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Clark EC, Burnett T, Blair R, Traynor RL, Hagerman L, Dobbins M. Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review. BMC Health Serv Res 2024; 24:405. [PMID: 38561796 PMCID: PMC10983660 DOI: 10.1186/s12913-024-10841-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Achievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health. METHODS A systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings. RESULTS Thirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management. CONCLUSION This review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success. REVIEW REGISTRATION PROSPERO CRD42022318994.
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Affiliation(s)
- Emily C Clark
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Trish Burnett
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Rebecca Blair
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Robyn L Traynor
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Leah Hagerman
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada
| | - Maureen Dobbins
- National Collaborating Centre for Methods and Tools, McMaster University, McMaster Innovation Park, 175 Longwood Rd S, Suite 210a, Hamilton, ON, L8P 0A1, Canada.
- School of Nursing, McMaster University, Health Sciences Centre, 2J20, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada.
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Xiong S, Klesges L, Doering M, Pratt RJ. Applications of implementation science frameworks, models and theories in disparities-focused cancer screening interventions: a scoping review protocol. BMJ Open 2023; 13:e078212. [PMID: 38081672 PMCID: PMC10729160 DOI: 10.1136/bmjopen-2023-078212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Implementation science (IS) frameworks, models and theories (FMTs) have gained popularity in guiding the implementation and evaluation of evidence-based interventions (EBIs) for cancer screening. However, there are significant research gaps in understanding their applications in cancer health disparities contexts. This paper outlines a scoping review protocol designed to explore the utilisation of IS FMTs in cancer screening EBIs to inform intervention designs and adaptations. METHODS AND ANALYSIS This scoping review protocol adheres to Arksey and O'Malley's five-step methodological framework for conducting scoping studies. Search strategies were conducted in five bibliographic databases: Ovid MEDLINE, PubMed, Scopus, Web of Science and EMBASE. The search was run on 22 June 2023 with an English language filter and a date limit of 2001-current. Two reviewers will independently screen studies for inclusion and exclusion criteria. A third reviewer will be consulted, where appropriate at any of the review stages, to achieve consensus or resolve conflicts. Data will be collected, managed and analysed using Covidence. A narrative synthesis, based on Popay et al's methodology, will guide reporting and summarisation of results. The review will adhere to the PRISMA Extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION This scoping review is a novel approach for examining a growing corpus of research literature on IS FMT applications used in cancer screening EBIs. As a secondary analysis, this scoping review does not require approval from an institutional review board. We anticipate the review will produce insightful information (eg, challenges, key areas for future directions) on the applications of IS TMFs in designing, deploying and testing EBIs for populations experiencing cancer screening disparities. We will disseminate the results through journals and conferences targeting IS and cancer prevention researchers and practitioners.
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Affiliation(s)
- Serena Xiong
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
- Family Medicine and Community Health, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Lisa Klesges
- Department of Surgery, Washington University, St Louis, Missouri, USA
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University, St. Louis, Missouri, USA
| | - Rebekah J Pratt
- Family Medicine and Community Health, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
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Wheeler SB, Lee RJ, Young AL, Dodd A, Ellis C, Weiner BJ, Ribisl KM, Adsul P, Birken SA, Fernández ME, Hannon PA, Hébert JR, Ko LK, Seaman A, Vu T, Brandt HM, Williams RS. The special sauce of the Cancer Prevention and Control Research Network: 20 years of lessons learned in developing the evidence base, building community capacity, and translating research into practice. Cancer Causes Control 2023; 34:217-239. [PMID: 37354320 PMCID: PMC10689533 DOI: 10.1007/s10552-023-01691-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE The Cancer Prevention and Control Research Network (CPCRN) is a national network focused on accelerating the translation of cancer prevention and control research evidence into practice through collaborative, multicenter projects in partnership with diverse communities. From 2003 to 2022, the CPCRN included 613 members. METHODS We: (1) characterize the extent and nature of collaborations through a bibliometric analysis of 20 years of Network publications; and (2) describe key features and functions of the CPCRN as related to organizational structure, productivity, impact, and focus on health equity, partnership development, and capacity building through analysis of 22 in-depth interviews and review of Network documentation. RESULTS Searching Scopus for multicenter publications among the CPCRN members from their time of Network engagement yielded 1,074 collaborative publications involving two or more members. Both the overall number and content breadth of multicenter publications increased over time as the Network matured. Since 2004, members submitted 123 multicenter grant applications, of which 72 were funded (59%), totaling more than $77 million secured. Thematic analysis of interviews revealed that the CPCRN's success-in terms of publication and grant productivity, as well as the breadth and depth of partnerships, subject matter expertise, and content area foci-is attributable to: (1) its people-the inclusion of members representing diverse content-area interests, multidisciplinary perspectives, and geographic contexts; (2) dedicated centralized structures and processes to enable and evaluate collaboration; and (3) focused attention to strategically adapting to change. CONCLUSION CPCRN's history highlights organizational, strategic, and practical lessons learned over two decades to optimize Network collaboration for enhanced collective impact in cancer prevention and control. These insights may be useful to others seeking to leverage collaborative networks to address public health problems.
