = 60.00), high perceived barriers (cut point = 1.62), and high social isolation (social support) (cut point = 2.33). CONCLUSIONS These characteristics linked to Asian American breast cancer survivors with high symptom experience need to be considered in future intervention development.
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Affiliation(s)
| | - Jee-Seon Yi
- Emory University, Atlanta, GA, USA
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
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Lech S, Gellert P, Spang RP, Voigt-Antons JN, Huscher D, O'Sullivan JL, Schuster J. Effectiveness of a tablet-based intervention for people living with dementia in primary care-A cluster randomized controlled trial. Int J Geriatr Psychiatry 2023; 38:e6035. [PMID: 38038608 DOI: 10.1002/gps.6035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Primary care physicians (PCP) play a key role in the care of people living with dementia. However, the implementation and practicability of the German S3 Dementia Guideline in primary care remain unclear. The main objective of the present study was to evaluate an intervention for improving guideline-based dementia care in primary care. DESIGN A two-arm, 9-month follow-up cluster-randomized controlled trial with two parallel groups. SETTING 28 primary care practices in Berlin and the surrounding area in Germany. PARTICIPANTS A total of N = 28 PCP, N = 91 people living with dementia, and N = 88 informal caregivers participated in the trial. INTERVENTION A tablet-based intervention to improve adherence to the German S3 Dementia Guideline in primary care was compared to a control group (care as usual plus a handbook on dementia). MeasurementsAdherence to dementia guideline (primary outcome) was measured on PCP' (23 items) and informal caregivers' level (19 items) with a self-developed checklist. Secondary outcomes (quality of life, neuropsychiatric symptoms, activities of daily living, general health status, depression, and caregiver burden) were measured with standardized assessments. Also, post-hoc per-protocol analyses were conducted. RESULTS No differences in guideline adherence between the intervention and the control group were observed. Further, no significant impact of the intervention on secondary outcomes was detected. CONCLUSION The DemTab Study did not improve self-reported guideline adherence in PCP. However, important implementation barriers such as lack of interoperability and low applicability of existing German S3 Dementia Guideline in the primary care setting were identified and are being discussed. TRIAL REGISTRATION The DemTab trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN15854413). Registered 01 April 2019, https://doi.org/10.1186/ISRCTN15854413.
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Affiliation(s)
- Sonia Lech
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Paul Gellert
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Robert P Spang
- Technische Universität Berlin, Quality and Usability Lab, Berlin, Germany
| | - Jan-Niklas Voigt-Antons
- Immersive Reality Lab, University of Applied Sciences Hamm-Lippstadt, Lippstadt, Germany
- Deutsches Forschungszentrum für Künstliche Intelligenz GmbH (DFKI), Speech and Language Technology, Berlin, Germany
| | - Dörte Huscher
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Berlin, Germany
| | - Julie L O'Sullivan
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
| | - Johanna Schuster
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute for Medical Sociology and Rehabilitation Science, Berlin, Germany
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Bahns C, Scheffler B, Kopkow C. Guideline-Adherent Physiotherapy for Patients With Hip and Knee Osteoarthritis in Germany: Protocol for an Implementation Research Project Using the Theoretical Domains Framework and the Behavior Change Wheel. JMIR Res Protoc 2023; 12:e47834. [PMID: 37971802 PMCID: PMC10690534 DOI: 10.2196/47834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Hip and knee osteoarthritis is common and leads to pain, stiffness, and disability. Clinical practice guidelines provide recommendations based on the best available evidence to assist health care professionals and patients in clinical decision-making. However, several studies have reported a gap between guideline recommendations and clinical practice in physiotherapy. Improved implementation strategies and the removal of existing barriers may facilitate the transfer of evidence into clinical practice and contribute to optimized quality of care. OBJECTIVE This paper presents the protocol for a study that aims to describe the current physiotherapy practice in patients with hip and knee osteoarthritis and to investigate physiotherapists' adherence to clinical practice guidelines, to identify and specify barriers to and facilitators of guideline use and implementation, and to develop and pilot test a theory-based tailored implementation intervention aiming to increase guideline use in osteoarthritis care. METHODS The research project is divided into 4 parts. During the first part, we will conduct a nationwide web-based survey among German physiotherapists to evaluate the current management of hip and knee osteoarthritis and to evaluate whether treatment aligns with guideline recommendations. Subsequently, semistructured interviews will be conducted to specify barriers to and facilitators of guideline use and implementation among physiotherapists (part 2). On the basis of these findings, in part 3, we will develop a theory-driven implementation intervention based on the Theoretical Domains Framework and the Behavior Change Wheel, which will be evaluated in a controlled pilot study in terms of effectiveness, feasibility, and acceptability (part 4). RESULTS Data collection of the web-based survey among German physiotherapists (part 1) was completed in December 2021. The semistructured interviews (part 2) were conducted between January and September 2023. Recruitment of physiotherapy practices to participate in the development of the implementation intervention is expected to start in January 2024. CONCLUSIONS This research project aims to develop a theory-driven implementation intervention to facilitate the transfer of evidence from hip and knee osteoarthritis guidelines in physiotherapy practice. We hypothesize that successful implementation will lead to increased guideline adherence in physiotherapists, which in turn will improve the quality of care. The results from our project will provide valuable knowledge concerning the development process and effectiveness of tailored implementation interventions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47834.
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Affiliation(s)
- Carolin Bahns
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Bettina Scheffler
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Christian Kopkow
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
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Rohde P, Bearman SK, Pauling S, Gau JM, Shaw H, Stice E. Setting and Provider Predictors of Implementation Success for an Eating Disorder Prevention Program Delivered by College Peer Educators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:912-925. [PMID: 37515696 PMCID: PMC10832988 DOI: 10.1007/s10488-023-01288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION College students face increased risk for a variety of mental health problems but experience barriers to treatment access. Prevention programs, including those implemented by peer educators, may decrease treatment needs and increase service access. We examined the implementation of an evidence-based eating disorder prevention program, Body Project, delivered by college peer educators at 63 colleges/universities, comparing three levels of implementation support: (1) Train-the-Trainer (TTT) training; (2) TTT plus a technical assistance workshop (TTT + TA); and (3) TTT + TA with one year of quality assurance calls (TTT + TA + QA). The present study tested the degree to which indicators proposed by the Consolidated Framework for Implementation Research (CFIR) were associated with core implementation outcomes. METHOD We tested whether indices of CFIR domains (i.e., perceived intervention characteristics, outer and inner setting factors, provider characteristics, and implementation process) were correlated with three implementation outcomes (program reach, fidelity, effectiveness) during a 1-year implementation period. RESULTS Greater program reach was associated with implementation process, specifically the completion of more implementation activities (β = 0.46). Greater program fidelity was associated with higher positive (β = 0.44) and lower negative (β = - 0.43) perceptions of the Body Project characteristics, and greater reported general support for evidence-based practices (β = 0.41). Greater effectiveness was associated with lower negative perceptions of Body Project characteristics (d = 0.49). CONCLUSIONS Several implementation determinants proposed by the CFIR model predicted outcomes, especially intervention fidelity. Across the outcomes of interest, implementation determinants related to peer educator and supervisor perceived characteristics of the specific intervention and general attitudes towards evidence-based practices emerged as robust predictors to inform future work investigating ongoing implementation and sustainability of programs in university settings.
