Barriers and facilitators of evidence-based practice perceived by behavioral science health professionals

Unveiling the paradoxes of implementing post graduate competency based medical education programs

PURPOSE

Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation.

METHOD

A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards.

RESULTS

Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators.

CONCLUSIONS

Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.

What Information Do Neuropsychologists Use to Guide their Clinical Decisions? A Survey on Knowledge and Application of Evidence-Based Practice in a French-Speaking Population

OBJECTIVE

Evidence-based practice (EBP) is an approach that encourages clinicians to base their practice on evidence to improve the quality of patient care and reduce uncertainty in their clinical decisions. However, the state of knowledge and practice of neuropsychologists in French-speaking countries is still unknown. This study aimed to find out what these neuropsychologists know about EBP and whether they use it.

METHOD

A questionnaire with 39 questions for French-speaking neuropsychologists was distributed. The questions focused on neuropsychologists' knowledge and use of EBP and information that guide their clinical decisions.

RESULTS

A total of 392 respondents started the survey. The data show that only 35% correctly defined EBP and there was confusion between this practice and the strict use of research data. In practice, their decisions are influenced by multiple factors, including the patient's difficulties and advice from peers. Regarding the research, a significant proportion of the sample stated that they did not search the scientific literature frequently. Barriers to accessing scientific information and ineffective article-reading behavior were highlighted.

CONCLUSION

A lack of knowledge of EBP among French-speaking neuropsychologists was observed. Furthermore, the factors influencing their decision-making do not clearly fit the definitions of EBP. Information-seeking behaviors show several weaknesses and barriers to the integration of scientific evidence into practice. These results are like those of other studies conducted among psychologists or in other health professions. We will discuss possible courses of action that could be implemented to improve the knowledge and use of EBP.

Healthcare professional communication behaviours, skills, barriers, and enablers: Exploring the perspectives of people living with Inflammatory Bowel Disease

This qualitative study conceptualised effective communication behaviours of healthcare professionals (gastroenterologists, surgeons, nurses, and general practitioners) and explored communication barriers and facilitators from the perspective of adults with Inflammatory Bowel Disease (IBD). Seventeen qualitative interviews were conducted with people living with IBD in the UK or USA (n = 17) and their spouses (n = 4). An inductive content analysis was firstly applied to participants' accounts to define which healthcare professionals' behaviours and skills were perceived as essential for effective communication. An inductive reflexive thematic analysis elucidated themes of perceived barriers and facilitators experienced when communicating with their IBD healthcare professionals. Thirty-three provider communication behaviours were grouped into nine healthcare professional skills. Five themes encompassed 11 barriers and facilitators: professionals' knowledge and behaviour, unequal power, patient navigation skills, time constraints and demand, and continuity and collaboration of care. For patients and some spouses, enhancing communication in IBD services means increasing patient, family, and health professional knowledge, encouraging collaborative partnership working, and promoting healthcare professional skills to communicate effectively within the reality of time restraints.

The acceptability and preliminary effectiveness of a brief, online parenting program: Expanding access to Evidence-Based parenting intervention content

Parenting interventions are a promising means for preventing and treating a variety of child behavior and conduct problems; yet, many families lack access to such services. Online parenting programs offer an opportunity to mitigate many barriers to intervention access by extending service delivery options. The purpose of the present study was to evaluate the acceptability and preliminary effectiveness of a brief, online parenting program. We developed a new online parenting program based on foundational content from the evidence-based GenerationPMTO intervention and used a mixed-methods, single-arm open trial (pre-post) design to perform a preliminary evaluation. The combined results from the quantitative and qualitative data provide initial support for the acceptability and preliminary effectiveness of the online program, based on participant self-report data from program completers. Participants indicated high levels of acceptability for the program topics and videos. They also reported statistically significant improvements from baseline to 4 weeks postintervention in parental efficacy, parenting practices, and child behavior problems. The qualitative data corroborated and expanded these findings. We go on to discuss important accessibility and sustainability considerations addressed by this online parenting program as well as to suggest implications for intervention research and mental health practice.

Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions

Anxiety disorders are a significant cause of disability globally, yet only one in ten sufferers receives adequate quality treatment. Exposure-based therapies are effective in reducing symptoms associated with a number of anxiety disorders. However, few therapists use exposure techniques to treat these conditions, even when they are adequately trained in them, often because of concerns about provoking distress, drop out, logistical barriers, and other concerns. Virtual reality exposure therapy (VRET) can address many of these concerns, and a large body of research decisively shows that VRET is as efficacious for treating these conditions as in vivo exposures. Yet, use of VRET remains low. In this article, we discuss several factors we believe are contributing to low VRET adoption among therapists and raise potential solutions to address them. We consider steps that VR experience developers and researchers might take, such as leading studies of VRET's real-world effectiveness and treatment optimization trials and continuing to improve the fit of platforms with clinicians' workflows. We also discuss steps to address therapist reservations using aligned implementation strategies, as well as barriers for clinics, and the roles that professional organizations and payers could have in improving care by encouraging adoption of VRET.

Barriers and facilitators to access mental health services among people with mental disorders in Indonesia: A qualitative study

Background

The care and treatment management of people with mental health problems has become a prominent global concern in recent years that requires consistent attention. However, the literature suggests that only a small percentage of individuals with mental health problems in Indonesia receive the necessary mental health care. Therefore, it is crucial to explore this gap.

Objective

This study aimed to explore barriers and facilitators that affect access to mental health services among people with mental health disorders in Indonesia.

Methods

The study employed a qualitative descriptive design and focused on individuals with depression, anxiety, or bipolar disorder. Data were collected through in-depth interviews conducted via WhatsApp chat with 90 participants aged 18-32, who were purposively selected from Sumatra, Java, Kalimantan, and Papua Islands in Indonesia between January and June 2022. Thematic analysis was used to analyze the data.

