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Sang E, Quinn R, Stawnychy MA, Song J, Hirschman KB, You SB, Pitcher KS, Hodgson NA, Garren P, O'Connor M, Oh S, Bowles KH. Organizational readiness for change towards implementing a sepsis survivor hospital to home transition-in-care protocol. FRONTIERS IN HEALTH SERVICES 2024; 4:1436375. [PMID: 39309468 PMCID: PMC11412944 DOI: 10.3389/frhs.2024.1436375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/14/2024] [Indexed: 09/25/2024]
Abstract
Background Organizational readiness for change, defined as the collective preparedness of organization members to enact changes, remains understudied in implementing sepsis survivor transition-in-care protocols. Effective implementation relies on collaboration between hospital and post-acute care informants, including those who are leaders and staff. Therefore, our cross-sectional study compared organizational readiness for change among hospital and post-acute care informants. Methods We invited informants from 16 hospitals and five affiliated HHC agencies involved in implementing a sepsis survivor transition-in-care protocol to complete a pre-implementation survey, where organizational readiness for change was measured via the Organizational Readiness to Implement Change (ORIC) scale (range 12-60). We also collected their demographic and job area information. Mann-Whitney U-tests and linear regressions, adjusting for leadership status, were used to compare organizational readiness of change between hospital and post-acute care informants. Results Eighty-four informants, 51 from hospitals and 33 from post-acute care, completed the survey. Hospital and post-acute care informants had a median ORIC score of 52 and 57 respectively. Post-acute care informants had a mean 4.39-unit higher ORIC score compared to hospital informants (p = 0.03). Conclusions Post-acute care informants had higher organizational readiness of change than hospital informants, potentially attributed to differences in health policies, expertise, organizational structure, and priorities. These findings and potential inferences may inform sepsis survivor transition-in-care protocol implementation. Future research should confirm, expand, and examine underlying factors related to these findings with a larger and more diverse sample. Additional studies may assess the predictive validity of ORIC towards implementation success.
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Affiliation(s)
- Elaine Sang
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
| | - Ryan Quinn
- Biostatistics Evaluation Collaboration Consultation Analysis (BECCA) Lab, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Michael A. Stawnychy
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Penn Medicine Princeton Medical Center, Plainsboro Township, NJ, United States
| | - Jiyoun Song
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Karen B. Hirschman
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Sang Bin You
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
| | - Katherine S. Pitcher
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
| | - Nancy A. Hodgson
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Patrik Garren
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Melissa O'Connor
- Gerontology Interest Group, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, United States
| | - Sungho Oh
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
| | - Kathryn H. Bowles
- NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA, United States
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
- Center for Home Care Policy & Research, VNS Health, New York, NY, United States
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Hente L, Schlesinger T. Benefits and functionality of an interorganisational workplace health management network - insights from the companies' perspective. Front Public Health 2024; 12:1380032. [PMID: 39114518 PMCID: PMC11304348 DOI: 10.3389/fpubh.2024.1380032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Workplace health management (WHM) is a worthwhile investment for companies. Nevertheless, the implementation of health-promoting interventions remains limited, especially in small and medium-sized enterprises. Interorganisational networks could be a promising way to raise awareness of the advantages of implementing WHM. Therefore, the aim of this study is to analyse the perceived functionality and benefits of a regional WHM network from companies' perspective and to present initial results on this specific topic. Methods An explorative qualitative case study was conducted analysing ERZgesund, a WHM network in a rural region in Germany. Twenty-two companies that participated in the network were interviewed about their experiences and perceived advantages and disadvantages participating in the WHM network ERZgesund. Results The findings show that the network has raised awareness about WHM among the companies, provides opportunities for exchange of knowledge and experiences, and generates or strengthens collaboration. The positive effects were enhanced by the network's structure, such as regionality and a direct contact person. Nevertheless, some companies stated that they would welcome a higher level of participation and transparency. Conclusion Overall, it becomes clear that a WHM network can be a valuable tool to emphasize the relevance of WHM to companies. Therefore, further studies should validate and intensify the research on WHM networks to ensure a long-term benefit from the network.
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Affiliation(s)
- Luisa Hente
- Department of Social Science of Physical Activity and Health, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
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Lebron CN, Atem F, Rana P, Natale R, Messiah SE. Child Care Center Staff Readiness to Change in an Early Childhood Obesity Prevention Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:526-534. [PMID: 38870370 PMCID: PMC11178244 DOI: 10.1097/phh.0000000000001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
CONTEXT The childcare center (CCC) setting has the potential to be a strong foundation that supports the introduction of sustainable healthy lifestyle behaviors to prevent childhood obesity. It is important to assess barriers and facilitators to healthy weight development initiatives via program evaluation, including measuring CCC staff readiness to change. OBJECTIVE The overall goal of this study was to assess the readiness level over 1 school year among CCC staff who participated in "Healthy Caregivers-Healthy Children" (HC2), a cluster randomized controlled trial that evaluated the effectiveness of a childhood obesity prevention program from 2015 to 2018 in 24 low-income, racially/ethnically diverse centers. A secondary outcome was to assess how a CCC's stage of readiness to change was associated with CCC nutrition and physical activity environment, measured via the Environment and Policy Assessment and Observation (EPAO) tool. DESIGN Mixed-models analysis with the CCC as the random effect assessed the impact of readiness to change over time on EPAO outcomes. PARTICIPANTS Eighty-eight CCC teachers and support staff completed the HC2 readiness to change survey in August 2015 and 68 in August 2016. Only teachers and staff randomized to the treatment arm of the trial were included. MAIN OUTCOME Readiness to change and the EPAO. RESULTS Results showed the majority of CCC staff in advanced stages of readiness to change at both time points. For every increase in readiness to change stage over 1 year (eg, precontemplation to contemplation), there was a 0.28 increase in EPAO nutrition scores (95% confidence interval [CI], 0.04-0.53; P = .02) and a 0.52 increase in PA score (95% CI, 0.09-0.95; P = .02). CONCLUSIONS This analysis highlights the importance between CCC staff readiness to change and the CCC environment to support healthy weight development. Future similar efforts can include consistent support for CCC staff who may not be ready for change to support successful outcomes.
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Affiliation(s)
| | - Folefac Atem
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
| | - Priyanka Rana
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
| | - Ruby Natale
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, Florida
| | - Sarah E. Messiah
- University of Texas School of Public Health, Health Science Center at Houston, Dallas Regional Campus, Dallas, Texas
- Center for Pediatric Population Health, Children’s Health System of Texas and University of Texas Health Science Center, Dallas, Texas
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Lamprea-Montealegre JA, Shapiro A, Bontrager NA, Rifkin DE, Jassal SK, Gregg LP, Navaneethan SD, Navarra K, Shlipak MG, Estrella MM, Wang V. Cystatin C Use for CKD Detection in the Veterans Health Administration System: A Qualitative Study of Barriers and Facilitators. Kidney Med 2024; 6:100830. [PMID: 38799784 PMCID: PMC11127258 DOI: 10.1016/j.xkme.2024.100830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Rationale & Objective The measurement of cystatin C has been recommended to enhance chronic kidney disease (CKD) detection and risk stratification in clinical practice. This study gathered insights into the perceptions and experiences of clinical staff regarding the use of cystatin C in CKD detection within the Veterans Health Administration (VHA) system. Study Design A qualitative approach was employed to explore barriers and facilitators of clinical staff regarding the use of cystatin C in CKD detection within the VHA system. The Organizational Theory of Implementation Effectiveness informed the development of a semistructured interview guide. Setting & Participants Health care providers, nurses, and clinical pharmacists from the VHA systems in San Francisco, San Diego, and Houston were interviewed between October 2021 and May 2022. Exposures Participants' experiences with cystatin C testing. Outcomes Perceived barriers and facilitators to cystatin C testing. Analytical Approach Participant responses from individual interviews were analyzed by a multidisciplinary team using rapid qualitative analysis methods. Results Fourteen in-depth interviews were conducted across the 3 VHA systems. Ten of 11 providers worked in primary care. Five key barriers to using cystatin C for CKD detection were identified. These included lack of patient awareness of CKD testing, lack of provider awareness about cystatin C, knowledge barriers about cystatin C testing, unclear roles and ownership of CKD detection, and lack of clinic support to enhance CKD detection. Suggested interventions to overcome these barriers included educational and training programs, improved clinic workflows, and electronic health record aids to support CKD detection and use of cystatin C. Limitations The results may not be generalizable to other health care systems outside the VHA. Conclusions The findings indicate a need for targeted interventions such as educational and training programs, improved clinical workflows, and electronic health record aids to address barriers limiting the use of cystatin C in clinical practice for enhanced CKD detection.
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Affiliation(s)
- Julio A. Lamprea-Montealegre
- Department of Medicine, University of California, San Francisco, CA
- Kidney Health Research Collaborative, University of California, San Francisco, CA
- San Francisco VA Health Care System, San Francisco, CA
| | | | - Natalie A.B. Bontrager
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, NC
- Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC
| | - Dena E. Rifkin
- University of California, San Diego, La Jolla, CA
- San Diego VA Health Care System, San Diego, CA
| | - Simerjot K. Jassal
- University of California, San Diego, La Jolla, CA
- San Diego VA Health Care System, San Diego, CA
| | - Lucile Parker Gregg
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX
- Michael E. DeBakey VA Medical Center, Houston, TX
| | - Sankar D. Navaneethan
- Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX
- Michael E. DeBakey VA Medical Center, Houston, TX
| | - Krista Navarra
- Department of Medicine, University of California, San Francisco, CA
- Kidney Health Research Collaborative, University of California, San Francisco, CA
| | - Michael G. Shlipak
- Department of Medicine, University of California, San Francisco, CA
- Kidney Health Research Collaborative, University of California, San Francisco, CA
- San Francisco VA Health Care System, San Francisco, CA
| | - Michelle M. Estrella
- Department of Medicine, University of California, San Francisco, CA
- Kidney Health Research Collaborative, University of California, San Francisco, CA
- San Francisco VA Health Care System, San Francisco, CA
| | - Virginia Wang
- Durham VA Health Care System, Durham, NC
- Department of Population Health Sciences, Duke University, Durham, NC
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Wippold GM, Crichlow ZR, Garcia KA, Domlyn A, Sanchez S, Frank L, Mote T, Frary SG, Woods T. Assessing organizational readiness for the Clean Cuts and Sharp Minds Collective: a barbershop health promotion network. Implement Sci Commun 2024; 5:42. [PMID: 38627824 PMCID: PMC11022399 DOI: 10.1186/s43058-024-00584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Black men have among the lowest life expectancy in the United States. Alarmingly, these men are underrepresented in health promotion efforts. There are well-documented barriers to recruiting and retaining Black men in health promotion efforts, such as exclusionary research practices - many researchers may be hesitant to reach Black men in culturally unique spaces, such as barbershops. Despite these practices, qualitative research among Black men unanimously find that Black men are interested in health promotion efforts. The Clean Cuts and Sharp Minds Collective (CCSMC) was designed to bridge this gap. The objectives of the CCSMC are to train barbers to be lay advocates for their clients, train barbers to be research partners, and serve as a nexus between barbers interested in health promotion at their shops and researchers interested in implementing such efforts. The present study sought to assess the organizational readiness of barbershops in South Carolina (SC) to participate in the CCSMC. METHODS Barbers in SC were invited to complete a modified version of the Readiness Thinking Tool to assess organizational readiness to participate in the CCSMC. RESULTS Thirty-six (36; mean age = 41.12; 94.4% identified as Black; 91.7% identified as male) barbers completed the organizational readiness assessment. Results indicated that there was a high level of motivation, innovation-specific capacity, and general capacity within barbershops to participate in the CCSMC. Additionally, many barbers indicated that there would be widespread support to join the CCSMC. CONCLUSIONS The results from the present study highlight exciting opportunities and future directions for barbershop-academic partnerships. Such partnerships have the potential to promote health equity among, and in partnership with, Black men.