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Affiliation(s)
- Stephanie B Wheeler
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC, 27599-7411, USA.
| | - Rebecca J Lee
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexa L Young
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Adam Dodd
- Impact Measurement and Visualization Team, Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charlotte Ellis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB#7411, McGavran Greenberg Hall, Chapel Hill, NC, 27599-7411, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Kurt M Ribisl
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Cancer Control and Population Sciences Research Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - María E Fernández
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peggy A Hannon
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - James R Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Nutrition, Connecting Health Innovations LLC, Columbia, SC, USA
| | - Linda K Ko
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Aaron Seaman
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Thuy Vu
- Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Heather M Brandt
- HPV Cancer Prevention Program, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wangen M, Escoffery C, Fernandez ME, Friedman DB, Hannon P, Ko LK, Maxwell AE, Petagna C, Risendal B, Rohweder C, Leeman J. Twenty years of capacity building across the cancer prevention and control research network. Cancer Causes Control 2023; 34:45-56. [PMID: 37067700 PMCID: PMC10106885 DOI: 10.1007/s10552-023-01690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To improve population health, community members need capacity (i.e., knowledge, skills, and tools) to select and implement evidence-based interventions (EBIs) to fit the needs of their local settings. Since 2002, the Centers for Disease Control and Prevention has funded the national Cancer Prevention and Control Research Network (CPCRN) to accelerate the implementation of cancer prevention and control EBIs in communities. The CPCRN has developed multiple strategies to build community members' capacity to implement EBIs. This paper describes the history of CPCRN's experience developing and lessons learned through the use of five capacity-building strategies: (1) mini-grant programs, (2) training, (3) online tools, (4) evidence academies, and (5) evaluation support for partners' capacity-building initiatives. METHODS We conducted a narrative review of peer-reviewed publications and grey literature reports on CPCRN capacity-building activities. Guided by the Interactive Systems Framework, we developed histories, case studies, and lessons learned for each strategy. Lessons were organized into themes. RESULTS Three themes emerged: the importance of (1) community-engagement prior to and during implementation of capacity-building strategies, (2) establishing and sustaining partnerships, and (3) co-learning at the levels of centers, networks, and beyond. CONCLUSION CPCRN activities have increased the ability of community organizations to compete for external funds to support implementation, increased the use of evidence in real-world settings, and promoted the broad-scale implementation of cancer control interventions across more than eight states. Lessons from this narrative review highlight the value of long-term thematic networks and provide useful guidance to other research networks and future capacity-building efforts.
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Affiliation(s)
- Mary Wangen
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Cam Escoffery
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Maria E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston, Health Promotion and Behavioral Sciences, Houston, TX, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Peggy Hannon
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Linda K Ko
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Annette E Maxwell
- Los Angeles, Fielding School of Public Health and Jonsson, Comprehensive Cancer Center, Health Policy and Management, The University of California, Los Angeles, CA, USA
| | - Courtney Petagna
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Betsy Risendal
- Colorado School of Public Health, Department of Community & Behavioral Health, The University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bilenduke E, Dwyer AJ, Staples ES, Kilbourn K, Valverde PA, Fernández ME, Risendal BC. A practical method for integrating community priorities in planning and implementing cancer control programs. Cancer Causes Control 2023; 34:113-123. [PMID: 37069456 PMCID: PMC10110487 DOI: 10.1007/s10552-023-01688-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Community engagement is essential in effective public health programs. This paper illustrates the methods used to engage community in the development of a multi-level implementation intervention to address cancer disparities related to hereditary cancer syndromes. METHODS Implementation Mapping (IM), was used to guide the co-creation of an intervention. Key partners were recruited to a 13-member statewide community advisory board (CAB) representing healthcare and community-based organizations. As part of a needs assessment, a 3-round modified Delphi method with the CAB was used to identify implementation outcomes to use in later steps of IM. An anonymous online survey of a validated community engagement measure assessed CAB members' satisfaction with the process. RESULTS Using a modified Delphi method as part of the needs assessment of IM, the CAB identified three broad categories of strategies: Changing infrastructure using patient navigation; training and educating patients, navigators and providers; and supporting clinicians in case identification and management. Self-reported satisfaction with the IM and Delphi process was high. CONCLUSIONS Implementation Mapping facilitated the use of available evidence, new data, and community engagement to identify strategies to improve the delivery of programs to reduce hereditary cancer disparities. The modified Delphi method was easy to administer in a virtual environment and may be a useful for others in community-engaged research.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Andrea J Dwyer
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Elsa S Staples
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Kristin Kilbourn
- Department of Psychology, University of Colorado Denver, Denver, CO, USA
| | - Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, School of Public Health, University of Colorado, Aurora, CO, USA
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Holcomb J, Rajan SS, Ferguson GM, Sun J, Walton GH, Highfield L. Implementation of an Evidence-Based Intervention with Safety Net Clinics to Improve Mammography Appointment Adherence Among Underserved Women. J Cancer Educ 2023; 38:309-318. [PMID: 34822118 PMCID: PMC9852109 DOI: 10.1007/s13187-021-02116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
The Peace of Mind Program is an evidence-based intervention to improve mammography appointment adherence in underserved women. The aim of this study was to assess effectiveness of the intervention and implementation of the intervention in safety net clinics. The intervention was implemented through a non-randomized stepped wedge cluster hybrid study design with 19 Federally Qualified Health Centers and charity care clinics within the Greater Houston area. A multivariable generalized estimating equation logistic regression was conducted to examine mammography appointment adherence. A survey assessing Consolidated Framework for Implementation Research constructs was also conducted with clinic staff prior to adoption and eight weeks post implementation. One-sided t-tests were conducted to analyze mean score changes between the surveys. A total of 4402 women (baseline period = 2078; intervention period = 2324) were included in the final regression analysis. Women in the intervention period were more likely to attend or reschedule their mammography appointment (OR = 1.30; p < 0.01) than those in the baseline period receiving usual care. Women who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention (OR = 1.62; p < 0.01). The mammography appointment no-show rates for those in the baseline period, in the intervention period, and who completed the intervention were, respectively, 22%, 19%, and 15%. A total of 15 clinics prior to adoption and eight clinics completed the survey at 8 weeks post implementation A statistically significant mean score decrease was observed in Inner Setting and in two Inner Setting CFIR constructs, Culture-Effort, and Implementation Climate. While the intervention improved mammography appointment adherence, there are opportunities to further integrate Consolidated Framework for Implementation Research constructs. Trial registration: Clinical trials registration number: NCT02296177.
