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Gogovor A, Zomahoun HTV, Ben Charif A, Ekanmian G, Moher D, McLean RKD, Milat A, Wolfenden L, Prévost K, Aubin E, Rochon P, Rheault N, Légaré F. Informing the development of the SUCCEED reporting guideline for studies on the scaling of health interventions: A systematic review. Medicine (Baltimore) 2024; 103:e37079. [PMID: 38363902 PMCID: PMC10869056 DOI: 10.1097/md.0000000000037079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 01/05/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Quality reporting contributes to effective translation of health research in practice and policy. As an initial step in the development of a reporting guideline for scaling, the Standards for reporting stUdies of sCaling evidenCEd-informED interventions (SUCCEED), we performed a systematic review to identify relevant guidelines and compile a list of potential items. METHODS We conducted a systematic review according to Cochrane method guidelines. We searched the following databases: MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL, Web of Science, from their respective inceptions. We also searched websites of relevant organizations and Google. We included any document that provided instructions or recommendations, e.g., reporting guideline, checklist, guidance, framework, standard; could inform the design or reporting of scaling interventions; and related to the health sector. We extracted characteristics of the included guidelines and assessed their methodological quality using a 3-item internal validity assessment tool. We extracted all items from the guidelines and classified them according to the main sections of reporting guidelines (title, abstract, introduction, methods, results, discussion and other information). We performed a narrative synthesis based on descriptive statistics. RESULTS Of 7704 records screened (published between 1999 and 2019), we included 39 guidelines, from which data were extracted from 57 reports. Of the 39 guidelines, 17 were for designing scaling interventions and 22 for reporting implementation interventions. At least one female author was listed in 31 guidelines, and 21 first authors were female. None of the authors belonged to the patient stakeholder group. Only one guideline clearly identified a patient as having participated in the consensus process. More than half the guidelines (56%) had been developed using an evidence-based process. In total, 750 items were extracted from the 39 guidelines and distributed into the 7 main sections. CONCLUSION Relevant items identified could inform the development of a reporting guideline for scaling studies of evidence-based health interventions. This and our assessment of guidelines could contribute to better reporting in the science and practice of scaling.
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Affiliation(s)
- Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
| | | | | | - Giraud Ekanmian
- Department of Social and Preventive Medicine, Université Laval, Quebec City, QC
| | - David Moher
- Ottawa Methods Centre, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON
| | - Robert K. D. McLean
- International Development Research Centre, Ottawa, ON
- Integrated Knowledge Translation Research Network, Ottawa Hospital Research Institute, Ottawa, ON
| | - Andrew Milat
- School of Public Health, University of Sydney, Camperdown, NSW
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW
- The National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW
| | | | | | - Paula Rochon
- Women’s Age Lab, Women’s College Hospital, Toronto, ON
- Department of Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - France Légaré
- VITAM – Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, QC
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC
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Doughty J, M Gallier S, Paisi M, Witton R, J Daley A. Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: experiences from a service evaluation and a call to action. Br Dent J 2023; 235:727-733. [PMID: 37945870 PMCID: PMC10635822 DOI: 10.1038/s41415-023-6449-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 11/12/2023]
Abstract
Introduction Substantial evidence has established associations between oral health and chronic diseases, mediated by common risk factors and inflammatory processes. Dental professionals are aptly positioned to screen for cardiovascular disease and diabetes high-risk indicators. This article presents a service evaluation of two dental practices delivering health screening in dental practice, and a call to action for the wider profession.Methods Following training, two general dental practices implemented a suite of health screens, including blood pressure, blood glucose, cholesterol, body mass index (BMI) and waist-to-height ratio. A service evaluation was undertaken to review and improve service provision.Results Most patients (78.4%) had blood pressure values above normal range. More than half (55.8%) were outside of the healthy range for BMI. Out-of-range results for cholesterol were observed in less than one-fifth (16.7%). High blood glucose values were observed for few patients (3.3%).Conclusion Dental professionals can be successfully trained to deliver health screening interventions. Out-of-range health screening results offer an opportunity to provide targeted health advice for both the oral and general health. Clear protocols and careful interpretation of screening tests are required to minimise patients' confusion. More robust alliances between dental and general medical care are recommended.
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Affiliation(s)
- Janine Doughty
- NIHR Clinical Lecturer in General Dental Practice, School of Dentistry, Royal Liverpool University Dental Hospital, Pembroke Place, Liverpool, UK.
| | - Simon M Gallier
- Future Health Partnership, Suite 11, 103-105 Harley Street, London, UK
| | - Martha Paisi
- Research Lead (Peninsula Dental Social Enterprise) and Senior Research Fellow in Public Health, School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Robert Witton
- Professor of Community Dentistry, Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Amanda J Daley
- Professor of Behavioural Medicine, Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, LE11 3TU, UK
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Poduval S, Ross J, Pal K, Newhouse N, Hamilton F, Murray E. Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach. JMIR Hum Factors 2022; 9:e31567. [PMID: 35029531 PMCID: PMC8800092 DOI: 10.2196/31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/24/2021] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background Digital health research encompasses methods from human-computer interaction and health research. Objective This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. Results The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. Conclusions The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs.
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Affiliation(s)
- Shoba Poduval
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Jamie Ross
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Kingshuk Pal
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Nikki Newhouse
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Fiona Hamilton
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
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Boileau-Falardeau M, Farooqi S, O'Rourke C, Payne L. Revisiting the Innovation Strategy performance measurement process: insights from practice. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2021; 112:262-269. [PMID: 34383269 PMCID: PMC8360244 DOI: 10.17269/s41997-021-00514-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/26/2021] [Indexed: 02/04/2023]
Abstract
Performance measurement (PM) aims to ensure transparency and effectiveness in public spending. More specifically, it provides a foundation that allows funders to determine whether an intervention has achieved its stated objective, thus improving understanding of what interventions should be funded in the future. Ideally, performance measurement should help us understand "what works, for whom, and in what context." Unfortunately, more often than not, performance reports are limited to a collection of indicators that make it difficult to answer this question. Based on our work with the Public Health Agency of Canada Innovation Strategy (PHAC-IS), we offer several recommendations to address this issue and support the performance measurement process, especially for complex interventions. We discuss the importance of contextualizing results to better understand impact and associating these results to a well-defined intervention. We also suggest using a validated tool to improve data collection and analysis and critically appraise the methods used to collect impact information. The integration of these key considerations will save time in data analysis and ensure funded recipients are not overburdened by the data collection process. Although this commentary is presented within the context of a complex multi-year population health funding program, we believe our approach can be applied to any performance management process and ultimately improve decisions such as whether an intervention should be continued, scaled up, or adapted to different contexts.