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Affiliation(s)
- Guillermo M Wippold
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA.
| | - Zion R Crichlow
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Kaylyn A Garcia
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Ariel Domlyn
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Shane Sanchez
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Lucina Frank
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Thrisha Mote
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Sarah Grace Frary
- Department of Psychology, University of South Carolina, 1512 Pendleton Avenue, Barnwell College, Mailbox 38, Columbia, SC, 29208, USA
| | - Terry Woods
- Main Attraction Barbershop, Sumter, SC, USA
- Healthy Mind, Body, and Family Foundation, Sumter, SC, USA
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Lambdin BH, Bluthenthal RN, Garner BR, Wenger LD, Browne EN, Morris T, Ongais L, Megerian CE, Kral AH. Organize and mobilize for implementation effectiveness to improve overdose education and naloxone distribution from syringe services programs: a randomized controlled trial. Implement Sci 2024; 19:22. [PMID: 38419058 PMCID: PMC10900734 DOI: 10.1186/s13012-024-01354-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The United States (US) continues to face decades-long increases in opioid overdose fatalities. As an opioid overdose reversal medication, naloxone can dramatically reduce opioid overdose mortality rates when distributed to people likely to experience or witness an opioid overdose and packaged with education on its use, known as overdose education and naloxone distribution (OEND). Syringe services programs (SSPs) are ideal venues for OEND with staff who are culturally competent in providing services for people who are at risk of experiencing or observing an opioid overdose. We carried out a randomized controlled trial of SSPs to understand the effectiveness of the organize and mobilize for implementation effectiveness (OMIE) approach at improving OEND implementation effectiveness within SSPs. METHODS Using simple randomization, 105 SSPs were enrolled into the trial and assigned to one of two study arms - (1) dissemination of OEND best practice recommendations (Control SSPs) or the OMIE approach along with dissemination of the OEND best practice recommendations (i.e., OMIE SSPs). OMIE SSPs could participate in 60-min OMIE sessions once a month for up to 12 months. At 12-month post-baseline, 102 of 105 SSPs (97%) responded to the follow-up survey. RESULTS The median number of sessions completed by OMIE SSPs was 10. Comparing OMIE SSPs to control SSPs, we observed significant increases in the number of participants receiving naloxone (incidence rate ratio: 2.15; 95% CI: 1.42, 3.25; p < 0.01) and the rate of naloxone doses distributed per SSP participant (adjusted incidence rate ratio: 1.97; 95% CI: 1.18, 3.30; p = 0.01). We observed no statistically significant difference in the number of adopted best practices between conditions (difference in means 0.2, 95% CI: - 0.7, 1.0; p = 0.68). We also observed a threshold effect where SSPs receiving a higher OMIE dose had greater effect sizes with regard to the number of people given naloxone and the number of naloxone doses distributed. CONCLUSIONS In conclusion, the multifaceted OMIE approach was effective at increasing naloxone distribution from SSPs, despite substantial external shocks during the trial. These findings have major implications for addressing the overdose crisis, which has continued unabated for decades. TRIAL REGISTRATION ClinicalTrials.gov, NCT03924505 . Registered 19 April 2019.
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Affiliation(s)
- Barrot H Lambdin
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
- Department of Global Health, University of Washington, Seattle, WA, USA.
| | - Ricky N Bluthenthal
- Keck Medicine, Department of Population and Public Health Sciences, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Bryan R Garner
- Department of Internal Medicine, College of Medicine, The Ohio State University, 370 W. 9Th Avenue, Columbus, OH, 43210, USA
| | - Lynn D Wenger
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA
| | - Erica N Browne
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA
| | - Terry Morris
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA
| | - Lee Ongais
- San Francisco AIDS Foundation, 1035 Market Street, 4Th Floor, San Francisco, CA, 94103, USA
| | - Cariné E Megerian
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA
| | - Alex H Kral
- RTI International, 2150 Shattuck Avenue, 8Th Floor, Berkeley, CA, 94704, USA
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Kim E, Duggan C, Helfrich C, Yoon H, Chue B, Moon AY, Ho E. A strategy to implement the American College of Sports Medicine's Exercise is Medicine® (EIM) initiative in a community oncology clinic. Support Care Cancer 2024; 32:156. [PMID: 38349581 DOI: 10.1007/s00520-024-08330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024]
Abstract
PURPOSE Despite proven benefits, few cancer patients exercise during chemotherapy. The American College of Sports Medicine's Exercise is Medicine® (EIM) initiative describes a model to integrate exercise into oncology care, based upon assessing patients' ability to exercise safely, advising on exercise benefits, and referring patients to exercise. We developed and tested a strategy to implement EIM in a community-based oncology clinic, to assess-advise-refer 20 patients undergoing chemotherapy to a 3-month online exercise class, and measured implementation outcomes. METHODS Using a community-based provider participation in research (CBPPR) model, researchers and staff co-designed and tested a 4-level implementation strategy, with a goal of assessing-advising-referring 20 cancer patients to exercise. Surveys and interviews were conducted with 12 (100%) staff at baseline and post-implementation on acceptability/appropriateness/feasibility, perceptions of individual implementation roles, and organizational strengths/conditions. Data were analyzed using correlations, t-tests, and content analysis. RESULTS The proposed strategy was revised in collaboration with staff who requested assistance for recruitment and data collection. EIM was successfully implemented with 41 (92%) patients assessed, 37 (90%) advised, and 22 (60%) referred to exercise classes. Barriers to implementation were staff shortages and time constraints; facilitators included research team supports. Staff's perceived organizational strengths were positively correlated with exercise promotion acceptability, appropriateness, and feasibility. There were no statistically significant changes in implementation outcomes (acceptability/appropriateness/feasibility) post-implementation. CONCLUSIONS Using a collaborative model, EIM was successfully implemented in a community oncology clinic; however, the clinic required significant support from the research team. Adaptations to the EIM process may be required to improve implementation outcomes.
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Affiliation(s)
- Eunjung Kim
- Child, Family and Population Health Nursing, University of Washington, Box 357262, Seattle, WA, 98195, USA.
| | - Catherine Duggan
- Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Christian Helfrich
- Health System and Population Health, University of Washington, Seattle, WA, USA
- Veterans Administration Puget Sound Health Care System, Seattle, WA, USA
| | - Hyesang Yoon
- Child, Family and Population Health Nursing, University of Washington, Box 357262, Seattle, WA, 98195, USA
| | - Ben Chue
- Lifespring Cancer Treatment Center, Seattle, WA, USA
| | | | - Easter Ho
- Lifespring Cancer Treatment Center, Seattle, WA, USA
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Peracca SB, Lachica O, Lamkin RP, Jackson GL, Mohr DC, King HA, Whited JD, Fonseca AS, Morris IJ, Gifford AL, Weinstock MA, Oh DH. Implementation of Direct-to-Patient Mobile Teledermatology in VA. J Gen Intern Med 2024; 39:97-105. [PMID: 38252250 PMCID: PMC10937882 DOI: 10.1007/s11606-023-08480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/12/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Innovative technology can enhance patient access to healthcare but must be successfully implemented to be effective. OBJECTIVE We evaluated Department of Veterans Affairs' (VA's) implementation of My VA Images, a direct-to-patient asynchronous teledermatology mobile application enabling established dermatology patients to receive follow-up care remotely instead of in-person. DESIGN /PARTICIPANTS/APPROACH Following pilot testing at 3 facilities, the app was introduced to 28 facilities (4 groups of 7) every 3 months using a stepped-wedge cluster-randomized design. Using the Organizational Theory of Implementation Effectiveness, we examined the app's implementation using qualitative and quantitative data consisting of encounter data from VA's corporate data warehouse; app usage from VA's Mobile Health database; bi-monthly reports from facility representatives; phone interviews with clinicians; and documented communications between the operational partner and facility staff. KEY RESULTS Implementation policies and practices included VA's vision to expand home telehealth and marketing/communication strategies. The COVID-19 pandemic dominated the implementation climate by stressing staffing, introducing competing demands, and influencing stakeholder attitudes to the app, including its fit to their values. These factors were associated with mixed implementation effectiveness, defined as high quality consistent use. Nineteen of 31 exposed facilities prepared to use the app; 10 facilities used it for actual patient care, 7 as originally intended. Residents, nurse practitioners, and physician assistants were more likely than attendings to use the app. Facilities exposed to the app pre-pandemic were more likely to use and sustain the new process. CONCLUSIONS Considerable heterogeneity existed in implementing mobile teledermatology, despite VA's common mission, integrated healthcare system, and stakeholders' broad interest. Identifying opportunities to target favorable facilities and user groups (such as teaching facilities and physician extenders, respectively) while addressing internal implementation barriers including incomplete integration with the electronic health record as well as inadequate staffing may help optimize the initial impact of direct-to-patient telehealth. The COVID pandemic was a notable extrinsic barrier. CLINICAL TRIALS REGISTRATION NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Olevie Lachica
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
- Division of General Internal Medicine, Duke University School of Medicine, 6301 Herndon Road, Durham, NC, 27713, USA
| | - Allene S Fonseca
- Department of Dermatology, Wayne State University, 18101 Oakwood Boulevard #402, Dearborn, MI, 48124, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, USA
- Department of Health Law, Policy & Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
| | - Martin A Weinstock
- Department of Dermatology and Epidemiology, Brown University, 593 Eddy Street, Providence, RI, 02903, USA
- Center for Dermatoepidemiology, Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA
| | - Dennis H Oh
- Dermatology Service (190), San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA, 94121, USA.
- Department of Dermatology, University of California San Francisco, 1701 Divisadero Street, San Francisco, CA, 94115, USA.
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Knepper AK, Feinstein RT, Sanchez-Flack J, Fitzgibbon M, Lefaiver C, McHugh A, Gladstone TR, Van Voorhees BW. Primary care-based screening and recruitment for an adolescent depression prevention trial: Contextual considerations during a youth mental health crisis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241246203. [PMID: 38655380 PMCID: PMC11036909 DOI: 10.1177/26334895241246203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background Rising rates of adolescent depression in the wake of COVID-19 and a youth mental health crisis highlight the urgent need for accessible mental healthcare and prevention within primary care. Digital mental health interventions (DMHIs) may increase access for underserved populations. However, these interventions are not well studied in adolescents, nor healthcare settings. The purpose of this study was to identify barriers and facilitators to screening and recruitment activities for PATH 2 Purpose (P2P): Primary Care and Community-Based Prevention of Mental Disorders in Adolescents, a multi-site adolescent depression prevention trial comparing two digital prevention programs within four diverse health systems in two U.S. states. Method This qualitative study is a component of a larger Hybrid Type I trial. We conducted semi-structured key informant interviews with clinical and non-clinical implementers involved with screening and recruitment for the P2P trial. Informed by the Consolidated Framework for Implementation Research (CFIR), interviews were conducted at the midpoint of the trial to identify barriers, facilitators, and needed adaptations, and to gather information on determinants that may affect future implementation. Findings Respondents perceived the P2P trial as valuable, well aligned with the mission of their health systems. However, several barriers were identified, many of which stemmed from influences outside of the healthcare settings. Universal and site-specific outer setting influences (COVID-19 pandemic, youth mental health crisis, local community conditions) interacted with Inner Setting and Innovation domains to create numerous challenges to the implementation of screening and recruitment. Conclusion Our findings emphasize the need for ongoing, comprehensive assessment of dynamic inner and outer setting contexts prior to and during implementation of clinical trials, as well as flexibility for adaptation to unique clinical contexts. The CFIR is useful for assessing determinants during times of rapid inner and outer setting change, such as those brought on by the COVID-19 pandemic, youth mental health crisis, and the corresponding exacerbation of resource strain within healthcare settings. Clinical trial registration PATH 2 Purpose: Primary Care and Community-Based Prevention of Mental Disorders in Adolescents https://www.clinicaltrials.gov/study/NCT04290754.
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Affiliation(s)
- Amanda K. Knepper
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Rebecca T. Feinstein
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jennifer Sanchez-Flack
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Marian Fitzgibbon
- Department of Pediatrics, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
- Institute of Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Cheryl Lefaiver
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
| | - Ashley McHugh
- Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA
| | - Tracy R.G. Gladstone
- Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Wellesley Centers for Women, Wellesley College, Wellesley, MA, USA
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Verweij L, Oesch S, Naef R. Tailored implementation of the FICUS multicomponent family support intervention in adult intensive care units: findings from a mixed methods contextual analysis. BMC Health Serv Res 2023; 23:1339. [PMID: 38041092 PMCID: PMC10693161 DOI: 10.1186/s12913-023-10285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The Family in Intensive Care UnitS (FICUS) trial investigates the clinical effectiveness of a multicomponent, nurse-led interprofessional family support intervention (FSI) and explores its implementation in intensive care units (ICUs). The local context of each ICU strongly influences intervention performance in practice. To promote FSI uptake and to reduce variation in intervention delivery, we aimed to develop tailored implementation strategies. METHODS A mixed method contextual analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed from March to June 2022 on eight ICUs assigned to the intervention group. ICU key clinical partners were asked to complete a questionnaire on CFIR inner setting measures (i.e., organizational culture, resources, learning climate and leadership engagement) and the Organizational Readiness for Implementing Change (ORIC) scale prior to group interviews, which were held to discuss barriers and facilitators to FSI implementation. Descriptive analysis and pragmatic rapid thematic analysis were used. Then, tailored implementation strategies were developed for each ICU. RESULTS In total, 33 key clinical partners returned the questionnaire and 40 attended eight group interviews. Results showed a supportive environment, with CFIR inner setting and ORIC measures each rated above 3 (scale: 1 low-5 high value), with leadership engagement scoring highest (median 4.00, IQR 0.38). Interview data showed that the ICU teams were highly motivated and committed to implementing the FSI. They reported limited resources, new interprofessional information exchange, and role adoption of nurses as challenging. CONCLUSION We found that important pre-conditions for FSI implementation, such as leadership support, a supportive team culture, and a good learning climate were present. Some aspects, such as available resources, interprofessional collaboration and family nurses' role adoption were of concern and needed attention. An initial set of implementation strategies were relevant to all ICUs, but some additions and adaptation to local needs were required. Multi-component interventions are challenging to implement within complex systems, such as ICUs. This pragmatic, theory-guided, mixed methods contextual analysis demonstrated high readiness and commitment to FSI implementation in the context of a clinical trial and enabled the specification of a tailored, multifaceted implementation strategy.