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Affiliation(s)
- Jennifer Holcomb
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Chicago, IL, 60608, USA.
| | - Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Gayla M Ferguson
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Jiali Sun
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
- Houston Hospice, 1905 Holcombe Blvd, Houston, TX, 77030, USA
| | - Gretchen H Walton
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA
| | - Linda Highfield
- Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), 1200 Pressler St, Houston, TX, 77030, USA.
- Department of Internal Medicine, The University of Texas Health Science Center at Houston (UTHealth) John P and Katherine G McGovern Medical School, 6431 Fannin St, Houston, TX, 77030, USA.
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Kenworthy T, Domlyn A, Scott VC, Schwartz R, Wandersman A. A Proactive, Systematic Approach to Building the Capacity of Technical Assistance Providers. Health Promot Pract 2022; 24:546-559. [PMID: 35301898 DOI: 10.1177/15248399221080096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technical assistance (TA) is a major capacity building strategy used by the government sector to promote health outcomes in the United States. However, there is minimal literature about how to develop TA provider capacities. This article describes a systematic and proactive approach for developing TA provider capacity, referred to as Technical Assistance for Technical Assistance Providers (TAFTAP), which draws on three implementation science frameworks (Interactive Systems Framework for Dissemination and Implementation, Getting To Outcomes, and R = MC2). We present an application of TAFTAP within a federal agency providing a readiness-informed TA approach to health departments of states, territories, and tribal areas implementing comprehensive tobacco prevention control programs. Pilot data suggest that TAFTAP is a promising approach for improving the quality of TA delivery. At the end of the 2-year project period, TAFTAP recipients provided generally positive qualitative feedback about the support they received. They chose to sustain the readiness-informed TA by incorporating it into a future funding announcement. Downstream state-level TA grantee recipients reported positive outcomes (e.g., accelerated progress, enjoying more one-on-one time with TA providers) from receiving the TA innovation from TAFTAP recipients. We suggest that funding agencies and training and TA centers consider this approach to bolster the capacity and motivation of TA providers for downstream benefit to health and human services staff and their clients. Practical steps for employing TAFTAP to advance health outcomes are included in this article.
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Affiliation(s)
- Tara Kenworthy
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
| | - Ariel Domlyn
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
| | - Victoria C Scott
- The University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Abraham Wandersman
- University of South Carolina, Columbia, SC, USA.,Wandersman Center, Columbia, SC, USA
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Ramanadhan S, Mahtani SL, Kirk S, Lee M, Weese M, Mita C, Brandt HM. Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review. J Clin Transl Sci 2022; 6:e92. [PMID: 36003212 PMCID: PMC9389281 DOI: 10.1017/cts.2022.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review. Methods: With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process Results: Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries. Conclusions: Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.
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Holcomb J, Ferguson G, Roth I, Walton G, Highfield L. Adoption of an Evidence-Based Intervention for Mammography Screening Adherence in Safety Net Clinics. Front Public Health 2021; 9:748361. [PMID: 34805072 PMCID: PMC8599425 DOI: 10.3389/fpubh.2021.748361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Through an academic-community partnership, an evidence-based intervention to reduce mammography appointment no-show rates in underserved women was expanded to safety net clinics. The partnership implemented four strategies to improve the adoption and scale-up of evidence-based interventions with Federally Qualified Health Centers and charity care clinics: (1) an outreach email blast targeting the community partner member clinics to increase program awareness, (2) an adoption video encouraging enrollment in the program, (3) an outreach webinar educating the community partner member clinics about the program, encouraging enrollment and outlining adoption steps, and (4) an adoption survey adapted from Consolidated Framework for Implementation Research constructs from the Cancer Prevention and Control Research Network for cancer control interventions with Federally Qualified Health Centers. The development of academic-community partnerships can lead to successful adoption of evidence-based interventions particularly in safety net clinics.
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Affiliation(s)
- Jennifer Holcomb
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gayla Ferguson
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Isabel Roth
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gretchen Walton
- University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Linda Highfield
- University of Texas Health Science Center at Houston, Houston, TX, United States.,School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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10
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Leeman J, Rohweder C, Lee M, Brenner A, Dwyer A, Ko LK, O'Leary MC, Ryan G, Vu T, Ramanadhan S. Aligning implementation science with improvement practice: a call to action. Implement Sci Commun 2021; 2:99. [PMID: 34496978 PMCID: PMC8424169 DOI: 10.1186/s43058-021-00201-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background In several recent articles, authors have called for aligning the fields of implementation and improvement science. In this paper, we call for implementation science to also align with improvement practice. Multiple implementation scholars have highlighted the importance of designing implementation strategies to fit the existing culture, infrastructure, and practice of a healthcare system. Worldwide, healthcare systems are adopting improvement models as their primary approach to improving healthcare delivery and outcomes. The prevalence of improvement models raises the question of how implementation scientists might best align their efforts with healthcare systems’ existing improvement infrastructure and practice. Main body We describe three challenges and five benefits to aligning implementation science and improvement practice. Challenges include (1) use of different models, terminology, and methods, (2) a focus on generalizable versus local knowledge, and (3) limited evidence in support of the effectiveness of improvement tools and methods. We contend that implementation science needs to move beyond these challenges and work toward greater alignment with improvement practice. Aligning with improvement practice would benefit implementation science by (1) strengthening research/practice partnerships, (2) fostering local ownership of implementation, (3) generating practice-based evidence, (4) developing context-specific implementation strategies, and (5) building practice-level capacity to implement interventions and improve care. Each of these potential benefits is illustrated in a case study from the Centers for Disease Control and Prevention’s Cancer Prevention and Control Research Network. Conclusion To effectively integrate evidence-based interventions into routine practice, implementation scientists need to align their efforts with the improvement culture and practice that is driving change within healthcare systems worldwide. This paper provides concrete examples of how researchers have aligned implementation science with improvement practice across five implementation projects. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00201-1.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599, USA.