Results

The barriers to accessing mental health services included: 1) uneasy access to mental healthcare facilities, 2) stigma, lack of social support, and delay in receiving proper treatment, and 3) expensive treatment costs without national health insurance membership. Importantly, the facilitators to access mental health services included: 1) national health insurance membership, 2) support from spouse, family, and closest friends and its association with mental health literacy, and 3) self-help.

Conclusion

The widespread distribution of mental health knowledge is recommended among healthcare providers, including public health practitioners and primary care nurses, to enhance their mental health literacy and competencies while rendering services to individuals with mental disorders. Additionally, efforts should be made to educate and promote awareness among caregivers and communities to reduce the stigma faced by those with mental disorders.

Attitudes Towards Evidence-Based Practice of Professionals Working with Children and Adolescents with Autism Spectrum Disorder in Bangladesh

Like in many lower-middle-income countries (LMIC), progress in implementing evidence-based practices (EBPs) for children with autism spectrum disorder (ASD) has been slow in Bangladesh. This cross-sectional study examined professionals' attitudes towards evidence-based practice (EBP) for children and adolescents with ASD and explored how providers' demographic factors are related to attitudes to and adoption of EBPs in Bangladesh. The sample consisted of 150 mental health professionals and special teachers from the urban area of Dhaka. Attitudes were assessed by the Evidence-based Practice Attitude Scale-36. Findings indicated that professionals have favorable attitudes towards EBP. Their attitudes varied depending on service settings (public clinical, private clinical, and special school) and caseload per year. Professionals who work in private and special school settings claimed to be more willing to adopt an EBP when required and perceived a higher fit of EBPs and their work than those in public clinical settings. The number of different EBPs used also differed by service setting. Every type of intervention (except medication) was used by more professionals in special schools than in private and public clinical settings. Many professionals reported few barriers to the implementation of EBPs. These findings indicate conditions that are often conducive to the implementation of EBPs. However, these results do not reflect the situation in rural areas, in which poverty is more widespread and the number of specialized professionals is low.

A Mixed-Method Study Examining Solutions to Common Barriers to Teachers' Adoption of Evidence-Based Classroom Practices

Objectives

We conducted a mixed-method focus group study to (a) assess the appropriateness and likely effectiveness of strategies that target individual behavior change mechanisms associated with perceived barriers of lack of time and unsupportive leadership and (b) identify recommendations regarding strategies for overcoming the barriers.

Method

Sample included 39 school-based staff (80% female, 77% White) across two districts in the Midwest. Mixed methods included a simultaneous approach.

Results

Lack of time and supportive leadership continue to pervade school-based implementation efforts. Recommendations centered around the need for school leaders to give teachers the power to re-prioritize how they spend their time as well as providing protected, facilitated time for teachers to collaborate and learn practical skills targeting self-advocacy.

Conclusion

Our findings provide compelling evidence for the use of implementation methodology to strategically target mechanisms of individual behavior change during the process of incorporating new and innovative practices in schools.

Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial

Background: The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. Methods: Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. Results: Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. Conclusions: Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally.

Plain Language Summary

What is known: Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. What this study adds: Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. Implications: Our findings provide information on barriers and facilitators to recruiting primary care practices for behavioral health projects and to implementing these activities. Using our findings, we provide a discussion of suggestions for conducting these types of projects in the future which may be of interest to researchers, practice managers, and providers.

Therapists’ Views of Mechanisms of Change in Psychotherapy: A Mixed-Method Approach

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists (n = 107), consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed.

A framework of evidence-based decision-making in health system management: a best-fit framework synthesis

Background

Scientific evidence is the basis for improving public health; decision-making without sufficient attention to evidence may lead to unpleasant consequences. Despite efforts to create comprehensive guidelines and models for evidence-based decision-making (EBDM), there isn`t any to make the best decisions concerning scarce resources and unlimited needs. The present study aimed to develop a comprehensive applied framework for EBDM.

Methods

This was a Best-Fit Framework (BFF) synthesis conducted in 2020. A comprehensive systematic review was done via six main databases including PUBMED, Scopus, Web of Science, Science Direct, EMBASE, and ProQuest using related keywords. After the evidence quality appraisal, data were extracted and analyzed via thematic analysis. Results of the thematic analysis and the concepts generated by the research team were then synthesized to achieve the best-fit framework applying Carroll et al. (2013) approach.

Results

Four thousand six hundred thirteen studies were retrieved, and due to the full-text screening of the studies, 17 final articles were selected for extracting the components and steps of EBDM in Health System Management (HSM). After collecting, synthesizing, and categorizing key information, the framework of EBDM in HSM was developed in the form of four general scopes. These comprised inquiring, inspecting, implementing, and integrating, which included 10 main steps and 47 sub-steps.

Conclusions

The present framework provided a comprehensive guideline that can be well adapted for implementing EBDM in health systems and related organizations especially in underdeveloped and developing countries where there is usually a lag in updating and applying evidence in their decision-making process. In addition, this framework by providing a complete, well-detailed, and the sequential process can be tested in the organizational decision-making process by developed countries to improve their EBDM cycle.

Mental health clinician perspectives regarding factors impacting implementation of evidence-based psychotherapies in Veterans Health Administration community-based outpatient clinics

OBJECTIVE

Uptake of Evidence-Based Psychotherapies (EBPs) by mental health (MH) clinicians, especially in community settings, remains highly variable. This formative pilot study aimed to understand the attitudes and practices of Veterans Health Administration community-based MH clinicians regarding EBPs and to identify multi-level factors that enable and hinder EBP implementation in this unique context.