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Affiliation(s)
- Lotte Verweij
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Saskia Oesch
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Pfaff H, Schmitt J. Reducing uncertainty in evidence-based health policy by integrating empirical and theoretical evidence: An EbM+theory approach. J Eval Clin Pract 2023; 29:1279-1293. [PMID: 37427556 DOI: 10.1111/jep.13890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND To reduce their decisional uncertainty, health policy decision-makers rely more often on experts or their intuition than on evidence-based knowledge, especially in times of urgency. However, this practice is unacceptable from an evidence-based medicine (EbM) perspective. Therefore, in fast-changing and complex situations, we need an approach that delivers recommendations that serve decision-makers' needs for urgent, sound and uncertainty-reducing decisions based on the principles of EbM. AIMS The aim of this paper is to propose an approach that serves this need by enriching EbM with theory. MATERIALS AND METHODS We call this the EbM+theory approach, which integrates empirical and theoretical evidence in a context-sensitive way to reduce intervention and implementation uncertainty. RESULTS Within this framework, we propose two distinct roadmaps to decrease intervention and implementation uncertainty: one for simple and the other for complex interventions. As part of the roadmap, we present a three-step approach: applying theory (step 1), conducting mechanistic studies (EbM+; step 2) and conducting experiments (EbM; step 3). DISCUSSION This paper is a plea for integrating empirical and theoretical knowledge by combining EbM, EbM+ and theoretical knowledge in a common procedural framework that allows flexibility even in dynamic times. A further aim is to stimulate a discussion on using theories in health sciences, health policy, and implementation. CONCLUSION The main implications are that scientists and health politicians - the two main target groups of this paper-should receive more training in theoretical thinking; moreover, regulatory agencies like NICE may think about the usefulness of integrating elements of the EbM+theory approach into their considerations.
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Affiliation(s)
- Holger Pfaff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Department of Rehabilitation and Special Education, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
- Centre for Health Services Research Cologne (CHSRC), Interfaculty Institution of the University of Cologne, Cologne, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
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Weber MB, Rhodes EC, Ranjani H, Jeemon P, Ali MK, Hennink MM, Anjana RM, Mohan V, Narayan KMV, Prabhakaran D. Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial. Implement Sci Commun 2023; 4:134. [PMID: 37957783 PMCID: PMC10642065 DOI: 10.1186/s43058-023-00516-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential. METHODS The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at 11 large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, and peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. RESULTS Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add a wider variety of exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. CONCLUSION This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. TRIAL REGISTRATION Clinicaltrials.gov NCT02813668. Registered June 27, 2016.
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Affiliation(s)
- Mary Beth Weber
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA.
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harish Ranjani
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Mohammed K Ali
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Monique M Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ranjit M Anjana
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation/Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
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13
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Burns A, Gutta J, Kooreman H, Spitznagle M, Yeager VA. Strategic use of tobacco treatment specialists as an innovation for tobacco cessation health systems change within health care organizations. Health Care Manage Rev 2023; 48:323-333. [PMID: 37615942 DOI: 10.1097/hmr.0000000000000380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Tobacco screening interventions have demonstrated effectiveness at improving population health, yet many people who want to quit using tobacco lack access to professional assistance. One way to address this gap is to train members of the clinical team as tobacco treatment specialists (TTSs). PURPOSE The purpose of this study was to understand how TTSs have been used across a variety of health care organizations implementing health systems change for tobacco treatment and examine the sustainability of TTSs as a health systems change innovation for tobacco cessation. METHODOLOGY This study used qualitative interviews ( n = 25) to identify themes related to implementing TTSs as a health systems change innovation and examined these themes within the constructs of the theory of innovation implementation. RESULTS Insights about implementing TTSs as an innovation primarily aligned with four theoretical constructs: implementation policies and practices, implementation climate, innovation-values fit, and implementation effectiveness. Specific themes were perceived to facilitate the sustainability of TTSs including team-based TTS efforts, widespread awareness of TTS roles, leadership buy-in, and recognized value of TTS services. Barriers to sustainability included inadequate resources (e.g., time and staff), lack of tracking outcomes, inappropriate referrals, and lack of reimbursement. PRACTICE IMPLICATIONS Health care organizations planning to implement health systems change for tobacco cessation can encourage committed use of TTSs as an innovation by considering the insights provided in this study. These primarily related to five overarching implementation considerations: staff selection and training, tracking and dissemination of impacts, adequate resources, referrals and workflow, and billing and reimbursement.
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Weber MB, Rhodes EC, Ranjani H, Jeemon P, Ali MK, Hennink MM, Anjana RM, Mohan V, Narayan KV, Prabhakaran D. Adapting and scaling a proven diabetes prevention program across 11 worksites in India: the INDIA-WORKS trial. RESEARCH SQUARE 2023:rs.3.rs-3143470. [PMID: 37577514 PMCID: PMC10418536 DOI: 10.21203/rs.3.rs-3143470/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Delivery of proven structured lifestyle change education for reducing the burden of cardiometabolic diseases such as diabetes at worksites could overcome barriers to program adoption and improve sustainability and reach of these programs; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at eleven large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. Results Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. Conclusion This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. Trial Registration Clinicaltrial.gov NCT02813668, registered June 27, 2016.
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Akiba CF, Patel SV, Wenger LD, Morgan-Lopez A, Zarkin GA, Orme S, Davidson PJ, Kral AH, Lambdin BH. Systems analysis and improvement approach to improve naloxone distribution within syringe service programs: study protocol of a randomized controlled trial. Implement Sci 2023; 18:33. [PMID: 37537665 PMCID: PMC10398915 DOI: 10.1186/s13012-023-01288-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND More than half a million Americans died of an opioid-related overdose between 1999 and 2020, the majority occurring between 2015 and 2020. The opioid overdose mortality epidemic disproportionately impacts Black, Indigenous, and people of color (BIPOC): since 2015, overdose mortality rates have increased substantially more among Black (114%) and Latinx (97%) populations compared with White populations (32%). This is in part due to disparities in access to naloxone, an opioid antagonist that can effectively reverse opioid overdose to prevent death. Our recent pilot work determined that many barriers to naloxone access can be identified and addressed by syringe service programs (SSPs) using the Systems Analysis and Improvement Approach to Naloxone distribution (SAIA-Naloxone). This randomized controlled trial will test SAIA-Naloxone's ability to improve naloxone distribution in general and among BIPOC specifically. METHODS We will conduct a trial with 32 SSPs across California, randomly assigning 16 to the SAIA-Naloxone arm and 16 to receive implementation as usual. SAIA-Naloxone is a multifaceted, multilevel implementation strategy through which trained facilitators work closely with SSPs to (1) assess organization-level barriers, (2) prioritize barriers for improvement, and (3) test solutions through iterative change cycles until achieving and sustaining improvements. SSPs receiving SAIA-Naloxone will work with a trained facilitator for a period of 12 months. We will test SAIA-Naloxone's ability to improve SSPs' naloxone distribution using an interrupted time series approach. Data collection will take place during a 3-month lead-in period, the 12-month active period, and for an additional 6 months afterward to determine whether impacts are sustained. We will use a structured approach to specify SAIA-Naloxone to ensure strategy activities are clearly defined and to assess SAIA-Naloxone fidelity to aid in interpreting study results. We will also assess the costs associated with SAIA-Naloxone and its cost-effectiveness. DISCUSSION This trial takes a novel approach to improving equitable distribution of naloxone amid the ongoing epidemic and associated racial disparities. If successful, SAIA-Naloxone represents an important organizational-level solution to the multifaceted and multilevel barriers to equitable naloxone distribution.
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Affiliation(s)
- Christopher F Akiba
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA.
| | - Sheila V Patel
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Lynn D Wenger
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Antonio Morgan-Lopez
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Gary A Zarkin
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Stephen Orme
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Peter J Davidson
- Department of Medicine, Division Global Public Health, UCSD, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Alex H Kral
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
| | - Barrot H Lambdin
- RTI International, 3040 E Cornwallis Rd, Research Triangle, Research Triangle Park, NC, 27709, USA
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Memmini AK, Kinnett-Hopkins DL, Hasson RE, Rifat SF, Broglio SP. Considerations for Implementing the Post-Concussion Collegiate Return-to-Learn Protocol in the National Collegiate Athletic Association Power 5 Conferences. J Head Trauma Rehabil 2023; 38:336-347. [PMID: 36854099 DOI: 10.1097/htr.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Although concussions affect millions of young adults annually, researchers have yet to assess factors that may affect future implementation of post-concussion academic supports within higher education. Therefore, we sought to evaluate preimplementation outcomes of the acceptability, feasibility, appropriateness, and readiness for change of the Post-Concussion Collegiate Return-to-Learn (RTL) Protocol among university stakeholders. SETTING An online survey. PARTICIPANTS A convenience sample ( N = 49; 63.3% female) of athletic trainers (ATs; n = 25, age = 30.1 ± 7.6 years) and university faculty/staff ( n = 24, age = 38.3 ± 9.9 years) across the National Collegiate Athletic Association (NCAA) Power 5 Conferences from January to February 2022. DESIGN A cross-sectional study. MAIN MEASURES To compare preimplementation outcome measures using the Acceptability of Intervention Measure (AIM), Feasibility of Intervention Measure (FIM), Intervention Appropriateness Measure (IAM), and Organizational Readiness for Implementing Change (ORIC) regarding the RTL protocol between ATs and university faculty/staff. Additional outcomes included internal and external barriers to implementing at their respective institutions. Statistical analyses were conducted using Mann-Whitney U tests, with effect sizes estimated using eta-squared coefficient (η 2 ). RESULTS Quantitative analyses yielded no statistically significant group differences ( P s > .05) across the AIM, FIM, and IAM outcomes, indicating both groups perceived the protocol to be acceptable, feasible, and appropriate. Moreover, ATs reported higher agreement regarding motivation, desire, willingness to do "whatever it takes," commitment, and determination to implement the novel protocol than faculty/staff. Further, ATs reported higher agreement regarding their institution's confidence to keep track of its progress, support adjustment, maintain momentum, manage institutional politics, coordinate tasks, encourage investment, and handle the challenges of future implementation of the RTL protocol. CONCLUSIONS Preliminary findings suggest ATs and university faculty/staff across the NCAA Power 5 Conferences may perceive the RTL protocol to be acceptable, feasible, and appropriate for future use; however, noteworthy internal and external barriers may influence its uptake. Future research should utilize implementation frameworks to support the protocol's adoption and reach.