| | - Catherine Rohweder
- Center for Health Promotion & Disease Prevention, The University of North Carolina at Chapel Hill, CB #7424, Carrboro, NC, 27510, USA
| | - Matthew Lee
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Alison Brenner
- Department of General Medicine & Clinical Epidemiology, UNC School of Medicine, The University of North Carolina at Chapel Hill, CB #7293, Carrboro, NC, 27510, USA
| | - Andrea Dwyer
- University of Colorado Cancer Center, 13001 East 17th Avenue, Aurora, CO, 80045, USA
| | - Linda K Ko
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA.,Department of Cancer Prevention, Fred Hutchinson Cancer Research Center, Hans Rosling Center for Public Health, 3980 15th Avenue NE, 4th Floor, Seattle, WA, 98195, USA
| | - Meghan C O'Leary
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, CB #7400, Chapel Hill, NC, 27599, USA
| | - Grace Ryan
- The University of Iowa, 145 N. Riverside Drive, N475 CPHB, Iowa City, IA, 52242, USA
| | - Thuy Vu
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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Leeman J, Askelson N, Ko LK, Rohweder CL, Avelis J, Best A, Friedman D, Glanz K, Seegmiller L, Stradtman L, Vanderpool RC. Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: a qualitative study. Transl Behav Med 2021; 10:394-403. [PMID: 30794725 DOI: 10.1093/tbm/ibz023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Colorectal cancer (CRC) screening is highly effective at reducing cancer-related morbidity and mortality, yet screening rates remain suboptimal. Evidence-based interventions can increase screening rates, particularly when they target multiple levels (e.g., patients, providers, health care systems). However, effective interventions remain underutilized. Thus, there is a pressing need to build capacity to select and implement multilevel CRC screening interventions. We report on formative research aimed at understanding how Federally Qualified Health Center (FQHC) staff select and implement CRC screening interventions, which will inform development of capacity-building strategies. We report the qualitative findings from a study that used a mixed methods design, starting with a quantitative survey followed by a qualitative study. In-depth interviews were conducted with 28 staff from 14 FQHCs in 8 states. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and data analysis. Related to the CFIR process domain, few respondents described conducting formal assessments of factors contributing to low screening rates prior to planning their interventions. Many described engaging champions, implementation leaders, and external change agents. Few described a systematic approach to executing implementation plans beyond conducting plan-do-study-act cycles. Reflection and evaluation consisted primarily of reviewing Uniform Data System performance measures. Findings also include themes related to factors influencing these implementation processes. Although FQHCs are implementing CRC screening interventions, they are not actively targeting the multilevel factors influencing their CRC screening rates. Our findings on gaps in FQHCs' implementation processes will inform development of strategies to build capacity to select and implement multilevel CRC screening interventions.
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Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Natoshia Askelson
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Linda K Ko
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Carrboro, NC, USA
| | - Jade Avelis
- Center for Health Behavior Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alicia Best
- Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Daniela Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Karen Glanz
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura Seegmiller
- Department of Community & Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lindsay Stradtman
- Health, Behavior, & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Robin C Vanderpool
- Health, Behavior, & Society, College of Public Health, University of Kentucky, Lexington, KY, USA
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Risendal BC, Hébert JR, Morrato EH, Thomson CA, Escoffery CN, Friedman DB, Dwyer AJ, Overholser LS, Wheeler SB. Addressing COVID-19 Using a Public Health Approach: Perspectives From the Cancer Prevention and Control Research Network. Am J Prev Med 2021; 60:877-882. [PMID: 33785276 PMCID: PMC7900782 DOI: 10.1016/j.amepre.2021.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022]
Affiliation(s)
- Betsy C Risendal
- Community & Behavioral Health, Colorado School of Public Health, Anschutz Medical Campus, Aurora, Colorado
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; The Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Elaine H Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois
| | - Cynthia A Thomson
- Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona; Population Sciences, University of Arizona Cancer Center, Tucson, Arizona.