METHODS

Semi-structured interviews were conducted with MH clinicians (N = 40) working in community-based outpatient clinics (CBOCs) in metro/urban (n = 20) and non-metro/rural (n = 20) locations. Interviews were guided by the Consolidated Framework for Implementation Research and were analyzed using rapid content analysis. Results were organized by system-, clinician-, patient-, and innovation-levels.

RESULTS

EBPs were consistently perceived as important to delivering quality MH care, with most clinicians having received training in at least one VHA EBP. However, limited EBP training and consultation opportunities, inadequate autonomy to schedule EBP sessions, high and complex caseloads, and feelings of isolation at CBOCs decreased EPB use. Social workers perceived disparities in EBP training access relative to psychologists. Some barriers were more salient in non-metro/rural settings (e.g., patient-level privacy concerns).

CONCLUSIONS

Increased EBP training opportunities- particularly for social workers-, greater flexibility over schedules and caseloads, and more mechanisms for consultation and professional development may increase EBP uptake in community-based clinics.

Lessons Learned from Implementing the SHIELD Intervention: A Peer Education Intervention for People Who Use Drugs

HIV prevention and care peer education interventions have demonstrated effectiveness at changing HIV risk and care behaviors among a variety of at-risk populations in different settings. However, little is known about the implementation of this type of intervention in community-based settings. Further, there is limited information available regarding the facilitators and barriers to implementing peer education interventions in community-based settings. In this study, we explore implementation facilitators, barriers, and strategies to overcome these barriers among 12 organizations that implemented the SHIELD intervention, an evidenced-based peer education intervention for people who use drugs. Guided by the Consolidated Framework for Implementation Research, we identified several facilitators and barriers at the outer, inner individuals, and intervention level of the implementation process. Future evidence-based public health programs should, in addition to addressing effectiveness, be relevant to the needs and lives of clients.

Acceptability and feasibility of peer-administered group interpersonal therapy for depression for people living with HIV/AIDS-a pilot study in Northwest Ethiopia

BACKGROUND

Psychological treatments are widely tested and have been effective in treating depressive symptoms. However, implementation of psychological treatments in the real world and in diverse populations remains difficult due to several interacting barriers. In this study, we assessed the acceptability and feasibility of peer-administered group interpersonal therapy for depressive symptoms among people living with HIV/AIDS in Northwest Ethiopia.

METHOD

We conducted a single-arm, peer-administered, group interpersonal therapy intervention with eight weekly sessions from 15 August to 15 December 2019 among people living with HIV/AIDS in Northwest Ethiopia. Four interpersonal therapy groups were formed for the intervention with a total of 31 participants.

RESULTS

Of the 31 recruited participants, 29 completed the intervention providing a retention rate of 93.5%. The process of the intervention and its outcomes were highly acceptable as most participants expressed success in resolving their psychosocial problems, adjusting to life changes and coping with stigma. The intervention was also reported to be feasible despite anticipated barriers such as access to transportation, perceived stigma and confidentiality concerns. The post-intervention assessment revealed significant reduction in depressive symptoms (mean difference (MD) = 9.92; t =  - 7.82; 95% CI, - 12.54, - 7.31; p < 0.001), improvement in perceived social support (MD = 0.79; t = 2.84; 95% CI, 0.22, 1.37; p = 0.009) and quality of life (MD = 0.39; t = 4.58; 95% CI, 0.21, 0.56; p < 0.001).

CONCLUSION

Group interpersonal therapy is feasible and acceptable, and people living with HIV/AIDS can benefit from group interpersonal therapy in managing depressive symptoms and in improving perceived social support and quality of life. Future studies should examine the effectiveness of group interpersonal therapy in this setting.

Evidence-based practice by physiotherapists in UAE: Investigating behavior, attitudes, awareness, knowledge and barriers

Evidence-based practice (EBP) is an important factor determining the quality of healthcare. The field of physiotherapy is still limited by indirect access in several countries including the United Arab Emirates (UAE) which creates added pressure to justify the merit in its practitioner’s capabilities. This study explores the behavior, attitudes, awareness and knowledge towards EBP among practicing physiotherapists in the UAE. It also enquires about their perception of the barriers in the implementation of EBP. Using a questionnaire survey of 258 physiotherapists, results show that the awareness of EBP is limited to a few terms including EBP, systematic literature review, and random trials while other terms associated with scientific studies are not known well. The attitude towards EBP was found to be significantly related to the knowledge of EBP (r = 0.208) and the perception of barriers to it (r = 0.156). The EBP behavior was found positively related to its knowledge (r = 0.134) and the perception of barriers (r = 0.216). The physiotherapists prefer to use their own experience and books and research articles to apply EBP but do not consider their peers to be as worthy sources as the others. However, their attitudes towards EBP are largely positive though their perception of barriers grows with better knowledge and understanding of EBP. The barriers in the implementation of EBP are a lack of research knowledge and skills, time, support, and resources which indicate opportunities for the decision-makers to improve the adoption of EBP among these professionals. This study concluded that although physiotherapists in the UAE claim awareness about EBP, their knowledge is limited to a few key terms whereas, attention is needed to improve EBP knowledge and practice.

The Association between Trainer Expertise and Changes in Adolescent Symptomatology in an Evidence-Based Family Prevention Programme

PURPOSE

The aim of this study is to assess whether the outcomes of implementations of the Universal Strengthening Families Program (SFP 11-14) are linked to the competences or specific skills of the trainers of social field who gave them.

METHOD

The analyzed data was based on ratings awarded by the 174 mothers participating in the SFP 11-14. By conducting a K-means cluster analysis, significant groups were identified, based on the ratings awarded to the trainers.

RESULTS/DISCUSSION

A comparison of the clusters led to the identification of significant differences between cluster 2 (trainers with limited skills) and the other clusters in terms of changes in the children's symptoms after participating in the SFP 11-14. Trainers with limited skills were associated with fewer changes in the symptomatology. It highlights the importance of proficient trainers in programme outcomes, and it could serve as a guide for the public social work in the design of EBP.