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Affiliation(s)
- Paul Rohde
- Oregon Research Institute, Springfield, OR, USA.
| | | | | | - Jeff M Gau
- Oregon Research Institute, Springfield, OR, USA
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Lovero KL, Kemp CG, Wagenaar BH, Giusto A, Greene MC, Powell BJ, Proctor EK. Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review. Implement Sci 2023; 18:56. [PMID: 37904218 PMCID: PMC10617067 DOI: 10.1186/s13012-023-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The Expert Recommendations for Implementing Change (ERIC) project developed a compilation of implementation strategies that are intended to standardize reporting and evaluation. Little is known about the application of ERIC in low- and middle-income countries (LMICs). We systematically reviewed the literature on the use and specification of ERIC strategies for health intervention implementation in LMICs to identify gaps and inform future research. METHODS We searched peer-reviewed articles published through March 2023 in any language that (1) were conducted in an LMIC and (2) cited seminal ERIC articles or (3) mentioned ERIC in the title or abstract. Two co-authors independently screened all titles, abstracts, and full-text articles, then abstracted study, intervention, and implementation strategy characteristics of included studies. RESULTS The final sample included 60 studies describing research from all world regions, with over 30% published in the final year of our review period. Most studies took place in healthcare settings (n = 52, 86.7%), while 11 (18.2%) took place in community settings and four (6.7%) at the policy level. Across studies, 548 distinct implementation strategies were identified with a median of six strategies (range 1-46 strategies) included in each study. Most studies (n = 32, 53.3%) explicitly matched implementation strategies used for the ERIC compilation. Among those that did, 64 (87.3%) of the 73 ERIC strategies were represented. Many of the strategies not cited included those that target systems- or policy-level barriers. Nearly 85% of strategies included some component of strategy specification, though most only included specification of their action (75.2%), actor (57.3%), and action target (60.8%). A minority of studies employed randomized trials or high-quality quasi-experimental designs; only one study evaluated implementation strategy effectiveness. CONCLUSIONS While ERIC use in LMICs is rapidly growing, its application has not been consistent nor commonly used to test strategy effectiveness. Research in LMICs must better specify strategies and evaluate their impact on outcomes. Moreover, strategies that are tested need to be better specified, so they may be compared across contexts. Finally, strategies targeting policy-, systems-, and community-level determinants should be further explored. TRIAL REGISTRATION PROSPERO, CRD42021268374.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Christopher G Kemp
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Ali Giusto
- Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - M Claire Greene
- Program On Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Byron J Powell
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Enola K Proctor
- Brown School, Center for Mental Health Services Research, Washington University in St. Louis, St. Louis, MO, USA
- Center for Dissemination & Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, MO, USA
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Barakou I, Hackett KL, Finch T, Hettinga FJ. Self-regulation of effort for a better health-related quality of life: a multidimensional activity pacing model for chronic pain and fatigue management. Ann Med 2023; 55:2270688. [PMID: 37871249 PMCID: PMC10595396 DOI: 10.1080/07853890.2023.2270688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
PURPOSE To propose a comprehensive multidimensional model of activity pacing that improves health-related quality of life and promotes sustained physical activity engagement among adults with chronic conditions. MATERIALS AND METHODS A narrative review was conducted to examine the existing literature on activity pacing, health-related quality of life, pain and fatigue management, and physical activity promotion in chronic conditions. RESULTS The literature revealed a lack of a cohesive approach towards a multidimensional model for using activity pacing to improve health-related quality of life. A comprehensive multidimensional model of activity pacing was proposed, emphasizing the importance of considering all aspects of pacing for sustained physical activity engagement and improved health-related quality of life. The model incorporates elements such as rest breaks, self-regulatory skills, environmental factors, and effective coping strategies for depression/anxiety. It takes into account physical, psychological, and environmental factors, all of which contribute significantly to the enhancement of health-related quality of life, physical function, and overall well-being, reflecting a holistic approach. CONCLUSIONS The model offers guidance to researchers and clinicians in effectively educating patients on activity pacing acquisition and in developing effective interventions to enhance physical activity engagement and health outcomes among adults with chronic conditions. Additionally, it serves as a tool towards facilitating discussions on sustained physical activity and a healthy lifestyle for patients, which can eventually lead to improved quality of life.
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Affiliation(s)
- Ioulia Barakou
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
| | - Katie L. Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- CRESTA Fatigue Clinic, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Newcastle upon Tyne, UK
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Reszel J, Daub O, Dunn SI, Cassidy CE, Hafizi K, Lightfoot M, Pervez D, Quosdorf A, Wood A, Graham ID. Planning and implementing practice changes in Ontario maternal-newborn hospital units: a secondary qualitative analysis. BMC Pregnancy Childbirth 2023; 23:735. [PMID: 37848826 PMCID: PMC10583424 DOI: 10.1186/s12884-023-06042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/03/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Moving evidence into practice is complex, and pregnant and birthing people and their infants do not always receive care that aligns with the best available evidence. Implementation science can inform how to effectively move evidence into practice. While there are a growing number of examples of implementation science being studied in maternal-newborn care settings, it remains unknown how real-world teams of healthcare providers and leaders approach the overall implementation process when making practice changes. The purpose of this study was to describe maternal-newborn hospital teams' approaches to implementing practice changes. We aimed to identify what implementation steps teams take (or not) and identify strengths and potential areas for improvement based on best practices in implementation science. METHODS We conducted a supplementary qualitative secondary analysis of 22 interviews completed in 2014-2015 with maternal-newborn nursing leaders in Ontario, Canada. We used directed content analysis to code the data to seven steps in an implementation framework (Implementation Roadmap): identify the problem and potential best practice; assemble local evidence; select and customize best practice; discover barriers and drivers; tailor implementation strategies; field-test, plan evaluation, prepare to launch; launch, evaluate, and sustain. Frequency counts are presented for each step. RESULTS Participants reported completing a median of 4.5 of 7 Implementation Roadmap steps (range = 3-7), with the most common being identifying a practice problem. Other steps were described less frequently (e.g., selecting and adapting evidence, field-testing, outcome evaluation) or discussed frequently but not optimally (e.g., barriers assessment). Participants provided examples of how they engaged point-of-care staff throughout the implementation process, but provided fewer examples of engaging pregnant and birthing people and their families. Some participants stated they used a formal framework or process to guide their implementation process, with the most common being quality improvement approaches and tools. CONCLUSIONS We identified variability across the 22 hospitals in the implementation steps taken. While we observed many strengths, we also identified areas where further support may be needed. Future work is needed to create opportunities and resources to support maternal-newborn healthcare providers and leaders to apply principles and tools from implementation science to their practice change initiatives.