| | - Cam N Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Linda S Overholser
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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13
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Bai X, Wu J, Liu Y, Xu Y. Research on the impact of global innovation network on 3D printing industry performance. Scientometrics 2020. [DOI: 10.1007/s11192-020-03534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ko LK, Jang SH, Friedman DB, Glanz K, Leeman J, Hannon PA, Shannon J, Cole A, Williams R, Vu T. An application of the Science Impact Framework to the Cancer Prevention and Control Research Network from 2014-2018. Prev Med 2019; 129S:105821. [PMID: 31479655 PMCID: PMC6925321 DOI: 10.1016/j.ypmed.2019.105821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 01/03/2023]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a strategic collaborative effort focused on accelerating the dissemination and implementation of evidence-based cancer prevention and control interventions to communities. In 2014, the CPCRN Coordinating Center began collecting information in alignment with the Centers for Disease Control and Prevention's (CDC) Science Impact Framework. The Science Impact Framework is a CDC-developed approach to trace and link CDC science to events and/or actions recognized as influential to public health, beyond peer-reviewed publications. The purpose of this paper is to highlight the impact of CPCRN activities using key indicators guided by the CDC's Science Impact Framework. We reviewed annual progress reports submitted by CPCRN centers from 2014 to 2019 to identify the impact indicators. The CPCRN activities were linked to four domains from the Science Impact Framework and its key indicators: Disseminating Science (presentations, training, general communication, and other communication reports), Creating Awareness (requests for expertise, and feedback), Catalyzing Action (grant applications, partnerships and collaborations, research & development, advocacy groups, office practice/point of care changes, and technology creating), and Effecting Change (building public health practice, creation of registries/surveillance, legal/policy changes, and change instilled). Overall, CPCRN activities demonstrate impact beyond peer-reviewed publications and thus should continue building scientific impact to ultimately influence health outcomes.
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Affiliation(s)
- Linda K Ko
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Ave. N, M3-B232, Seattle, WA 98102, USA; University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA.
| | - Sou H Jang
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
| | - Daniela B Friedman
- University of South Carolina, Department of Health Promotion, Education, and Behavior, 915 Greene Street, Suite 557, Columbia, SC 29208, USA
| | - Karen Glanz
- University of Pennsylvania, Perelman School of Medicine and School of Nursing, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA
| | - Jennifer Leeman
- University of North Carolina, School of Nursing, 120 N. Medical Drive, Chapel Hill, NC 27599-7460, USA
| | - Peggy A Hannon
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
| | - Jackilen Shannon
- Oregon Health and Science University, School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Allison Cole
- University of Washington, Department of Family Medicine, 1959 NE Pacific St., Seattle, WA 98195, USA
| | - Rebecca Williams
- University of North Carolina, Lineberger Comprehensive Cancer Center, 200 North Greensboro Street, Suite D-15, Carrboro, NC 27510, USA
| | - Thuy Vu
- University of Washington, Department of Health Services, 1959 NE Pacific Street, Magnuson Health Sciences Bldg, Box 357660, Seattle, WA 98195, USA
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Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis 2019; 16:E139. [PMID: 31603404 PMCID: PMC6795067 DOI: 10.5888/pcd16.180682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose and Objectives Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation. Intervention Approach CDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates. Evaluation Methods We surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation. Results Most grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity. Implications for Public Health CRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.
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Affiliation(s)
- Peggy A Hannon
- University of Washington, Seattle, Washington.,1107 NE 45th St, Ste 200, Seattle, WA 98105.
| | | | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | | | | | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Walker TJ, Rodriguez SA, Vernon SW, Savas LS, Frost EL, Fernandez ME. Validity and reliability of measures to assess constructs from the inner setting domain of the consolidated framework for implementation research in a pediatric clinic network implementing HPV programs. BMC Health Serv Res 2019; 19:205. [PMID: 30925870 PMCID: PMC6441163 DOI: 10.1186/s12913-019-4021-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and valid measures for implementation constructs are critical to advance research and guide implementation efforts. However, there is a continued need for valid and reliable measures for implementation research. The purpose of this study was to assess the psychometric properties of measures for the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR) in a network of pediatric clinics. METHODS This study used cross-sectional survey data collected from physicians, advanced practice providers, clinic managers, and clinical staff (n = 546) working in a pediatric clinic network (n = 51). Surveys included measures assessing Inner Setting constructs from CFIR (culture, learning climate, leadership engagement, and available resources). We used a series multilevel confirmatory factor analysis (CFA) models to assess factorial validity. We also examined measure correlations to test discriminant validity and intraclass correlation coefficients, ICC(1) and ICC(2), to assess inter-rater reliability. RESULTS Factor loadings were high (≥0.60) for all but one of the measurement items. Most CFA models for respective constructs demonstrated adequate or good model fit (CFI > 0.90, TLI > 0.90, RMSEA< 0.08, and SRMR< 0.08). The measures also demonstrated good discriminant validity (correlations< 0.90) aside from some evidence of overlap between leadership engagement and learning climate at the clinic level (0.91). The ICC(1) values ranged from 0.05-0.16 while the ICC(2) values ranged from 0.34-0.67. CONCLUSIONS The measures demonstrated good validity and adequate reliability with the exception of available resources, which had some evidence of lower than desired reliability and validity at the clinic level. Our findings extend previous work by providing additional psychometric evidence to support the use of these Inner Setting measures in pediatric clinics implementing human papillomavirus programs.
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Affiliation(s)
- Timothy J. Walker
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Serena A. Rodriguez
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390 USA
| | - Sally W. Vernon
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Lara S. Savas
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Erica L. Frost
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
| | - Maria E. Fernandez
- Center for Health Promotion and Prevention Research, Department of Health Promotion & Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin St., Houston, TX 77030 USA
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17
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Davis MM, Shafer P, Renfro S, Hassmiller Lich K, Shannon J, Coronado GD, McConnell KJ, Wheeler SB. Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing? BMC Health Serv Res 2019; 19:54. [PMID: 30665396 PMCID: PMC6341697 DOI: 10.1186/s12913-018-3864-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/28/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) - two provisions of the Affordable Care Act (ACA) - within the state of Oregon, USA. METHODS Retrospective analysis of Oregon's Medicaid claims for enrollee's eligible for CRC screening (50-64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation - called Coordinated Care Organizations (CCOs). RESULTS A total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs. CONCLUSIONS Observed CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.
