Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges

Using Implementation Science to Improve Evidence-Based Policing: An Introduction for Researchers and Practitioners

As "the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice," implementation science (IS) offers the potential to translate effective innovations in policing across agencies and local contexts with fidelity and sustainability in support of a commitment to evidence-based policing (EBP). Despite this potential, and its widespread use in adjacent fields facing similar challenges, implementation science remains almost completely unstudied and unutilized in police settings. To fill these gaps in research and practice, this paper provides an orientation to IS for police researchers and practitioners. It recounts EBP's historical roots in an evidence-based approach to health care, demonstrates the commonalities that make IS as natural to policing as medicine, and surveys the existing literature on the employment of IS in policing. It adapts a conceptual model of IS to policing, presents two well-developed frameworks, and introduces three types of hybrid implementation/effectiveness trials suitable for use in dynamic police settings. It then provides illustrative cases in policing where the use of IS would be apt, and highlights the importance of the de-implementation of substandard or problematic practices as a key but often overlooked aspect of IS. It concludes by discussing how police practices that fully embrace evidence will nonetheless be guided by contestable values and norms, and how IS provides a way to address this concern. The paper provides research and practice agendas for integrating IS into EBP as police seek to adopt evidence-informed practices that deliver public safety, respect rights, and increase community satisfaction and trust.

Leveraging research steering committees for stakeholder engagement: a multifaceted strategy in Brazilian implementation projects

INTRODUCTION

Research steering committees (RSCs) are increasingly recognized as a strategy for stakeholder engagement. Drawing on the experiences of participants from three RSCs involved in health care implementation projects in Brazil, this study aims to examine the contributions of RSCs to implementation research based on their impact on implementation outcomes.

METHODS

This descriptive, exploratory, qualitative study was conducted between August and December 2024. Shared appreciation groups with eight researchers facilitated consensus on RSC operationalization. Additionally, semistructured interviews with 12 RSC members from three research projects explored the contributions to stakeholder engagement and implementation outcomes. Data were analyzed using thematic content analysis.

RESULTS

Thirteen discrete implementation strategies were identified within four categories: use evaluative and iterative strategies, adapt and tailor to context, develop stakeholder interrelationships, and train and educate stakeholders. The RSCs influenced six implementation outcomes: acceptability, adoption, appropriateness, feasibility, penetration, and sustainability. Appropriateness and feasibility emerged as the most prominent outcomes.

CONCLUSION

Research steering committees constitute a multifaceted implementation strategy that fosters structured stakeholder engagement. By integrating multiple implementation strategies, they enhance collaboration, contextual adaptation, and shared governance. Their impact on appropriateness and feasibility highlights their relevance as a support mechanism for implementation success and sustainability.

Adapting an early autism caregiver coaching intervention for telehealth delivery in low-resource settings: A South African study of the 'what' and the 'why'

The COVID-19 pandemic required in-person interventions to be adapted for remote delivery all over the globe. In South Africa, an in-person cascaded task-sharing naturalistic developmental behavioural intervention was adapted for telehealth delivery in a low-resource context. Here we describe the adaptations made (the 'what') and reasons for adaptations (the 'why'). The Framework for Modification and Adaptations (FRAME) was used to document the 'what', and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to describe the 'why'. Systematic member-checking ensured robustness of results. The 'what' included 10 adaptations: selecting WhatsApp as delivery platform, developing images with simple text to communicate intervention concepts, modifying session structure for hybrid delivery, including a caregiver self-reflection checklist, utilizing online practitioner training, supervision, assessment and consent procedures, developing session recording procedures, distributing session materials electronically, and developing caregiver-child interaction recording and uploading protocols. The 'why' included three outer contextual factors (the digital divide, WhatsApp security/privacy policy, and COVID-19 restrictions), three inner contextual factors (characteristics of caregivers and practitioners, ethics board guidance, and school leadership and organizational characteristics) and one innovation factor (support from intervention co-developers). Adaptations were made in response to unchangeable outer contextual factors and through identification of malleable inner contextual factors.Lay abstractWe were busy with an early autism caregiver-coaching programme in South Africa, when COVID-19 stopped all in-person work. We changed the programme so it could be done using computers and/or phones. Here, we describe programme changes (which we call the 'what') and the reasons for those changes (which we call the 'why'). We used a tool called the Framework for Modification and Adaptations (FRAME) to describe the 'what', and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to describe the 'why' of our programme changes. The team members who helped make these changes checked that the changes described were correct. We made 10 changes in total: we used WhatsApp to deliver the programme, made simple pictures with words as visual tools for the programme, changed some session activities, changed a self-reflection checklist, provided all activities online, changed the way assessment and consent was done, made a session recording guide, sent things needed for sessions by email and WhatsApp, and made a caregiver-child play recording guide. The reasons for changes (the 'why') were about factors outside schools (the types of phones and data people had, WhatsApp security rules, COVID-19 rules), things inside schools/workplace (about the caregivers and nonspecialists themselves, ethics boards, things about the school itself), and support from people who developed the programme. Changes were made by working with things inside schools/workplace that could change. Identifying what could change helped focus and guide which changes were made to a programme.

Targeting mental health and wellbeing in women who have experienced gender-based violence through moderate-vigorous physical activity: a systematic review

BACKGROUND

Gender-based violence (GBV) is associated with high rates of psychopathology (i.e., depression, anxiety, post-traumatic stress disorder) in victim-survivors. Existing research has demonstrated that physical activity is beneficial for mental health and wellbeing across various populations. However, it is currently unclear whether moderate-vigorous physical activity (MVPA) is efficacious for victim-survivors of GBV. Therefore, this systematic review aims to understand 1) the acceptability and feasibility of leisure-time MVPA interventions for victim-survivors of GBV, 2) the efficacy of leisure-time MVPA interventions for mental health and wellbeing in this cohort, and 3) the implementation strategies used in the development of such interventions.

METHODS

Four databases were searched from inception to January 2024. Leisure-time MVPA intervention studies that reported on at least one measure of mental health or wellbeing for self-identified/biological women who had lived experience of GBV were eligible.

RESULTS

Eleven studies met inclusion criteria, and analysis revealed a range of different types of MVPA (n = 5) and mental health/wellbeing outcomes measured (n = 9). The main findings include: 1) feasibility and acceptability of MVPA for victim-survivors was enhanced where trauma and violence-informed (TVI) practices were used in the development and delivery of interventions. 2) There was a lack of clarity and consistency around TVI practice in physical activity intervention research. 3) Leisure-time MVPA may be positively associated with mental health and wellbeing.

CONCLUSIONS

Limited evidence exists regarding the impact of MVPA on mental health and wellbeing for this important population group. Future studies should embed TVI strategy within the design, delivery, and implementation of interventions.

Innovation in Providing Equitable Pre-exposure Prophylaxis Services in the United States: Expanding Access in Nontraditional Settings

BACKGROUND

Pre-exposure prophylaxis (PrEP) usage has slowly increased in the United States, but significant disparities persist across race, ethnicity, sex, gender, age, and geography. Determinants of PrEP inequities include stigma and medical mistrust, lack of patient-centered services, lack of access to clinical care, and organizational resistance to change-within a health care system that neglects these barriers.

METHODS

We describe 5 implementation strategies to providing PrEP in nontraditional settings to underserved populations, using an equity-based approach to address key structural determinants. The alternative settings used in these Ending the HIV Epidemic projects (community-based organizations, telePrEP, mobile clinics, pharmacies, emergency departments) were chosen for the setting characteristics and their serving structurally underserved populations.

RESULTS

Community-based organizations have earned trust within communities and can serve as hubs for comprehensive sexual health services, including PrEP. Telehealth, which expanded significantly because of COVID-19, can help overcome transportation and scheduling barriers to PrEP access. Mobile clinics can also broaden PrEP delivery by bringing tailored services directly to communities, often providing shorter wait times and extended hours. Pharmacists can prescribe PrEP in certain states through legislation or collaborative practice agreements, offering a convenient, community-based option. Emergency departments provide an alternative site for PrEP delivery, with the potential to reach individuals not currently engaged in regular care.

CONCLUSION

These alternative PrEP approaches can expand options for accessing PrEP and alleviate key barriers to care in traditional settings, although they may not eliminate all inequities. Offering more choices increases the likelihood that a broader population will be reached, thereby enhancing overall access to PrEP.

Integrating cardiovascular implementation science research within healthcare systems

Only 1 in 5 evidence-based interventions make it to routine clinical practice and the evidence generated from clinical research may take 17 years to be implemented. This represents a lost opportunity to improve clinical care in healthcare systems. Implementation science refers to the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into real-world clinical settings to positively impact population health. Therefore, implementation roadmaps can be crucial for learning healthcare systems (LHS) to bridge the research-to-practice gap, particularly for cardiovascular disease which remains the leading cause of death in the United States. Implementation models exist, all of which require a thorough understanding of the key phases of implementation for effective healthcare system incorporation and optimization (pre-implementation, implementation, monitoring the implementation, evaluation, sustaining, and scaling-up or de-implementation). This review serves as a call-to-action for involvement of large-scale LHS for cardiovascular implementation science, and provides a roadmap by summarizing various implementation science models, highlighting key implementation phases and discussing successful initiatives to improve the process. We also assess challenges associated with implementation science and provide possible solutions to improve translation of evidence in real-world clinical settings.