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Affiliation(s)
- Michèle Boileau-Falardeau
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
- École de santé publique - Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
| | - Shermeen Farooqi
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
| | - Christine O'Rourke
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada
| | - Leslie Payne
- Health Promotion and Chronic Disease Prevention Branch/Direction générale de la promotion de la santé et de la prévention des maladies chroniques, Public Health Agency of Canada/Agence de la santé publique du Canada, Ottawa, ON, Canada.
- Public Health Agency of Canada, 301-351 Abbott St., 3rd Floor, Vancouver, BC, V6B 0G6, Canada.
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Tabak RG, Morshed AB, Schwarz CD, Haire‐Joshu D. Weight gain prevention content delivered to mothers: Lessons from an intervention embedded in a community organization. Obes Sci Pract 2019; 5:540-547. [PMID: 31890244 PMCID: PMC6934432 DOI: 10.1002/osp4.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transparent reporting of the intervention content study participants receive is particularly important for dissemination and implementation of evidence-based interventions to address obesity. This study explores intervention delivery and perceptions of content when an intervention is embedded within an organization's usual practice and associations with weight outcomes. METHODS This is a secondary analysis from the Healthy Eating and Active Living Taught at Home (HEALTH) randomized trial. HEALTH is a weight gain prevention intervention embedded within a national home visiting programme (Parents as Teachers, PAT). To be consistent with PAT practice, HEALTH has a suggested but also flexible home visit structure. Therefore, the number and frequency of home visits are determined by the family's needs and preferences based on the parent educator's professional judgement. The proportion of participants who received each curriculum core lesson was explored among the 105 families randomized to the HEALTH intervention group, as were mean parent educator perception ratings of the visits (5-point Likert-type scale). A chi-square test was used to examine the association between utilization (ie, low: 1-6, middle: 7-12, or high: 13-18 visits) category and weight maintenance. RESULTS Mothers received on average 13.3 (standard deviation 6.2) core visits. Mean parent educator perception of the mothers' response (out of 5) ranged from 3.99 to 4.27; educators' perception of their own experience with the lesson ranged from 4.13 to 4.34. Among mothers who maintained their weight, 13% were low, 22% were middle, and 65% were high utilizers, while among mothers who gained weight, 3%, 31%, and 67% were low, middle, and high utilizers, respectively; this difference was not statistically significant. CONCLUSIONS This study identified wide variation in the visits families received from the curriculum but minimal variation in visit perceptions. Future studies could explore whether there are optimal patterns for visit content, associated with successful outcomes.
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Affiliation(s)
- Rachel G. Tabak
- The Brown SchoolWashington University in St. LouisSt. LouisMissouri
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Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions. Int J Behav Nutr Phys Act 2019; 16:97. [PMID: 31675954 PMCID: PMC6825353 DOI: 10.1186/s12966-019-0859-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/10/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. METHODS A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration's tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie's et al's BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. RESULTS From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). 'Self-monitoring of behaviour' was the most frequently used BCTs (76.5%), with 'social support' being newly identified for this pregnant population with overweight or obesity. CONCLUSIONS This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.
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Kemp CG, Jarrett BA, Kwon CS, Song L, Jetté N, Sapag JC, Bass J, Murray L, Rao D, Baral S. Implementation science and stigma reduction interventions in low- and middle-income countries: a systematic review. BMC Med 2019; 17:6. [PMID: 30764820 PMCID: PMC6376798 DOI: 10.1186/s12916-018-1237-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to alleviate stigma are demonstrating effectiveness across a range of conditions, though few move beyond the pilot phase, especially in low- and middle-income countries (LMICs). Implementation science offers tools to study complex interventions, understand barriers to implementation, and generate evidence of affordability, scalability, and sustainability. Such evidence could be used to convince policy-makers and donors to invest in implementation. However, the utility of implementation research depends on its rigor and replicability. Our objectives were to systematically review implementation studies of health-related stigma reduction interventions in LMICs and critically assess the reporting of implementation outcomes and intervention descriptions. METHODS PubMed, CINAHL, PsycINFO, and EMBASE were searched for evaluations of stigma reduction interventions in LMICs reporting at least one implementation outcome. Study- and intervention-level characteristics were abstracted. The quality of reporting of implementation outcomes was assessed using a five-item rubric, and the comprehensiveness of intervention description and specification was assessed using the 12-item Template for Intervention Description and Replication (TIDieR). RESULTS A total of 35 eligible studies published between 2003 and 2017 were identified; of these, 20 (57%) used qualitative methods, 32 (91%) were type 1 hybrid effectiveness-implementation studies, and 29 (83%) were evaluations of once-off or pilot implementations. No studies adopted a formal theoretical framework for implementation research. Acceptability (20, 57%) and feasibility (14, 40%) were the most frequently reported implementation outcomes. The quality of reporting of implementation outcomes was low. The 35 studies evaluated 29 different interventions, of which 18 (62%) were implemented across sub-Saharan Africa, 20 (69%) focused on stigma related to HIV/AIDS, and 28 (97%) used information or education to reduce stigma. Intervention specification and description was uneven. CONCLUSION Implementation science could support the dissemination of stigma reduction interventions in LMICs, though usage to date has been limited. Theoretical frameworks and validated measures have not been used, key implementation outcomes like cost and sustainability have rarely been assessed, and intervention processes have not been presented in detail. Adapted frameworks, new measures, and increased LMIC-based implementation research capacity could promote the rigor of future stigma implementation research, helping the field deliver on the promise of stigma reduction interventions worldwide.