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Affiliation(s)
- Jessica Reszel
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Olivia Daub
- School of Communication Sciences and Disorders, Western University, 1201 Western Road, London, ON, N6G 1H1, Canada
| | - Sandra I Dunn
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Christine E Cassidy
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
- IWK Health Centre, 5980 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Kaamel Hafizi
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Marnie Lightfoot
- Women and Children's Health Network, Orillia Soldiers' Memorial Hospital, 170 Colborne St W, Orillia, ON, L3V 2Z3, Canada
| | | | - Ashley Quosdorf
- Neonatal Intensive Care Unit, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Allison Wood
- Better Outcomes Registry & Network (BORN) Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Ian D Graham
- School of Nursing, University of Ottawa, 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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McBain K, Dinh C, Haffar M, Steinberg E, Cachecho S, Bussières A, Dahan-Oliel N. Perspectives from clinicians and managers: facilitators and barriers to the uptake of rehabilitation guidance for children with arthrogryposis. Disabil Rehabil 2023:1-17. [PMID: 37782214 DOI: 10.1080/09638288.2023.2263361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To identify the perceived facilitators and barriers among clinicians and managers about the uptake of expert guidance for rehabilitation of children with arthrogryposis multiplex congenita (AMC) in practice. METHODS Qualitative study using individual interviews, guided by the Theoretical Domains Framework (TDF), to explore beliefs and to identify facilitators and barriers to guidance uptake. Interviews were conducted with a convenience sample of 15 clinicians working with children with AMC and four pediatric clinical managers using Microsoft Teams©. Interviews were then transcribed verbatim and analyzed by four independent reviewers using deductive and inductive coding. RESULTS The TDF domains of Environmental Context and Resources, Behavioural Regulation, Reinforcement, Beliefs about Consequences, and Social Influences were shared amongst clinicians and clinical managers across North America and Europe as being relevant and influential on the target behaviour of using rehabilitation expert guidance to manage pediatric patients. Among clinicians only, the domain Memory, Attention, and Decision-Making Processes was also found relevant. Among managers only, the domain Social/Professional Role and Identity was found relevant. CONCLUSIONS Coupling shared relevant domains amongst clinicians and managers with individual supports and barriers helps to map out what is needed to promote the uptake of rehabilitation guidance at multiple levels.
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Affiliation(s)
- Kimberly McBain
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cameron Dinh
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Melanie Haffar
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Emily Steinberg
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Sarah Cachecho
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Noémi Dahan-Oliel
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Clinical Research Department, Shriners Hospital for Children, Montreal, Canada
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Palm K, Kronlid C, Brantnell A, Elf M, Borg J. Identifying and Addressing Barriers and Facilitators for the Implementation of Internet of Things in Distributed Care: Protocol for a Case Study. JMIR Res Protoc 2023; 12:e44562. [PMID: 37768725 PMCID: PMC10570898 DOI: 10.2196/44562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The internet of things (IoT) is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. This study aims to identify the facilitators and barriers associated with implementing IoT solutions in health care within a Scandinavian context. It addresses the pressing need to adapt health care systems to the demographic changes occurring in Scandinavia. The vision of "Vision eHealth 2025," a long-term strategic direction for digitalization in Sweden, serves as the background for this project. The implementation of IoT solutions is a crucial aspect of achieving the vision's goal of making Sweden a global leader in using digitalization and eHealth opportunities by 2025. IoT is recognized as a valuable approach to supporting health care to achieve quality and person-centered care. Previous research has shown that there is a gap in our understanding of social and organizational challenges related to IoT and that the implementation and introduction of new technology in health care is often problematic. OBJECTIVE In this study, we will identify facilitating and hindering factors for the implementation of IoT solutions in social and health care. METHODS We will use an explorative design with a case study approach. The data collection will comprise questionnaires and qualitative interviews. Also, a literature review will be conducted at the start of the project. Thus, quantitative and qualitative data will be collected concurrently and integrated into a convergent mixed methods approach. RESULTS As of June 2023, data for the review and 22 interviews with the stakeholders have been performed. The co-design with stakeholders will be performed in the fall of 2023. CONCLUSIONS This study represents a unique and innovative opportunity to gain new knowledge relevant and useful for future implementation of new technology at health care organizations so they can continue to offer high-quality, person-centered care. The outcomes of this research will contribute to a better understanding of the conditions necessary to implement and fully use the potential of IoT solutions. By developing cocreated implementation strategies, the study seeks to bridge the gap between theory and practice. Ultimately, this project aims to facilitate the adoption of IoT solutions in health care for promoting improved patient care and using technology to meet the evolving needs of health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44562.