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Affiliation(s)
- Melinda M. Davis
- Department of Family Medicine, OHSU-PSU School of Public Health, and Oregon Rural Practice-based Research Network, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code L222, Portland, OR 97239 USA
| | - Paul Shafer
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Stephanie Renfro
- Center for Health Systems Effectiveness, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Kristen Hassmiller Lich
- Department of Health Policy & Management, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Gloria D. Coronado
- Center for Health Research Northwest, Kaiser Permanente, 3800 N. Interstate Avenue, Portland, OR 97227-1098 USA
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 USA
| | - Stephanie B. Wheeler
- Department of Health Policy & Management, Lineberger Comprehensive Cancer Center, and Center for Health Promotion & Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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Escoffery C, Lebow-Skelley E, Udelson H, Böing EA, Wood R, Fernandez ME, Mullen PD. A scoping study of frameworks for adapting public health evidence-based interventions. Transl Behav Med 2019; 9:1-10. [PMID: 29346635 PMCID: PMC6305563 DOI: 10.1093/tbm/ibx067] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Evidence-based public health translation of research to practice is essential to improve the public's health. Dissemination and implementation researchers have explored what happens once practitioners adopt evidence-based interventions (EBIs) and have developed models and frameworks to describe the adaptation process. This scoping study identified and summarized adaptation frameworks in published reports and grey literature. We followed the recommended steps of a scoping study: (a) identifying the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; (e) collating, summarizing, and reporting the results; and (f) consulting with experts. We searched PubMed, PsycINFO, PsycNET, and CINAHL databases for articles referencing adaptation frameworks for public health interventions in the published and gray literature, and from reference lists of framework articles. Two reviewers independently coded the frameworks and their steps and identified common steps. We found 13 adaptation frameworks with 11 program adaptation steps: (a) assess community, (b) understand the EBI(s), (c) select the EBI, (d) consult with experts, (e) consult with stakeholders, (f) decide on needed adaptations, (g) adapt the original EBI, (h) train staff, (i) test the adapted materials, (j) implement the adapted EBI, and (k) evaluate. Eight of these steps were recommended by more than five frameworks: #1-3, 6-7, and 9-11. This study is the first to systematically identify, review, describe, and summarize frameworks for adapting EBIs. It contributes to the literature by consolidating key steps in program adaptation of EBIs and describing the associated tasks in each step.
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Affiliation(s)
- Cam Escoffery
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | | | - Hallie Udelson
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Elaine A Böing
- Emory University, Rollins School of Public Health, Atlanta, GA, USA
| | - Richard Wood
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Maria E Fernandez
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Patricia D Mullen
- The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Walker TJ, Risendal B, Kegler MC, Friedman DB, Weiner BJ, Williams RS, Tu SP, Fernandez ME. Assessing Levels and Correlates of Implementation of Evidence-Based Approaches for Colorectal Cancer Screening: A Cross-Sectional Study With Federally Qualified Health Centers. Health Educ Behav 2018; 45:1008-1015. [PMID: 29991294 PMCID: PMC6226355 DOI: 10.1177/1090198118778333] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Multiple evidence-based approaches (EBAs) exist to improve colorectal cancer screening in health clinics. The success of these approaches is tied to effective implementation. Therefore, the purpose of this study was to assess the implementation of EBAs for colorectal cancer screening and clinic-level correlates of implementation in federally qualified health centers (FQHCs). We conducted descriptive and cross-sectional analyses using data collected from FQHC clinics across seven states ( n = 51). A clinic representative completed electronic surveys about clinic characteristics (e.g., size, patient characteristics, and medical record system characteristics) and the implementation of Community Guide recommended EBAs (e.g., client reminders, small media, and provider assessment and feedback). We used bivariate Spearman correlations to assess clinic-level correlates with implementation outcomes. Most clinics were planning to implement, in the early implementation stages, or inconsistently implementing EBAs. No EBA was fully implemented by more than nine (17.6%) clinics. Clinic size variables were inversely related to implementation levels of one-on-one education; medical record variables were directly related to implementation levels of client and provider reminders as well as provider assessment and feedback; and rapid and timely feedback from clinic leaders was directly associated with implementation levels of four out of six EBAs. Given the varying levels of implementation, clinics need to assess current use of implementation strategies and improve effective program delivery to increase colorectal cancer screening among their patients. In addition, clinics should also consider how their characteristics may support or serve as a barrier to implementation in their respective settings.