Protocol of the Tailored Evidence-based Enhancements in Mental Health-Gamified and Individualized Follow-Up Treatment for Suicide (TEEM-GIFTS): a Multiphase Optimization Strategy (MOST) study implementing a gamified mHealth intervention to reduce postdischarge suicide risk in patients with mental disorders in Shenzhen

INTRODUCTION

Postdischarge suicide risk among psychiatric patients is a great concern. Gamified interventions have demonstrated promise in reducing the risk. This study aims to reduce postdischarge suicide risk through a mHealth intervention that engages and supports patients through gamified features. Built on our previous research, this study will develop, optimise and evaluate a gamified intervention under the Multi-phase Optimization Strategy (MOST) framework in implementation science.

METHODS AND ANALYSIS

This study will be conducted at the Shenzhen Kangning Hospital. Following the MOST framework, we will develop the gamified mHealth app (Tailored Evidence-based Enhancements in Mental Health (TEEM)) with four intervention components in the selection phase. In the optimisation phase, a factorial design randomised controlled trial (RCT) will be conducted to identify the optimised configuration. A total of 320 patients with mental disorders will be recruited and randomised into 16 groups to receive TEEM with different combinations of intervention components, with follow-ups scheduled at 1 week, 1 month, 2 months and 3 months after discharge. In the confirmation phase, we will assess the optimised TEEM through a standard RCT, comparing it to usual care. An additional 320 patients with mental disorders will be recruited for this phase, and the follow-up schedule is the same as in the optimisation phase. Psychiatric patients and family members, clinical and community mental health service providers will be recruited as the community team to help develop and evaluate the TEEM. Quantitative data will be analysed using the intention-to-treat approach and generalised estimating equations, and qualitative data will be coded and categorised to identify key themes.

ETHICS/DISSEMINATION

The Ethics Committee Review Board of Shenzhen Kangning Hospital has approved this study. All participants will provide written informed consent prior to enrolment. The findings will be disseminated through peer-reviewed scientific journals and conference presentations, and a report will be submitted to the National Natural Science Foundation of China and the mental health authorities in the Shenzhen Municipal Health Commission.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, ID: NCT06358339.

Optimal characteristics of peer navigators: adapting peer-based intervention with street-involved youth in Canada and Kenya with the aim of increasing HIV prevention, testing and treatment

BACKGROUND

We sought to adapt a peer navigator (PN) model to increase uptake of human immunodeficiency virus (HIV) prevention, testing and treatment of street-involved youth (SIY) in Canada and Kenya. This article presents key findings on the optimal characteristics of the PN model for SIY across and between sites, prior to intervention implementation.

METHODS

Using an integrated mixed methods approach, eligible participants included SIY aged 16-29 years, healthcare providers and community stakeholders. Data collection tools drew from the CATIE (Canada) PN practice guidelines related to: PN role and responsibilities, training, supervision and integration into sites, among others. During interviews (n = 53) or focus groups (n = 11) with participants, a 39-item PN components checklist was administered (quantitative data), followed immediately by a semi-structured interview protocol with questions that allowed for deeper exploration into the acceptability and appropriateness of the PN intervention (qualitative data). The checklist enabled participants to identify PN characteristics and/or activities as core (essential) or peripheral (adaptable and less important). Spearman's rank correlations (ρ) were used to quantify agreement across sites and participant groups. Qualitative data were inductively coded and analysed using a single codebook.

RESULTS

Quantitative data analysis revealed that out of 39 checklist items, 31 (79%) were considered core. These primarily pertained to host organization, PN characteristics and PN activities. For example, it was agreed that core PN activities included outreach to out-of-care SIY and providing health and social service referrals. There were mixed opinions about asking the PN to declare previous experience with drug use and HIV status, but there was agreement that the PN should have previous experience of street-involvement. Qualitative data analysis suggested that although all participant groups across sites agreed that the PN intervention was acceptable and appropriate, the participants from each site also identified specific adaptations related to their host organization and target SIY.

CONCLUSIONS

Our findings indicate high agreement among participant groups across all sites on some optimal PN intervention characteristics, particularly host organization characteristics, the PN themselves and their activities. However, context-specific adaptations are necessary to successfully scale-up the PN intervention. This model is applicable in diverse regions and organizational contexts.

A mapping review and critique of the literature on translation, dissemination, and implementation capacity building initiatives for different audiences

BACKGROUND

Capacity building is critical for research and practice as the fields of dissemination, implementation and translation science continue to grow. Some scholars state that capacity building should be grounded in competencies. However, the fields are unclear in determining which competencies are relevant for whom, including the content and appropriate level of information and skills for different roles. The goal of this study was to catalogue competencies across current D&I capacity building initiatives.

METHODS

We conducted a mapping review to examine to what extent are theories or frameworks used to guide capacity building, who is being trained, to what extent do capacity building initiatives include a health equity focus, which competencies are being outlined or suggested, how are they being defined, and whether the competencies can be organized along different roles of participants. As a mapping review, we broadly searched for papers using the keywords "training D&I" OR "training implementation" OR "training translation" OR "training dissemination" and included debate and empirical papers about capacity building initiatives in the sample.

RESULTS

A total of 42 articles (from 2011 to 2024) were reviewed, including training development and/or evaluation (n = 25) and conceptual (n = 17) articles. Of the training articles, 13 (52%) specified a framework that guided training. Participants in training included graduate students, researchers, practitioners, and mixed audiences. Fourteen (56%) of the trainings were conducted in the USA, seven (28%) in Canada and other countries. The length of training ranged from two days to two years. Four trainings had an explicit focus on equity. A total of 307 unique competencies were identified and divided into themes: Knowledge, Skills, Engagement with Other Disciplines, Equity, Attitude and Relational Aspects, Capacity Building, Quality Improvement, and Mentorship.

CONCLUSIONS

While there are many D&I capacity building initiatives, we found little consistency in competencies that guided training activities for diverse audiences. Few training activities explicitly identified guiding theories or frameworks or tailored competencies toward different levels of interest in D&I research. Even fewer had an explicit focus on health equity. As the fields continue to foster capacity building programs, it will be important to think critically about the types of competencies we are developing for whom, how, and why.

Pre-implementation patient, provider, and administrator perspectives of remote measurement-based care in a safety net outpatient psychiatry department

Introduction

Psychiatric measurement-based care (MBC) can be more effective than usual care, but health systems face implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few studies incorporate perspectives from multiple stakeholders this early in planning. This analysis identifies alignment and themes in pre-implementation feedback from patients, providers, and administrators regarding a planned MBC implementation in a safety net psychiatry clinic.

Methods

We used interview guides informed by Conceptual Model of Implementation Research to gather qualitative pre-implementation attitudes about perceived Appropriateness, Acceptability, and Feasibility of an MBC measure (Computerized Adaptive Test-Mental Health; CAT-MH) from five patients, two providers, and six administrators. We applied rapid qualitative analysis methods to generate actionable feedback for department leadership still planning implementation. [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word 'general' was replaced with the word 'generate'.] We used a multistep process to generate thematic findings with potential relevance for other similar mental health settings.

Results

There was more attitudinal alignment across stakeholder groups regarding MBC's Acceptability and Feasibility than its Appropriateness. All three groups agreed that it was important to contextualize MBC for patients and providers, anticipate MBC's impact on patient-provider relationships, and consider the system's capacity to respond to patient needs unearthed by CAT-MH before implementation began. Our thematic analysis suggests: (1) Introducing MBC may complicate patient-provider relationships by adding a new and potentially conflicting input for decision making, that is, MBC data, to the more typical inputs of patient report and provider expertise; [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word 'complicated' was replaced with the word 'complicate'.] (2) MBC poses theoretical risks to health equity for safety net patients because of limitations in access to MBC tools themselves and the resources needed to respond to MBC data; and (3) Tension exists between individual- and system-level applications of MBC.

Conclusions

Our analysis highlights shifting treatment dynamics, equity considerations, and tension between individual- and population-level needs that our participants anticipated when planning for MBC implementation in a safety net psychiatry clinic.

Dissemination and Implementation-A Primer for Accelerating "Time to Translation" in Radiation Oncology

The field of radiation oncology has achieved significant technological and scientific advancements in the 21st century. Yet uptake of new evidence-based practices has been heterogeneous, even in the presence of national and international guidelines. Addressing barriers to practice change requires a deliberate focus on developing and testing strategies tailored to improving care delivery and quality, especially for vulnerable patient populations. Implementation science provides a systematic approach to developing and testing strategies, though applications in radiation oncology remain limited. In this critical review, we aim to (1) assess the time from first evidence to widespread adoption, or "time to translation," across multiple evidence-based practices involving radiation therapy, and (2) provide a primer on the application of implementation science to radiation oncology. Specifically, we discuss potential targets for implementation research in radiation oncology, including both evidence-based practices and quality metrics, and highlight examples of studies evaluating implementation strategies. We also define key concepts and frameworks in the field of implementation science, review common study designs, including hybrid trials and cluster randomization, and discuss the interaction with related disciplines such as quality improvement and behavioral economics. Ultimately, this review aims to illustrate how a comprehensive understanding of implementation science could be used to promote equity and quality in cancer care through the development of effective, scalable, and sustainable care delivery solutions.

School-based mindfulness: Application of the PARiHS framework to contextualize implementation

Although school-based mindfulness programs are increasing, contextual issues that facilitate or hinder program implementation are poorly understood. Utilizing an implementation science framework (i.e., Promoting Action on Research in Health Services [PARiHS]) as a heuristic for data collection and analysis, we used an exploratory sequential mixed methods design to investigate implementation barriers and facilitators of the Peace of Mind (PoM) program from the perspective of educators (n = 27) in eight schools and PoM staff (n = 4) using diverse implementation approaches. The integration of qualitative interview data and mixed methods survey data suggests that a combination of personal and structural factors is critical for successful program implementation, with these factors operating synergistically. The most salient factors related to facilitation of PoM implementation included robust buy-in supported by strong champions who were also in leadership positions. The most salient factors indicated for context related to time and implementation process. First-hand, informal evidence impacted buy-in more than distal research studies. The implications for SBMP implementation and implementation research are discussed.