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Affiliation(s)
- Klas Palm
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Carl Kronlid
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Anders Brantnell
- Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Marie Elf
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
| | - Johan Borg
- School of Health and Social Sciences, Dalarna University, Falun, Sweden
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Landsverk NG, Olsen NR, Brovold T. Instruments measuring evidence-based practice behavior, attitudes, and self-efficacy among healthcare professionals: a systematic review of measurement properties. Implement Sci 2023; 18:42. [PMID: 37705031 PMCID: PMC10500884 DOI: 10.1186/s13012-023-01301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Evidence-based practice (EBP) is well known to most healthcare professionals. Implementing EBP in clinical practice is a complex process that can be challenging and slow. Lack of EBP knowledge, skills, attitudes, self-efficacy, and behavior can be essential barriers that should be measured using valid and reliable instruments for the population in question. Results from previous systematic reviews show that information regarding high-quality instruments that measure EBP attitudes, behavior, and self-efficacy in various healthcare disciplines need to be improved. This systematic review aimed to summarize the measurement properties of existing instruments that measure healthcare professionals' EBP attitudes, behaviors, and self-efficacy. METHODS We included studies that reported measurement properties of instruments that measure healthcare professionals' EBP attitudes, behaviors, and self-efficacy. Medline, Embase, PsycINFO, HaPI, AMED via Ovid, and Cinahl via Ebscohost were searched in October 2020. The search was updated in December 2022. The measurement properties extracted included data on the item development process, content validity, structural validity, internal consistency, reliability, and measurement error. The quality assessment, rating of measurement properties, synthesis, and modified grading of the evidence were conducted in accordance with the COSMIN methodology for systematic reviews. RESULTS Thirty-four instruments that measure healthcare professionals' EBP attitudes, behaviors or self-efficacy were identified. Seventeen of the 34 were validated in two or more healthcare disciplines. Nurses were most frequently represented (n = 53). Despite the varying quality of instrument development and content validity studies, most instruments received sufficient ( +) ratings on content validity, with the quality of evidence graded as "very low" in most cases. Structural validity and internal consistency were the measurement properties most often assessed, and reliability and measurement error were most rarely assessed. The quality assessment results and overall rating of these measurement properties varied, but the quality of evidence was generally graded higher for these properties than for content validity. CONCLUSIONS Based on the summarized results, the constructs, and the population of interest, several instruments can be recommended for use in various healthcare disciplines. However, future studies should strive to use qualitative methods to further develop existing EBP instruments and involve the target population. TRIAL REGISTRATION This review is registered in PROSPERO. CRD42020196009. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020196009.
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Affiliation(s)
- Nils Gunnar Landsverk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.
| | - Nina Rydland Olsen
- Department of Health and Functioning, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Liu M, Whittam S, Thornton A, Goncharov L, Slade D, McElduff B, Kelly P, Law CK, Walsh S, Pollnow V, Cuffe J, McMahon J, Aggar C, Bilo J, Bowen K, Chow JSF, Duffy K, Everett B, Ferguson C, Frost SA, Gleeson N, Hackett K, Komusanac I, Marshall S, May S, McErlean G, Melbourne G, Murphy J, Newbury J, Newman D, Rihari-Thomas J, Sciuriaga H, Sturgess L, Taylor J, Tuqiri K, McInnes E, Middleton S. The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation. BMC Nurs 2023; 22:275. [PMID: 37605224 PMCID: PMC10440862 DOI: 10.1186/s12912-023-01439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients' bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost-benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. METHODS A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement; a train-the-trainer model for cascading facilitation; embedded site leads; nursing unit manager leadership training; nursing and medical ward-level clinical champions; ward nurses' education workshops; intervention tailoring; and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and 'Code Blue' calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries; these measures individually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses' perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses' and medical officers' perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost-benefit analysis and post-trial process evaluation will also be undertaken. DISCUSSION If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces; if cost-effective, it will be readily translatable to other hospitals nationally. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.
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Grants
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- Big Ideas Grant Maridulu Budyari Gumal Sydney Partnership for Health, Education, Research and Enterprise (SPHERE)
- 1196352 National Health and Medical Research Council Investigator Leadership Grant
- New South Wales Nursing and Midwifery Strategy Reserve Fund
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Affiliation(s)
- Mark Liu
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Susan Whittam
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Anna Thornton
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Liza Goncharov
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Diana Slade
- Institute for Communication in Healthcare, Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Acton, ACT, 2601, Australia
| | - Benjamin McElduff
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Patrick Kelly
- School of Public Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, NSW, 2006, Australia
| | - Chi Kin Law
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Medical Foundation Building, 92-94 Parramatta Road, Camperdown, NSW, 2050, Australia
| | - Sarah Walsh
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Vivien Pollnow
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Jayde Cuffe
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jake McMahon
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Christina Aggar
- Southern Cross University, Military Road, East Lismore, NSW, 2480, Australia
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Jacqueline Bilo
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Karen Bowen
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Josephine S F Chow
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Katharine Duffy
- Northern NSW Local Health District, Crawford House, Hunter Street, Lismore, NSW, 2480, Australia
| | - Bronwyn Everett
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Caleb Ferguson
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Steven A Frost
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Narelle Gleeson
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - Kate Hackett
- South Eastern Sydney Local Health District, The Sutherland Hospital and Community Health Service, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Ivanka Komusanac
- Sydney Local Health District, King George V Building, Missenden Road, Camperdown, NSW, 2050, Australia
| | - Sonia Marshall
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Sharon May
- Fairfield Hospital, Polding Street and Prairie Vale Road, Prairiewood, NSW, 2176, Australia
| | - Gemma McErlean
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Gregory Melbourne
- South Western Sydney Local Health District, Liverpool Hospital Eastern Campus, Corner of Lachlan and Hart Streets, Liverpool, NSW, 2170, Australia
| | - Jade Murphy
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Joanne Newbury
- The Sutherland Hospital, Corner The Kingsway and Kareena Road, Caringbah, NSW, 2229, Australia
| | - Deb Newman
- Lismore Base Hospital, 60 Uralba Street, Lismore, NSW, 2480, Australia
| | - John Rihari-Thomas
- University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia
| | - Hayley Sciuriaga
- Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia
| | - Lauren Sturgess
- St George Hospital, Gray Street, Kogarah, NSW, 2217, Australia
| | - Joanne Taylor
- St Vincent's Health Network Sydney, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
| | - Karen Tuqiri
- Prince of Wales Hospital, 320-346 Barker Street, Randwick, NSW, 2031, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne, Australian Catholic University, De Lacy Building, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 40 Edward Street, North Sydney, NSW, 2060, Australia.