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Affiliation(s)
| | - Brooke A. Jarrett
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Churl-Su Kwon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Lanxin Song
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City, NY USA
| | - Jaime C. Sapag
- Departments of Public Health and Family Medicine, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
- Office of Transformative Global Health, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Judith Bass
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Laura Murray
- Department of Mental Health, Johns Hopkins University, Baltimore, MD USA
| | - Deepa Rao
- Department of Global Health, University of Washington, Seattle, WA USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD USA
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Baumann AA, Belle SH, James A, King AA. Specifying sickle cell disease interventions: a study protocol of the Sickle Cell Disease Implementation Consortium (SCDIC). BMC Health Serv Res 2018; 18:500. [PMID: 29945631 PMCID: PMC6020469 DOI: 10.1186/s12913-018-3297-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited blood disorder that results in a lifetime of anemia, severe pain, and end-organ damage that can lead to premature mortality. While the SCD field has made major medical advances, much needs to be done to improve the quality of care for people with SCD. This study capitalizes on the Sickle Cell Disease Implementation Consortium (SCDIC), a consortium of eight academic sites aiming to test implementation strategies that could lead to more accelerated application of the NHLBI guidelines for treating SCD. This report documents the process to support the consortium by specifying the interventions being developed. METHODS This study consists of three steps. The Principal Investigator of each site and two site representatives who are knowledgeable of the intervention (e.g., study coordinator or the person delivering the intervention) will answer an online survey aiming to capture components of the interventions. This survey will be completed by the site representatives three times during the study: during the development of the interventions, after one year of the interventions being implemented, and at the end of this study (after 2 years). A site visit and semi-structured interview (Step 2) in the first year of the process will capture the context of the sites. Step 3 comprises of the development of a framework with the details of the multi-component SCDIC interventions at the sites. DISCUSSION The outcome of this study, a framework of the SCDIC, will enable accurate replication and extension of published research, facilitating the translation of SCD studies to diverse populations and settings and allowing for theory testing of the effects of the intervention components across studies in different contexts and for different populations. TRIAL REGISTRATION ClinicalTrial.Gov (# NCT03380351 ). Registered December 21, 2017.
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Affiliation(s)
- Ana A. Baumann
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
| | - Steven H. Belle
- Graduate School of Public Health, University of Pittsburgh, Suite 605, 4420 Bayard St., Pittsburgh, PA 15260 USA
| | - Aimee James
- Division of Public Health Sciences, 660 South Euclid Ave. Box 8100, St Louis, MO 63110 USA
| | - Allison A. King
- Division of Public Health Sciences, 660 South Euclid Ave. Box 8100, St Louis, MO 63110 USA
- Program in Occupational Therapy; Department of Pediatrics, Division of Pediatric Hematology/Oncology; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63108 USA
| | - the Sickle Cell Disease Implementation Consortium
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA
- Graduate School of Public Health, University of Pittsburgh, Suite 605, 4420 Bayard St., Pittsburgh, PA 15260 USA
- Division of Public Health Sciences, 660 South Euclid Ave. Box 8100, St Louis, MO 63110 USA
- Program in Occupational Therapy; Department of Pediatrics, Division of Pediatric Hematology/Oncology; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63108 USA
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Ramsay JE, Janevic MR, Hogan CK, Edwards DL, Connell CM. Using the Replicating Effective Programs Framework to Adapt a Heart Health Intervention. Health Promot Pract 2018; 20:760-769. [PMID: 29759012 DOI: 10.1177/1524839918775740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Heart disease is the leading cause of death in the United States. African Americans and people of low socioeconomic status suffer disproportionately from heart disease-related morbidity and mortality. In Detroit, Michigan, a primarily African American and low-income urban area, heart disease mortality is at twice the national rate. Despite evidence for the effectiveness of self-management support interventions in reducing chronic disease burden for older adults, few are adapted for communities most in need. This article describes the process of adapting Take PRIDE, an evidence-based heart disease self-management intervention, for older adults in Detroit via the Replicating Effective Programs (REP) framework. Working within a community-academic partnership, we found REP useful in facilitating the identification of diverse stakeholders, core versus adaptable elements of the intervention and barriers to implementation. We also made several modifications to the REP framework in order to better fit our project needs. Overall, we found REP to be an effective, flexible tool that allowed us to successfully adapt a disease-management intervention for this setting. Processes, lessons learned, and recommendations offered in this article may help researchers and practitioners working to expand access to self-management support for populations most affected by chronic disease.
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Affiliation(s)
- Jessica E Ramsay
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Mary R Janevic
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Cainnear K Hogan
- 1 University of Michigan School of Public Health, Ann Arbor, MI, USA
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Fredrix M, McSharry J, Flannery C, Dinneen S, Byrne M. Goal-setting in diabetes self-management: A systematic review and meta-analysis examining content and effectiveness of goal-setting interventions. Psychol Health 2018; 33:955-977. [DOI: 10.1080/08870446.2018.1432760] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Milou Fredrix
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Jenny McSharry
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Caragh Flannery
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- School of Psychology, National University of Ireland, Galway, Ireland
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Adjemian R, Moradi Zirkohi A, Coombs R, Mickan S, Vaillancourt C. Are emergency department clinical pathway interventions adequately described, and are they delivered as intended? A systematic review. INTERNATIONAL JOURNAL OF CARE COORDINATION 2017. [DOI: 10.1177/2053434517732507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction The accurate reproduction of clinical interventions and the evaluation of provider adherence in research publications improve the evaluation and implementation of research findings into clinical practice. We sought to examine the proportion of clinical pathway publications in an emergency department setting that adequately reported the following: (1) the exact reproduction of the clinical pathway that was implemented in the study, (2) the adherence to and correct execution of the clinical pathway intervention, and (3) the presence of a pre-implementation education phase. Methods We performed a descriptive systematic review of the literature from 2006 to 2015 using MEDLINE, EMBASE, CENTRAL, and CINAHL. All types of prospective trial designs were eligible. Validated clinical pathway criteria were used to identify relevant publications. Two reviewers independently collected data using a piloted data abstraction tool. Risk of bias was assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Tool and the Newcastle-Ottawa Scale. Results We identified 5947 publications, 44 of which met our inclusion criteria. The formal clinical pathway was fully reproduced in 27 (61%) publications, partially reproduced in 9 (21%), and not reproduced in 8 (18%). Only 14 (32%) studies reported whether at least one decision step was executed correctly. The presence of a pre-implementation education phase was reported in 33 (75%) studies. Conclusion The underreporting of intervention elements may present a barrier to both the evaluation and accurate replication of clinical pathway interventions. These finding may be useful for the elaboration of complex intervention reporting guidelines, improved reporting in future clinical pathway publications, and improved knowledge translation and exchange of clinical pathway interventions.