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Affiliation(s)
- Allyssa K Memmini
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, New Mexico (Dr Memmini); Concussion Center, University of Michigan, Ann Arbor (Drs Memmini, Kinnett-Hopkins, Hasson, and Broglio); and School of Kinesiology, University of Michigan, Ann Arbor, and University of Michigan Athletics, Michigan Medicine, Ann Arbor (Dr Rifat)
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Cunha-Cruz J, Hilgert JB, Harter C, Rothen ML, Hort K, Mallott E. Feedback on audit and action planning for dental caries control: a qualitative study to investigate the acceptability among interdisciplinary pediatric dental care teams. FRONTIERS IN ORAL HEALTH 2023; 4:1195736. [PMID: 37456360 PMCID: PMC10348878 DOI: 10.3389/froh.2023.1195736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction American Indian and Alaska Native children suffer from the poorest oral health of all populational groups in the United States. Evidence-based practices (EBP) for caries control are well established, but systematically implementing such practices have proven difficult. Audit and feedback with goal setting, and action planning to implement these EBPs have not been tested or adapted for Alaska Native healthcare settings. The aim of this study was to investigate acceptability and perceived feasibility of an audit and feedback intervention for pediatric dental caries control among dental providers and patient stakeholders. Methods The pilot program was implemented in two dental clinics from a tribal healthcare consortium in Alaska. Key-informant interviews were conducted to investigate the contextual, organizational, and behavioral facilitators and barriers to the implementation and expansion of the program. Interview transcripts were analyzed by two researchers using thematic analysis. Results Eight key informants were interviewed twice (during and after the intervention period), and one once, for a total of 17 interviews. Patient stakeholders were not interviewed due to COVID-19 pandemic clinic closures and social isolation mandates. Three principal themes emerged: a positive organizational climate and culture fostered the acceptability of the program, the positive impacts of the program observed in the pediatric dental teams and the organization, and the challenges to implement the program including understanding the data reports, trusting the accuracy of the data, and competing priorities. Conclusions The intervention of audit and feedback with goal setting and action planning was well accepted and perceived as feasible by the study participants given the financial and human resources provided by the research project. This qualitative study can inform the design and evaluation of process-oriented implementation strategies geared towards decreasing health inequities and improving health outcomes, such as dental caries in American Indian and Alaska Native children and adolescents.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Juliana Balbinot Hilgert
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Post Graduate Program in Dentistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Catherine Harter
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Marilynn L. Rothen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, United States
| | - Kim Hort
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
| | - Elizabeth Mallott
- SouthEast Alaska Regional Health Consortium (SEARHC), Juneau, AK, United States
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Voils CI, Coffman CJ, Wu RR, Grubber JM, Fisher DA, Strawbridge EM, Sperber N, Wang V, Scheuner MT, Provenzale D, Nelson RE, Hauser E, Orlando LA, Goldstein KM. A Cluster Randomized Trial of a Family Health History Platform to Identify and Manage Patients at Increased Risk for Colorectal Cancer. J Gen Intern Med 2023; 38:1375-1383. [PMID: 36307642 PMCID: PMC10160317 DOI: 10.1007/s11606-022-07787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Obtaining comprehensive family health history (FHH) to inform colorectal cancer (CRC) risk management in primary care settings is challenging. OBJECTIVE To examine the effectiveness of a patient-facing FHH platform to identify and manage patients at increased CRC risk. DESIGN Two-site, two-arm, cluster-randomized, implementation-effectiveness trial with primary care providers (PCPs) randomized to immediate intervention versus wait-list control. PARTICIPANTS PCPs treating patients at least one half-day per week; patients aged 40-64 with no medical conditions that increased CRC risk. INTERVENTIONS Immediate-arm patients entered their FHH into a web-based platform that provided risk assessment and guideline-driven decision support; wait-list control patients did so 12 months later. MAIN MEASURES McNemar's test examined differences between the platform and electronic medical record (EMR) in rates of increased risk documentation. General estimating equations using logistic regression models compared arms in risk-concordant provider actions and patient screening test completion. Referral for genetic consultation was analyzed descriptively. KEY RESULTS Seventeen PCPs were randomized to each arm. Patients (n = 252 immediate, n = 253 control) averaged 51.4 (SD = 7.2) years, with 83% assigned male at birth, 58% White persons, and 33% Black persons. The percentage of patients identified as increased risk for CRC was greater with the platform (9.9%) versus EMR (5.2%), difference = 4.8% (95% CI: 2.6%, 6.9%), p < .0001. There was no difference in PCP risk-concordant action [odds ratio (OR) = 0.7, 95% CI (0.4, 1.2; p = 0.16)]. Among 177 patients with a risk-concordant screening test ordered, there was no difference in test completion, OR = 0.8 [0.5,1.3]; p = 0.36. Of 50 patients identified by the platform as increased risk, 78.6% immediate and 68.2% control patients received a recommendation for genetic consultation, of which only one in each arm had a referral placed. CONCLUSIONS FHH tools could accurately assess and document the clinical needs of patients at increased risk for CRC. Barriers to acting on those recommendations warrant further exploration. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02247336 https://clinicaltrials.gov/ct2/show/NCT02247336.
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Affiliation(s)
- Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
| | - Cynthia J Coffman
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - R Ryanne Wu
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Deborah A Fisher
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Nina Sperber
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Virginia Wang
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Maren T Scheuner
- San Francisco VA Health Care System, San Francisco, VA, USA
- Departments of Medicine and Pediatrics, University of California at San Francisco, San Francisco, CA, USA
| | - Dawn Provenzale
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Richard E Nelson
- Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Elizabeth Hauser
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lori A Orlando
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Karen M Goldstein
- Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Reynolds GS, Bennett JB. The Role of Wellness Climate in Small Business Health Promotion and Employee Wellbeing. OCCUPATIONAL HEALTH SCIENCE 2023:1-36. [PMID: 37359456 PMCID: PMC10131546 DOI: 10.1007/s41542-023-00148-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 06/28/2023]
Abstract
Wellness involves physical, emotional, behavioral, social, and spiritual dimensions. A climate for wellness exists at both the psychological and organizational levels, consisting of individual and shared perceptions of policies, structures, and managerial behavior that support or promote employee wellbeing. This study explored the associations between psychological and organizational wellness climate and the effectiveness of a team health promotion training on employees' perceived physical and mental wellbeing and substance use. Employees from 45 small businesses completed self-report measures of wellness climate, wellbeing, positive unwinding behavior, work-family conflict, job stress, drug use, and alcohol use, assessed before, and one and six months after, attending either of two types of onsite health promotion training. Team Awareness training targeted improvements in the social climate at work. Healthy Choices training targeted individual health behavior. A control group did not receive training until after the study. Businesses were randomly assigned to conditions and data were analyzed using multi-level modeling. Models that included wellness climate as a mediator fit the data significantly better than models without climate as a mediator. Team Awareness participants showed greater improvements in wellness climate and wellbeing compared to the control group. Healthy Choices participants showed no changes in climate and no mediation effects of climate. Health promotion efforts may be enhanced by including wellness climate as a target in program design at multiple levels.
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Affiliation(s)
- G. Shawn Reynolds
- Organizational Wellness & Learning Systems, 2221 Justin Rd. #119485, Flower Mound, TX 75028 USA
| | - Joel B. Bennett
- Organizational Wellness & Learning Systems, 2221 Justin Rd. #119485, Flower Mound, TX 75028 USA
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20
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Meza RD, Moreland JC, Pullmann MD, Klasnja P, Lewis CC, Weiner BJ. Theorizing is for everybody: Advancing the process of theorizing in implementation science. FRONTIERS IN HEALTH SERVICES 2023; 3:1134931. [PMID: 36926499 PMCID: PMC10012624 DOI: 10.3389/frhs.2023.1134931] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
There has been a call to shift from treating theories as static products to engaging in a process of theorizing that develops, modifies, and advances implementation theory through the accumulation of knowledge. Stimulating theoretical advances is necessary to improve our understanding of the causal processes that influence implementation and to enhance the value of existing theory. We argue that a primary reason that existing theory has lacked iteration and evolution is that the process for theorizing is obscure and daunting. We present recommendations for advancing the process of theorizing in implementation science to draw more people in the process of developing and advancing theory.
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Affiliation(s)
- Rosemary D. Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | | | - Michael D. Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Predrag Klasnja
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Cara C. Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
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21
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Underwood NL, Kane H, Cance J, Emery K, Elek E, Zule W, Rooks-Peck C, Sargent W, Mells J. Achieving Reductions in Opioid Dispensing: A Qualitative Comparative Analysis of State-Level Efforts to Improve Prescribing. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:262-270. [PMID: 36112160 PMCID: PMC9892169 DOI: 10.1097/phh.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether any combinations of state-level public health activities were necessary or sufficient to reduce prescription opioid dispensing. DESIGN We examined 2016-2019 annual progress reports, 2014-2019 national opioid dispensing data (IQVIA), and interview data from states to categorize activities. We used crisp-set Qualitative Comparative Analysis to determine which program activities, individually or in combination, were necessary or sufficient for a better than average decrease in morphine milligram equivalent (MME) per capita. SETTING Twenty-nine US state health departments. PARTICIPANTS State health departments implementing the Centers for Disease Control and Prevention's Prevention for States (PfS) program. MAIN OUTCOME Combinations of prevention activities related to changes in the rate of prescription opioid MME per capita dispensing from 2014 to 2019. RESULTS Three combinations were sufficient for greater than average state-level reductions in MME per capita: (1) expanding and improving proactive reporting in combination with enhancing the uptake of evidence-based opioid prescribing guidelines and not moving toward a real-time Prescription Drug Monitoring Program; (2) implementing or improving prescribing interventions for insurers, health systems, or pharmacy benefit managers in combination with enhancing the uptake of evidence-based opioid prescribing guidelines; and (3) not implementing or improving prescribing interventions for insurers, health systems, or pharmacy benefit managers in combination with not enhancing the uptake of evidence-based opioid prescribing guidelines. Interview data suggested that the 3 combinations indicate how state contexts and history with addressing opioid overdose shaped programming and the ability to reduce MME per capita. CONCLUSIONS States successful in reducing opioid dispensing selected activities that built upon existing policies and interventions, which may indicate thoughtful use of resources. To maximize impact in addressing the opioid overdose epidemic, states and agencies may benefit from building on existing policies and interventions.
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Affiliation(s)
- Natasha L Underwood
- Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Underwood, Rooks-Peck, Sargent, and Mells); and RTI International, Research Triangle Park, North Carolina (Drs Kane, Cance, Elek, and Zule and Ms Emery)
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22
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Aruldas K, Dawson K, Saxena M, Titus A, Johnson J, Gwayi-Chore MC, Muliyil J, Kang G, Walson JL, Khera A, Ajjampur SSR, Means AR. Evaluation of opportunities to implement community-wide mass drug administration for interrupting transmission of soil-transmitted helminths infections in India. PLoS Negl Trop Dis 2023; 17:e0011176. [PMID: 36897877 PMCID: PMC10004831 DOI: 10.1371/journal.pntd.0011176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND The World Health Organization Neglected Tropical Disease (NTD) guidelines recommend control of soil transmitted helminth (STH)-associated morbidity with targeted deworming of preschool and school-aged children who are disproportionately affected by STH-associated morbidity. However, this strategy leaves many adults untreated and reinfection within communities perpetuates transmission even when mass drug administration (MDA) coverage of children is high. Evidence suggests that it may be possible to interrupt STH transmission by expanding MDA to a community-wide MDA (cMDA). METHODS This multi-methods study of organizational readiness survey, key informant interviews, and program mapping, were conducted with government stakeholders in three Indian states, Goa, Sikkim, and Odisha, to assess readiness of the states for transitioning from school-based MDA to cMDA and identify opportunities to leverage existing infrastructure from other NTD programs like lymphatic filariasis (LF) for STH cMDA. PRINCIPAL FINDINGS Overall, all three states indicated a highly favorable policy environment, effective leadership structure, adequate material resources, demonstrated technical capacity, and adequate community infrastructure needed to launch a STH cMDA program. The findings indicated a high-level of health system readiness to implement provided human resources and financial resources to deliver cMDA is strengthened. Areas with a significant overlap between LF and STH MDA platforms, particularly at the community-level, may be best primed for transitioning. Immunization, maternal child health, and non-communicable disease control programs were the other programs for possible integration of cMDA. States indicated having effective leadership structures in place at the state-level, however, engaging local leaders and community groups were considered crucial for successful implementation of cMDA. In-migration was a perceived challenge for estimating drug requirement and preventing possible stockouts. CONCLUSIONS Findings from this study are intended to proactively support government decision making, prioritization, and program planning across heterogenous implementation contexts in India to speed the translation of research findings into practice. CLINICAL TRIAL REGISTRATION NCT03014167; ClinicalTrials.gov.