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Snider MDH, Boyd MR, Walker MR, Powell BJ, Lewis CC. Using audit and feedback to guide tailored implementations of measurement-based care in community mental health: a multiple case study. Implement Sci Commun 2023; 4:94. [PMID: 37580815 PMCID: PMC10424451 DOI: 10.1186/s43058-023-00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is an implementation strategy that can facilitate implementation tailoring by identifying gaps between desired and actual clinical care. While there are several theory-based propositions on which A&F components lead to better implementation outcomes, many have not been empirically investigated, and there is limited guidance for stakeholders when applying A&F in practice. The current study aims to illustrate A&F procedures in six community mental health clinics, with an emphasis on reporting A&F components that are relevant to theories of how feedback elicits behavior change. METHODS Six clinics from a larger trial using a tailored approach to implement measurement-based care (MBC) were analyzed for feedback content, delivery mechanisms, barriers to feedback, and outcomes of feedback using archival data. Pattern analysis was conducted to examine relations between A&F components and changes in MBC use. RESULTS Several sites utilized both aggregate and individualized data summaries, and data accuracy concerns were common. Feedback cycles featuring individual-level clinician data, data relevant to MBC barriers, and information requested by data recipients were related to patterns of increased MBC use. CONCLUSIONS These findings support extant theory, such as Feedback Intervention Theory. Mental health professionals wishing to apply A&F should consider establishing reciprocal feedback mechanisms on the quality and amount of data being received and adopting specific roles communicating and addressing data quality concerns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02266134.
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Affiliation(s)
- Mira D H Snider
- Department of Psychology, West Virginia University, 53 Campus Drive Morgantown, Morgantown, WV, 26505, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, Los Angeles, USA
| | - Madison R Walker
- Center for Health Equity Research, University of North Carolina, Chapel Hill, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
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Im EO, Yi JS, Chee W. The Characteristics of Asian American Breast Cancer Survivors with Low Quality of Life: a Decision Tree Analysis. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1277-1285. [PMID: 36627471 PMCID: PMC9838420 DOI: 10.1007/s13187-022-02260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
To provide appropriate and adequate information and support for Asian American breast cancer survivors, it would be essential to identify risk groups among them to target in future cancer education interventions. In this secondary analysis, the characteristics of risk groups within Asian American breast cancer survivors who had low quality of life were identified using a decision tree analysis. For this analysis, only the pre-test data of 185 women from a parent study were selected. Multiple instruments including the Functional Assessment of Cancer Therapy Scale-Breast Cancer (FACT-B) were used in the parent study. The data were analyzed using descriptive and inferential statistics and decision tree analyses. The decision tree analyses showed six combined characteristics associated with lower quality of life scores than the total mean quality of life scores. For instance, the women with lower quality of life scores (than the total mean quality of life scores) had high perceived barriers (cut point = 1.84), low self-efficacy for coping (cut point = 81.50), and high global symptom distress (cut point = 2.27). Also, the characteristics linked to the lowest quality life scores were different depending on the dimensions of the quality of life. The characteristics associated with the quality of life of Asian American breast cancer survivors need to be considered in future education programs for this specific population.
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Affiliation(s)
- Eun-Ok Im
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322 USA
| | - Jee-Seon Yi
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322 USA
- College of Nursing, Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea
| | - Wonshik Chee
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Atlanta, GA 30322 USA
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Reiter NL, Rosen D, Erhart M, Vogel B. Barriers, facilitators and implementation strategies for guideline-adherence in physiotherapy: a scoping review protocol. BMJ Open 2023; 13:e074640. [PMID: 37451730 PMCID: PMC10351290 DOI: 10.1136/bmjopen-2023-074640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Guideline-adherent physiotherapy can improve patient outcomes and reduce costs in the healthcare system. However, although there are numerous guidelines for physiotherapy practice, services are not consistently based on clinical practice guidelines. While various systematic and scoping reviews have highlighted barriers, facilitators and implementation strategies for guideline-adherent practice in other health professions, this scoping review aims to explore the barriers and facilitators for guideline-adherent physiotherapy and summarises the strategies used to implement such practice. METHODS AND ANALYSIS This scoping review will be based on Arksey and O'Malley's scoping review methodology and the methodological guidance for conducting scoping reviews published by Joanna Briggs Institute. Relevant publications will be first searched from the beginning of June 2023 on the MEDLINE and CINAHL databases before we expand the search to other databases such as EMBASE, the Cochrane Library and PEDro at the end of June 2023. Two reviewers will independently screen the titles and abstracts of all retrieved citations for inclusion against the eligibility criteria before conducting an independent full-text screening. The criteria will be tested on a sample of abstracts before beginning the abstract review to ensure that they are robust enough to capture any articles that may relate. The extracted data will finally be collated and charted to summarise key findings regarding our research question. ETHICS AND DISSEMINATION This scoping review will provide an extensive overview of the barriers, facilitators and implementation strategies for guideline-adherent physiotherapy. As scoping reviews are a form of secondary data analysis, ethical review is not required. Results will be disseminated through a peer-reviewed publication and stakeholder meetings. TRIAL REGISTRATION NUMBER This scoping review has been registered on 3 April 2023 on the Open Science Framework under https://doi.org/10.17605/OSF.IO/SEUW6.
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Affiliation(s)
- Nils L Reiter
- Department of Health, Alice Salomon University of Applied Sciences, Berlin, Germany
- PhsioBib GbR, Berlin, Germany
| | - Diane Rosen
- Department of Health, Alice Salomon University of Applied Sciences, Berlin, Germany
- Berlin School of Public Health, Berlin, Germany
- JBI Affiliated Group EBB, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Michael Erhart
- Department of Health, Alice Salomon University of Applied Sciences, Berlin, Germany
- Apollon University of Applied Sciences, Bremen, Germany
| | - Barbara Vogel
- Department of Orthopedics and Sports Orthopedics, Physical Therapy, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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Helmer SM, Matthias K, Mergenthal L, Reimer M, De Santis KK. Dissemination of knowledge from Cochrane Public Health reviews: a bibliographic study. Syst Rev 2023; 12:113. [PMID: 37400880 DOI: 10.1186/s13643-023-02272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 06/15/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Appropriate dissemination of public health evidence is of high importance to ensure that scientific knowledge reaches potential stakeholders and relevant population groups. A wide distrust towards science and its findings indicates that communication thereof remains below its potential. Cochrane Public Health provides an important source of high-quality scientific evidence in the field of public health via reviews with systematic methodology. The aims of this study were to identify (1) dissemination strategies and (2) stakeholders of Cochrane Public Health reviews. METHODS This is a bibliographic study with a cross-sectional design. All 68 records (reviews or review protocols) listed on the Cochrane Public Health website ( https://ph.cochrane.org/cph-reviews-and-topics ) up to 8 March 2022 were included. Record characteristics, dissemination strategies, and potential stakeholder details were coded by one author, and 10% of records were checked by another author. Data were analyzed using descriptive statistics or narratively into common themes. RESULTS The 68 records were published between 2010 and 2022 and included 15 review protocols and 53 reviews with systematic methodology (46 systematic, 6 rapid, and 1 scoping review). All 53 reviews were disseminated via open-access plain language summaries (PLS) in English with translations into 3-13 other languages. Other dissemination strategies included information on Cochrane websites (e.g., clinical answers or guidelines) available for 41/53 reviews and Cochrane news or blogs that mentioned 19/53 reviews. Overall, 23/68 records mentioned the actual stakeholder involvement in review production, protocol development, or formulation of dissemination plans. The potential stakeholders included several highly diverse groups, such as the general population or specific communities (e.g., racial minority groups), policy and decision makers, and researchers and professionals in various fields (e.g., nutrition, physical activity, education, or care). CONCLUSIONS This study shows that Cochrane Public Health reviews are disseminated predominantly via PLS in different languages and via review information on Cochrane websites. Planned dissemination strategies were rarely reported although actual stakeholders were involved in the planning and production of some reviews. The relevance of Cochrane Public Health reviews for non-academic stakeholders and the general population highlights the need for the dissemination of evidence from such reviews beyond academia. SYSTEMATIC REVIEW REGISTRATION The study was prospectively registered at the Open Science Framework ( https://osf.io/ga9pt/ ).