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Affiliation(s)
- Raffi Adjemian
- Department of Primary Health Care, International Program in Evidence Based Health Care, University of Oxford, Oxford, UK
- Department of Family Medicine, McGill University, Quebec, Canada
| | | | - Robin Coombs
- Department of Family Medicine, McGill University, Quebec, Canada
| | - Sharon Mickan
- Department of Primary Health Care, International Program in Evidence Based Health Care, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Gold Coast Health, Griffith University, Gold Coast, Australia
| | - Christian Vaillancourt
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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Crespo-Gonzalez C, Garcia-Cardenas V, Benrimoj SI. The next phase in professional services research: From implementation to sustainability. Res Social Adm Pharm 2017; 13:896-901. [PMID: 28602278 DOI: 10.1016/j.sapharm.2017.05.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/17/2022]
Abstract
The provision of professional pharmacy services has been heralded as the professional and the economic future of pharmacy. There are different phases involved in a service creation including service design, impact evaluation, implementation and sustainability. The two first phases have been subject to extensive research. In the last years the principles of Implementation science have been applied in pharmacy to study the initial uptake and integration of evidence-based services into routine practice. However, little attention has been paid to the sustainability of those services, during which there is a continued use of the service previously implemented to achieve and sustain long-term outcomes. The objective of this commentary is to describe the differences and common characteristics between the implementation and the sustainability phase and to propose a definition for pharmacy. A literature search was performed. Four critical elements were identified: 1. The aim of the implementation phase is to incorporate new services into practice, the sustainability phase's aim is to make the services routine to achieve and sustain long-term benefits 2. At the implementation phase planned activities are used as a process to integrate the new service, at the sustainability phase there is a continuous improvement of the service 3. The implementation phase occurs during the period of time between the adoption of a service and its integration. Some authors suggest the sustainability phase is a concomitant phase with the implementation phase and others suggest it is independent 4. There is a lack of consensus regarding the duration of each phase. The following definition of sustainability for pharmacy services is proposed: "Sustainability is a phase in the process of a professional pharmacy service, in which the service previously integrated into practice during the implementation phase is routinized and institutionalized over time to achieve and sustain the expected service outcomes". An agreement on a definition will facilitate an understanding of when the profession has reached this ultimate goal.
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Affiliation(s)
- Carmen Crespo-Gonzalez
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
| | - Victoria Garcia-Cardenas
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
| | - Shalom I Benrimoj
- University of Technology Sydney, Graduate School of Health, PO Box 123 Broadway, New South Wales, 2007, Sydney, Australia.
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Tuti T, Nzinga J, Njoroge M, Brown B, Peek N, English M, Paton C, van der Veer SN. A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory. Implement Sci 2017; 12:61. [PMID: 28494799 PMCID: PMC5427645 DOI: 10.1186/s13012-017-0590-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 04/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Audit and feedback is a common intervention for supporting clinical behaviour change. Increasingly, health data are available in electronic format. Yet, little is known regarding if and how electronic audit and feedback (e-A&F) improves quality of care in practice. OBJECTIVE The study aimed to assess the effectiveness of e-A&F interventions in a primary care and hospital context and to identify theoretical mechanisms of behaviour change underlying these interventions. METHODS In August 2016, we searched five electronic databases, including MEDLINE and EMBASE via Ovid, and the Cochrane Central Register of Controlled Trials for published randomised controlled trials. We included studies that evaluated e-A&F interventions, defined as a summary of clinical performance delivered through an interactive computer interface to healthcare providers. Data on feedback characteristics, underlying theoretical domains, effect size and risk of bias were extracted by two independent review authors, who determined the domains within the Theoretical Domains Framework (TDF). We performed a meta-analysis of e-A&F effectiveness, and a narrative analysis of the nature and patterns of TDF domains and potential links with the intervention effect. RESULTS We included seven studies comprising of 81,700 patients being cared for by 329 healthcare professionals/primary care facilities. Given the extremely high heterogeneity of the e-A&F interventions and five studies having a medium or high risk of bias, the average effect was deemed unreliable. Only two studies explicitly used theory to guide intervention design. The most frequent theoretical domains targeted by the e-A&F interventions included 'knowledge', 'social influences', 'goals' and 'behaviour regulation', with each intervention targeting a combination of at least three. None of the interventions addressed the domains 'social/professional role and identity' or 'emotion'. Analyses identified the number of different domains coded in control arm to have the biggest role in heterogeneity in e-A&F effect size. CONCLUSIONS Given the high heterogeneity of identified studies, the effects of e-A&F were found to be highly variable. Additionally, e-A&F interventions tend to implicitly target only a fraction of known theoretical domains, even after omitting domains presumed not to be linked to e-A&F. Also, little evaluation of comparative effectiveness across trial arms was conducted. Future research should seek to further unpack the theoretical domains essential for effective e-A&F in order to better support strategic individual and team goals.
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Affiliation(s)
- Timothy Tuti
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.
| | | | | | - Benjamin Brown
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Niels Peek
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Chris Paton
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- MRC Health e-Research Centre, Farr Institute for Health Informatics Research, Manchester, UK
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Alcohol Prevention and Evaluation in the Era of Evidence Based Practice – the Need for a Systematic Approach to Evaluation. NORDIC STUDIES ON ALCOHOL AND DRUGS 2017. [DOI: 10.2478/v10199-011-0022-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS This article focuses on the shortcomings of experimental outcome evaluations. MATERIAL The study uses two studies of the alcohol prevention program Prime for Life (PFL) to illustrate problems associated with a ‘one dimensional’ goal focus and how implementation may affect the efficiency of an intervention. Results As evidence based practice often fails to acknowledge the importance of context and implementation quality in its quest to find ‘what works’, it is argued in the article that a wider perspective on efficiency is needed in evaluations of alcohol prevention. CONSLUSIONS To be able to find out what works and during what circumstances, evaluators need to look for a wider set of traits that constitute effective interventions.
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Morrissey EC, Durand H, Nieuwlaat R, Navarro T, Haynes RB, Walsh JC, Molloy GJ. Effectiveness and content analysis of interventions to enhance medication adherence and blood pressure control in hypertension: A systematic review and meta-analysis. Psychol Health 2017; 32:1195-1232. [DOI: 10.1080/08870446.2016.1273356] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Hannah Durand
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Robby Nieuwlaat
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Tamara Navarro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - R. Brian Haynes
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Jane C. Walsh
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Gerard J. Molloy
- School of Psychology, National University of Ireland, Galway, Ireland
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McPherson C, Ndumbe-Eyoh S, Betker C, Oickle D, Peroff-Johnston N. Swimming against the tide: A Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity. Int J Equity Health 2016; 15:129. [PMID: 27539080 PMCID: PMC4991018 DOI: 10.1186/s12939-016-0419-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 08/05/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. METHODS A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. RESULTS Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. CONCLUSIONS This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity.