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Affiliation(s)
- Kumudha Aruldas
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Kim Dawson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Malvika Saxena
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Angelin Titus
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Jabaselvi Johnson
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Marie-Claire Gwayi-Chore
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jayaprakash Muliyil
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Judd L. Walson
- Departments of Global Health, Medicine (Infectious Disease), Pediatrics and Epidemiology, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
| | - Ajay Khera
- Ministry of Health and Family Welfare (former), Government of India, New Delhi, India
| | - Sitara S. R. Ajjampur
- The Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
- * E-mail:
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- The DeWorm3 Project, University of Washington, Seattle, Washington, United States of America
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23
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Peracca SB, Fonseca AS, Lachica O, Jackson GL, Morris IJ, King HA, Misitzis A, Whited JD, Mohr DC, Lamkin RP, Gifford AL, Weinstock MA, Oh DH. Organizational Readiness for Patient-Facing Mobile Teledermatology to Care for Established Veteran Patients in the United States. Telemed J E Health 2023; 29:72-80. [PMID: 35612465 DOI: 10.1089/tmj.2022.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose: To improve patient access to skin care, the Department of Veterans Affairs (VA) developed a patient-facing asynchronous mobile teledermatology application (app), which allows patients to follow up remotely with dermatologists. To understand how the app would be received in VA, we examined Organizational Readiness for Change (ORC), an important prelude to effective implementation, which includes the shared resolve and collective ability of organizational members to implement a change. Methods: We used a mixed-methods multiple case study approach to assess ORC at three VA facilities. Data derived from a site process call, surveys, and semistructured telephone interviews of VA staff, field notes, and administrative data. Results: Participants at all three facilities supported the intervention and recognized the value of using the app to increase patients' access to dermatologists, but expressed concerns largely related to disruption of the pre-existing clinical workflow. Participants at the facility most actively using the app had the highest overall ORC score and reported the most facilitators. Facility leadership support when guided by a clinical champion minimized barriers by recognizing the complexities of health care provision at specialty clinics. Discussion: While provider buy-in remained a barrier, leadership, guided by the clinical champion, played a critical role instituting implementation strategies. The strong association between the ORC survey score and the presence of facilitators and barriers suggests that the ORC survey may be a rapid, convenient, and effective tool for health care systems to identify favorable sites for wider implementation of mobile telehealth care. Clinical Trials Identifier: NCT03241589.
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Affiliation(s)
- Sara B Peracca
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Allene S Fonseca
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Olevie Lachica
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - George L Jackson
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina, USA
| | - Isis J Morris
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Heather A King
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Angelica Misitzis
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - John D Whited
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Rebecca P Lamkin
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Health Care System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts, USA.,Department of Medicine, Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Providence VA Medical Center, Providence, Rhode Island, USA.,Department of Dermatology and Epidemiology, Brown University, Providence, Rhode Island, USA
| | - Dennis H Oh
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA.,Department of Dermatology, University of California at San Francisco, San Francisco, California, USA
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24
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Petrovskis A, Bekemeier B, Heitkemper E, van Draanen J. The DASH model: Data for addressing social determinants of health in local health departments. Nurs Inq 2023; 30:e12518. [PMID: 35982547 DOI: 10.1111/nin.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023]
Abstract
Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making-the use of data for public health activities such as program implementation, policy development, and resource allocation-is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, Washington, USA
| | | | - Jenna van Draanen
- School of Nursing, University of Washington, Seattle, Washington, USA
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25
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Valdiserri RO. The Shape of Things to Come: COVID's Organizational Impact. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:5-7. [PMID: 36398934 PMCID: PMC9722322 DOI: 10.1097/phh.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Ronald O. Valdiserri
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Hazelzet E, Houkes I, Bosma H, de Rijk A. How a steeper organisational hierarchy prevents change-adoption and implementation of a sustainable employability intervention for employees in low-skilled jobs: a qualitative study. BMC Public Health 2022; 22:2373. [PMID: 36528559 PMCID: PMC9759045 DOI: 10.1186/s12889-022-14754-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adoption and implementation are prerequisites for the effectiveness of organisational interventions, but successful implementation is not self-evident. This article provides insights into the implementation of the organisational intervention 'Healthy Human Resources' (HHR). HHR is developed with Intervention Mapping and aims at improving sustainable employability (SE) of employees in low-skilled jobs. METHODS Qualitative data on adoption and implementation were collected by interviews with three employees and seven middle managers in five Dutch organisations and by extensive notes of observations and conversations in a logbook. Data triangulation was applied and all data were transcribed and analysed thematically using the qualitative analysis guide of Leuven (QUAGOL). RESULTS All organisations adopted HHR, but three failed during the transition from adoption to implementation, and two implemented HHR only partially. The steepness of the organisational hierarchy emerged as an overarching barrier: steeper hierarchical organisations faced more difficulties with implementing HHR than flatter ones. This was reflected in middle managers' lack of decision-making authority and being overruled by senior management. Middle managers felt incapable of remedying the lack of employees' voice. Subsequently, 'us-versus-them' thinking patterns emerged. These power imbalances and 'us-versus-them' thinking reinforced each other, further strengthening the hierarchical steepness. Both processes could be the result of wider socio-political forces. CONCLUSIONS This study improved the understanding of the difficulties to adopt and implement such organisational intervention to contribute to the sustainable employability of employees in low-skilled jobs. Practical implications are given for future implementation of organisational interventions.
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Affiliation(s)
- Emmelie Hazelzet
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands.
| | - Inge Houkes
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Hans Bosma
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Angelique de Rijk
- Department of Social Medicine, Faculty of Health, Medicine and Life Sciences, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands
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Girgis A, Bamgboje-Ayodele A, Rincones O, Vinod SK, Avery S, Descallar J, Smith A‘B, Arnold B, Arnold A, Bray V, Durcinoska I, Rankin NM, Chang CF, Eifler B, Elliott S, Hardy C, Ivimey B, Jansens W, Kaadan N, Koh ES, Livio N, Lozenkovski S, McErlean G, Nasser E, Ryan N, Smeal T, Thomas T, Tran T, Wiltshire J, Delaney GP. Stepping into the real world: a mixed-methods evaluation of the implementation of electronic patient reported outcomes in routine lung cancer care. J Patient Rep Outcomes 2022; 6:70. [PMID: 35723827 PMCID: PMC9207870 DOI: 10.1186/s41687-022-00475-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/03/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To realize the broader benefits of electronic patient-reported outcome measures (ePROMs) in routine care, we used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to inform the translation of a clinically effective ePROM system (hereafter referred to as the PRM system) into practice. The study aimed to evaluate the processes and success of implementing the PRM system in the routine care of patients diagnosed with lung cancer.
Method
A controlled before-and-after mixed-methods study was undertaken. Data sources included a self-report questionnaire and interviews with healthcare providers, electronic health record data for PRMs patients and historical controls, and field notes. Descriptive statistics, logistic regression modelling, negative binomial models, generalized estimating equations and repeated measures ANOVA were used to analyze quantitative data. Qualitative data was thematically analyzed.
Results
A total of 48/79 eligible people diagnosed with lung cancer completed 90 assessments during the 5-month implementation period (RE-AIM reach). Every assessment breached the pre-defined threshold and care coordinators reviewed and actioned 95.6% of breaches, resulting in 146 referrals to allied health services, most frequently for social work (25.3%), dietetics (18.5%), physiotherapy (18.5%) and occupational therapy (17.1%). PRMs patients had significantly fewer visits to the cancer assessment unit for problematic symptoms (M = 0.23 vs. M = 0.43; p = 0.035), and were significantly more likely to be offered referrals (71% vs. 29%, p < 0.0001) than historical controls (RE-AIM effect). The levels of ‘organizational readiness for implementing change’ (ORIC) did not show much differences between baseline and follow-up, though this was already high at baseline; but significantly more staff reported improved confidence when asking patients to complete assessments (64.7% at baseline vs. 88.2% at follow-up, p = 0.0046), and when describing the assessment tool to patients (64.7% at baseline vs. 76.47% at follow-up, p = 0.0018) (RE-AIM adoption). A total of 78 staff received PRM system training, and 95.6% of the PRM system alerts were actioned (RE-AIM implementation); and all lung cancer care coordinators were engaged with the PRM system beyond the end of the study period (RE-AIM maintenance).
Conclusion
This study demonstrates the potential of the PRM system in enhancing the routine care of lung cancer patients, through leveraging the capabilities of automated web-based care options.
Plain English summary
Research has shown the clear benefits of using electronically collected patient-reported outcome measures (ePROMs) for cancer patients and health services. However, we need to better understand how to implement ePROMs as part of routine care. This study evaluated the processes and outcomes of implementing an ePROMs system in the routine care of patients diagnosed with lung cancer. Key findings included: (a) a majority of eligible patients completed the scheduled assessments; (b) patient concerns were identified in every assessment, and care coordinators reviewed and actioned almost all of these, including making significantly more referrals to allied health services; (c) patients completing assessments regularly were less likely to present to the cancer assessment unit with problematic symptoms, suggesting that ePROMs identified patient concerns early and this led to a timely response to concerns; (d) staff training and engagement was high, and staff reporting increased confidence when asking patients to complete assessments and when describing the assessment tool to patients at the end of the implementation period. This study shows that implementing ePROMs in routine care is feasible and can lead to improvements in patient care.
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Lindberg M, Skytt B, Lindberg M, Wijk K, Strömberg A. A complex challenge with unclear improvement: the need for involvement, contextualization and facilitation when managers implement a leadership model. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print:236-246. [PMID: 36193881 PMCID: PMC10433968 DOI: 10.1108/lhs-05-2022-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/05/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Management and leadership in health care are described as complex and challenging, and the span of control is known to be a key component in the manager's job demands. The implementation of change can be a challenge in health care, and managers often have roles as implementation leaders. Little attention has been given to how managers perceive the process of implementation. Thus, this study aims to explore second-line managers' perceptions of, prerequisites for and experiences from the implementation of changes in their manager's work conditions. DESIGN/METHODOLOGY/APPROACH A grounded theory-based qualitative design was used. Data were collected from a purposive sample of nine second-line managers by individual semi-structured interviews. The three stages of initial coding, focus codes and axial coding were used in data analysis. FINDINGS Three thematic areas were identified: engagement, facilitation and achievement. The second-line managers' descriptions suggest that the change work entails a complex challenge with an unclear result. Involvement, consideration for the context and facilitation are needed to be able to conduct a cohesive implementation process. ORIGINALITY/VALUE This study findings outline that to succeed when implementing change in complex organizations, it is crucial that managers at different levels are involved in the entire process, and that there are prerequisites established for the facilitation and achievement of goals during the planning, implementation and follow-up.
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Affiliation(s)
- Maria Lindberg
- Department of Caring Sciences, University of Gävle, Gävle, Sweden; Centre for Research and Development, Uppsala University, Uppsala, Sweden and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Bernice Skytt
- Department of Caring Sciences, University of Gävle, Gävle, Sweden and Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Magnus Lindberg
- Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Katarina Wijk
- Centre for Research and Development, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden and Department of Occupational Health Sciences and Psychology, University of Gävle, Gävle, Sweden
| | - Annika Strömberg
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden and Department of Business and Economics studies, University of Gävle, Gävle, Sweden
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Hente L, Hodeck A, Schlesinger T. Establishment and management of a workplace health promotion network in rural areas: a case study. Health Promot Int 2022; 37:6730777. [PMID: 36173605 DOI: 10.1093/heapro/daac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health is an increasingly important issue in the workplace, but the dissemination of health-promoting interventions in companies, especially in small and medium-sized enterprises (SMEs), remains limited. Inter-organizational networks seem to be a promising approach to promote and implement workplace health management (WHM) in SMEs. This study analyses the establishment and coordination of the network 'ERZgesund-Healthy Companies in the Ore Mountains' for WHM in SMEs in a rural area of Germany. The case study, which builds on a mixed method approach (expert interviews, participant observations and document analysis), finds that ERZgesund evolved from a top-down approach (politically initiated, regionally anchored and financed from promotional funds). The network's hierarchy is disproportionately vertical, and the project group has limited decision-taking power and limited opportunities to act, which has reduced their overall engagement in the network. We conclude that although long and stable relationships are important for successful networks, change-especially at the leadership level-can lead to increased engagement of network participants if the hierarchy within the network is horizontally aligned. The findings of this explorative case study contribute to the planning process, the development and implementation of network structures, and successful WHM interventions.