Implementation science and genetic testing for familial hypercholesterolemia

PURPOSE OF REVIEW

Familial hypercholesterolemia is a treatable genetic disorder of cholesterol metabolism. Genetic testing is the most specific method for diagnosing familial hypercholesterolemia, but it remains underutilized. Implementation science aims to bridge the gap between evidence and practice and, thereby, support improved familial hypercholesterolemia care. This review presents the current evidence on the use of implementation science to improve the use of genetic testing for familial hypercholesterolemia.

RECENT FINDINGS

Recent research has focused on developing implementation strategies to improve the use of genetic testing, particularly cascade testing of at-risk blood relatives of known familial hypercholesterolemia cases. Stakeholder informed strategies aimed at improving communication between families and detection of familial hypercholesterolemia in primary care have been developed and implemented. Findings demonstrate implementation science methods can help remove barriers and improve the uptake of cascade genetic testing.

SUMMARY

Significant gaps in familial hypercholesterolemia care emphasize the importance of practical and realistic approaches to improve the detection of this preventable cause of premature heart disease, and recent efforts using implementation science have shown some promising results. More implementation science studies are needed that address the considerable gaps in familial hypercholesterolemia care, including the underutilization of genetic testing, so that all individuals receive the best clinical care.

Supportive supervision visits in a large community hypertension programme in Nigeria: implementation methods and outcomes

BACKGROUND

The Hypertension Treatment in Nigeria (HTN) Programme established a system for hypertension diagnosis and management in 60 public primary healthcare facilities in the Federal Capital Territory of Nigeria through the implementation of HEARTS, a multi-level strategy bundle including team-based care led by community health extension workers (CHEWs). To improve HEARTS implementation, supportive supervision was added as an implementation strategy in April 2020.

METHODS

A multidisciplinary supportive supervision team and data collection forms were developed and implemented at HTN-supported sites. Data from April 2020 to December 2023 from supportive supervision visits were used to measure supportive supervision implementation outcomes, including reach, fidelity, adoption and feasibility and effectiveness of quality of care, data reporting and facility readiness. Descriptive analyses were performed to summarise outcomes. Jonckheere-Terpstra or Cochran-Armitage trend test was used to measure change over time for medians or proportions, respectively.

RESULTS

The programme successfully designed and performed quarterly supportive supervision visits. There was high reach (100% sites with visits each year), fidelity (median 100% (IQR 89%-100%) of core components completed), adoption (100% teams provided quarterly visits) and increase in feasibility (planned visits completed) (90.8% to 97.8%, p=0.002). Effectiveness outcomes included an increase in patients with blood pressure (BP) checked in the last 3 days (78.4% to 84.4%, p=0.009), treatment cards without errors (71.5% to 85%. p<0.001), but a slight drop in CHEW fidelity to BP measurement technique (91.5% to 86.5%, p=0.02). Facility readiness increased in adequate staffing (56.7% to 98.3%, p<0.001), but decreased for equipment availability (98.3% to 90.0%, p=0.03). Overall, the proportion of facilities with all readiness components present increased from 0% to 63.3% (p<0.001).

CONCLUSIONS

We designed and implemented a supportive supervision strategy with strong implementation outcomes and most effectiveness outcomes including facility readiness to provide quality hypertension care in Nigeria. This approach can be modelled for supporting HEARTS implementation in other settings.

TRIAL REGISTRATION NUMBER

The trial was prospectively registered at www.

CLINICALTRIALS

gov under NCT04158154 on 8 November 2019; https://clinicaltrials.gov/ct2/show/NCT04158154.

The design and implementation of an innovative indicated suicide prevention service in Melbourne

BACKGROUND

Suicide prevention strategies are targeted at three levels: the general population (Universal), persons at risk (Selected), and persons who have attempted suicide or have suicidal ideation (Indicated). This study describes the implementation of an innovative indicated suicide prevention service that prioritizes peer and psychosocial support at one of Australia's largest mental health services. The purpose of this paper is threefold. (1) To describe the process of designing and implementing an innovative indicated suicide prevention service in Melbourne (2) To compare the implementation framework developed around it with other relevant frameworks and (3) To describe its stages of care.

RESULTS

Based on the activities undertaken by the 'project champion' in designing and implementing Clayton HOPE, a pragmatic framework of implementation (PFI) was developed. The PFI included six steps. 1: Determine client needs; 2: Plan the model of care; 3: Determine the workforce and other resource requirements to achieve client needs; 4: Establish the workforce and finalize the team; 5: Facilitate stakeholder buy-in and 6: Regular monitoring and evaluation. The steps of the PFI, fit within the Quality Implementation Framework, albeit in a different sequence, owing to variations in settings, organizational circumstances, and readiness for change. The PFI also enhances the Levels of Change model by including additional requirements. A five-stage model of care was developed and implemented. They are 1: Early engagement and empathetic support (within 24 h of referral); 2: Assessment of psychosocial needs and suicidal risk (within 72 h of referral) 3: Construction of a personal safety plan (within 7 days of referral) 4: Implementation of the personal safety plan and risk management (week 2 - week12) and 5: Discharge and handover to ongoing supports (12 weeks from enrollment).

CONCLUSIONS

The main implications of this work are twofold: (1) The implementation of innovative models of care can be achieved by a 'project champion' with the relevant experience, authority and determination when funding is available and (2) Indicated suicide prevention models of care can strike a balance between clinical and non-clinical interventions that are tailored to client needs.

Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study

Background

Our objective is to determine the effect of a new national clinical practice guideline (CPG) for pain management after childbirth, as implemented with less vs. more intensive implementation support, on postpartum opioid prescribing.

Methods

A quasi-experimental analysis will measure the impact of post-childbirth pain management guidelines on opioid prescribing in a statewide hospital collaborative, overall and among key patient subgroups at risk for inequitable care and outcomes. We will also use a randomized, non-responder design and mixed-methods approaches to evaluate the effects of Replicating Effective Programs (REP), a theory-driven, scalable implementation intervention, and Enhanced REP (E-REP; i.e., REP augmented with facilitation, which is individualized consultation with site champions to overcome local barriers) on the uptake of the CPG. The study will include hospitals within the Obstetrics Initiative (OBI), a perinatal collaborative quality initiative funded by Blue Cross Blue Shield of Michigan that includes 68 member hospitals serving more than 120,000 postpartum people, over approximately 15 months. Hospitals not initially responding to REP-defined by performance <15th percentile of all OBI hospitals for (a) inpatient order for opioid-sparing postpartum pain management (e.g., scheduled acetaminophen and non-steroidal anti-inflammatory drugs when not contraindicated), or (b) amount of opioid prescribed at discharge-will be allocated via block randomization to continue REP or to E-REP. Using interrupted time series analyses, the primary analysis will evaluate the rate of postpartum opioid-sparing prescribing metrics at the time of discharge (primary outcome) and opioid prescription refills and high-risk prescribing (secondary outcomes) before and after CPG implementation with REP. We will evaluate inequities in outcomes by patient, procedure, prescriber, and hospital factors. Exploratory analyses will examine temporal trends in patient-reported outcomes and the effects of continued REP vs. E-REP among slower-responder sites. We will evaluate implementation outcomes (e.g., acceptability, feasibility, costs, needed REP and E-REP adaptations) using clinician and patient surveys and qualitative methods (ClinicalTrials.gov identifier: NCT06285123).

Discussion

Findings will inform refinements to the REP and E-REP interventions and add to the literature on the effectiveness of facilitation to promote uptake of evidence-based clinical practices in maternity care.

The wide-angle lens of implementation science to improve health outcomes in criminal legal settings

BACKGROUND

Implementation science (IS) is an emerging discipline that offers frameworks, theories, measures, and interventions to understand both the effective organizational change processes and the contextual factors that affect how well an innovation operates in real-world settings.

RESULTS

In this article, we present an overview of the basic concepts and methods of IS. We then present six studies where IS was used as a means to understand implementation of a new innovations designed to improve the health and well-being of individuals under criminal legal system supervision.

CONCLUSION

We discuss how IS has developed new knowledge on how to implement efficacious innovations and suggesting future research needed to further our understanding of implementation and sustainability of innovations in the legal context.

Attitudes, experiences, and implications of asking about suicide during the perinatal period: A qualitative study with maternity healthcare practitioners

BACKGROUND

Suicide is a leading cause of maternal death. Maternity healthcare practitioners (HCPs) are uniquely positioned to identify perinatal mental health (PMH) problems and/or suicidality. Research exploring HCPs attitudes towards suicide-related screening items and their experiences of asking about perinatal suicidality is limited.

OBJECTIVES

(i) to explore HCPs attitudes towards 16 suicide-related screening items; and (ii) to explore HCPs broader views, experiences and implications of discussing suicide with perinatal women in maternity care settings.

METHODS

Fifteen semi-structured interviews were conducted with maternity HCPs. The sample included midwives, health visitors, general practitioners, and specialist PMH practitioners working in the United Kingdom (UK). Inductive thematic analysis was used to explore the data and identify themes.