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Affiliation(s)
- Charmaine McPherson
- School of Nursing, Faculty of Science, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
| | - Sume Ndumbe-Eyoh
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
| | - Claire Betker
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
- Population Health and Health Equity, Public Health and Primary Health Care, Manitoba Health, Healthy Living and Seniors, 4th floor, 300 Carlton St, Winnipeg, MB R3B 3M9 Canada
| | - Dianne Oickle
- National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Box 5000, Antigonish, NS B2G 2W5 Canada
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Williams G. The IDEFICS intervention: what can we learn for public policy? Obes Rev 2015; 16 Suppl 2:151-61. [PMID: 26707024 DOI: 10.1111/obr.12355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 10/09/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION As considered in the rest of this volume, the effects of the IDEFICS intervention on obesity rates were not encouraging. This paper considers how far findings from the IDEFICS study and similar intervention studies are relevant to the policy process and political decision-making. METHODS The paper offers theoretical and policy-level arguments concerning the evaluation of evidence and its implications for policymaking. The paper is divided into three parts. The first considers problems in the nature and applicability of evidence gained from school- and community-level obesity interventions. The second part considers whether such interventions present a model that policymakers could implement. The third part considers how we should think about policy measures given the limited evidence we can obtain and the many different goals that public policy must take account of. RESULTS The paper argues that (1) there are clear reasons why we are not obtaining good evidence for effective school- and community-level interventions; (2) public policy is not in a good position to mandate larger-scale, long-term versions of these interventions; and (3) there are serious problems in obtaining 'evidence' for most public policy options, but this should not deter us from pursuing options that tackle systemic problems and have a good likelihood of delivering benefits on several dimensions. CONCLUSIONS Research on school- and community-level obesity interventions has not produced much evidence that is directly relevant to policymaking. Instead, it shows how difficult it is to affect obesity rates without changing wider social and economic factors. Public policy should focus on these.
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Affiliation(s)
- G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
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Drozd F, Haga SM, Brendryen H, Slinning K. An Internet-Based Intervention (Mamma Mia) for Postpartum Depression: Mapping the Development from Theory to Practice. JMIR Res Protoc 2015; 4:e120. [PMID: 26476481 PMCID: PMC4704906 DOI: 10.2196/resprot.4858] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/14/2015] [Accepted: 08/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As much as 10-15% of new mothers experience depression postpartum. An Internet-based intervention (Mamma Mia) was developed with the primary aims of preventing depressive symptoms and enhancing subjective well-being among pregnant and postpartum women. A secondary aim of Mamma Mia was to ease the transition of becoming a mother by providing knowledge, techniques, and support during pregnancy and after birth. OBJECTIVE The aim of the paper is to provide a systematic and comprehensive description of the intervention rationale and the development of Mamma Mia. METHODS For this purpose, we used the intervention mapping (IM) protocol as descriptive tool, which consists of the following 6 steps: (1) a needs assessment, (2) definition of change objectives, (3) selection of theoretical methods and practical strategies, (4) development of program components, (5) planning adoption and implementation, and (6) planning evaluation. RESULTS Mamma Mia is a fully automated Internet intervention available for computers, tablets, and smartphones, intended for individual use by the mother. It starts in gestational week 18-24 and lasts up to when the baby becomes 6 months old. This intervention applies a tunneled design to guide the woman through the program in a step-by-step fashion in accordance with the psychological preparations of becoming a mother. The intervention is delivered by email and interactive websites, combining text, pictures, prerecorded audio files, and user input. It targets risk and protective factors for postpartum depression such as prepartum and postpartum attachment, couple satisfaction, social support, and subjective well-being, as identified in the needs assessment. The plan is to implement Mamma Mia directly to users and as part of ordinary services at well-baby clinics, and to evaluate the effectiveness of Mamma Mia in a randomized controlled trial and assess users' experiences with the program. CONCLUSIONS The IM of Mamma Mia has made clear the rationale for the intervention, and linked theories and empirical evidence to the contents and materials of the program. This meets the recent calls for intervention descriptions and may inform future studies, development of interventions, and systematic reviews.
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Affiliation(s)
- Filip Drozd
- National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
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19
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Villeval M, Bidault E, Gaborit E, Grosclaude P, Haschar-Noé N, Lang T. [An intervention research program (AAPRISS) to reduce social inequalities in health: methods and validation]. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2015; 106:e434-41. [PMID: 26680436 PMCID: PMC6972046 DOI: 10.17269/cjph.106.4955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 10/03/2015] [Accepted: 08/07/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The AAPRISS intervention-research program (Apprendre et Agir Pour Réduire les Inégalités Sociales de Santé) aims to change prevention projects to improve the extent to which they take health inequalities into account. The goal is to assess a project's feasibility and its acceptability, from the viewpoint of the sponsors of the project in question, and to present its tools and potentially-transferable elements. PARTICIPANTS Five cancer-prevention projects focused on nutrition have been included in the AAPRISS program: two projects conducted in school, one community-health project conducted in a disadvantaged neighbourhood and two hospital therapeutic-education programes. For each one, a workgroup was created bringing together the project sponsors and their team as well as researchers from various disciplines. LOCATION The study involves projects currently underway in the Midi- Pyrénées region of France. INTERVENTION AAPRISS is based on the exchange of knowledge among project sponsors and researchers and the co-construction of the analysis, reorientations and the assessment of the prevention projects included in the program. The validation of the program and its feasibility from the project sponsors' point of view is based on a questionnaire and presentations carried out during a symposium that took place in May 2014 in Toulouse. RESULTS Twelve key program functions have been described. They have been shown to be feasible and acceptable and concrete project modifications towards a better consideration of social inequalities of health (SIH) have been realized in most of the projects. Co-construction among the stakeholders raises many issues and difficulties that could have been overcome by the establishment of a relationship of trust between project sponsors and researchers. CONCLUSION The complexity of the determinants leading to SIH calls for programs that revisit existing projects rather than a new intervention aimed at reducing them.
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Little EA, Presseau J, Eccles MP. Understanding effects in reviews of implementation interventions using the Theoretical Domains Framework. Implement Sci 2015; 10:90. [PMID: 26082136 PMCID: PMC4469259 DOI: 10.1186/s13012-015-0280-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/08/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Behavioural theory can be used to better understand the effects of behaviour change interventions targeting healthcare professional behaviour to improve quality of care. However, the explicit use of theory is rarely reported despite interventions inevitably involving at least an implicit idea of what factors to target to implement change. There is a quality of care gap in the post-fracture investigation (bone mineral density (BMD) scanning) and management (bisphosphonate prescription) of patients at risk of osteoporosis. We aimed to use the Theoretical Domains Framework (TDF) within a systematic review of interventions to improve quality of care in post-fracture investigation. Our objectives were to explore which theoretical factors the interventions in the review may have been targeting and how this might be related to the size of the effect on rates of BMD scanning and osteoporosis treatment with bisphosphonate medication. METHODS A behavioural scientist and a clinician independently coded TDF domains in intervention and control groups. Quantitative analyses explored the relationship between intervention effect size and total number of domains targeted, and as number of different domains targeted. RESULTS Nine randomised controlled trials (RCTs) (10 interventions) were analysed. The five theoretical domains most frequently coded as being targeted by the interventions in the review included "memory, attention and decision processes", "knowledge", "environmental context and resources", "social influences" and "beliefs about consequences". Each intervention targeted a combination of at least four of these five domains. Analyses identified an inverse relationship between both number of times and number of different domains coded and the effect size for BMD scanning but not for bisphosphonate prescription, suggesting that the more domains the intervention targeted, the lower the observed effect size. CONCLUSIONS When explicit use of theory to inform interventions is absent, it is possible to retrospectively identify the likely targeted factors using theoretical frameworks such as the TDF. In osteoporosis management, this suggested that several likely determinants of healthcare professional behaviour appear not yet to have been considered in implementation interventions. This approach may serve as a useful basis for using theory-based frameworks such as the TDF to retrospectively identify targeted factors within systematic reviews of implementation interventions in other implementation contexts.