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Affiliation(s)
- Luisa Hente
- Department of Human Movement Science and Health, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany
| | - Alexander Hodeck
- Department of Marketing, Tourism and Sports, International School of Management (ISM), Hauptstraße 27, 10827 Berlin, Germany
| | - Torsten Schlesinger
- Department of Human Movement Science and Health, Chemnitz University of Technology, Thüringer Weg 11, 09126 Chemnitz, Germany
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Kim E, Boutain DM, Lim S, Parker S, Wang D, Maldonado Nofziger R, Weiner BJ. Organizational contexts, implementation process, and capacity outcomes of multicultural, multilingual Home-Based Programs in public initiatives: A Mixed-Methods study. J Adv Nurs 2022; 78:3409-3426. [PMID: 35986591 PMCID: PMC9541645 DOI: 10.1111/jan.15276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 02/09/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
AIMS The study aim was to examine the impact of a home-based programme intervention on organizational contexts, implementation processes and organizational capacity outcomes from multicultural, multilingual participants working at community-based organizations. DESIGN This was a sequential exploratory, mixed-methods longitudinal study using community-based participatory research principles. SAMPLE Twenty participants from nine multicultural, multilingual community-based organizations were in this public health initiative's intervention to develop community-designed, home-based programmes. METHODS Capacity building providers delivered the intervention selected by the funders. Workshop outcomes were descriptively measured in April/May 2019. In April/May and November 2019, participants completed surveys about organizational contexts, implementation processes and organizational capacity outcomes, which were analysed with t-tests using the organization as the unit of analysis. Qualitative data were analysed using content analysis. RESULTS Seven programmes were new and two were modified. As workshop outcomes, 59% of participants reported increased overall implementation knowledge and 74% reported capacity building providers as the most helpful resource. After 6 to 7 months, no statistically significant changes were noted in organizational contexts, implementation processes or organizational capacity outcomes. Participants benefited from capacity building because they had programmes developed, formed partnerships with capacity building providers, gained implementation knowledge, and engaged in networking. CONCLUSION Participants reported excellent individual and organizational strengths. Many Initiative factors contributed to no statistical changes. Namely, there was no opportunity for baseline data; limited community-based organization engagement in the intervention model selection, timeline and processes; the Initiative's timeline did not fit participants' timeline; insufficient time to develop culturally and linguistically appropriate programmes; late literature review abstracts; lack of adequate, planful and paid capacity building time; and a contract requirement to have the programme due when it was not implementable. These Initiative design factors, as reported by participants, limited the Initiative's home-based programme development. IMPACT This study highlights the strengths of participants, community-based organizations and capacity building providers. Model selection, timeline and budget were identified as key factors for equitable implementation in multicultural, multilingual organizations.
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Affiliation(s)
- Eunjung Kim
- University of Washington School of NursingSeattleWAUSA
| | | | - Sungwon Lim
- University of Washington School of NursingSeattleWAUSA
| | | | - Di Wang
- University of Washington School of NursingSeattleWAUSA
| | | | - Byran J. Weiner
- Department of Global Health & Department of Health Services and Population HealthUniversity of WashingtonSeattleWAUSA
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Garner BR, Burrus O, Ortiz A, Tueller SJ, Peinado S, Hedrick H, Harshbarger C, Galindo C, Courtenay-Quirk C, Lewis MA. A Longitudinal Mixed-Methods Examination of Positive Health Check: Implementation Results From a Type 1 Effectiveness-Implementation Hybrid Trial. J Acquir Immune Defic Syndr 2022; 91:47-57. [PMID: 35583962 PMCID: PMC9377502 DOI: 10.1097/qai.0000000000003018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Positive Health Check is an evidence-based video doctor intervention developed for improving the medication adherence, retention in care, and viral load suppression of people with HIV receiving clinical care. SETTING Four HIV primary care clinics within the United States. METHODS As part of a type 1 hybrid trial, a mixed-methods approach was used to longitudinally assess the following 3 key implementation constructs over a 23-month period: innovation-values fit (ie, the extent to which staff perceive innovation use will foster the fulfillment of their values), organizational readiness for change (ie, the extent to which organizational members are psychologically and behaviorally prepared to implement organizational change), and implementation climate (ie, the extent to which implementation is expected, supported, and rewarded). Quantitative mixed-effects regression analyses were conducted to assess changes over time in these constructs. Qualitative analyses were integrated to help provide validation and understanding. RESULTS Innovation-values fit and organizational readiness for change were found to be high and relatively stable. However, significant curvilinear change over time was found for implementation climate. Based on the qualitative data, implementation climate declined toward the end of implementation because of decreased engagement from clinic champions and differences in priorities between research and clinic staff. CONCLUSIONS The Positive Health Check intervention was found to fit within HIV primary care service settings, but there were some logistical challenges that needed to be addressed. Additionally, even within the context of an effectiveness trial, significant and nonlinear change in implementation climate should be expected over time.
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Affiliation(s)
| | | | - Alexa Ortiz
- RTI International, Research Triangle Park, NC; and
| | | | | | | | - Camilla Harshbarger
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Carla Galindo
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
| | - Cari Courtenay-Quirk
- Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA
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Cheung WJ, Hall AK, Skutovich A, Brzezina S, Dalseg TR, Oswald A, Cooke LJ, Van Melle E, Hamstra SJ, Frank JR. Ready, set, go! Evaluating readiness to implement competency-based medical education. MEDICAL TEACHER 2022; 44:886-892. [PMID: 36083123 DOI: 10.1080/0142159x.2022.2041585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Organizational readiness is critical for successful implementation of an innovation. We evaluated program readiness to implement Competence by Design (CBD), a model of Competency-Based Medical Education (CBME), among Canadian postgraduate training programs. METHODS A survey of program directors was distributed 1 month prior to CBD implementation in 2019. Questions were informed by the R = MC2 framework of organizational readiness and addressed: program motivation, general capacity for change, and innovation-specific capacity. An overall readiness score was calculated. An ANOVA was conducted to compare overall readiness between disciplines. RESULTS Survey response rate was 42% (n = 79). The mean overall readiness score was 74% (30-98%). There was no difference in scores between disciplines. The majority of respondents agreed that successful implementation of CBD was a priority (74%), and that their leadership (94%) and faculty and residents (87%) were supportive of change. Fewer perceived that CBD was a move in the right direction (58%) and that implementation was a manageable change (53%). Curriculum mapping, competence committees and programmatic assessment activities were completed by >90% of programs, while <50% had engaged off-service disciplines. CONCLUSION Our study highlights important areas where programs excelled in their preparation for CBD, as well as common challenges that serve as targets for future intervention to improve program readiness for CBD implementation.
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Affiliation(s)
- Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Andrew K Hall
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | | | - Stacey Brzezina
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
| | - Timothy R Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lara J Cooke
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Stanley J Hamstra
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Milestones Research and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois, USA
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jason R Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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Roehl MT. Putting implementation into context: Exploring the influence of physical, social, and task contexts on the implementation of health promotion programs. GERMAN JOURNAL OF HUMAN RESOURCE MANAGEMENT-ZEITSCHRIFT FUR PERSONALFORSCHUNG 2022. [DOI: 10.1177/23970022221108117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this paper is to empirically examine the influence of organizational context on the implementation effectiveness of human resource management (HRM) practices with the aim of maintaining the health and well-being of employees, known as health promotion programs (HPPs). HPPs are a strategic function in HRM and play a crucial role in creating and maintaining human capital. Effective implementation is typically viewed as a critical prerequisite for the success of HPPs. By exploring the influence of organizational context on the implementation of HPPs, this paper offers a fresh approach to understanding HRM implementation in a relatively neglected area of research. To uncover contextual influences a multiple-case study in four German organizations operating in the chemical industry was conducted. Data was collected using a multi-method design consisting of an analysis of documents and 28 semi-structured interviews. The study is among the first to apply the categorical model of context by Johns to the investigation of the implementation of health promotion programs. The results contribute to a more nuanced view of HRM implementation by highlighting the interrelationships between contextual factors stemming from the physical, social, and task context and implementation fidelity. By providing initial empirical evidence of the mechanisms underlying this relationship, this study sheds light on the complexity and breadth of contextual influences during the implementation of HPPs and offers several theoretical and practical implications.
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Vis C, Kleiboer A, Mol M, Pedersen CD, Finch T, Smit J, Riper H. Organisational implementation climate in implementing internet-based cognitive behaviour therapy for depression. BMC Health Serv Res 2022; 22:720. [PMID: 35641927 PMCID: PMC9153170 DOI: 10.1186/s12913-022-08041-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Internet-based Cognitive Behaviour Therapy (iCBT) for depression have been implemented in routine care across Europe in varying ways, at various scales and with varying success. This study aimed to advance our understanding of organisational implementation climate from the perspectives of implementers and mental health service deliverers. Methods Qualitative and quantitative methods were combined to study the concept of organisational implementation climate in mental health care settings. Based on concept mapping, a qualitative workshop with implementers was used to conceptualise organisational implementation climate for optimizing iCBT use in routine practice. Service deliverers involved in the provision of iCBT were invited to participate in an explorative cross-sectional survey assessing levels of satisfaction and usability of iCBT, and organisational implementation climate in implementing iCBT. The two methods were applied independently to study viewpoints of implementers as well as service deliverers. Corresponding to the explorative nature of the study, inductive reasoning was applied to identify patterns and develop a reasonable explanation of the observations made. Correlative associations between satisfaction, usability and implementation climate were explored. Results Sixteen implementers representing fourteen service delivery organisations across Europe participated in the workshop. The top-three characteristics of a supportive organisational implementation climate included: (1) clear roles and skills of implementers, (2) feasible implementation targets, and (3) a dedicated implementation team. The top-three tools for creating a supportive implementation climate included: (1) feedback on job performance, (2) progress monitoring in achieving implementation targets, and (3) guidelines for assessing the impact of iCBT. The survey (n=111) indicated that service providers generally regarded their organisational implementation climate as supportive in implementing iCBT services. Organisational implementation climate was weakly associated with perceived usability and moderately with satisfaction with iCBT services. Conclusions Organisational implementation climate is a relevant factor to implementers and service deliverers in implementing iCBT in routine care. It is not only an inherent characteristic of the context in which implementation takes place, it can also be shaped to improve implementation of iCBT services. Future research should further theorise organisational implementation climate and empirically validate the measurement instruments such as used in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08041-y.
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Affiliation(s)
- Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands. .,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands. .,World Health Organization (WHO) Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, Netherlands.
| | - Annet Kleiboer
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands
| | - Mayke Mol
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
| | | | - Tracy Finch
- Department of Nursing, Midwifery & Health, Northumbria University, Northumbria, United Kingdom
| | - Jan Smit
- Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.,Amsterdam Public Health Research Institute - Mental Health, Amsterdam, Netherlands.,Dept. of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, The Netherlands
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Spoelstra SL, Schueller M, Dorn E, Sikorskii A. Measuring Organizational Readiness for Change in Michigan's Home and Community-based Services Program: Instrument Adaptation and Psychometric Testing. Home Health Care Serv Q 2022; 41:255-266. [PMID: 35585762 DOI: 10.1080/01621424.2022.2077161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Short, valid, and reliable tools that measure organizational readiness are needed in practice. This study adapted and tested a previously developed instrument for measuring organizational readiness in a Medicaid Home and Community-Based Services (HCBS) program. The Texas Christian University Organizational Readiness for Change (TCU-ORC) scale was adapted and tested for validity and reliability in a sample of 522 registered nurses and social workers employed at 18 program sites. Structural validity was established using the exploratory factor analysis. Convergent validity was evaluated via correlations with the Implementation Leadership Scale (ILS) score. The adapted ORC scale consisted of 23 items. Cronbach's alphas for 5 subscales, Climate, Culture, Training, Motivation, and Pressure to Change exceeded .70. Convergent validity was supported by significant moderate correlations with the ILS. The adapted 23-item TCU-ORC scale is a valid and reliable instrument for measuring the organizational readiness for change in the Medicaid Home and Community-Based Services programs.
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Affiliation(s)
- Sandra L Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan, USA
| | - Monica Schueller
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan, USA
| | - Emily Dorn
- Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA
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Kebede S, Wang A. Organizational Justice and Employee Readiness for Change: The Mediating Role of Perceived Organizational Support. Front Psychol 2022; 13:806109. [PMID: 35369209 PMCID: PMC8965650 DOI: 10.3389/fpsyg.2022.806109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/20/2022] [Indexed: 11/23/2022] Open
Abstract
Recent studies have shown that an organization must adapt to change to succeed in a constantly changing market. However, most change efforts fail due to employee resistance to change. It is critical to address employee readiness for change to avoid employee resistance. Employees’ perceptions of fair treatment by their organizations have positively predicted their Readiness for organizational change. This research aims to investigate the influence of organizational justice on employee readiness for change using perceived organizational support (POS) as a mediator. This study was carried out on the Ethiopian Revenue and Customs Authority (ERCA) and conducted with 359 employees. The study used a structural equation model and multiple regression analysis to analyze the data. The model developed explains how POS mediates the positive relationship between organizational justice and employee readiness for change. The result shows that organizational justice is a significant influencing factor on employee readiness for change. Furthermore, POS mediates the positive influence of organizational justice on employee readiness for change. This study can assist public and private organizations, as well as policymakers and practitioners, in improving and encouraging different organizational change practices in Ethiopia. Moreover, this study can also contribute to the literature on organizational change by filling the gaps in the relationship between organizational justice and employees’ Readiness for organizational change. Overall, this study concludes that organizations in Ethiopia, including ERCA, should investigate the influence of organizational justice on employee readiness for change to have successful organizational change.