RESULTS

Most HCPs felt uncomfortable with, disliked, or found half of the suicide-related items unhelpful. Reasons included use of ambiguous or emotive terms. HCPs preferred not to use the word 'suicide' with pregnant or postnatal women. In the thematic analysis, four themes were identified: (i) Approaches for discussing and identifying PMH problems and suicidality; (ii) Competing demands and continuity of carer; (iii) PMH and suicidality training and support; and (iv) Availability of PMH services and referral pathways. These factors affected HCPs capacity, willingness, and confidence to ask women suicide-related questions.

CONCLUSIONS

HCPs need targeted PMH and suicidality training and support in maternity care contexts to enable them to feel more equipped, comfortable, and available to have conversations with women about PMH and suicide. Timely detection and intervention may help to improve care for women experiencing perinatal suicidality.

Prevalence of anxiety, depression, and post-traumatic stress disorder among paramedic students: a systematic review and meta-analysis

PURPOSE

There are elevated mental health concerns in paramedic students, but estimates vary between studies and countries, and no review has established the overall prevalence. This systematic review addressed this by estimating the global prevalence of common mental health disorders, namely anxiety, depression, and post-traumatic stress disorder (PTSD), in paramedic students internationally.

METHODS

A systematic search of six databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and medRxiv, was conducted to identify studies relating to mental health among paramedicine students. The search encompassed studies from inception until February 2023. To be considered for inclusion in the review, the studies had to report prevalence data on at least one symptom of anxiety, depression, or PTSD in paramedicine students, using quantitative validated scales. The quality of the studies was assessed using Joanna Briggs Institute (JBI) Checklist, which is a specific methodological tool for assessing prevalence studies. Subgroup analyses were not conducted due to insufficient data.

RESULTS

1638 articles were identified from the searches, and 193 full texts were screened, resulting in 13 papers for the systematic review and meta-analysis. The total number of participants was 1064 from 10 countries. The pooled prevalence of moderate PTSD was 17.9% (95% CI 14.8-21.6%), anxiety was 56.4% (95% CI 35,9-75%), and depression was at 34.7% (95% CI 23.4-48.1%).

CONCLUSION

This systematic review and meta-analysis has found that paramedicine students globally exhibit a high prevalence of moderate PTSD, anxiety, and depression. The prevalence of these mental health conditions surpasses those among paramedic providers and the general population, as indicated by previous reviews. Further research is therefore warranted to determine appropriate support and interventions for this group.

Do Cognitive Behavioural Therapy Interventions Lead to Schema Change in People With Psychosis? A Systematic Review and Meta-Analysis

BACKGROUND

Negative schemas have been highlighted as important factors in the development and maintenance of psychosis. However, evidence for schema therapy in people with experiences of psychosis and for schema-specific interventions is lacking for these disabling core beliefs. Cognitive behavioural therapy (CBT) interventions remain a first-line recommended psychological treatment for psychosis, alongside psychotropic medication. The current review aimed for the first time to investigate if CBT interventions led to schema change in this population.

METHOD

A systematic search of five databases (PsycINFO, MEDLINE, Embase, CINAHL and Web of Science) identified 19 eligible studies, of which 10 were eligible for inclusion in the meta-analyses.

RESULTS

A narrative synthesis highlighted the variety in CBT intervention length and focus. A small proportion of studies highlighted schema theory within their therapy rationale and within their subsequent CBT intervention. Meta-analytic findings demonstrated that participants receiving a CBT intervention experienced a significant reduction in their negative-self schemas at the end of therapy, compared with control participants.

CONCLUSION

The findings provide evidence that CBT for psychosis can reduce negative schemas in people with psychosis. The review also offers a rationale for considering schema more explicitly within CBT for psychosis intervention studies and clinical practice.

Participant Perspectives on Pulse-Echo Ultrasound Technology vs. Dual Energy X-Ray Absorptiometry (DXA): A Comparative Study

BACKGROUND/AIM

Osteoporosis is a global health concern causing severe fractures, and timely diagnosis with thorough bone assessment is crucial for effective management. Diagnostic tools such as Bindex® (a novel ultrasound-based diagnostic technology) and DXA (X-ray-based) play a key role in identifying and assessing bone conditions. This study aimed to evaluate and compare these two approaches' overall acceptability, comfort, and preference. Feelings of pain and perceptions regarding the scan length during the Bindex® scanning procedure were also assessed.

PATIENTS AND METHODS

Two diagnostic imaging tools were used in this comparative study: Bindex® (pulse-echo ultrasound technology) and DXA (X-ray technology). A bespoke questionnaire was employed to gather the participants' responses, which were coded numerically, and data were analysed statistically.

RESULTS

Despite minor discomfort associated with the gel application, Bindex® received significantly higher acceptability and comfort ratings than DXA, with many participants preferring its non-ionising radiation. Both methods were generally well-received, though some favoured DXA for not requiring gel.

CONCLUSION

In addition to enhancing diagnostic workflows, we demonstrated that Bindex® scans can improve patient satisfaction. This study emphasised the importance of innovating medical imaging diagnostic tools to prioritise patient acceptability and comfort.

Connecting the bibliographic-directed citation networks of translational research and implementation science

Introduction

Translational science and implementation science are two disciplines that integrate scientific findings into practice within healthcare. One method to assess the integration of these fields is to review the academic crossover between the disciplines with respect to shared citations in the peer-reviewed literature.

Methods

This paper used direct citation network analysis to identify potential conceptual gaps and connections between the literature in implementation science and translational science. Bibliographic references were downloaded from Web of Science to create directed citation network maps in VosViewer. Heat maps visualized the top cited literature in each field.

Results

A literature search yielded 6,111 publications in translational science and 7,003 publications in implementation science. When all publications were combined in a directed citation network map, two separate groups of publications emerged, representing the two fields of implementation science and translational science. When the top 50 cited translational science publications were combined with implementation science publications, 14% had a 100%+ increase in citation links, 44% had a mean increase of 2.4%, and 42% shared no links. When the top 50 cited implementation science publications were combined with translational science publications, 2% had a 100%+ increase in citation links, 92% had a 3.3% mean increase, and 6% had no shared links.

Conclusions

Results suggest moderate academic overlap in the way published authors cite each other between translational science and implementation science. We hope the implications of this paper may promote continued collaborations between these fields to disseminate lessons learned and bridge research into practice more efficiently.

Implementing reablement for community dwelling people with dementia: A formative evaluation using single-case experimental design

BACKGROUND

Reablement is recommended to maximise functioning in people with dementia, yet in Australia, is not routinely available. This study aimed to provide insight into the implementation and program outcomes of reablement in real-world practice for a person living with dementia.

METHODS

Reablement was implemented for a client with dementia. In parallel, a formative mixed-methods pilot evaluation was performed, using single-case experimental A-B-A design (n = 1), supplemented by routinely collected pre-post program clinical measures. Implementation was evaluated qualitatively via clinical notes for fidelity, feasibility and client engagement.

RESULTS

Single-case experimental design outcomes indicated the program positively impacted the participant's physical functioning. Additionally, most routinely collected pre-post clinical measures demonstrated improvement. Intervention fidelity varied, with differences in length and client engagement.

CONCLUSION

Implementation of evidence-informed reablement has been shown to be feasible in real-world practice for a community-dwelling person living with dementia. Larger implementation trials are needed to build on preliminary outcomes to ultimately improve access to these important programs.

Stakeholders' perspectives on barriers and facilitators to implementing extra physical activity in secondary schools to improve adolescents' health and academic performance

Introduction

There is an association between physical activity and both health and academic performance. However, there is still a lack of consensus on how to engage adolescents in physical activity interventions in secondary schools. One approach to better understand the activities and strategies supporting effective implementation is to involve school staff and adolescents in the early stages of planning and preparing for interventions. Therefore, the aim of this study is to explore how multiple stakeholders, including school staff, students, and experts, perceive the barriers and facilitators for implementing a school-based intervention that extends the school day with additional physical activity in Sweden.

Material and methods

This inductive explorative qualitative study involved 16 participants. Three focus groups with school staff, including principals (n = 3), teachers (n = 6), and students (n = 4), and three interviews with experts were conducted. The planned intervention and its components were presented to the participants in the focus group and interviews to discuss them based on their previous experiences and thoughts of implementing physical activities or health promotion programmes in their schools or with adolescents. Data were analysed using qualitative content analysis.

Results

Three categories emerged: (1) "types of activities offered", highlighting the importance of designing activities that are fun, inclusive and unusual; (2) "integration of the activities into school curriculum" to promote sustainability of the intervention and incorporate physical activity throughout the school day and across school subjects, and (3) "Management support and funding" referring to the funded time and facilities that teachers leading the activities need to facilitate implementation.

Conclusions

Before implementing extra physical activity in a school setting, it is important to understand what activities enhance students' motivation and the type of support teachers need from the school principal and administration. This includes funding for teachers' time, appropriate scheduling of the activities, and access to facilities.

Measuring Implementation Outcomes Change Over Time Using an Adapted Checklist for Assessing Readiness to Implement (CARI)

In 2017, the Health Resources and Services Administration's HIV/AIDS Bureau funded an Evaluation Center (EC) to assess the rapid implementation of 11 evidence-informed interventions at 25 HIV care and treatment providers across the U.S. The EC conducted an implementation science-based evaluation, including longitudinal assessment of implementation outcomes as defined by Implementation Outcome Framework (IOF) of the Conceptual Model for Implementation Research. The EC adapted a measure originally designed for implementation readiness to capture seven implementation outcomes and administered the measure to site leadership every six months, from intervention launch through the end of the initiative. The adapted measure demonstrated adequate internal consistency within and across time periods. Individual outcomes changed over the course of implementation, with the greatest period of growth during the first six months. Longitudinal relationships between outcomes posited to be most relevant at early, mid- or late-implementation were not evident in these analyses; rather, relationships between the outcomes were significant within time periods. Finally, there were differences in the trajectory of outcomes based on characteristics of the site's larger context. The use of this adapted measure across multiple implementation settings, assessing multiple interventions, is an important step forward in the comparability of implementation outcomes more broadly.