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Affiliation(s)
- Elizabeth A Little
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Justin Presseau
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK.
| | - Martin P Eccles
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX, UK.
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Richard L, Torres S, Tremblay MC, Chiocchio F, Litvak É, Fortin-Pellerin L, Beaudet N. An analysis of the adaptability of a professional development program in public health: results from the ALPS Study. BMC Health Serv Res 2015; 15:233. [PMID: 26072223 PMCID: PMC4465469 DOI: 10.1186/s12913-015-0903-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 06/03/2015] [Indexed: 11/25/2022] Open
Abstract
Background Professional development is a key component of effective public health infrastructures. To be successful, professional development programs in public health and health promotion must adapt to practitioners’ complex real-world practice settings while preserving the core components of those programs’ models and theoretical bases. An appropriate balance must be struck between implementation fidelity, defined as respecting the core nature of the program that underlies its effects, and adaptability to context to maximize benefit in specific situations. This article presents a professional development pilot program, the Health Promotion Laboratory (HPL), and analyzes how it was adapted to three different settings while preserving its core components. An exploratory analysis was also conducted to identify team and contextual factors that might have been at play in the emergence of implementation profiles in each site. Methods This paper describes the program, its core components and adaptive features, along with three implementation experiences in local public health teams in Quebec, Canada. For each setting, documentary sources were analyzed to trace the implementation of activities, including temporal patterns throughout the project for each program component. Information about teams and their contexts/settings was obtained through documentary analysis and semi-structured interviews with HPL participants, colleagues and managers from each organization. Results While each team developed a unique pattern of implementing the activities, all the program’s core components were implemented. Differences of implementation were observed in terms of numbers and percentages of activities related to different components of the program as well as in the patterns of activities across time. It is plausible that organizational characteristics influencing, for example, work schedule flexibility or learning culture might have played a role in the HPL implementation process. Conclusions This paper shows how a professional development program model can be adapted to different contexts while preserving its core components. Capturing the heterogeneity of the intervention’s exposure, as was done here, will make possible in-depth impact analyses involving, for example, the testing of program–context interactions to identify program outcomes predictors. Such work is essential to advance knowledge on the action mechanisms of professional development programs. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0903-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lucie Richard
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada. .,Faculty of Nursing, Université de Montréal, Montréal, Canada. .,Léa-Roback Research Centre on Social Inequalities of Health in Montréal, Université de Montréal, Montréal, Canada.
| | - Sara Torres
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada.
| | - Marie-Claude Tremblay
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - François Chiocchio
- Telfer School of Management, University of Ottawa, 55 Laurier Ave. East, Ottawa, ON, K1N 6 N5, Canada. .,Institut de recherche de l'Hôpital Montfort, Ottawa, ON, Canada.
| | - Éric Litvak
- Public Health Directorate for Montreal, Montreal Health and Social Services Agency, 1301 Sherbrooke St. East, Montreal, QC, H2L 1 M3, Canada.
| | - Laurence Fortin-Pellerin
- IRSPUM, Université de Montréal, P.O. Box 6128, Centre-ville Station, Montréal, QC, H3C 3 J7, Canada
| | - Nicole Beaudet
- Public Health Directorate for Montreal, Montreal Health and Social Services Agency, 1301 Sherbrooke St. East, Montreal, QC, H2L 1 M3, Canada. .,Department of Social and Preventive Medicine, Université de Montréal, Montréal, Canada.
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Compernolle S, De Cocker K, Lakerveld J, Mackenbach JD, Nijpels G, Oppert JM, Rutter H, Teixeira PJ, Cardon G, De Bourdeaudhuij I. A RE-AIM evaluation of evidence-based multi-level interventions to improve obesity-related behaviours in adults: a systematic review (the SPOTLIGHT project). Int J Behav Nutr Phys Act 2014; 11:147. [PMID: 25480391 PMCID: PMC4266878 DOI: 10.1186/s12966-014-0147-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 11/17/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This systematic literature review describes the potential public health impact of evidence-based multi-level interventions to improve obesity-related behaviours in adults, using the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework. METHODS Electronic databases (PubMed, Embase, and The Cochrane Library) were searched to identify intervention studies published between January 2000 and October 2013. The following inclusion criteria were used: (1) the study included at least one outcome measure assessing obesity-related behaviours (i.e. diet, physical activity or sedentary behaviour), (2) the study collected data over at least one year and (3) the study's intervention targeted adults, was conducted in a specified geographical area or worksite, and was multi-level (i.e. targeting both individual and environmental level). Evidence of RE-AIM of the selected interventions was assessed. Potential public health impact of an intervention was evaluated if information was provided on at least four of the five RE-AIM dimensions. RESULTS Thirty-five multi-level interventions met the inclusion criteria. RE-AIM evaluation revealed that the included interventions generally had the potential to: reach a large number of people (on average 58% of the target population was aware of the intervention); achieve the assumed goals (89% found positive outcomes); be broadly adopted (the proportion of intervention deliverers varied from 9% to 92%) and be sustained (sixteen interventions were maintained). The highest potential public health impact was found in multi-level interventions that: 1) focused on all levels at the beginning of the planning process, 2) guided the implementation process using diffusion theory, and 3) used a website to disseminate the intervention. CONCLUSIONS Although most studies underreported results within the RE-AIM dimensions, the reported Reach, Effectiveness, Adoption, Implementation and Maintenance were positively evaluated. However, more information on external validity and sustainability is needed in order to take informed decisions on the choice of interventions that should be implemented in real-world settings to accomplish long-term changes in obesity-related behaviours.