Knowledge translation for the everyday optometrist

A gap exists between best evidence and actual clinical care provided to patients. The advent of evidence-based practice was meant to address this gap by providing practitioners with a method to search, evaluate and incorporate evidence into practice. However, the gap continues to exist. The health research fields of knowledge translation and implementation science have evolved over the last few decades to assist practitioners in embedding research findings and best evidence into routine practice. Knowledge translation seeks to improve public health outcomes by facilitating the movement of best evidence from the bench to clinical practice. Implementation science is the study of methods to integrate research findings and evidence-based practice into routine practice. This literature review aims to revisit the concepts of evidence-based practice and to introduce knowledge translation and implementation science by exploring their roles and influences in the delivery of appropriate glaucoma care by optometrists.

A mapping of facilitators and barriers to evidence-based management in health systems: a scoping review study

BACKGROUND

Healthcare settings are complex, and the decision-making process is usually complicated, too. Precise use of best evidence from different sources for increasing the desired outcomes is the result of EBM. Therefore, this study aimed to map the potential facilitators and barriers to EBM in health systems to help the healthcare managers to better implement EBM in their organizations.

METHODS

The present study was a scoping review (SR) conducted in 2020 based on the integration of the frameworks presented by Arksey and O'Malley (2005) and Levac et al. (2010) considering the Joanna Briggs Institute guideline (2015). These frameworks consist of 6 steps. After finalizing the search strategy, 7 databases were searched, and the PRISMA-ScR was used to manage the retrieval and inclusion of the evidence. Microsoft Excel 2013 was used to extract the data, and the graphic description was presented. The summative analysis approach was used applying MAXQDA10.

RESULTS

According to the systematic search, 4815 studies were retrieved after eliminating duplicates and unrelated articles, 49 articles remained to extract EBM facilitators and barriers. Six main aspects attitude toward EBM, external factors, contextual factors, resources, policies and procedures, and research capacity and data availability were summarized as EBM facilitators. The barriers to EBM were similarly summarized as attitude toward EBM, external factors, contextual factors, policies and procedures, limited resources, and research capacity and data availability. The streamgraphs describe that the international attention to the sub-aspects of facilitators and barriers of EBM has been increased since 2011.

CONCLUSIONS

The importance of decision-making regarding complex health systems, especially in terms of resource constraints and uncertainty conditions, requires EBM in the health system as much as possible. Identifying the factors that facilitate the use of evidence, as well as its barriers to management and decision-making in the organization, can play an important role in making systematic and reliable decisions that can be defended by the officials and ultimately lead to greater savings in organization resources and prevent them from being wasted.

Peer-Developed Modules on Basic Biostatistics and Evidence-Based Medicine Principles for Undergraduate Medical Education

Introduction

Evidence-based medicine (EBM) is pivotal in shaping patient care, yet it is challenging to incorporate into undergraduate medical education (UME) due to a lack of dedicated resources within the preclinical curriculum. To address this challenge, we used a peer-led approach to explain difficult concepts through language that students can understand at their shared level of understanding.

Methods

Four second-year medical students trained in EBM over 18 months by facilitating monthly journal clubs, ultimately leading to their involvement as peer-instructors. With input from a faculty expert, peer-instructors designed integrative PowerPoint modules and interactive problem sets on basic biostatistics and EBM principles. Assessment included formative quizzes with multiple attempts to achieve at least 80% to demonstrate mastery of core learning objectives. Afterwards, students were invited to provide feedback using a 5-point Likert scale survey.

Results

Of second-year students who participated, all 151 demonstrated 80% competency on each quiz. Eighty-seven (58%) students completed the survey on which, 77% agreed/strongly agreed that their level of understanding of EBM improved after the peer-led sessions, 76% agreed/strongly agreed that the sessions were more conducive to learning compared to traditional lectures, and 94% agreed/strongly agreed that the material covered was relevant to the USMLE Step 1.

Discussion

This peer-led approach has been rated as effective by learners, improving their ability to critically appraise and apply clinical evidence. To promote integration of EBM into UME, we have prepared modules, problem sets, quizzes, and an outline of the problem-solving sessions for universal adoption.

Leveraging human-centered design to implement modern psychological science: Return on an early investment

Although classic models of implementation emphasized the importance of innovation characteristics in their adoption and sustained use, contemporary implementation research and practice have deprioritized these variables. Human-centered design (HCD) is an approach that grounds product development in information collected about the people and settings that will ultimately use those products. HCD has strong roots in psychological theory, but its application is typically limited to the development of digital technologies. HCD is rarely applied to the design of psychosocial innovations-including both service-recipient-facing interventions and implementation strategies-within the applied psychological disciplines. The current article reviews the psychological origins of HCD and details pathways through which HCD theories and methods can be leveraged to advance the "core tasks" of contemporary implementation research and practice in psychology. These include (a) identification of multilevel implementation determinants through specification of user needs and contexts; (b) tailoring of implementation strategies, such as contextually driven intervention redesign; and (c) evaluating implementation mechanisms and outcomes, including disentangling how the core HCD focus on usability relates to closely associated implementation variables such as acceptability, feasibility, and appropriateness. Collectively, these applications provide directions through which to leverage the mature field of HCD, maximize psychology's return on its early theoretical investment, and promote the large-scale impact of findings from across the applied fields of psychology. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Identifying and measuring the common elements of naturalistic developmental behavioral interventions for autism spectrum disorder: Development of the NDBI-Fi