Tools to improve discharge equity: Protocol for the pilot TIDE trial

Background

Written discharge instructions after hospitalization promote patient understanding and positive clinical outcomes. Despite the rising prevalence of patients with non-English language preference (NELP) in the U.S., most hospitals do not routinely provide discharge instructions in their preferred language, thereby placing them at higher risk for medical errors and hospital readmission. Innovative solutions to close this implementation gap at hospital discharge for patients with NELP are needed. The Tools to Improve Discharge Equity (TIDE) intervention leverages communication practices proven effective in addressing communication barriers to create language concordant discharge tools from hospital discharge paperwork.

Methods

We present the protocol for a type I hybrid implementation-effectiveness pilot randomized trial. The TIDE intervention includes a translated medication calendar, pictographs, and an audio recording of the discharge instructions in the patient's preferred language. We will recruit an estimated 50 patient participants from the hospital's top four non-English language groups-Spanish, Haitian Creole, Cape Verdean Creole, and Vietnamese-as well as the nurse and in-person interpreter caring for them. Outcomes include patient recall of primary diagnosis and overall understanding of discharge instructions using a newly developed 24-point score, patient experience, implementation measures (acceptability, feasibility, and appropriateness), and clinical effectiveness (including hospital reutilization). A mixed methods evaluation will identify determinants of intervention uptake to guide selection of multi-level implementation strategies to test in a future hybrid type III trial.

Discussion

The TIDE intervention is the first hospital discharge intervention designed for patients with NELP. Result will inform future efforts to improve the safety and equity of the hospital discharge process.

Trial registration

clinicaltrials.gov NCT05988229 (August 14, 2023) https://classic.clinicaltrials.gov/ct2/show/NCT05988229.

Lessons Learned from the Rapid Implementation of Telehealth Group Psychotherapy at a Safety-Net Health System in the U.S

There is inadequate availability and access to behavioral health services to meet demand, and this issue amplified during the pandemic, creating a mental health crisis. Group therapy is an effective way to meet this need. The rapid implementation of telehealth group psychotherapy as part of a Primary Care Behavioral Health Integration program in a U.S. safety-net health care setting is described. Implementation lessons are summarized as barriers or facilitators, using thematic analysis of qualitative data from meeting notes. Major facilitators identified include having key staff serve as technology champions, dedicated administrative leadership to operationalize workflows, and communication and collaboration across teams and layers of infrastructure. Major barriers include uncertainty about operational workflows and technological challenges. While group visit volume initially waned, it began to rebound and quantitative analysis of demographic data shows that important underserved populations were reached. Frequent communication, collaboration, and adaptation among teams are critical elements for improving the likelihood of successful telehealth group therapy. It is feasible to expeditiously implement telehealth group psychotherapy in safety-net health care systems with limited resources.

Barriers, Facilitators, and a Proposed Model of Care for Implementation of Upper Limb Distributed Practice Approaches for Children with Unilateral Cerebral Palsy

Background/Objectives: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. Methods: A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (<5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. Results: A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1-22). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family's needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. Conclusions: Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice.

A mixed-methods observational study of strategies for success in implementation science: overcoming emergency departments hurdles

BACKGROUND

Heart failure is a major public health concern, affecting 6.7 million Americans. An estimated 16% of emergency department (ED) patients with acute heart failure (AHF) are discharged home. Our Get with the Guidelines in Emergency Department Patients with Heart Failure (GUIDED-HF) toolkit aims to improve AHF self-care and facilitate safer transitions in care for these patients. We describe implementation barriers and facilitators, and the selection and refinement of implementation strategies, to facilitate future GUIDED-HF implementation.

METHODS

A mixed-methods cross-sectional observational study was conducted in four United States EDs in two diverse healthcare systems in the Pacific West and Midwest. Data were collected using a survey and interviews with ED providers, nurses, and leaders. The survey assessed the ED context using the context scale of the Organizational Readiness to Change Assessment (ORCA). The Consolidated Framework for Implementation Research informed interviews. Quantitative data were summarized using medians (interquartile ranges) or percentages (frequencies). Wilcoxon rank-sum tests and Kruskal-Wallis tests were used to assess differences in the healthcare system and profession. Qualitative data were analyzed and summarized using rapid qualitative analysis. Convergence of quantitative and qualitative data was used to inform specific refining of implementation strategies to the local context (e.g., who should serve as champions, how best practice alerts should be implemented).

RESULTS

Participants were predominately white (76%) with median (IQR) age 37.0 (32.0, 41.0). ED leaders/administrators, providers, and nurses comprised 15%, 55%, and 29% of participants, respectively. Sites reported an ORCA context scale score of 3.7 [3.4, 4.0] (scale of 1 = strongly disagree to 5 = strongly agree). Comparison of scores by profession showed a significant difference in the context score among providers (3.9 [3.5, 4.0]), leaders (3.7 [3.5, 4.0]), and nurses (3.6 [3.0, 3.9]) (p = 0.048). Qualitative data indicated implementation barriers (e.g., resource limitations, patient health literacy), facilitators (e.g., GUIDED-HF is patient-centric; site and intervention congruent values, norms, and goals), and site-specific needs due to contextual factors (e.g., education needs, feedback mechanisms, champions).

CONCLUSIONS

Specific determinants of implementation exist in ED settings and require the refining of implementation strategies to overcome site-specific barriers and enhance facilitators.

TRIAL REGISTRATION

n/a.

"It's a good idea, but…": a qualitative evaluation of the GoldiCare intervention in Norwegian home care services

Background

Addressing high levels of physical strain among Norwegian home care workers is crucial if home care services are to continue to provide cost-effective and high-quality health care for people in their homes. Excessive physical demands may contribute to poor long-term musculoskeletal health and high sick leave rates among home care workers. Based on the Goldilocks Work Principle of redistributing an uneven distribution of physical demands to promote a working environment with a "just right" physical demands conducive to promoting long-term health, the GoldiCare intervention in home care services was conducted. The objective of this qualitative process evaluation study was to gain insights into how the implementation outcomes of acceptability, appropriateness, feasibility, adoption and fidelity, respectively, impacted the implementation of the GoldiCare intervention.

Methods

We conducted ten individual interviews with operations managers and five focus group interviews with home care workers from the intervention units. Interviews were transcribed verbatim and a three step-content analysis was employed to analyze interview material.

Results

Our analysis identified that although the intervention was considered broadly acceptable, there were several challenges corresponding to the dimensions of appropriateness, feasibility, adoption and fidelity. Major barriers were identified in particular with regard to appropriateness, that is underlying ways of measuring physical demands; and feasibility, that is barriers to implementing the tool. Further synthesis of these findings resulted in four core issues that need to be addressed if the GoldiCare intervention is to be successfully implemented in comparable Norwegian home care settings: proxy issues; complexity and unpredictability; organization-level issues; and operational autonomy.

Conclusion

The findings provide valuable insights for future attempts to implement GoldiCare interventions in home care settings, highlighting the need to further integrate GoldiCare and other comparable types of intervention into the political, economic, sociocultural, professional, and technological context of home care services. Performed in the right way, such integration will also allow for more participatory input from those enacting such interventions.

Trial registration

This clinical trial was registered on 08/05/2022 under NCT05 487027.

Implementation outcomes of 1-3-7 focus investigation for malaria in a low transmission setting in Southern Province, Zambia: A mixed methods study

Eleven countries have been certified as malaria free since 2016, but none of these are in subSaharan Africa where elimination challenges are unique. The 1-3-7 focus investigation approach is an implementation strategy that requires case reporting, case investigation/classification, and focal classification/response to be completed one, three, and seven days, respectively, after index case diagnosis. Real-time short-messaging-service reports are sent at each step to add accountability and data transparency. Reactive case detection is one focal response of the 1-3-7 strategy. China, Thailand, Myanmar, and other countries cite high fidelity to deadlines and broad acceptability of 1-3-7, but this strategy has yet to be widely deployed in Africa. This mixed-methods study evaluated implementation and service outcomes of 1-3-7 focus investigation in a rural area of southern Zambia. Selected outcomes were fidelity, efficiency, feasibility, equity, and acceptability, assessed via program metadata and semi-structured interviews with program personnel. Fidelity was moderate with 61% of cases reported. Focus investigation and reactive case detection completion doubled in areas using 1-3-7, from 20% to 42%. However, reactive case detection, which involved screening community members residing within 140 meter of index cases with a rapid diagnostic test, detected few parasitemic individuals, suggesting this may not be the most efficient day 7 response in this setting. Mobile phone network coverage was a common challenge to feasibility that likely affected reporting rates and fidelity. Thirty-four percent of health-facility diagnosed cases were not eligible for 1-3-7 follow-up. Distance from the health center was a barrier to feasibility and equitable reach of services. Reporting was faster in areas where health workers classified transmission as higher and slower in areas with poor mobile phone network coverage. The strategy was widely accepted. Scale-up should include adherence-focused management strategies, spatially targeted interventions not reliant on RDTs, and complementary surveillance that targets hard-to-reach populations.