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Affiliation(s)
- Timothy J Walker
- 1 The University of Texas Health Science Center at Houston, TX, USA
| | | | | | | | | | | | - Shin-Ping Tu
- 7 University of California Davis, Sacramento, CA, USA
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20
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Kegler MC, Liang S, Weiner BJ, Tu SP, Friedman DB, Glenn BA, Herrmann AK, Risendal B, Fernandez ME. Measuring Constructs of the Consolidated Framework for Implementation Research in the Context of Increasing Colorectal Cancer Screening in Federally Qualified Health Center. Health Serv Res 2018; 53:4178-4203. [PMID: 30260471 DOI: 10.1111/1475-6773.13035] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To operationalize constructs from each of the Consolidated Framework for Implementation Research domains and to present psychometric properties within the context of evidence-based approaches for promoting colorectal cancer screening in federally qualified health centers (FQHCs). METHODS Data were collected from FQHC clinics across seven states. A web-based Staff Survey and a Clinic Characteristics Survey were completed by staff and leaders (n = 277) from 59 FQHCs. RESULTS Internal reliability of scales was adequate ranging from 0.62 for compatibility to 0.88 for other personal attributes (openness). Intraclass correlations for the scales indicated that 2.4 percent to 20.9 percent of the variance in scale scores occurs within clinics. Discriminant validity was adequate at the clinic level, with all correlations less than 0.75. Convergent validity was more difficult to assess given lack of hypothesized associations between factors expected to predict implementation. CONCLUSIONS Our results move the field forward by describing initial psychometric properties of constructs across CFIR domains.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shuting Liang
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Bryan J Weiner
- Departments of Global Health and Health Services, University of Washington, Seattle, WA
| | - Shin Ping Tu
- General Internal Medicine, University of California Davis, Sacramento, CA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Beth A Glenn
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health & Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA
| | - Alison K Herrmann
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health & Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, CA
| | - Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, Aurora, CO
| | - Maria E Fernandez
- School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
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Fernandez ME, Walker TJ, Weiner BJ, Calo WA, Liang S, Risendal B, Friedman DB, Tu SP, Williams RS, Jacobs S, Herrmann AK, Kegler MC. Developing measures to assess constructs from the Inner Setting domain of the Consolidated Framework for Implementation Research. Implement Sci 2018; 13:52. [PMID: 29587804 PMCID: PMC5870186 DOI: 10.1186/s13012-018-0736-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/05/2018] [Indexed: 01/13/2023] Open
Abstract
Background Scientists and practitioners alike need reliable, valid measures of contextual factors that influence implementation. Yet, few existing measures demonstrate reliability or validity. To meet this need, we developed and assessed the psychometric properties of measures of several constructs within the Inner Setting domain of the Consolidated Framework for Implementation Research (CFIR). Methods We searched the literature for existing measures for the 7 Inner Setting domain constructs (Culture Overall, Culture Stress, Culture Effort, Implementation Climate, Learning Climate, Leadership Engagement, and Available Resources). We adapted items for the healthcare context, pilot-tested the adapted measures in 4 Federally Qualified Health Centers (FQHCs), and implemented the revised measures in 78 FQHCs in the 7 states (N = 327 respondents) with a focus on colorectal cancer (CRC) screening practices. To psychometrically assess our measures, we conducted confirmatory factor analysis models (CFA; structural validity), assessed inter-item consistency (reliability), computed scale correlations (discriminant validity), and calculated inter-rater reliability and agreement (organization-level construct reliability and validity). Results CFAs for most constructs exhibited good model fit (CFI > 0.90, TLI > 0.90, SRMR < 0.08, RMSEA < 0.08), with almost all factor loadings exceeding 0.40. Scale reliabilities ranged from good (0.7 ≤ α < 0.9) to excellent (α ≥ 0.9). Scale correlations fell below 0.90, indicating discriminant validity. Inter-rater reliability and agreement were sufficiently high to justify measuring constructs at the clinic-level. Conclusions Our findings provide psychometric evidence in support of the CFIR Inner Setting measures. Our findings also suggest the Inner Setting measures from individuals can be aggregated to represent the clinic-level. Measurement of the Inner Setting constructs can be useful in better understanding and predicting implementation in FQHCs and can be used to identify targets of strategies to accelerate and enhance implementation efforts in FQHCs.
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Affiliation(s)
- Maria E Fernandez
- University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA.
| | - Timothy J Walker
- University of Texas Health Science Center at Houston, Center for Health Promotion and Prevention Research, School of Public Health, 7000 Fannin St, Houston, TX, 77030, USA
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Box 357965, 1510 San Juan Road, Seattle, WA, 98195, USA
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Mail Code CH69
- 500 University Drive, Hershey, PA, 17033, USA
| | - Shuting Liang
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Betsy Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Comprehensive Cancer Center, 13001 E. 17th Place, MSF538, Aurora, CO, 80045, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior and the Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shin Ping Tu
- Department of Internal Medicine, University of California Davis, Suite 2400 , 4150 V Street, Sacramento, CA, 95817, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, CB 7424, Chapel Hill, NC, 27599, USA
| | - Sara Jacobs
- Public Health Research Division, RTI International, 3040 East Cornwallis Road, Research Triangle Park, Durham, NC, 27709-2194, USA
| | - Alison K Herrmann
- UCLA Kaiser Permanente Center for Health Equity, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles E. Young Dr. S., A2-125 CHS, Box 690015, Los Angeles, CA, 90095-6900, USA
| | - Michelle C Kegler
- Emory Prevention Research Center, Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
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Mainor AG, Decosimo K, Escoffrey C, Farris P, Shannon J, Winters-Stone K, Williams B, Leeman J. Scaling Up and Tailoring the "Putting Public Health in Action" Training Curriculum. Health Promot Pract 2017; 19:664-672. [PMID: 29191082 DOI: 10.1177/1524839917741486] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite access to a growing menu of evidence-based interventions, public health practitioners continue to underuse them, in part because practitioners may require new knowledge, skills, and resources to do so. Numerous foundations, universities, governmental agencies, and consultants are providing trainings to address the gaps in practitioners' capacity. To most significantly affect population health, these trainings need to reach practitioners who may have limited access to on-site trainings. Despite the number of organizations offering trainings, little is known about how to scale up trainings to efficiently extend their reach or how to tailor trainings to the needs of different intervention. The Cancer Prevention and Control Research Network and its collaborating centers have developed a training curriculum and delivered it in both in-person and distance formats to a range of audiences. The purpose of this article is to describe the training curriculum and findings from the Network's evaluation of approaches used to scale up delivery of the "Putting Public Health Evidence in Action" curriculum and tailor content for specific evidence-based interventions.