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Affiliation(s)
- Senay Kebede
- School of Management, Wuhan University of Technology, Wuhan, China
| | - Aimin Wang
- School of Management, Wuhan University of Technology, Wuhan, China
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Saito J, Odawara M, Takahashi H, Fujimori M, Yaguchi-Saito A, Inoue M, Uchitomi Y, Shimazu T. Barriers and facilitative factors in the implementation of workplace health promotion activities in small and medium-sized enterprises: a qualitative study. Implement Sci Commun 2022; 3:23. [PMID: 35236511 PMCID: PMC8889638 DOI: 10.1186/s43058-022-00268-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/01/2022] [Indexed: 03/27/2024] Open
Abstract
Background There is an immense difference between large companies and small and medium-sized enterprises (SMEs) in implementation of evidence-based interventions (EBIs). Previous literature reveals various barriers that SMEs face during implementation, such as a lack of time, accessibility, and resources. However, few studies have comprehensively examined those influential factors at multi-levels. This study aims to identify the factors influencing the implementation of non-communicable disease prevention activities (tobacco, alcohol, diet, physical activity, and health check-up) in SMEs using Consolidated Framework for Implementation Research (CFIR). Methods We conducted 15 semi-structured interviews with health managers and/or employers in 15 enterprises with less than 300 employees, and four focus groups among public health nurses/nutritionists of health insurers who support SMEs in four prefectures across Japan. A qualitative content analysis by a deductive directed approach was performed. After coding the interview transcript text into the CFIR framework constructs by two independent researchers, the coding results were compared and revised in each enterprise until an agreement was reached. Results Of the 39 CFIR constructs, 25 were facilitative and 7 were inhibitory for workplace health promotion implementation in SMEs, which were across individual, internal, and external levels. In particular, the leadership engagement of employers in implementing the workplace health promotion activities was identified as a fundamental factor which may influence other facilitators, including “access to knowledge and information,” “relative priority,” “learning climate,” at organizational level, and “self-efficacy” at the health manager level. The main barrier was the beliefs held by the employer/manager that “health management is one’s own responsibility.” Conclusions Multi-level factors influencing the implementation of non-communicable diseases prevention activities in SMEs were identified. In resource-poor settings, strong endorsement and support, and positive feedback from employers would be important for health managers and employees to be highly motivated and promote or participate in health promotion. Future studies are needed to develop context-specific strategies based on identified barriers and facilitative factors, and empirically evaluate them, which would contribute to narrowing the differences in worksite health promotion implementation by company size. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00268-4.
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Affiliation(s)
- Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Miyuki Odawara
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hirokazu Takahashi
- Division of Screening Assessment and Management, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Maiko Fujimori
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akiko Yaguchi-Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yosuke Uchitomi
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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Ober AJ, Hunter SB, McCullough CM, Leamon I, McCreary M, Beas I, Montero A, Tarn DM, Bromley E, Hurley B, Sheehe J, Martinez J, Watkins KE. Opioid Use Disorder Among Clients of Community Mental Health Clinics: Prevalence, Characteristics, and Treatment Willingness. Psychiatr Serv 2022; 73:271-279. [PMID: 34281359 PMCID: PMC8770719 DOI: 10.1176/appi.ps.202000818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the prevalence of co-occurring opioid use disorder and willingness to engage in treatment among clients of eight Los Angeles County Department of Mental Health outpatient clinics. METHODS Adults presenting for an appointment over a 2-week period were invited to complete a voluntary, anonymous health survey. Clients who indicated opioid use in the past year were offered a longer survey assessing probable opioid use disorder. Willingness to take medication and receive treatment also was assessed. RESULTS In total, 3,090 clients completed screening. Among these, 8% had a probable prescription (Rx) opioid use disorder and 2% a probable heroin use disorder. Of the clients with probable Rx opioid use or heroin use disorder, 49% and 25% were female, respectively. Among those with probable Rx opioid use disorder, 43% were Black, 33% were Hispanic, and 12% were White, and among those with probable heroin use disorder, 24% were Black, 22% were Hispanic, and 39% were White. Seventy-eight percent of those with Rx opioid use disorder had never received any treatment, and 82% had never taken a medication for this disorder; 39% of those with heroin use disorder had never received any treatment, and 39% had never received a medication. The strongest predictor of willingness to take a medication was believing that it would help stop opioid use (buprenorphine, β=13.54, p=0.003, and naltrexone long-acting injection, β=15.83, p<0.001). CONCLUSIONS These findings highlight the need to identify people with opioid use disorder and to educate clients in mental health settings about medications for these disorders.
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Affiliation(s)
| | | | | | - Isabel Leamon
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Ivan Beas
- David Geffen School of Medicine at UCLA
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Lobczowska K, Banik A, Romaniuk P, Forberger S, Kubiak T, Meshkovska B, Neumann-Podczaska A, Kaczmarek K, Scheidmeir M, Wendt J, Scheller DA, Wieczorowska-Tobis K, Steinacker JM, Zeeb H, Luszczynska A. Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review. Int J Behav Nutr Phys Act 2022; 19:16. [PMID: 35151330 PMCID: PMC8841124 DOI: 10.1186/s12966-021-01242-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors.
Methods
A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed.
Results
Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture).
Conclusions
The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs.
Registration
PROSPERO, #CRD42019133251.
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Serhal E, Pereira C, Armata R, Hardy J, Sockalingam S, Crawford A. Describing implementation outcomes for a virtual community of practice: The ECHO Ontario Mental Health experience. Health Res Policy Syst 2022; 20:17. [PMID: 35135565 PMCID: PMC8822668 DOI: 10.1186/s12961-022-00818-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/20/2022] [Indexed: 01/01/2023] Open
Abstract
Background Project ECHO is a virtual education model aimed at building capacity among healthcare providers to support optimal management for a range of health conditions. The expansion of the ECHO model, further amplified by the pandemic, has demonstrated an increased need to evaluate implementation success to ensure that interventions are implemented as planned. This study describes how Proctor et al.’s implementation outcomes (acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability) were adapted and used to assess the implementation of ECHO Ontario Mental Health (ECHO-ONMH), a mental health-focused capacity-building programme. Methods Using Proctor et al.’s implementation outcomes, the authors developed an implementation outcomes framework for ECHO-ONMH more generally. Using this, outcome measures and success thresholds were identified for each outcome for the ECHO-ONMH context, and then applied to evaluate the implementation of ECHO-ONMH using data from the first 4 years of the programme. Results An ECHO-ONMH implementation outcomes framework was developed using Proctor’s implementation outcomes. ECHO-ONMH adapted implementation outcomes suggest that ECHO-ONMH was implemented successfully in all domains except for penetration, which only had participation from 13/14 regions. Acceptability, appropriateness and adoption success thresholds were surpassed for all 4 years, showing strong signs of sustainability. The programme was deemed feasible all 4 years and was found to be more cost-effective. ECHO-ONMH also showed high rates of fidelity to the ECHO model, and high rates of penetration. Conclusions This is the first study to use Proctor et al.’s implementation outcomes to describe implementation success for a virtual capacity-building model. The proposed ECHO implementation outcomes framework provides a base for similar interventions to evaluate implementation success, which is an important precursor to understanding learning, service or health outcomes related to the model. Additionally, these findings can act as a benchmark for other international ECHOs and educational programmes.
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Affiliation(s)
- Eva Serhal
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Cheryl Pereira
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rosaria Armata
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jenny Hardy
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison Crawford
- Virtual Care, Outreach, and ECHO Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Sunjaya DK, Paskaria C, Herawati DMD, Pramayanti M, Riani R, Parwati I. Initiating a district-based public-private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage. BMC Health Serv Res 2022; 22:110. [PMID: 35078467 PMCID: PMC8789543 DOI: 10.1186/s12913-022-07506-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background District-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy. Methods The research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression. Results District TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05). Conclusions Engaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.
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Affiliation(s)
- Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia.
| | - Cindra Paskaria
- Department of Public Health, Faculty of Medicine, Maranatha Christian University, Bandung, Indonesia.,Post Graduate Program, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia
| | - Dewi Marhaeni Diah Herawati
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No 38, Bandung, West Java, 40161, Indonesia
| | | | - Rini Riani
- District Health Office, City of Bandung, Bandung, Indonesia
| | - Ida Parwati
- Departement of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran; Dr. Hasan Sadikin General Hospital, Bandung, 40161, Indonesia
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Wakida EK, Atuhaire CD, Karungi CK, Maling S, Obua C. Mbarara University Research Training Initiative: Experiences and Accomplishments of the MEPI Junior D43 TW010128 Award in Uganda. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1397-1410. [PMID: 34887692 PMCID: PMC8650769 DOI: 10.2147/amep.s339752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In 2015, Mbarara University of Science and Technology was awarded the Mbarara University Research Training Initiative (MURTI) under grant number D43 TW010128 to build capacity of junior faculty to become the next generation of researchers in Africa. In this paper, we document the experiences and achievements of the research capacity building efforts at MUST. METHODS We conducted a descriptive evaluation study which involved document review and in-depth interviews. We used "Reach" and 'Effectiveness' from the RE-AIM framework to guide the document review, and the organizational theory of implementation effectiveness to guide the in-depth interviews. RESULTS In the MURTI program, we conducted 17 short courses between August 2015 and July 2021, a total of 6597 attendances were recorded. The most attended courses were responsible conduct of research (n = 826), qualitative research methods (n = 744), and data management (n = 613). Thirty-three fellows were recruited and funded to conduct mentored research leading to 48 publications and 14 extramural grant applications were yielded. From the in-depth interviews, the participants appreciated the research training program, the enhanced research skills attained, and the institutional capacity built. They attributed the success of the program to the training approach of using short courses, readiness of the junior faculty to change, and the supportive environment by the mentors and trainers in the program. CONCLUSION The D43 TW010128 research training grant-built capacity for the junior faculty at MUST, enhanced their research skills, promoted research capacity institutionally and provided career development for the junior faculty. This was possible due to the positive attitude of the junior faculty (organizational readiness) to change and the supportive environment (mentors and trainers) during implementation of the grant. These two factors provided a favorable institutional climate that guaranteed success of the funding goals.
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Affiliation(s)
- Edith K Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Clara D Atuhaire
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christine K Karungi
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
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Kuchenbaur M, Peter R. Assessing the Role of Collective Efficacy Beliefs During Participative Occupational Health Interventions. Front Public Health 2021; 9:797838. [PMID: 34900928 PMCID: PMC8655112 DOI: 10.3389/fpubh.2021.797838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background: For group-based participatory interventions in the context of occupational health, no questionnaires exist to assess the participants' active engagement in the interventions. On the basis of the construct of collective efficacy beliefs, this study has developed a questionnaire with which the group-related efficacy beliefs can be assessed as a precondition for participants actively engaging in participative interventions. Methods: Participants were drawn from a two-arm cluster-randomized intervention study to fill out the questionnaire. A Factor analysis and an initial psychometric calibration were performed. In a second step, the group-related properties of the questionnaire were validated using a Multilevel analysis. Results: The factorial structure of the questionnaire is consistent with the theory of efficacy beliefs according to A. Bandura. Furthermore, the collective efficacy expectations of the interventions' participants are lowered in the absence of appreciation and support in the psychosocial environment of the worksite. Conclusions: Assessing participant's quality of interventional activity in participatory interventions by collective efficacy can be valuable in understanding the amount of interventional activity. In addition, it is recommended to consider the influence of the worksite's psychosocial environment on collective efficacy beliefs when implementing participatory interventions. Clinical Trial Registration: Registration trial DRKS00021138 on the German Registry of Clinical Studies (DRKS), retrospectively registered on 25 March, 2020.
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Affiliation(s)
- Marco Kuchenbaur
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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Alonso JP, Belizán M, Comolli M, González L, Roberti J, Pichón-Riviere A, Bardach A. [Formative research for the design and implementation of a strategy to increase colorectal cancer screening in the workplace in Argentina]. CAD SAUDE PUBLICA 2021; 37:e00313620. [PMID: 34816962 DOI: 10.1590/0102-311x00313620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/07/2021] [Indexed: 11/22/2022] Open
Abstract
The workplace has great potential to disseminate information and implement health promotion activities such as cancer prevention and early detection. Due to the challenges of deploying health interventions in this setting, formative studies are needed to adjust the design and implementation of successful strategies. To inform the intervention's design and implementation and improve the adherence rate to screening with fecal occult blood test in a workplace in Argentina, a formative study was conducted to identify potential barriers and facilitators. The formative study adopted a qualitative methodological design. Interviews were held with 10 individuals in charge of key areas in the institution where the main study was conducted, besides 8 focus groups with workers over 50 years of age. Challenges were identified at the institutional level for the intervention's implementation, such as workers' geographic dispersion and the complexity of the institution's flowchart, as well as at the population level, such as low knowledge about colorectal cancer and diagnostic tests and low risk perception. The facilitators featured the intervention's acceptability and the availability of human and material resources to proceed with the intervention, such as institutional communications channels for disseminating the information and logistics for distribution of diagnostic kits. The formative study allowed identifying resources and potential barriers that informed the intervention's design and implementation.