Mapping the landscape and evidence of cross-sectoral collaboration models targeting individuals referred for assessment of attention-deficit hyperactivity disorder or autism spectrum disorder: protocol for a scoping review

INTRODUCTION

Neurodevelopmental disorders, notably attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), present substantial challenges in mental health. Individuals referred for assessment in a psychiatric unit experience complex needs. This implies that their needs necessitate coordination across multiple sectors. Cross-sectoral collaboration models have emerged as essential strategies for addressing the complexities of these disorders. However, evidence of their existence, implementation and success remains limited. This protocol aims to outline a scoping review where we will explore existing collaboration models, evaluate their implementation and gain an understanding of how cross-sectoral collaboration models can be developed to ultimately benefit individuals referred for assessment of ADHD or ASD.

METHODS AND ANALYSIS

This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across PubMed, CINAHL, Embase, PsycINFO and Google Scholar, as well as grey literature sources, between 1 December 2024 and 1 January 2025. Inclusion criteria will encompass studies focusing on cross-sectoral collaboration for individuals referred for assessment of ADHD or ASD, published in English, Danish, Norwegian or Swedish. The search will use a three-block search string, with iterative refinement guided by familiarity with the evidence base. Data extraction will involve study characteristics and implementation details, using the Consolidated Framework for Implementation Research in combination with Proctor et al's implementation outcomes framework. Results will be synthesised into descriptive tables, providing a comprehensive mapping of existing models and emphasising implementation feasibility.

ETHICS AND DISSEMINATION

Ethical approval is not required for this protocol since it involves the review of existing literature without the involvement of human participants or personal data. Findings will be disseminated at national and international conferences and will be integrated into future efforts to develop cross-sectoral collaboration models in Denmark.

Use of patient-centred outcome measures alongside the personal wheelchair budget process in NHS England: A mixed methods approach to exploring the staff and service user experience of using the WATCh and WATCh-Ad

BACKGROUND AND OBJECTIVE

Personal wheelchair budgets (PWBs) are offered to everyone in England eligible for a wheelchair provided through the National Health Service (NHS) to support their choice of equipment. The WATCh (Wheelchair outcomes Assessment Tool for Children) and related WATCh-Ad for adults are patient-centred outcome measures (PCOMs) developed to help individual users express their main outcome needs when obtaining a wheelchair and rate their satisfaction with subsequent outcomes after receiving their equipment. Use was explored in a real-world setting, aiming to produce guidance for use alongside the PWB process.

METHODS

Three wheelchair service provider organisations across four sites participated. Staff and users completed surveys about their experience of assessments using the WATCh and/or WATCh-Ad. Selected patients were interviewed after receipt of their equipment, and staff were interviewed after experiencing a number of assessments. Thematic analysis was undertaken using the tool, survey and interview data. Results of pre- and post-equipment provision were presented graphically.

RESULTS

Information on 75 assessments by 15 staff was obtained. Three-quarters of users or their carers rated the use of the tools in the assessment process as 'helpful' or 'very helpful'. Staff reported that the WATCh or WATCh-Ad had been considered 'useful' in developing individual care plans in around 1 in 3 cases and affected the prescription in 1 in 4 cases. Concerns were expressed about the length of time taken to administer the tools in clinic. However, some staff noted this reduced with more hands-on experience and by providing the tools to users in advance of the appointment.

CONCLUSIONS

The WATCh and WATCh-Ad PCOMs are suitable for routine use by wheelchair service providers to assist the assessment process. It is recommended that tool materials are provided in advance to users/carers and that staff are allowed time to develop their ways of working with them.

Implementation research logic model in the design and execution of eHealth innovations for maternal and newborn healthcare in Ethiopia

BACKGROUND

The use of eHealth innovations is becoming increasingly important in improving health outcomes, especially for maternal and newborn health. However, planning and executing these innovations can be challenging due to their complex nature. To provide guidance and clarity on implementation approaches, researchers need to use implementation research (IR) tools. We conducted IR to recognize the challenges in implementing eHealth innovations in the context of maternal and newborn healthcare using the implementation research logic model (IRLM). Therefore, this paper aims to describe the practical application of IRLM to design, execute and evaluate eHealth innovations that improve maternal and newborn care in public facilities in Ethiopia.

METHODS

We employed rapid review, formative assessment and process evaluation of an eHealth innovation in selected healthcare facilities serving maternal and newborn care. The eHealth innovation we developed and deployed was named 'ADHERE' (Antenatal Care, ChilDbirtH CarE and Postnatal CaRE), representing the continuum of maternal care. The rapid review was conducted as an initial step using the Consolidated Framework for Implementation Research (CFIR). We employed a mix of data collection methods: interview/discussion, eHealth system or document review and direct observation. Furthermore, we executed various stakeholder engagement activities: two co-creation workshops and on-site iterative discussions. We applied the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) to capture ongoing implementation learnings.

RESULTS

We developed IRLM of the eHealth innovation implementation for three contexts: urban, peri-urban and remote public healthcare facilities. The model depicted the mechanism of interaction between implementation determinants and implementation strategies to produce the intended implementation outcomes. The IRLM helped to identify more than 35 implementation barriers or facilitators for eHealth interventions and to develop over 17 mitigation strategies for the study contexts. The initial IRLM was refined through ongoing implementation learnings and the mitigation strategies that were executed.

CONCLUSIONS

The IRLM is a comprehensive and effective guiding tool for the development, implementation and evaluation of innovations in various low- and middle-income contexts. Researchers and implementing partners should adapt and use it.

Evaluating behavioral intervention technologies: Integrating human-centered design and implementation science outcomes

Background

Behavioral intervention technologies (BITs) offer scalable, cost-effective healthcare solutions but often show reduced impacts in community settings and are rarely sustained. Human-centered design (HCD) enhances usability by tailoring BITs to stakeholder needs, while implementation science (IS) identifies contextual barriers and strategies to promote uptake and sustainability. Both HCD and IS aim to improve BIT usability and implementation through iterative, user-focused processes but are rarely integrated.

Objective

We introduced the user-centered and sustainable implementation science (USIS) model, a novel and systematic framework that combines HCD and IS principles to enhance BIT effectiveness and sustainability. We aimed to (1) synthesize the HCD and IS outcomes and integrate them into a USIS framework; (2) apply USIS to a case study: the sleep shared-management intervention for children with juvenile idiopathic arthritis and their parents (SLEEPSMART).

Methods

We conducted a narrative literature review on HCD and IS outcomes for BITs from the PubMed, CINAHL, and Web of Science databases. Articles were selected based on their focus on usability, implementation outcomes, and evidence-based healthcare practices. This synthesis informed the development of the USIS model.

Results

The USIS model incorporates five domains: (1) user-centeredness (empathy, engagement, and equity), (2) efficiency (cost, timeliness, and rapidity), (3) feasibility (learnability, memorability, error reduction, and low cognitive load), (4) satisfaction (acceptability and appropriateness), and (5) fidelity (adoption, penetration, and sustainability). We applied the USIS model to evaluate the SLEEPSMART project to demonstrate the application of the USIS model in guiding BIT design and refinement. Insights from the review informed the design principles applied during the development and testing stages of SLEEPSMART.

Conclusion

The USIS model serves as a practical and theoretical guide to improve BIT design and evaluation. By emphasizing implementation considerations early and centering user needs, USIS provides a pathway to bridge HCD and IS approaches to enhance the real-world impact and sustainability of digital health innovations.

Delivery of enhanced asthma care in pharmacies: Perceptions and experiences of Australian service providers

BACKGROUND

Evidence-based asthma management services have been tested in Australian community pharmacies for over 2 decades and have been well received by patients but are not retained in practice. The positive clinical outcomes of these tested services suggest the potential for wider implementation, for which the providers' perspective is critical.

OBJECTIVE

This investigation evaluates the implementability of the Pharmacy Asthma Service (PAS) through the experiences and perceptions of the community pharmacists delivering the service.

METHODS

Forty-eight pharmacists took part in a posttrial semi-structured qualitative telephone interview, representing 42 of 51 (82%) eligible PAS intervention arm pharmacies. Qualitative data were deductively analyzed in accordance with the Implementation Outcomes Framework.

RESULTS

Pharmacists recognized the positive impact of the service on patients' health outcomes, the pharmacist's practice, and in fostering stronger and more beneficial pharmacist-patient relationships. However, whilst acknowledging the importance of such a service, the pharmacists faced challenges in recruitment and patient follow-up. Pharmacists stated that further work is required to address pharmacist and patient time constraints, patient health beliefs and to increase the acceptance of pharmaceutical care provision in community pharmacy practice by patients and other health care professionals.

CONCLUSION

Pharmacists can deliver enhanced clinical care for asthma patients with positive perceived professional and patient outcomes. However, it remains evident that time, remuneration, and recognition of the pharmacist's role in chronic care management form barriers to the implementation of asthma services in community pharmacies. Broader policy and systemic changes are required to successfully balance medication supply and quality patient management roles at the same time as a required shift in research processes.

Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents

OBJECTIVE

This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents.

METHODS

Parent-child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, "Making Mistakes", consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content.

RESULTS

Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program.

CONCLUSIONS

Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.

The inclusion of implementation outcomes in digital health interventions for young adults: A scoping review

Objective

Implementation outcomes are important in intervention research as a necessary precursor to achieving desired health outcomes. Considering the critical role of implementation outcomes, this study involved a comprehensive review of implementation outcome measures used in digital health interventions specifically targeting young adults.