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Affiliation(s)
- Avia G Mainor
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kasey Decosimo
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Paige Farris
- 3 Oregon Health & Science University, Portland, OR, USA
| | | | | | | | - Jennifer Leeman
- 1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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McAlindon K. Selling Innovations Like Soap: The Interactive Systems Framework and Social Marketing. Am J Community Psychol 2017; 60:242-256. [PMID: 28815622 DOI: 10.1002/ajcp.12157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Despite the popularity and noted utility of Wandersman and colleagues' (2008) Interactive Systems Framework, the literature currently provides a primary focus on delivery organizations' and supportive stakeholders' capacities and strategies to implement innovations, presenting a critical gap in understanding. Unfortunately, reflective of a larger void in community dissemination and implementation efforts, there is a more limited focus on the dissemination of innovations. This paper presents the social marketing literature as a supplement to the Prevention Synthesis and Translation System (PSTS), the system responsible for dissemination. The study and practice of innovation synthesis and translation is examined in the literature; and based on the conclusions drawn, social marketing theory is used to provide a systematic approach to improving dissemination within the Interactive Systems Framework. Specifically, three gaps related to the PSTS are identified in the literature that align with and can be filled using social marketing. Social marketing is defined and presented as a supplement by providing theory and practices, within a systems context, for effectively communicating and influencing change. By blending social marketing with the Interactive Systems Framework, the aim is to improve the understanding of strategic communication and its role in the effective dissemination, and subsequent implementation, of innovations.
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Affiliation(s)
- Kathryn McAlindon
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Ribisl KM, Fernandez ME, Friedman DB, Hannon PA, Leeman J, Moore A, Olson L, Ory M, Risendal B, Sheble L, Taylor VM, Williams RS, Weiner BJ. Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice. Am J Prev Med 2017; 52:S233-S240. [PMID: 28215371 PMCID: PMC5812747 DOI: 10.1016/j.amepre.2016.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating network center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration is often advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN's multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. This paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control.
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Affiliation(s)
- Kurt M Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Peggy A Hannon
- Department of Health Services, University of Washington, Seattle, Washington
| | - Jennifer Leeman
- Department of Health Care Environments, University of North Carolina School of Nursing, Chapel Hill, North Carolina
| | - Alexis Moore
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsay Olson
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marcia Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M University, College Station, Texas
| | - Betsy Risendal
- Department of Community and Behavioral Health, University of Colorado Denver, Denver, Colorado
| | - Laura Sheble
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vicky M Taylor
- Department of Health Services, University of Washington, Seattle, Washington
| | - Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryan J Weiner
- Department of Health Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Leeman J, Calancie L, Kegler MC, Escoffery CT, Herrmann AK, Thatcher E, Hartman MA, Fernandez ME. Developing Theory to Guide Building Practitioners' Capacity to Implement Evidence-Based Interventions. Health Educ Behav 2016; 44:59-69. [PMID: 26500080 DOI: 10.1177/1090198115610572] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners' capacity to adopt and implement a variety of EBIs across diverse practice contexts.
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Highfield L, Rajan SS, Valerio MA, Walton G, Fernandez ME, Bartholomew LK. A non-randomized controlled stepped wedge trial to evaluate the effectiveness of a multi-level mammography intervention in improving appointment adherence in underserved women. Implement Sci 2015; 10:143. [PMID: 26464110 PMCID: PMC4604615 DOI: 10.1186/s13012-015-0334-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 10/06/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Considerable racial and socio-economic disparities exist in breast cancer. In spite of the existence of numerous evidence-based interventions (EBIs) aimed at reducing breast cancer screening barriers among the underserved, there is a lack of uptake or sub-optimal uptake of EBIs in community and clinical settings. This study evaluates a theoretically based, systematically designed implementation strategy to support adoption and implementation of a patient navigation-based intervention, called Peace of Mind Program (PMP), aimed at improving breast cancer screening among underserved women. METHODS/DESIGN The PMP will be offered to federally qualified health centers and charity clinics in the Greater Houston area using a non-randomized stepped wedge design. Due to practical constraints of implementing and adopting in the real-world, randomization of start times and blinding will not be used. Any potential confounding or bias will be controlled in the analysis. Outcomes such as appointment adherence, patient referral to diagnostics, time to diagnostic referral, patient referral to treatment, time to treatment referral, and budget impact of the intervention will be assessed. Assessment of constructs from the consolidated framework for implementation research (CFIR) will be assessed during implementation and at the end of the study (sustainment) from each participating clinic. Data will be analyzed using descriptive statistics (chi-square tests) and generalized estimating equations (GEE). DISCUSSION While parallel group randomized controlled trials (RCT) are considered the gold standard for evaluating EBI efficacy, withholding an effective EBI in practice can be both unethical and/or impractical. The stepped wedge design addresses this issue by enabling all clinics to eventually receive the EBI during the study and allowing each clinic to serve as its own control, while maintaining strong internal validity. We expect that the PMP will prove to be a feasible and successful strategy for reducing appointment no-shows in underserved women. TRIAL REGISTRATION CLINICAL TRIALS REGISTRATION NUMBER NCT02296177.
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Affiliation(s)
- L Highfield
- Department of Management, Policy and Community Health Practice, University of Texas School of Public Health, Houston, TX, USA.
| | - S S Rajan
- Department of Management, Policy and Community Health Practice, University of Texas School of Public Health, Houston, TX, USA
| | - M A Valerio
- Department of Management, Policy and Community Health Practice, University of Texas School of Public Health, Houston, TX, USA.,Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - G Walton
- Breast Health Collaborative of Texas, Houston, TX, USA
| | - M E Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
| | - L K Bartholomew
- Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX, USA
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