LAY ABSTRACT

Naturalistic developmental behavioral interventions for young children with autism spectrum disorder share key elements. However, the extent of similarity between programs within this class of evidence-based interventions is unknown. There is also currently no tool that can be used to measure the implementation of their common elements. This article presents a multi-stage process which began with defining all intervention elements of naturalistic developmental behavioral interventions. Next, intervention experts identified the common elements of naturalistic developmental behavioral interventions using a survey. An observational rating scheme of those common elements, the eight-item NDBI-Fi, was developed. We evaluated the quality of the NDBI-Fi using videos from completed trials of caregiver-implemented naturalistic developmental behavioral interventions. Results showed that the NDBI-Fi measure has promise; it was sensitive to change, related to other similar measures, and demonstrated adequate agreement between raters. This unique measure has the potential to advance intervention science in autism spectrum disorder by providing a tool to measure the implementation of common elements across naturalistic developmental behavioral intervention models. Given that naturalistic developmental behavioral interventions have numerous shared strategies, this may ease clinicians' uncertainty about choosing the "right" intervention package. It also suggests that there may not be a need for extensive training in more than one naturalistic developmental behavioral intervention. Future research should determine whether these common elements are part of other treatment approaches to better understand the quality of services children and families receive as part of usual care.

Factors Affecting Implementation of Evidence-Based Practices in Public Health Preparedness and Response

CONTEXT

There is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur.

OBJECTIVE

This study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation.

DESIGN

A Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed.

SETTING

State, local, and territorial public health agencies across the United States.

PARTICIPANTS

Preparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs).

RESULTS

Respondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation.

CONCLUSIONS

Findings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.

Evaluation of Facilitators and Barriers to Implementing Evidence-Based Practice in the Health Services: A Systematic Review

BACKGROUND

Evidence-based practice (EBP) is an ambition for health service administrators. We aimed to systematically review the major relevant articles in case of barriers and facilitators to implementing evidence-based practice in health services.

MATERIALS AND METHODS

The type of study was a systematic review. We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included "Evidence-Based Practice", "Evidence-Based Management", "Healthcare", "Care Management, Evidence-Based Healthcare Management", "Health Care", Health", "Barrier", "Facilitator", policy and "Evidence-Based Healthcare".

RESULTS

In total, 12 studies were included. Several barriers and facilitators were recognized through the included papers, the factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP. The outcomes of studies were identified as the employ of the internet as a highest-rated skill for increasing EBP quality.

CONCLUSION

Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Warum nehmen Verhaltenstherapeut_innen an Fortbildungen teil?

Zusammenfassung. Theoretischer Hintergrund: Um psychotherapeutische Kompetenzen zu erhalten, kommt Fortbildungen eine zentrale Rolle zu. Fragestellung: Ziel war es, Verhaltenstherapeut_innen zu Motivatoren und Barrieren bezüglich der Teilnahme an Fortbildungen und zu Einstellungen zu evidenzbasierter Praxis zu befragen. Methode: In die Befragung einbezogen wurden N = 48 Teilnehmer_innen eines zweitägigen Workshops zu aktuellen Ansätzen der Traumatherapie. Fortbildungsmotivation, Teilnahmebarrieren und Einstellungen zu evidenzbasierter Praxis wurden in Zusammenhang mit der aktuellen Fortbildungsteilnahme geprüft. Ergebnisse: Der Wunsch nach beruflicher Verbesserung und persönliches Interesse motivierten am häufigsten, soziale Anreize und beruflicher Aufstieg waren weniger relevant. Die Vereinbarkeit von Fortbildungen mit der Arbeitstätigkeit und Fortbildungskosten waren häufige Barrieren. Schlussfolgerungen: Die Ergebnisse liefern Hinweise zur Diskussion des Konzepts der evidenzbasierten Psychotherapie und zur Dissemination wissenschaftlicher Ergebnisse in die Praxis.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.

Nursing Managers' Perspectives on the Facilitators and Barriers to Implementation of Evidence-Based Management

BACKGROUND

Evidence-based health management is defined as a new approach to improve the quality of hospital decisions by systematic application of the best available evidence. To use that, facilitators and barriers to implementation of evidence-based management (EBMgt) in the decision-making process need to be identified.

AIM

The purpose of this study was to assess nursing managers' perspectives on the facilitators and barriers to implementation of EBMgt in Tabriz hospitals, northwest Iran.

METHODS

A cross-sectional study design was used in 2017. The study was conducted in one state in Iran (Tabriz). A total of 276 nursing managers (e.g., matrons, supervisors, & head nurses [HNs]) were invited to participate from the Tabriz hospitals (N = 20); 212 completed and returned the survey, yielding a response rate of 76.81%. The EBMgt assessment questionnaire was used to collect data. The questionnaire consists of two parts. The first part includes barriers to EBMgt (five main domains and 46 questions). The second part includes the facilitators of EBMgt (five main domains and 42 questions). Data entry and analysis were carried out using SPSS-21 software.

RESULTS

Highest mean scores of barriers were observed for "training and research systems" (64.65 ± 12.42). "Lack of communication between knowledge producers and hospital decision-makers" (68.19 ± 17.32) had highest mean scores among all 46 barriers. Also, the results showed that mean scores for all the barriers were higher than 55. The highest mean scores were observed for "social/interpersonal factors" (65.84 ± 17.07). "Interest and willingness to scientific management principles" (68.62 ± 20.17) had highest mean scores among all 42 facilitators.

LINKING EVIDENCE TO ACTION

The aim of EBMgt is to provide the most effective healthcare outcomes. Identifying barriers and facilitators is essential for implementing EBMgt in hospitals. Building the facilitators and eliminating barriers are foundation of EBMgt. Filling the gap between knowledge producers and nursing managers can be a starting point for improvement of the decision-making process in nursing care.