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Affiliation(s)
- Stefanie Maria Helmer
- Institute of Public Health and Nursing Research, Faculty 11 Human and Health Sciences, University of Bremen, Grazer Str. 4, 28359, Bremen, Germany.
- Cochrane Public Health Europe (https://ph.cochrane.org/cochrane-public-health-europe), Bremen, Germany.
| | - Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Lea Mergenthal
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Mia Reimer
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Karina Karolina De Santis
- Cochrane Public Health Europe (https://ph.cochrane.org/cochrane-public-health-europe), Bremen, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Albers B, Rapley T, Nilsen P, Clack L. Editorial: Tailoring in implementation science. FRONTIERS IN HEALTH SERVICES 2023; 3:1233597. [PMID: 37389149 PMCID: PMC10304283 DOI: 10.3389/frhs.2023.1233597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Bianca Albers
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- NIHR ARC North East-North Cumbria, Newcastle, United Kingdom
| | - Per Nilsen
- Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lauren Clack
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zürich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
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Lau EY, Small SS, Butcher K, Cragg A, Loh GW, Shalansky S, Hohl CM. An external facilitation intervention to increase uptake of an adverse drug event reporting intervention. FRONTIERS IN HEALTH SERVICES 2023; 3:1106586. [PMID: 37332530 PMCID: PMC10272762 DOI: 10.3389/frhs.2023.1106586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023]
Abstract
Background Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. Methods In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. Results The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. Conclusion External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.
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Affiliation(s)
- Erica Y. Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Serena S. Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Kate Butcher
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Amber Cragg
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Gabriel W. Loh
- Richmond Hospital Pharmacy Department, Lower Mainland Pharmacy Services, Richmond, BC, Canada
| | - Steve Shalansky
- Pharmacy Department, St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
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Sridhar A, Olesegun O, Drahota A. Identifying Methods to Select and Tailor Implementation Strategies to Context-Specific Determinants in Child Mental Health Settings: A Scoping Review. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2023; 3:212-229. [PMID: 37304058 PMCID: PMC10247563 DOI: 10.1007/s43477-023-00086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023]
Abstract
This scoping review describes the state of the literature regarding Implementation Strategy Mapping Methods (ISMMs) within the context of child mental health practice delivery. Goals included (a) identify and describe ISMMs addressing determinants of implementing mental health evidence-based interventions (MH-EBIs) for children and (b) describe the scope of the literature (e.g., outcomes, remaining gaps) related to identified ISMMs. Following PRISMA-ScR guidelines, 197 articles were identified. After removing 54 duplicates, 152 titles and abstracts were screened, yielding 36 articles that were screened during the full-text review. The final sample included four studies and two protocol papers (n = 6). A data charting codebook was developed a priori to capture relevant information (e.g., outcomes) and content analysis was utilized to synthesize findings. Six ISMMs were identified: innovation tournament, concept mapping, modified conjoint analysis, COAST-IS, focus group, and intervention mapping. ISMMs were successful in leading to the identification and selection of implementation strategies at participating organizations, and all ISMMs included stakeholders throughout these processes. Findings revealed the novelty of this research area and highlighted numerous areas for future investigation. Implications related to implementation, service, and client outcomes are discussed, including the possible impact of utilizing ISMMs to increase access to MH-EBIs for children receiving services in community settings. Overall, these findings contribute to our understanding of one of the five priority areas within implementation strategy research-enhancing methods used to design and tailor implementation strategies-by providing an overview of methods that may be utilized to facilitate MH-EBI implementation in child mental health care settings. Trial Registration: Not applicable. Supplementary Information The online version contains supplementary material available at 10.1007/s43477-023-00086-3.
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Affiliation(s)
- Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI USA
| | - Ola Olesegun
- Department of Psychology, Michigan State University, East Lansing, MI USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI USA
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Arnold C, Hennrich P, Wensing M, Ullrich C. Keeping up with evidence-based recommendations - a qualitative interview study with general practitioners in Germany on information-seeking behaviour in cardiovascular care. BMC PRIMARY CARE 2023; 24:118. [PMID: 37231391 DOI: 10.1186/s12875-023-02069-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Due to the nature of their work, general practitioners (GPs) need to be up to date with evidence in various medical domains. While much synthesised research evidence is easily accessible nowadays, in practice, the time to search for and review this evidence proposes a challenge. In German primary care, the knowledge infrastructure is rather fragmented, leaving GPs with relatively few primary care specific resources of information and many resources from other medical fields. This study aimed to explore GPs information-seeking behaviour regarding evidence-based recommendations in cardiovascular care in Germany. METHODS To explore views of GPs a qualitative research design was chosen. Data was collected through semi-structured interviews. In total, 27 telephone interviews with GPs were conducted between June and November 2021.Verbatim transcript interviews were then analysed using thematic analysis, deriving at themes inductively. RESULTS Two broad strategies of information-seeking behaviour in GP could be distinguished: (a) generic information-seeking behaviour and (b) casuistic information-seeking. The first referring to strategies GPs apply to keep up with medical developments such as new medication and the second referring to purposeful information exchange regarding individual patients, such as referral letters. The second strategy was also used to keep up with medical developments in general. CONCLUSION In a fragmented information landscape, GPs used information exchange on individual patients to remain informed about medical developments in general. Initiatives to implement recommended practices need to take this into account, either by using these sources of influence or by making GPs aware of possible bias and risks. The findings also emphasize the importance of systematic evidence-based sources of information for GPs. TRAIL REGISTRATION We registered the study prospectively on 07/11/2019 at the German Clinical Trials Register (DRKS, www.drks.de ) under ID no. DRKS00019219.