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Affiliation(s)
- Sofie Compernolle
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Katrien De Cocker
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Research Foundation Flanders (FWO), B-1000, Ghent, Belgium.
| | - Jeroen Lakerveld
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Joreintje D Mackenbach
- The EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
| | - Giel Nijpels
- The EMGO Institute for Health and Care Research, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands.
| | - Jean-Michel Oppert
- Université Paris 13, Sorbonne Paris Cité - UREN (Unité de Recherche en Epidémiologie Nutritionnelle), U557 Inserm; U1125 Inra; Cnam, Centre for Research on Human Nutrition Ile-de-France (CRNH IdF), Bobigny, France. .,Université Pierre et Marie Curie-Paris 6, Department of Nutrition Pitié-Salpêtrière Hospital (AP-HP), (CRNH IdF), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France.
| | - Harry Rutter
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
| | - Pedro J Teixeira
- Interdisciplinary Center for the Study of Human Performance, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Greet Cardon
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
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Diep CS, Chen TA, Davies VF, Baranowski JC, Baranowski T. Influence of behavioral theory on fruit and vegetable intervention effectiveness among children: a meta-analysis. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:506-546. [PMID: 25457730 DOI: 10.1016/j.jneb.2014.05.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 05/12/2014] [Accepted: 05/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To test the hypotheses that interventions clearly based on theory, multiple theories, or a formal intervention planning process will be more effective in changing fruit and vegetable consumption among children than interventions with no behavioral theoretical foundation. DESIGN Systematic review and meta-analysis. SETTING Identification of articles in PubMed, PsycInfo, Medline, Cochrane Collaborative database, and existing literature reviews and meta-analyses. PARTICIPANTS Children aged 2-18 years. INTERVENTIONS Change in fruit and/or vegetable consumption in dietary change interventions. METHODS Meta-analysis, meta-regression analysis, and summary reporting for articles. CONCLUSIONS AND IMPLICATIONS Predicating an intervention on behavioral theory had a small to moderate enhancement (P < .001) of outcome effectiveness. Differences in mean Hedges' g effect sizes between theory and non-theory interventions were 0.232 for fruit, 0.043 for vegetables, and 0.333 for fruit and vegetables combined. There was mixed support, however, for enhanced dietary change with multiple theories or a formal planning process. After controlling for study quality, theory use was related only to vegetable consumption (β = 0.373; P < .001). More research is needed on theory's influences on dietary behaviors to guide future interventions among children. More research is also needed to identify what may be effective practical- or experience-based procedures that complement theory, to incorporate into interventions.
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Affiliation(s)
- Cassandra S Diep
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX.
| | - Tzu-An Chen
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Vanessa F Davies
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX; Department of Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Janice C Baranowski
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Tom Baranowski
- US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Faggiano F, Allara E, Giannotta F, Molinar R, Sumnall H, Wiers R, Michie S, Collins L, Conrod P. Europe needs a central, transparent, and evidence-based approval process for behavioural prevention interventions. PLoS Med 2014; 11:e1001740. [PMID: 25291521 PMCID: PMC4188564 DOI: 10.1371/journal.pmed.1001740] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Fabrizio Faggiano and colleagues discuss how a central, transparent, and evidence-based approval process is needed for behavioral prevention interventions in Europe and propose a way forward. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Fabrizio Faggiano
- Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Elias Allara
- Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
- School of Public Health, University of Turin, Torino, Italy
| | - Fabrizia Giannotta
- Child and Baby Lab, Department of Psychology, Uppsala University, Uppsala, Sweden
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Roberta Molinar
- Department of Translational Medicine, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Harry Sumnall
- Centre for Public Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Reinout Wiers
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Linda Collins
- The Methodology Center and Department of Human Development and Family Studies, Pennsylvania State University, State College, United States of America
| | - Patricia Conrod
- Addictions Department Institute of Psychiatry, King's College London, London, United Kingdom
- Department of Psychiatry, University of Montreal, Montreal, Québec, Canada
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Albert D, Fortin R, Lessio A, Herrera C, Riley B, Hanning R, Rush B. Strengthening chronic disease prevention programming: the Toward Evidence-Informed Practice (TEIP) Program Assessment Tool. Prev Chronic Dis 2013; 10:E88. [PMID: 23721789 PMCID: PMC3675807 DOI: 10.5888/pcd10.120106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Best practices identified solely on the strength of research evidence may not be entirely relevant or practical for use in community-based public health and the practice of chronic disease prevention. Aiming to bridge the gap between best practices literature and local knowledge and expertise, the Ontario Public Health Association, through the Toward Evidence-Informed Practice initiative, developed a set of resources to strengthen evidence-informed decision making in chronic disease prevention programs. A Program Assessment Tool, described in this article, emphasizes better processes by incorporating review criteria into the program planning and implementation process. In a companion paper, "Strengthening Chronic Disease Prevention Programming: The Toward Evidence-Informed Practice (TEIP) Program Evidence Tool," we describe another tool, which emphasizes better evidence by providing guidelines and worksheets to identify, synthesize, and incorporate evidence from a range of sources (eg, peer-reviewed literature, gray literature, local expertise) to strengthen local programs.The Program Assessment Tool uses 19 criteria derived from literature on best and promising practices to assess and strengthen program planning and implementation. We describe the benefits, strengths, and challenges in implementing the tool in 22 community-based chronic disease prevention projects in Ontario, Canada. The Program Assessment Tool helps put best processes into operation to complement adoption and adaptation of evidence-informed practices for chronic disease prevention.
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Affiliation(s)
- Dayna Albert
- Ontario Public Health Association, Toronto, Ontario
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26
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Stacey D, Bakker D, Ballantyne B, Chapman K, Cumminger J, Green E, Harrison M, Howell D, Kuziemsky C, MacKenzie T, Sabo B, Skrutkowski M, Syme A, Whynot A. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols. Implement Sci 2012; 7:110. [PMID: 23164244 PMCID: PMC3527220 DOI: 10.1186/1748-5908-7-110] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/06/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. METHODS A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses' use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses' barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. DISCUSSION Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Debra Bakker
- School of Nursing, Laurentian University, Sudbury, ON, Canada
| | | | | | | | | | | | - Doris Howell
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Craig Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Terry MacKenzie
- Sudbury Regional Hospital, Regional Cancer Program, Sudbury, ON, Canada
| | - Brenda Sabo
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Myriam Skrutkowski
- Cancer Care Mission, Nursing Department, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Ann Syme
- Canadian Partnership Against Cancer, Toronto, ON, Canada
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Alexander J, Prabhu Das I, Johnson TP. Time issues in multilevel interventions for cancer treatment and prevention. J Natl Cancer Inst Monogr 2012; 2012:42-8. [PMID: 22623595 DOI: 10.1093/jncimonographs/lgs002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The concept of time introduces important complexities in estimating intervention effects, program and evaluation design, and measurement and analysis of individual change in multilevel interventions (MLIs). Despite growing recognition that time is a critical element for assessing both individual-level outcomes and higher-level changes in organizational, community, and policy contexts, most MLI designs and evaluations have not addressed these issues. In this chapter we discuss 1) conceptualizing disease life-course and treatment theory in MLIs, 2) approaches to incorporating time in research and program design for MLIs in cancer treatment and prevention, 3) analysis of time-varying multilevel data in the context of cancer treatment and prevention, and 4) resource considerations and trade-offs of incorporating time as a dimension of MLIs and analysis. Although analytic techniques for analyzing time-related phenomena are becoming more available and powerful, there has not been corresponding progress made in the development of theory to guide the application of these techniques in program design and implementation.