Nurturing Practitioner-Researcher Partnerships to Improve Adoption and Delivery of Research-Based Social and Public Health Services Worldwide

Research-based practices—psychosocial, behavioral, and public health interventions—have been demonstrated to be effective and often cost-saving treatments, but they can take up to two decades to reach practitioners within the health and human services workforce worldwide. Practitioners often rely on anecdotal evidence and their “practice wisdom” rather than on research, and may thus unintentionally provide less effective or ineffective services. Worldwide, community engagement in research is recommended, particularly in low-resource contexts. However, practitioner involvement has not been adequately explored in its own right as an innovative community-engaged practice that requires a tailored approach. The involvement of practitioners in research has been shown to improve their use of research-based interventions, and thus the quality of care and client outcomes. Nevertheless, the literature is lacking specificity about when and how (that is, using which tasks and procedures) to nurture and develop practitioner–researcher partnerships. This paper offers theoretical and empirical evidence on practitioner–researcher partnerships as an innovation with potential to enhance each phase of the research cycle and improve services, using data from the United States, Brazil, and Spain. Recommendations for partnership development and sustainability are offered, and a case is made for involving practitioners in research in order to advance social justice by amplifying the local relevance of research, increasing the likelihood of dissemination to community settings, and securing the sustainability of research-based interventions in practice settings.

Examining the sustainability potential of a multisite pilot to integrate alcohol screening and brief intervention within three primary care systems

The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.

Attitudes of mental health providers towards adoption of evidence-based interventions: relationship to workplace, staff roles and social and psychological factors at work

Background

Gaining insight into factors influencing the adoption of evidence-based interventions (EBI) is essential to ensuring their sustainability in the mental healthcare setting. This article describes 1) differences between professional staff roles in attitudes towards EBI and 2) individual and organizational predictors of attitudes towards adopting EBI.

Methods

The participants were psychologists and psychiatric nurses (N = 792). Student t-tests were used to investigate group differences of global attitude scores on the Evidence-based Practice Attitude Scale-36 (EBPAS-36). A confirmatory factor analysis (CFA) of the EBPAS-36 measurement model, and a principal component analysis (PCA) of the factor scores were used to obtain attitudinal components for the subsequent hierarchical regression analyses.

Results

Three second-order attitudinal components were retained and named: professional concern, attitudes related to work conditions and requirements, and attitudes related to fit and preferences. Nurses’ global attitudinal scores were more positive than those of psychologists, while clinicians had less positive global attitudinal scores than non-clinicians. Hierarchical regression analysis showed that provider demographic, social and psychological factors in the workplace and staff role predicted attitudes towards adopting EBI, e.g. male gender, older age and working in private practice predicted more negative global attitudes, while working in academia, experiencing social support from colleagues and empowering leadership predicted more positive global attitudes to adopt EBI. The prediction outcomes for the specific attitudinal components are presented, as well.

Conclusion

The findings suggest that implementation efforts may benefit from being tailored to the different needs and values of the affected professionals, including the role of the context they operate within. Implications with a special emphasis on training efforts and organizational development are discussed.

Evaluating Practitioner Training to Improve Competencies and Organizational Practices for Engaging Fathers in Parenting Interventions

Fathers are consistently underrepresented in parenting interventions and practitioners are an important target for change in interventions to enhance father engagement. This research examined the effects of two practitioner training programs in improving practitioner rated competencies and organizational father-inclusive practices. Two studies were conducted, each with a single group, repeated measures (pre, post and 2-month follow-up) design. Study 1 (N = 233) examined the outcomes of face-to-face training in improving practitioner ratings of competencies in engaging fathers, perceived effectiveness and use of father engagement strategies, organizational practices and rates of father engagement. Study 2 (N = 356) examined online training using the same outcome measures. Practitioners in both training formats improved in their competencies, organizational practices and rates of father engagement over time, yet those in the online format deteriorated in three competencies from post-training to follow-up. The implications for delivering practitioner training programs to enhance competencies and rates of father engagement are discussed.

Consumer and staff perspectives of the implementation frequency and value of recovery and wellbeing oriented practices

Background

Despite advances in our understanding of what mental health systems and services can do to enhance recovery and wellbeing outcomes for people seeking support, there is limited evidence demonstrating that this body of work has translated successfully into mental health service practice. The Collaborative Recovery Model (CRM) is a practice framework that has been designed to support application of recovery and wellbeing oriented principles and practices within mental health service delivery. The aims of this study were to assess consumer and staff perceptions of implementation frequency during service engagement and the value of this approach for assisting recovery within a setting where the CRM approach had been adopted.

Methods

The setting was a large Australian community managed mental health organisation. The study involved a cross-sectional analysis of consumer (n = 116) and staff practitioner (n = 62) perspectives. A series of paired sample t-tests assessed for differences between consumer and staff perceptions of the: (i) importance of key practice elements for assisting recovery, and the (ii) frequency that key practice elements are utilised during engagement sessions. Spearman's r correlational analysis explored associations between importance, frequency and helpfulness of sessions.

Results

Key practice elements of the model were applied during service interactions at a high level and perceived by the majority of consumers and staff participants as being important or very important for assisting recovery. Significant moderate correlations were found between the extent that practice elements were valued and the level at which they were applied. Higher levels of implementation of CRM practices were associated with higher ratings of perceived session helpfulness. The strongest association was between 'encouragement to set tasks to complete between support visits' and perceived helpfulness.

Conclusions

Consumer and staff responses revealed that the key practice elements of the CRM were frequently implemented during service engagement interactions and were seen as valuable for assisting recovery. The level of agreement between raters suggests firstly, that the key practice elements were apparent and able to be rated as occurring, and secondly that the CRM approach is seen as responsive to consumer needs. The results have implications for translating recovery and wellbeing oriented knowledge into mental health service practice.