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Affiliation(s)
- Christine Arnold
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
- Division of Neonatology, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Friedbühlstrasse 19, Bern, 3010, Switzerland
| | - Patrick Hennrich
- Section for Translational Health Economics, Department for Conservative Dentistry, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Charlotte Ullrich
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
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Triplett NS, Mbwayo A, Kiche S, Liu L, Silva J, AlRasheed R, Johnson C, Amanya C, Munson S, Weiner BJ, Collins PY, Dorsey S. Co-developed implementation guidelines to maximize acceptability, feasibility, and usability of mobile phone supervision in Kenya. Glob Ment Health (Camb) 2023; 10:e31. [PMID: 37854429 PMCID: PMC10579659 DOI: 10.1017/gmh.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 05/16/2023] [Indexed: 10/20/2023] Open
Abstract
Opportunities exist to leverage mobile phones to replace or supplement in-person supervision of lay counselors. However, contextual variables, such as network connectivity and provider preferences, must be considered. Using an iterative and mixed methods approach, we co-developed implementation guidelines to support the implementation of mobile phone supervision with lay counselors and supervisors delivering a culturally adapted trauma-focused cognitive behavioral therapy in Western Kenya. Guidelines were shared and discussed with lay counselors in educational outreach visits led by supervisors. We evaluated the impact of guidelines and outreach on the acceptability, feasibility, and usability of mobile phone supervision. Guidelines were associated with significant improvements in acceptability and usability of mobile phone supervision. There was no evidence of a significant difference in feasibility. Qualitative interviews with lay counselors and supervisors contextualized how guidelines impacted acceptability and feasibility - by setting expectations for mobile phone supervision, emphasizing importance, increasing comfort, and sharing strategies to improve mobile phone supervision. Introducing and discussing co-developed implementation guidelines significantly improved the acceptability and usability of mobile phone supervision. This approach may provide a flexible and scalable model to address challenges with implementing evidence-based practices and implementation strategies in lower-resourced areas.
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Affiliation(s)
- Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lucy Liu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jacinto Silva
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Sean Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Pamela Y. Collins
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Bélanger-Gravel A, Janezic I, Desroches S, Paquette MC, Therrien F, Barnett T, Lavoie KL, Gauvin L. Examining public health practitioners' perceptions and use of behavioural sciences to design health promotion interventions. BMC Health Serv Res 2023; 23:493. [PMID: 37194044 DOI: 10.1186/s12913-023-09455-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Behavioural sciences have been shown to support the development of more effective interventions aimed at promoting healthy lifestyles. However, the operationalization of this knowledge seems to be sub-optimal in public health. Effective knowledge transfer strategies are thus needed to optimize the use of knowledge from behavioural sciences in this field. To this end, the present study examined public health practitioners' perceptions and use of theories and frameworks from behavioural sciences to design health promotion interventions. METHODS This study adopted an exploratory qualitative design. Semi-structured interviews were conducted among 27 public health practitioners from across Canada to explore current intervention development processes, the extent to which they integrate theory and framework from behavioural sciences, and their perceptions regarding the use of this knowledge to inform intervention design. Practitioners from the public sector or non-profit/private organizations who were involved in the development of interventions aimed at promoting physical activity, healthy eating, or other healthy lifestyle habits (e.g., not smoking) were eligible to participate. RESULTS Public health practitioners generally agreed that behaviour change is an important goal of public health interventions. On the other hand, behavioural science theories and frameworks did not appear to be fully integrated in the design of public health interventions. The main reasons were (1) a perceived lack of fit with current professional roles and tasks; (2) a greater reliance on experiential-produced knowledge rather than academic knowledge (mainly for tailoring interventions to local setting characteristics); (3) the presence of a fragmented knowledge base; (4) the belief that theories and frameworks require too much time and resources to be operationalized; and 4) the belief that using behavioural sciences might undermine partnership building. CONCLUSIONS This study provided valuable insights that may inform knowledge transfer strategies that could be optimally designed to support the integration of behavioural sciences theories and frameworks into public health practices.
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Affiliation(s)
- Ariane Bélanger-Gravel
- Departement of Information and Communication, Université Laval, 1055, Ave du Séminaire, Québec, G1V 0A6, Canada.
- NUTRISS-INAF research Center, Université Laval, Quebec City, Québec, Canada.
- Research Center of the Quebec Heart and Lung Institute, Quebec City, Québec, Canada.