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Affiliation(s)
- Jeffrey Alexander
- Department of Health Management and Policy, The University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
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Using documents to investigate links between implementation and sustainability in a complex community intervention: the PRISM study. Soc Sci Med 2012; 75:1222-9. [PMID: 22749443 DOI: 10.1016/j.socscimed.2012.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 05/01/2012] [Accepted: 05/18/2012] [Indexed: 11/20/2022]
Abstract
The increasing imperative to find what works in health services has meant a rise in research trialing interventions deemed 'complex'. While the strength of these interventions comes from taking a 'whole of problem' approach using multiple and inter-linking strategies, ways of examining implementation are under-explored. Building sustainability is an important part of implementing complex intervention research, but this too has received little exploration in the implementation literature. This paper explores issues of implementation and sustainability by examining the case of PRISM (Program of Resources, Information and Support for Mothers), a community randomised trial in Victoria, Australia aimed at improving maternal health and wellbeing. It examines documents placed on the project website. Three groups of documents relating to implementation of the intervention were examined - implementation reports, media reports and community newsletters. Analysing these documents allowed a focus on the 'work' of the intervention - who does the work and what activities comprise the work - in order to examine implementation as it relates to sustainability. Document analysis provides a useful way of considering implementation and sustainability of complex intervention research. It can 'value add' to findings from process evaluation and extend our understanding of an intervention beyond outcome measures. Analysis of the documents in this case provides insights into why sustainability of an intervention may be difficult to achieve during implementation.
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Alexander JA, Hearld LR. Methods and metrics challenges of delivery-system research. Implement Sci 2012; 7:15. [PMID: 22409885 PMCID: PMC3317852 DOI: 10.1186/1748-5908-7-15] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/12/2012] [Indexed: 11/23/2022] Open
Abstract
Background Many delivery-system interventions are fundamentally about change in social systems (both planned and unplanned). This systems perspective raises a number of methodological challenges for studying the effects of delivery-system change--particularly for answering questions related to whether the change will work under different conditions and how the change is integrated (or not) into the operating context of the delivery system. Methods The purpose of this paper is to describe the methodological and measurement challenges posed by five key issues in delivery-system research: (1) modeling intervention context; (2) measuring readiness for change; (3) assessing intervention fidelity and sustainability; (4) assessing complex, multicomponent interventions; and (5) incorporating time in delivery-system models to discuss recommendations for addressing these issues. For each issue, we provide recommendations for how research may be designed and implemented to overcome these challenges. Results and conclusions We suggest that a more refined understanding of the mechanisms underlying delivery-system interventions (treatment theory) and the ways in which outcomes for different classes of individuals change over time are fundamental starting points for capturing the heterogeneity in samples of individuals exposed to delivery-system interventions. To support the research recommendations outlined in this paper and to advance understanding of the "why" and "how" questions of delivery-system change and their effects, funding agencies should consider supporting studies with larger organizational sample sizes; longer duration; and nontraditional, mixed-methods designs. A version of this paper was prepared under contract with the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services for presentation and discussion at a meeting on "The Challenge and Promise of Delivery System Research," held in Sterling, VA, on February 16-17, 2011. The opinions in the paper are those of the author and do not represent the views or recommendations of AHRQ or the US Department of Health and Human Services.1
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Affiliation(s)
- Jeffrey A Alexander
- School of Public Health, Department of Health Management and Policy, The University of Michigan, Ann Arbor, MI, USA.
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31
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Hawe P, Bond L, Butler H. Knowledge theories can inform evaluation practice: What can a complexity lens add? ACTA ACUST UNITED AC 2009. [DOI: 10.1002/ev.316] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Michie S, Fixsen D, Grimshaw JM, Eccles MP. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci 2009; 4:40. [PMID: 19607700 PMCID: PMC2717906 DOI: 10.1186/1748-5908-4-40] [Citation(s) in RCA: 541] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 07/16/2009] [Indexed: 11/10/2022] Open
Abstract
Complex behaviour change interventions are not well described; when they are described, the terminology used is inconsistent. This constrains scientific replication, and limits the subsequent introduction of successful interventions. Implementation Science is introducing a policy of initially encouraging and subsequently requiring the scientific reporting of complex behaviour change interventions.
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Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci 2009. [PMID: 19607700 DOI: 10.1186/1748–5908–4–40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Complex behaviour change interventions are not well described; when they are described, the terminology used is inconsistent. This constrains scientific replication, and limits the subsequent introduction of successful interventions. Implementation Science is introducing a policy of initially encouraging and subsequently requiring the scientific reporting of complex behaviour change interventions.
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Baranowski T, Cerin E, Baranowski J. Steps in the design, development and formative evaluation of obesity prevention-related behavior change trials. Int J Behav Nutr Phys Act 2009; 6:6. [PMID: 19159476 PMCID: PMC2656450 DOI: 10.1186/1479-5868-6-6] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/21/2009] [Indexed: 11/10/2022] Open
Abstract
Obesity prevention interventions through dietary and physical activity change have generally not been effective. Limitations on possible program effectiveness are herein identified at every step in the mediating variable model, a generic conceptual framework for understanding how interventions may promote behavior change. To minimize these problems, and thereby enhance likely intervention effectiveness, four sequential types of formative studies are proposed: targeted behavior validation, targeted mediator validation, intervention procedure validation, and pilot feasibility intervention. Implementing these studies would establish the relationships at each step in the mediating variable model, thereby maximizing the likelihood that an intervention would work and its effects would be detected. Building consensus among researchers, funding agencies, and journal editors on distinct intervention development studies should avoid identified limitations and move the field forward.
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Affiliation(s)
- Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Ester Cerin
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Janice Baranowski
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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