Methods

This scoping review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, and the search incorporated the elements of population, concept, and content framework in three electronic databases (PubMed, Embase, and CINAHL). A matrix was used for data extraction and integrative thematic synthesis for analysis. Implementation outcomes were reported based on the indicators in each study, totaling eight outcomes: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability.

Results

The search yielded 2441 articles, and 17 were finally identified. The intervention implementation techniques that were adopted were telephone calls (n = 1); social media (n = 2); web-based programs (n = 4); short message service (n = 5); wearable devices (n = 1); mobile applications (n = 3); and a combination of phone calls, emails, and text messaging (n = 1). The highest number of implementation outcomes that were assessed in all the studies were acceptability (n = 10), feasibility (n = 10), and fidelity (n = 8). Short message service (n = 14), web-based programs (n = 11), and mobile applications (n = 7) had the highest number of implementation outcomes.

Conclusions

Researchers have largely assessed the acceptability and feasibility outcomes. The need to integrate the implementation outcomes framework in intervention research design is underscored.

Barriers and facilitators in the implementation of youth and young adult models of mental health care

AIM

It is increasingly recognised that traditional models of mental health (MH) care, with a service transition at age 18 years, may not reflect best practice. The literature supports a move towards youth and young adult focused models of MH care, for young people up to the age of 25, which specifically cater to the unique psychosocial and developmental needs of this population. This service evaluation aimed to explore the facilitators and barriers to the implementation of youth models of MH care across England (UK).

METHODS

Six services participated in separate focus groups pertaining to their experience of implementing youth models of MH care. The interview guide for the focus groups was informed by the Consolidated Framework for Implementation Research (CFIR) and explored barriers and facilitators to implementation and sustainment. The focus groups were recorded, transcribed verbatim and analysed thematically.

RESULTS

Seven key themes relevant to the implementation of youth models of MH care were identified: a clear rationale for doing things differently, for young people by young people, "building those relationships is key", service identity development, resource and infrastructure, leadership at multiple levels, and valuing and developing staff.

CONCLUSIONS

The findings suggest effective communication and leadership, co-production and cross system collaboration contribute to successful implementation of youth models of MH care. The findings will be of interest to those involved in informing and supporting successful implementation and delivery of youth models of mental health care at local and national levels.

A comparison of scalable routine clinical materials and observer ratings to assess CBT fidelity

Decades of research have demonstrated the efficacy of cognitive behavioral therapies (CBTs) for a wide variety of psychiatric diagnoses, resulting in the inclusion of CBT as a first-line evidence-based practice (EBP) in treatment guidelines for mood and anxiety disorders. However, some research suggests that many providers do not implement EBPs as intended. Ongoing quality monitoring is needed to support EBP implementation and sustainability, but "gold standard" fidelity monitoring (e.g. observer ratings) is time-consuming, requires extensive training, and may feel intrusive to providers and clients. In the current study, we aimed to develop a scalable method of assessing CBT fidelity that leverages information generated in routine clinical care (e.g. session worksheets and clinician checklists). Ratings of adherence based on worksheets were not correlated with ratings of adherence based on observer ratings. However, ratings of competence based on worksheets were significantly correlated with observer ratings of competence. Ratings of adherence based on clinician checklist ratings were also significantly correlated with observer-rated adherence. Results did not indicate a strong relationship between adherence or competence measured by worksheet ratings or observer and symptom change. However, adherence as measured by clinician checklists were associated with subsequent depression symptom change. Findings have a strong potential to impact fidelity monitoring strategies for a variety of CBTs. Given the limited resources and time to do full audio review in routine care settings, findings suggest that using routine materials generated in session to assess therapist competence may be a feasible alternative to the "gold standard" audio review. The trial is registered at ClinicalTrials.gov, number NCT03479398.

Medications for opioid use disorders among incarcerated persons and those in the community supervision setting: exploration of implementation issues with key stakeholders

INTRODUCTION

Receipt of medications for opioid use disorder (MOUD) critically reduces opioid-related mortality during the post-incarceration period. Optimal provision of this care to individuals on community supervision (i.e., probation) requires an understanding of this unique and complex system at the local level.

METHODS

We conducted in-depth individual interviews with key treatment providers and probation staff (n = 10) involved with the provision of MOUD to individuals on community supervision in the Northeast. Interviews explored perspectives on the provision of MOUD and support services during the community supervision period. Thematic analysis was conducted to describe inductive and deductive codes, subcodes, and themes.

RESULTS

Stakeholders shared diverse attitudes about the benefits and drawbacks of MOUD utilization. The provision of MOUD during the community supervision period was perceived to be influenced by both treatment and probation organizational characteristics, including the structures and values of the agencies. As such, the specific context of the community supervision setting facilitated and impeded MOUD delivery. Persistent challenges to enhancing MOUD delivery to this population remain including widespread MOUD stigma, inter-agency communication issues, and structural barriers to healthcare (i.e., transportation, finances).

CONCLUSIONS

There are opportunities to enhance access to evidence-based OUD treatment for persons on community supervision by engaging probation agencies and community treatment staff in systems change.

Development and validation of a supported housing programme for homeless women with severe mental illness

BACKGROUND

The bidirectional phenomenon of homelessness and Mental Illness (MI) creates a vicious circle that is hard to escape. In India, Homeless Women with Severe Mental Illness (HWSMI) often rely on institutional care due to the absence of family or community alternatives, which distances them from socio-economic, cultural, political resources and the right to live with dignity. Hence, there is a need to develop a model that will help reintegrate HWSMI into the community.

AIM

We aimed to develop and validate (content and face validity) a supported housing programme (SHP) for HWSMI in Bengaluru, India.

METHOD

We developed the SHP using 1) a needs assessment from HWSMI (n = 14), 2) qualitative interviews with Mental Health Professionals (MHPs) (n = 18), and 3) visits to organizations (n = 3) involved in reintegration and supported housing for HWSMI. We articulated a Theory of Change (ToC) for the program. Three international experts and seven Indian experts reviewed the same.

RESULTS

Five themes- Causes of homelessness/barriers to reintegration, consequences of homelessness, models/processes, facilitators, and needs of HWSMI and eighty sub-themes emerged from the qualitative thematic analysis of the interviews and observational visits. The themes and subthemes were organized as interventions in each phase of the SHP: Interventions in the tertiary care setting, transit home, and community.

CONCLUSION

We describe the development and validation of a comprehensive need-based SHP. We will implement and test the feasibility of the SHP for HWSMI.

Interventions to improve quality of life and knowledge in Hypersensitivity Pneumonitis, a survey of clinician practices and perspectives

Background

Behavioral and educational interventions are promising approaches to improve health-related quality of life (HRQOL), however few have been studied in Hypersensitivity Pneumonitis (HP) or other interstitial lung diseases (ILD). The objective of this study was to gather ILD clinicians' current practices and perspectives on the management of HRQOL and disease-specific education in HP, knowledge and attitudes about behavioral and educational interventions, and identify potential clinician perceived barriers to address during intervention development.

Methods

An electronic survey was administered to ILD clinicians across the United States. Survey data were analyzed using descriptive statistics and open-ended questions were analyzed using qualitative content analysis.

Results

74 clinicians responded to the survey, of whom 93% identified as physicians. All respondents (100%) indicated that offering an intervention to improve HRQOL in their patients with HP is either very important, or absolutely essential. Only 5% of clinicians reported currently using a validated assessment tool to measure HRQOL. When asked about specific behavioral intervention techniques, most clinicians (92%) reported possessing a small amount, or zero knowledge about peer coaching interventions, and a small amount or zero knowledge (69%) about cognitive behavioral therapy (CBT) principles. Despite this, a majority (68%) of clinicians desire the ability to educate their patients about these potentially effective behavioral interventions, and a majority (67%) of clinicians indicated the desire to reinforce the principles of an intervention after completion. Perceived barriers to referring patients to a virtually delivered behavioral intervention included time constraints, availability and access for all patients, cost and reimbursement, and difficulty with technology.

Conclusion

Clinicians in this survey unanimously agree that interventions to improve HRQOL and knowledge are needed for people living with HP. Clinicians' desire for involvement in education, referral and reinforcement of these interventions will require clinician education in behavioral strategies and implementation-related strategies early in the development process.

How Can Implementation Science Advance Behavioral Interventions in Preschool? A Scoping Review and Recommendations

Behavioral interventions delivered in preschools can help young children who need support for their behavior. However, preschool teachers face barriers to implementing behavioral interventions, leading to a research-to-practice gap. To better understand how to support preschool teachers, we conducted a scoping review of determinants (i.e., barriers and facilitators) and strategies used to support the implementation of behavioral interventions in preschool settings. A systematic search identified peer-reviewed manuscripts describing the implementation of teacher-delivered behavioral interventions in preschools. Each included manuscript was evaluated to answer the following questions: (1) what determinants to teacher implementation of behavioral interventions have been explored and (2) what strategies have been identified as promising in addressing determinants (i.e., implementation strategies)? Twenty-two manuscripts met inclusion criteria. Data extraction and synthesis were used to summarize key findings. Results indicate that few studies have explored determinants of implementation, and while these determinants span numerous implementation domains, there was little consensus on common determinants. In contrast, all the included studies deployed an implementation strategy, and there were two clear foci of the strategies: training and quality monitoring. Implications and recommendations are discussed for both the preschool context and the implementation science field.