Measuring Costs to Community-Based Agencies for Implementation of an Evidence-Based Practice

Healthcare reform has led to an increase in dissemination of evidence-based practices. Cost is frequently cited as a significant yet rarely studied barrier to dissemination of evidence-based practices and the associated improvements in quality of care. This study describes an approach to measuring the incremental, unreimbursed costs in staff time and direct costs to community-based clinics implementing an evidence-based practice through participating in a learning collaborative. Initial implementation costs exceeding those for providing "treatment as usual" were collected for ten clinics implementing trauma-focused cognitive behavioral therapy through participation in 10-month learning collaboratives. Incremental implementation costs of these ten community-based clinic teams averaged the equivalent of US$89,575 (US$ 2012). The most costly activities were training, supervision, preparation time, and implementation team meetings. Recommendations are made for further research on implementation costs, dissemination of evidence-based practices, and implications for researchers and policy makers.

Methods to Improve the Selection and Tailoring of Implementation Strategies

Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research.

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System

Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.

Does patient reluctance towards exposure and psychologists' attitudes about evidence based practice influence treatment recommendations for panic disorder? An experimental investigation

This study examined the effects of patient reluctance towards exposure on practitioners' subsequent treatment recommendations. Participants (N=236) were doctoral level psychologists who received a vignette of a patient with panic disorder, which either did (experimental group) or did not (control group) mention patient reluctance towards exposure. Evidence Based Practice (EBP) attitudes were also assessed and taken into account. A significant main effect of reluctance, averaged across all levels of EBP attitudes, and theoretical orientations was obtained (OR=2.85, 95% CI=[1.51, 5.39], p=0.001, RR=1.46), with controls 1.46 times more likely to recommend exposure. A significant main effect of EBP attitudes was also obtained (p<0.001). The odds of recommending exposure increased by 11% with each increase of positive EBP attitudes, across both levels of patient reluctance and theoretical orientation.

Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system

Background

System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings.

Methods

We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate.

Results

We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits.

Conclusions

While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain.

Exploring Acceptability and Feasibility of Evidence-Based Practice in Child Welfare Settings: A Pilot Study with Attachment-Based Family Therapy

The Flemish Child Welfare System (CWS) is in great need of a shared empirically informed clinical strategy for working with depressed adolescents and their families. Many evidence-based practices (EBP) exist, but little is known as to whether they can be successfully imported in the CWS. Therefore, the current study explores the implementation of a particular EBP, Attachment-Based Family Therapy (ABFT), in home-based services of the Flemish CWS in Belgium. Specifically, the study focused on (1) the acceptability of ABFT by counselors and whether negative attitudes about EBP can be changed (n = 73 counselors), and (2) the feasibility of implementing ABFT (n = 43 adolescents, 11-17 years old, 72% female) by exploring initial effectiveness. The results suggest that (1) initial negative attitudes of counselors towards ABFT were significantly more positive after attending training and discussions about ABFT, and that (2) ABFT could be used by counselors to successfully reduce adolescent depressive symptoms. Future research should include a control group to draw stronger causal conclusions. Strengths and limitations of the study's design and implications for further dissemination are discussed.

Can we address depression in vision rehabilitation settings? Professionals' perspectives on the barriers to integrating problem-solving treatment

PURPOSE

Low vision rehabilitation (LVR) is a pertinent context for integrating early, evidence-based psychological interventions given the high prevalence of untreated depression in adults with vision impairment. This study aims to identify the perceived barriers and facilitators to staff-delivered telephone-based problem-solving treatment for primary care (PST-PC) offered as an integrated component of LVR.

METHODS

Qualitative semi-structured interviews, developed using the theoretical domains framework (TDF) and Consolidated Framework for Implementation Research (CFIR), were conducted with 21 LVR professionals and a clinical psychologist involved in the delivery of PST-PC. Barriers and facilitators at the practitioner, client, intervention, and organizational level were identified with thematic analysis using a "theoretical" approach.

RESULTS

Prominent barriers were a lack of role recognition for PST-PC practitioners (n = 32), unmet client expectation with PST-PC (n = 28), dissatisfaction with telephone delivery (n = 27), and limited organizational awareness of PST-PC (n = 39). Facilitating factors included a recognized need for evidence-based psychological services (n = 28), clients experiencing benefits in early sessions (n = 38), PST-PC promoting practical skills (n = 26), and comprehensive PST-PC training (n = 36).

CONCLUSIONS

PST-PC may provide an accessible early intervention for LVR clients with depressive symptoms. Ongoing practitioner training, clinical support, and screening potential LVR clients for treatment suitability are likely to enhance delivery in this setting. Implications for rehabilitation Depression is highly prevalent in adults engaged in low vision rehabilitation (LVR) programs, yet few receive support. Clinical guidelines recommend integrated models of care be offered within rehabilitation settings as early intervention for mild to moderate levels of depressive symptoms. Integrated telephone-based problem-solving treatment for primary care (PST-PC) delivered by trained LVR practitioners is a practical, skills-based model that has potential to increase access to an early psychological intervention in LVR clients with depressive symptoms. LVR clients are often older in age, have multiple comorbid health conditions and a significant level of functional disability, requiring flexibility in the delivery of PST-PC and specialized staff training, and support in working with older and more complex clients.

Identifying and Prioritizing Implementation Barriers, Gaps, and Strategies Through the Nigeria Implementation Science Alliance: Getting to Zero in the Prevention of Mother-to-Child Transmission of HIV

BACKGROUND

In 2013, Nigeria accounted for 15% of the 1.3 million pregnant women living with HIV in sub-Saharan Africa and 26% of new infections among children worldwide. Despite this, less than 20% of pregnant women in Nigeria received an HIV test during pregnancy, and only 23% of HIV-infected pregnant women received appropriate intervention following HIV diagnosis. This article reports findings from 2 structured group exercises conducted at the first Nigeria Implementation Science Alliance Conference to identify (1) barriers and research gaps related to prevention of mother-to-child transmission (PMTCT) and (2) potential strategies and interventions that could address PMTCT challenges.