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Affiliation(s)
- Juan Pedro Alonso
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina
| | - María Belizán
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Mariana Comolli
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Lucas González
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Javier Roberti
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Centro de Investigación de Epidemiología y Salud Pública, Buenos Aires, Argentina
| | - Andrés Pichón-Riviere
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ariel Bardach
- Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Abstract
In light of readiness to change, organizational readiness has received little attention with the extensive assessment of individual readiness to change. (1) Background: Therefore, this conceptual paper aims to address the need for change at the organizational level through the lenses of Lewin theory, organizational change theory, and social exchange theory. It will identify issues and implications in readiness to change at the organizational level; (2) Methods: The primary method used in the study was mainly a literature review to add neglected factors driving change such as contextual factors and technology. (3) Results: The paper shows how various players and other determinants of successful change implementation can derail the organization’s readiness to embrace change. (4) Conclusions: The paper adds to the available knowledge on how technology is likely to affect organizational willingness to change. The study suggests various solutions that seek to address the issues on organizational readiness to change. Hence, this study may provide organizational managers with takeaway implications on change management for policymakers and practitioners to improve an organization’s preparedness towards change implementation.
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Jonas DE, Barclay C, Grammer D, Weathington C, Birken SA, DeWalt DA, Shoenbill KA, Boynton MH, Mackey M, Riley S, Cykert S. The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care. Trials 2021; 22:810. [PMID: 34784953 PMCID: PMC8593635 DOI: 10.1186/s13063-021-05641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use is a leading cause of preventable deaths in the USA and is associated with many societal and health problems. Less than a third of people who visit primary care providers in the USA are asked about or ever discuss alcohol use with a health professional. METHODS/DESIGN This study is an adaptive, randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in small-to-medium-sized primary care practices. Study participants will include primary care practices in North Carolina with 10 or fewer providers. All enrolled practices will receive a practice facilitation intervention that includes quality improvement (QI) coaching, electronic health record (EHR) support, training, and expert consultation. After 6 months, practices in the lower 50th percentile (based on performance) will be randomized to continued practice facilitation or provision of telehealth services plus ongoing facilitation for the next 6 months. Practices in the upper 50th percentile after the initial 6 months of intervention will continue to receive practice facilitation alone. The main outcome measures include the number (and %) of patients in the target population who are screened for unhealthy alcohol use, screen positive, and receive brief counseling. Additional measures include the number (and %) of patients who receive pharmacotherapy for AUD or are referred for AUD services. Sample size calculations determined that 35 practices are needed to detect a 10% increase in the main outcome (percent screened for unhealthy alcohol use) over 6 months. DISCUSSION A successful intervention would significantly reduce morbidity among adults from unhealthy alcohol use by increasing counseling and other treatment opportunities. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. It will also generate scientific knowledge about whether embedded telehealth services can improve the use of evidence-based screening and interventions for practices with slower uptake. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices. TRIAL REGISTRATION ClinicalTrials.gov NCT04317989 . Registered on March 23, 2020.
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Affiliation(s)
- Daniel E Jonas
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, 2050 Kenny Road, Columbus, Ohio, 43221, USA.
- Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Colleen Barclay
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, 2050 Kenny Road, Columbus, Ohio, 43221, USA
- Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Debbie Grammer
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Chris Weathington
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, 27101, USA
| | - Darren A DeWalt
- Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of General Medicine and Clinical Epidemiology, CB 7110, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Kimberly A Shoenbill
- Department of Family Medicine, CB 7370, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Program on Health and Clinical Informatics, CB 7064, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Marcella H Boynton
- Division of General Medicine and Clinical Epidemiology, CB 7110, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Monique Mackey
- North Carolina Area Health Education Centers, CB 7165, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sean Riley
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, 2050 Kenny Road, Columbus, Ohio, 43221, USA
- Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Samuel Cykert
- Cecil G. Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Division of General Medicine and Clinical Epidemiology, CB 7110, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Doukani A, Cerga Pashoja A, Fanaj N, Qirjako G, Meksi A, Mustafa S, Vis C, Hug J. Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis. JMIR Form Res 2021; 5:e29280. [PMID: 34723822 PMCID: PMC8593793 DOI: 10.2196/29280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/07/2021] [Accepted: 09/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods We used qualitative semistructured focus group discussions that were guided by Bryan Weiner’s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting “change efficacy” included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For “change commitment,” participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883
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Affiliation(s)
- Asmae Doukani
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Arlinda Cerga Pashoja
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.,Global Public Health, United Kingdom Health Security Agency, London, United Kingdom
| | | | - Gentiana Qirjako
- Community Centre for Health and Wellbeing, Tirana, Albania.,Department of Promotion, Institute of Public Health, Tirana, Albania.,Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Andia Meksi
- Community Centre for Health and Wellbeing, Tirana, Albania.,Department of Promotion, Institute of Public Health, Tirana, Albania
| | | | - Christiaan Vis
- Department of Clinical, Neuro & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Mental Health, Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,World Health Organization, Collaborating Centre for Research and Dissemination of Psychological Interventions, Geneva, Switzerland
| | - Juliane Hug
- European Alliance Against Depression, Leipzig, Germany
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Lundmark R, Hasson H, Richter A, Khachatryan E, Åkesson A, Eriksson L. Alignment in implementation of evidence-based interventions: a scoping review. Implement Sci 2021; 16:93. [PMID: 34711259 PMCID: PMC8554825 DOI: 10.1186/s13012-021-01160-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/02/2021] [Indexed: 11/22/2022] Open
Abstract
Background Alignment (i.e., the process of creating fit between elements of the inner and outer context of an organization or system) in conjunction with implementation of an evidence-based intervention (EBI) has been identified as important for implementation outcomes. However, research evidence has so far not been systematically summarized. The aim of this scoping review is therefore to create an overview of how the concept of alignment has been applied in the EBI implementation literature to provide a starting point for future implementation efforts in health care. Methods We searched for peer-reviewed English language articles in four databases (MEDLINE, Cinahl, Embase, and Web of Science) published between 2003 and 2019. Extracted data were analyzed to address the study aims. A qualitative content analysis was carried out for items with more extensive information. The review was reported according to the preferred reporting items for systematic reviews and meta-analyses extension for scoping review (PRISMA-ScR) guidelines. Results The database searches yielded 3629 publications, of which 235 were considered potentially relevant based on the predetermined eligibility criteria, and retrieved in full text. In this review, the results of 53 studies are presented. Different definitions and conceptualizations of alignment were found, which in general could be categorized as structural, as well as social, types of alignments. Whereas the majority of studies viewed alignment as important to understand the implementation process, only a few studies actually assessed alignment. Outcomes of alignment were focused on either EBI implementation, EBI sustainment, or healthcare procedures. Different actors were identified as important for creating alignment and five overall strategies were found for achieving alignment. Conclusions Although investigating alignment has not been the primary focus of studies focusing on EBI implementation, it has still been identified as an important factor for the implementation success. Based on the findings from this review, future research should incorporate alignment and put a stronger emphasize on testing the effectiveness of alignment related to implementation outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01160-w.
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Affiliation(s)
- Robert Lundmark
- Department of Psychology, Umeå University, SE 901 87, Umeå, Sweden.
| | - Henna Hasson
- Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden
| | - Anne Richter
- Procome research group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE 171 77, Stockholm, Sweden.,Unit for implementation and evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden
| | - Ermine Khachatryan
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden
| | - Amanda Åkesson
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden
| | - Leif Eriksson
- Unit for implementation and evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, SE 171 29, Stockholm, Sweden
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An organizational approach to exploring the determinants of community-based exercise program implementation for breast cancer survivors. Support Care Cancer 2021; 30:2183-2196. [PMID: 34697676 DOI: 10.1007/s00520-021-06591-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The majority of breast cancer survivors do not engage in sufficient levels of exercise. Community-based exercise programs (CBEP) may mitigate low rates of exercise participation; however, few programs exist. Previous research exploring the determinants of CBEP implementation for cancer survivors is limited in that it has predominantly focused on cancer survivor perspectives or it has failed to rely on a theoretical framework to explore determinants to implementation across various implementation domains. An organizational exploration of the determinants of CBEP implementation for breast cancer survivors is warranted to guide future program implementation. PURPOSE The purpose of this study was to apply the Consolidated Framework for Implementation Research (CFIR) to explore the determinants of CBEP implementation for breast cancer survivors from a program provider perspective. METHODS Data collection and analysis were guided by the CFIR. Program providers completed an online questionnaire and an interview. Transcripts were analyzed using inductive content analysis. Resulting codes were deductively mapped onto the CFIR. RESULTS Seven barriers and seven facilitators were identified, with three key influencers (e.g., program awareness, financial support, and knowledge regarding the benefits of exercise for breast cancer survivors) cited as both barriers and facilitators to program implementation. Barriers primarily operated within the outer setting (e.g., needs and resources) domain of the CFIR, whereas facilitators and key influencers operated across multiple CFIR domains (e.g., culture and planning). CONCLUSIONS Study findings provide insight into the current challenges to CBEP implementation experienced by program providers and highlight potential avenues for future exercise program development and implementation.
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Le K, Chen TA, Martinez Leal I, Correa-Fernández V, Obasi EM, Kyburz B, Williams T, Casey K, Taing M, O’Connor DP, Reitzel LR. Organizational Factors Moderating Changes in Tobacco Use Dependence Care Delivery Following a Comprehensive Tobacco-Free Workplace Intervention in Non-Profit Substance Use Treatment Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10485. [PMID: 34639785 PMCID: PMC8507614 DOI: 10.3390/ijerph181910485] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 11/16/2022]
Abstract
Although tobacco use is the leading preventable cause of death and is elevated among patients with substance use disorders, many substance use treatment centers (SUTCs) do not offer tobacco use interventions (i.e., screening and treatment). This study examined a key outcome of the implementation of a tobacco-free workplace program that provided education and specialized training to employees; namely, changes in clinician provision of the five As (Asking about tobacco use; Advising to quit; Assessing willingness to quit; Assisting with quitting; Arranging follow-up) from before to after the larger program implementation. The five As are a brief tobacco screening and treatment protocol that was taught as part of the program and that formed the basis for further intervention (e.g., provision of nicotine replacement therapies, Motivational Interviewing to enhance desire and willingness to make a quit attempt). Moreover, we also examined organizational moderators that may have impacted changes in the delivery of the five As over time among clinicians from 15 participating SUTCs. The number of the centers' total and unique annual patient visits; full-time employees; and organizational readiness for implementing change were assessed as potential moderators of change in clinicians' behaviors over time. Clinicians completed pre- and post-program implementation surveys assessing their provision of the five As. Results demonstrated significant increases in Asking (p = 0.0036), Advising (p = 0.0176), Assisting (p < 0.0001), and Arranging (p < 0.0001). SUTCs with higher Change Efficacy (p = 0.025) and lower Resource Availability (p = 0.019) had greater increases in Asking. SUTCs with lower Resource Availability had greater increases in Assessing (p = 0.010). These results help guide tobacco control program implementation to increase the provision of tobacco use interventions (i.e., the five As) to SUTC patients and elucidate Change Efficacy and Resource Availability as organizational factors promoting this clinician behavior change.
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Affiliation(s)
- Kathy Le
- Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA;
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Isabel Martinez Leal
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Ezemenari M. Obasi
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Bryce Kyburz
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Teresa Williams
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Kathleen Casey
- Integral Care, 1430 Collier Street, Austin, TX 78704, USA; (B.K.); (T.W.); (K.C.)
| | - Matthew Taing
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Daniel P. O’Connor
- Department of Health & Human Performance, The University of Houston, 3875 Holman Street, Garrison Gymnasium, Room 104, Houston, TX 77204, USA;
| | - Lorraine R. Reitzel
- Department of Psychological, Health & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204-5029, USA; (T.A.C.); (I.M.L.); (V.C.-F.); (E.M.O.); (M.T.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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