Integrated Case Presentation Seminar: Bridging Parallel Fields to Improve Psychiatry and Psychology Learner Experience

Daily clinical practice of mental health professionals often requires interaction between providers from diverse training and professional backgrounds. Efforts to engage mental health trainees across disciplines are necessary and have had varied outcomes. The current study reviews the development and implementation of a monthly one-hour integrated case presentation seminar (ICPS) as part of independent psychology and psychiatry two-year fellowships at a Midwestern teaching hospital. The training integrated a semi-structured seminar to facilitate case presentation within a group setting. The focus of the seminar was to allow for exposure to conceptualization, diagnostic, and treatment strategies and skills, as well as science-based practice techniques for trainees. Learner survey results and the sustained offering of the seminar suggest the format and goals of the seminar are feasible and acceptable. Based on the current preliminary findings, similar training programs may find benefit in strategies to enhance integrated training opportunities for psychiatry and psychology trainees.

Optimising instructional materials for Covid-19 rapid tests for self-sampling and testing: Mapping the optimization process of manufacturer's instructions for use for self-testing RDTs intended for low-literacy contexts

Simple and easy to use kits for SARS-Cov-2 self-testing during epidemic waves are needed to optimize diagnostic capacity in low- and middle-income countries. SARS-Cov-2 self-testing kits are available, but application of these novel diagnostic technologies is less understood in low and middle-income contexts. We investigated the ability to understand and perform instructions for use (IFUs) for STANDARD Q COVID-19 Ag Test (SD Biosensor) and Panbio COVID-19 Ag Rapid Test Device (Abbott Rapid Diagnostics) for anterior nares (AN) nasal self-sampling and self-testing for COVID-19 in rural and urban Malawi. Qualitative research methods using iterative cognitive interview approach was used to investigate the ability of healthcare providers and lay community members to understand and perform a COVID-19 self-sample or self-test using the manufacturer's instructions for use. A total of 120 iterative cognitive interviews were done with healthcare providers and lay community members for self-sampling (N = 76) and self-testing (N = 44). Cognitive interviews began with the manufacturers version of instructions for use followed by subsequent iterations to refine problematic instructions. Structured interview guide and an observation checklist were used to collect data which was then coded inductively. A framework analysis approach was used to synthesize qualitative data. Study participants were generally proficient at performing a COVID-19 self-sampling and self-testing using the two COVID-19 Rapid Testing Devices. Several of design and content problems within manufacturer's instructions for use made their contextual application sub-optimal. Overall, participants experienced difficulties because of the omission of essential elements within instructions, use of short texts/phrase or lack of a word instruction, the lack of labels on where to open the package; the inconsistencies between word instructions within the instructions for use and the physical contents of the test package; the inability to digest and apply certain technical concepts and the lack of clarity in the phrasing of some text instructions. As expected, healthcare providers experienced fewer problems compared to lay community members. The refinement of these instructions greatly improved comprehension among lay community members. Self-sampling and self-testing for COVID-19 can be performed lay community members with fidelity in a scaled context if the manufacturer's instructions for use have been refined and tailored to the context. In the current study, we have used the study findings to map the optimisation process of manufacturer's IFU'S for self-testing RDT's intended for low literacy contexts including Malawi.

Moving psychedelic-assisted therapies from promising research into routine clinical practice: Lessons from the field of implementation science

Psychedelics (e.g., 3,4-Methylenedioxymethamphetamine [MDMA], lysergic acid diethylamide [LSD], psilocybin) are molecules that have the potential to produce rapid therapeutic effects when paired with psychotherapy. Randomized clinical trials of psychedelic-assisted psychotherapy (PAT) have shown promising results for post-traumatic stress disorder (PTSD), depression, and substance use disorders. The U.S. Food and Drug Administration has acknowledged the promise of PAT, signaling potential approval of psilocybin-assisted therapy for depression by 2026. Given this timeline, implementation scientists must engage with PAT researchers, policymakers, and practitioners to think critically about bringing these promising new treatments into routine practice settings while maintaining quality and safety. This commentary aims to initiate a dialogue between implementation scientists and PAT researchers and practitioners on addressing these questions with a lens toward equity. Specifically, we discuss how the field of implementation science can support PAT stakeholders to accelerate the translational process from research into practice, focusing specifically on safety-net settings (i.e., Federally Qualified Health Centers and Veterans Affairs health systems) that serve historically marginalized populations. We use the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to illustrate five critical areas where implementation science can help move PAT from research into real-world practice. For each RE-AIM dimension, we highlight ways the field of implementation science can contribute tools (e.g., implementation strategies), methodologies (e.g., pragmatic hybrid implementation-effectiveness trials), and approaches (community-based participatory research) for establishing the safety, effectiveness, and accessibility of PAT for historically underserved communities.

A tailored intervention for the detection of patients with coronary heart disease and mental or cognitive comorbidities in the German primary care setting: qualitative evaluation of implementation success

BACKGROUND

Guidelines recommend the identification of potential mental and/or cognitive disorders (MCD) in patients with coronary heart disease (CHD). However, compliance with these guidelines appears to be lacking in primary care. A minimal invasive intervention was tailored with experts for the primary care setting to increase the identification of this patient group and ensure proper treatment. The intervention includes: A trigger question, screening tests and question prompt sheet for patients. Following the implementation of this intervention in primary care physician (PCP) offices, the aim of this study is to evaluate the implementation outcomes.

METHODS

Semi-structured interviews were conducted with ten PCPs who tested the intervention for six months. The study was guided by Proctor's Framework on Implementation Outcomes to understand the appropriateness, feasibility, acceptability, fidelity and sustainability of the intervention as proxies for implementation success.

RESULTS

Relevance of the topic and the need for the intervention is recognised by all of the PCPs. All PCPs were willing to try the intervention and considered it generally appropriate and feasible. Additionally, supporting implementation resources were considered helpful in familiarising with the intervention. Screening of patients with a first diagnosis of CHD, those who have had experienced a recent coronary event and those who have been hospitalised for CHD is considered practical and appropriate. Known barriers such as lack of knowledge, perceived relevance and awareness were successfully addressed. It was not possible to overcome barriers such as time pressure, forgetfulness, and patient reaction. Additionally, the paper format of the information materials was perceived as impractical, and integration into the physician information system was identified as a possible way to increase acceptance. Nevertheless, PCPs stated they will continue to be aware of the link between CHD and MCD and want to maintain their individualised approach.

CONCLUSIONS

The study provides important insights into the use of a minimal invasive intervention in primary care. Despite tailoring the intervention to the primary care setting, implementation success was suboptimal due to individual barriers in PCP offices. This highlights the need for tailored approaches at the level of individual PCP offices to better address context-specific barriers.

Applying health equity implementation science frameworks to population genetic screening

Introduction

Implementation science frameworks with a focus on health equity have emerged to help guide the introduction of new interventions into healthcare and community settings while limiting health disparities. The purpose of this research was to explore the applicability of such frameworks to guide the equitable implementation of population genetic screening programs.

Methods

We searched PubMed and reference lists for relevant frameworks and examples of their use in health settings. We then assessed if and how selected frameworks provide guidance for different stages of population genetic screening: recruitment, sample collection, result return, follow-up care and long-term management, and cascade screening. Findings were synthesized into a list of health equity considerations specific to each stage.

Results

We identified 5 implementation frameworks that focus on health equity. Guidance varied by framework type: determinant (explaining what affects implementation outcomes), process (translating research into practice), or evaluation (assessing implementation). Common characteristics included focusing implementation efforts on populations who have historically experienced health inequities and adapting interventions to fit local contexts. Process models also highlighted the importance of community partnerships.

Discussion

Overall, frameworks offered broad recommendations applicable to population genetic screening program implementation. However, gaps still exist in guidance provided for later stages of population genetic screening. To improve the equitable implementation of genetic screening, future programs may benefit from utilizing one or more of these frameworks or by incorporating the health equity considerations and outcomes compiled in this analysis.

Mindfulness's moderating role applied on online SEL education

Introduction

Mild to moderate depression, anxiety, and stress imbalances are prevalent emotional issues among college students and are primary factors leading to deficiencies in social-emotional skills within this population. Without timely intervention, these mild to moderate emotional issues may escalate into more severe conditions. Social-Emotional Learning (SEL) programs are effective for building social-emotional skills. However, current research on SEL programs has not adequately addressed the issue of high-quality teacher-student interactions for students who suffer emotional problems. To tackle this issue, this study proposes a curriculum approach that integrates mindfulness with rhythmic music? and evaluated the emotional changes of students after mindfulness with rhythmic music curriculum.

Methods

This study adopted a pre-post experimental design. Two hundred and ninety-four firefighting universities students participated in a one-semester "online mindfulness combined with music rhythm SEL course". The study used the Beck Anxiety Inventory, Center for Epidemiologic Studies Depression Scale and Perceived Stress Scale to measure the anxiety, depression and stress levels of the participants before and after the course, and used the participants' self-reflection reports as a method to explore the students' emotional transformation patterns.

Results

The research findings indicate that: (1) eighth-note, quarter-note, and sixteenth-note rhythmic music significantly improve the emotional wellbeing of students with depression, anxiety, and stress imbalances, respectively. (2) The degree of emotional improvement has a certain impact on academic performance. (3) Students with anxiety require more instructional support focused on attention concentration during the early phases of the course; students with depression should not be scheduled for social skills learning modules in the short term and need long-term instructional guidance; individuals experiencing stress imbalances require attention to their personal music preferences and benefit from additional listening activities and exercise.

Discussion

These findings assist teachers in accurately identifying emotional changes among students with emotional problems and managing the patterns of these emotional transitions, thereby providing effective instructional support and promoting high-quality interactions between teachers and students.