| | - Isidora Janezic
- Departement of Information and Communication, Université Laval, 1055, Ave du Séminaire, Québec, G1V 0A6, Canada
| | - Sophie Desroches
- NUTRISS-INAF research Center, Université Laval, Quebec City, Québec, Canada
- School of Nutrition, Université Laval, Quebec City, Québec, Canada
| | | | | | - Tracie Barnett
- Departement of Family Medicine, McGill University, Montréal, Québec, Canada
- Research Center of Sainte-Justine, Montréal, Québec, Canada
| | - Kim L Lavoie
- Departement of Psychology, University of Quebec at Montreal, Montréal, Québec, Canada
- Montreal Behavioural Medicine Center, Montréal, Québec, Canada
| | - Lise Gauvin
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Research Center of the Centre hospitalier universitaire de l'Université de Montréal, Montréal, Québec, Canada
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Iwelunmor J, Ogedegbe G, Dulli L, Aifah A, Nwaozuru U, Obiezu-Umeh C, Onakomaiya D, Rakhra A, Mishra S, Colvin CL, Adeoti E, Badejo O, Murray K, Uguru H, Shedul G, Hade EM, Henry D, Igbong A, Lew D, Bansal GP, Ojji D. Organizational readiness to implement task-strengthening strategy for hypertension management among people living with HIV in Nigeria. Implement Sci Commun 2023; 4:47. [PMID: 37143131 PMCID: PMC10157928 DOI: 10.1186/s43058-023-00425-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Hypertension (HTN) is highly prevalent among people living with HIV (PLHIV), but there is limited access to standardized HTN management strategies in public primary healthcare facilities in Nigeria. The shortage of trained healthcare providers in Nigeria is an important contributor to the increased unmet need for HTN management among PLHIV. Evidence-based TAsk-Strengthening Strategies for HTN control (TASSH) have shown promise to address this gap in other resource-constrained settings. However, little is known regarding primary health care facilities' capacity to implement this strategy. The objective of this study was to determine primary healthcare facilities' readiness to implement TASSH among PLHIV in Nigeria. METHODS This study was conducted with purposively selected healthcare providers at fifty-nine primary healthcare facilities in Akwa-Ibom State, Nigeria. Healthcare facility readiness data were measured using the Organizational Readiness to Change Assessment (ORCA) tool. ORCA is based on the Promoting Action on Research Implementation in Health Services (PARIHS) framework that identifies evidence, context, and facilitation as the key factors for effective knowledge translation. Quantitative data were analyzed using descriptive statistics (including mean ORCA subscales). We focused on the ORCA context domain, and responses were scored on a 5-point Likert scale, with 1 corresponding to disagree strongly. FINDINGS Fifty-nine healthcare providers (mean age 45; standard deviation [SD]: 7.4, 88% female, 68% with technical training, 56% nurses, 56% with 1-5 years providing HIV care) participated in the study. Most healthcare providers provide care to 11-30 patients living with HIV per month in their health facility, with about 42% of providers reporting that they see between 1 and 10 patients with HTN each month. Overall, staff culture (mean 4.9 [0.4]), leadership support (mean 4.9 [0.4]), and measurement/evidence-assessment (mean 4.6 [0.5]) were the topped-scored ORCA subscales, while scores on facility resources (mean 3.6 [0.8]) were the lowest. CONCLUSION Findings show organizational support for innovation and the health providers at the participating health facilities. However, a concerted effort is needed to promote training capabilities and resources to deliver services within these primary healthcare facilities. These results are invaluable in developing future strategies to improve the integration, adoption, and sustainability of TASSH in primary healthcare facilities in Nigeria. TRIAL REGISTRATION NCT05031819.
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Affiliation(s)
- Juliet Iwelunmor
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA.
| | - Gbenga Ogedegbe
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA
| | - Lisa Dulli
- Family Health International 360, Durham, USA
| | - Angela Aifah
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | - Deborah Onakomaiya
- Vilcek Institute of Graduate Biomedical Sciences, New York University Grossman School of Medicine, New York, NY, USA
| | - Ashlin Rakhra
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Shivani Mishra
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Calvin L Colvin
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Ebenezer Adeoti
- Department of Behavioral Science and Health Education, College for Public Health and Social Justice, Saint Louis University, St. Louis, USA
| | | | - Kate Murray
- Family Health International 360, Durham, USA
| | - Henry Uguru
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Gabriel Shedul
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Erinn M Hade
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Daniel Henry
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Ayei Igbong
- Family Health International 360, Durham, USA
| | - Daphne Lew
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
| | | | - Dike Ojji
- Cardiovascular Research Unit, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Health Sciences, University of Abuja, Gwagwalada, Abuja, Nigeria
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Raju S, Cowdell F, Dyson J. A Systematic Review of Women's Experiences of Interventions to Prevent Excessive Gestational Weight Gain. Nurs Womens Health 2023; 27:211-219. [PMID: 37080250 DOI: 10.1016/j.nwh.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 03/08/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE To synthesize research on women's experiences of interventions to prevent excessive gestational weight gain. DATA SOURCES A systematic search of the following databases was conducted: CINAHL Complete, Maternity and Infant Care Database, American Psychological Association PsycArticles, American Psychological Association PsycInfo, and MEDLINE. STUDY SELECTION Studies were included if they involved primary research regarding the experiences of women who were pregnant or up to 1 year postpartum when reflecting on their involvement in interventions to prevent excessive weight gain during pregnancy. Nonempirical studies and those that examined experiences of women who were not pregnant or who were beyond 1 year postpartum were excluded. DATA EXTRACTION Information was extracted and captured in a summary table that included the study aim, participants, study design, intervention, findings, and summary score, with exceptions to quality. DATA SYNTHESIS Data were synthesized thematically into three themes: (a) Intervention Qualities Valued by Women, (b) Challenges Faced by Women, and (c) Perceived Benefits and Recommendations for Modifications. CONCLUSION Interventions intended to help women prevent excessive gestational weight gain should be tailored to individuals' unique needs to ensure that the interventions are acceptable and effective.
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50
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Spronk I, Van Wijck SFM, Van Lieshout EMM, Verhofstad MHJ, Prins JTH, Wijffels MME, Polinder S. Rib Fixation for Multiple Rib Fractures: Healthcare Professionals Perceived Barriers and Facilitators to Clinical Implementation. World J Surg 2023; 47:1692-1703. [PMID: 37014429 DOI: 10.1007/s00268-023-06973-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Surgical stabilization of rib fractures (SSRF) is associated with improved respiratory symptoms and shorter intensive care admission in patients with flail chest. For multiple rib fractures, the benefit of SSRF remains a topic of debate. This study investigated barriers and facilitators of healthcare professionals to SSRF as treatment for multiple traumatic rib fractures. METHODS Dutch healthcare professionals were asked to complete an adapted version of the Measurement Instrument for Determinants of Innovations questionnaire to identify barriers and facilitators of SSRF. If ≥ 20% of participants responded negatively, the item was considered a barrier, and if ≥ 80% responded positively, the item was considered a facilitator. RESULTS Sixty-one healthcare professionals participated; 32 surgeons, 19 non-surgical physicians, and 10 residents. The median experience was 10 years (P25-P75 4-12). Sixteen barriers and two facilitators for SSRF in multiple rib fractures were identified. Barriers included lack of knowledge, experience, evidence on (cost-)effectiveness, and the implication of more operations and higher medical costs. Facilitators were the assumption that SSRF alleviates respiratory problems and the feeling that surgeons are supported by colleagues for SSRF. Non-surgeons and residents reported more and several different barriers than surgeons (surgeons: 14; non-surgical physicians: 20; residents: 21; p < 0.001). CONCLUSION For adequate implementation of SSRF in patients with multiple rib fractures, implementation strategies should address the identified barriers. Especially, improved clinical experience and scientific knowledge of healthcare professionals, and high-level evidence on the (cost-) effectiveness of SSRF potentially increase its use and acceptance.
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Affiliation(s)
- Inge Spronk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
| | - Suzanne F M Van Wijck
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jonne T H Prins
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Mathieu M E Wijffels
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
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