METHODS

Two 1-hour structured group exercises were conducted with 10 groups of 14-15 individuals (n = 145), who were asked to brainstorm barriers and strategies and to rank their top 3 in each category. Data analysis eliminated duplicate responses and categorized each of the priorities along the HIV care continuum: HIV diagnosis, linkage to care, or retention in care.

RESULTS

Participating stakeholders identified 20 unique barriers and research gaps related to PMTCT across the HIV continuum. Twenty-five unique interventions and implementation strategies were identified. Similar to the barriers and research gaps, these interventions and strategies were distributed across the HIV care continuum.

CONCLUSIONS

The barriers and strategies identified in this study represent important pathways to progress addressing MTCT. The deliberate involvement of state and federal policy makers, program implementers, and researchers helps ensure that they are relevant and actionable.

The role of setting versus treatment type in alliance within youth therapy

OBJECTIVE

Does the strength of the youth-therapist alliance differ across treatment settings or treatment type? We examined these questions in the context of youth therapy.

METHOD

Eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with an anxiety disorder received (a) manual-based individual cognitive-behavioral therapy (ICBT) in a research setting, (b) manual-based ICBT in practice settings, or (c) nonmanualized usual care (UC) in practice settings. Coders, using the Therapy Process Observational Coding System-Alliance scale, rated 865 sessions. Youth completed the Therapeutic Alliance Scale for Children at posttreatment.

RESULTS

Youth who received ICBT in a research setting had significantly higher observer-rated alliance than youth who received either therapy delivered in practice settings. In practice settings, youth who received ICBT had significantly stronger observer-rated alliance early in treatment than youth in UC, but this difference was not observed at the end of treatment. Similarly, youth-report alliance at posttreatment was significantly higher in ICBT in the research setting, and there was no difference between ICBT and UC delivered in practice settings. Alliance differences largely held when controlling for youth characteristics; however, differences early in treatment between the ICBT groups were no longer statistically significant when controlling for anxiety severity or primary anxiety diagnosis.

CONCLUSIONS

Our findings suggest that (a) the alliance may be stronger in research settings, and (b) treatment manuals do not undermine alliance. Future research is required to help pinpoint whether other youth, therapist, or setting factors contribute to the lower alliance seen in practice settings.

Practitioners' views and use of evidence-based treatment: positive attitudes but missed opportunities in children's services

The extent evidence-based treatments (EBTs) are used in clinical practice within the Australian therapeutic child welfare sector is unknown. In this study, we investigated practitioners' knowledge, attitudes, and use of EBT when providing interventions to children and families and how the intended outcomes of interventions are evaluated. Practitioners (N = 112) from 41 non-government organizations were surveyed and reported few barriers to implementing EBTs and positive attitudes. While just over half the practitioners surveyed provided an accurate definition of EBT, 72 % of practitioners reported using EBTs in their clinical practice. Of those, 88 % reported modifying the EBT, however interventions were rarely evaluated systematically. Implications for the use of EBTs, how they are modified, and the role of systematic evaluation are discussed.

Methods to Improve the Selection and Tailoring of Implementation Strategies

Implementing behavioral health interventions is a complicated process. It has been suggested that implementation strategies should be selected and tailored to address the contextual needs of a given change effort; however, there is limited guidance as to how to do this. This article proposes four methods (concept mapping, group model building, conjoint analysis, and intervention mapping) that could be used to match implementation strategies to identified barriers and facilitators for a particular evidence-based practice or process change being implemented in a given setting. Each method is reviewed, examples of their use are provided, and their strengths and weaknesses are discussed. The discussion includes suggestions for future research pertaining to implementation strategies and highlights these methods' relevance to behavioral health services and research.

Evidence-based psychosocial treatment in the community: considerations for dissemination and implementation

BACKGROUND

In psycho-oncology care, steps toward dissemination and implementation of evidence-based treatments (EBTs) have not been made. For this to change, factors associated with real-world dissemination and implementation must be identified. In the community, providers, their organizations, and patients are key stakeholders.

METHOD

A focused review of literatures in continuing education, dissemination, and implementation of mental health services is provided.

RESULTS

Early-career providers are most ready to implement as they have greater openness and more positive attitudes toward EBTs. Current continuing education practices to teach EBTs have limited effectiveness. Instruction using interactive strategies tailored to therapists' clinical needs and the provision of post-education consultation is needed. There is tension between EBT delivery with fidelity and the necessity for adaptation. EBT service provision is the key outcome of implementation, and documenting such is important to patients, providers, and organizations.

CONCLUSION

A multilevel conceptual framework, Setting, Therapist, Education, imPlementation, and Sustainability, is offered and provides directions for dissemination and sustainable implementation. Guidelines from the Commission on Cancer of the American College of Surgeons and the American Society of Clinical Oncology underscore the timeliness of the proposed framework to move EBTs from the research settings where they were developed to the practice settings where they are needed.

Direct-to-Consumer Marketing: A Complementary Approach to Traditional Dissemination and implementation Efforts for Mental Health and Substance Abuse Interventions

The overall chasm between those who need treatment for mental health and substance abuse (M/SU) and those who receive effective treatment consists of two, interrelated gaps: the research-to-practice gap and the treatment gap. Prior efforts to disseminate evidence-based practice (EBP) for M/SU have predominantly targeted the research-to-practice gap, by focusing efforts toward treatment providers. This article introduces direct-to-consumer (DTC) marketing that targets patients and caregivers as a complementary approach to existing dissemination efforts. Specific issues discussed include: rationale for DTC marketing based on the concept of push versus pull marketing; overview of key stakeholders involved in DTC marketing; and description of the Marketing Mix planning framework. The applicability of these issues to the dissemination of EBP for M/SU is discussed.